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Journal of Reconstructive Microsurgery Jul 2017Although conservative management of lymphedema remains the first-line approach, surgery is effective in select patients. The purpose of this study was to review the... (Review)
Review
Although conservative management of lymphedema remains the first-line approach, surgery is effective in select patients. The purpose of this study was to review the literature and develop a treatment algorithm based on the highest quality lymphedema research. A systematic literature review was performed to examine the surgical treatments for lymphedema. Studies were categorized into five groups describing excision, liposuction, lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and combined/multiple approaches. Studies were scored for methodological quality using the methodological index for nonrandomized studies (MINORS) scoring system. A total of 69 articles met inclusion criteria and were assigned MINORS scores with a maximum score of 16 or 24 for noncomparative or comparative studies, respectively. The average MINORS scores using noncomparative criteria were 12.1 for excision, 13.2 for liposuction, 12.6 for LVA, 13.1 for VLNT, and 13.5 for combined/multiple approaches. Loss to follow-up was the most common cause of low scores. Thirty-nine studies scoring > 12/16 or > 19/24 were considered high quality. In studies measuring excess volume reduction, the mean reduction was 96.6% (95% confidence interval [CI]: 86.2-107%) for liposuction, 33.1% (95% CI: 14.4-51.9%) for LVA, and 26.4% (95% CI: - 7.98 to 60.8%) for VLNT. Included excision articles did not report excess volume reduction. Although the overall quality of lymphedema literature is fair, the MINORS scoring system is an effective method to isolate high-quality studies. These studies were used to develop an evidence-based algorithm to guide clinical practice. Further studies with a particular focus on patient follow-up will improve the validity of lymphedema surgery research.
Topics: Algorithms; Anastomosis, Surgical; Extremities; Humans; Lipectomy; Lymph Node Excision; Lymphangiogenesis; Lymphedema; Microsurgery; Postoperative Complications; Practice Guidelines as Topic; Treatment Outcome
PubMed: 28235214
DOI: 10.1055/s-0037-1599100 -
Journal of Cranio-maxillo-facial... Jun 2017The number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to... (Review)
Review
BACKGROUND
The number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to investigate the relationship between the number of surgical procedures performed to repair the cleft palate and maxillofacial growth, speech and fistula formation in non-syndromic patients with unilateral cleft lip and palate.
MATERIAL AND METHODS
An electronic search was performed in PubMed/old MEDLINE, the Cochrane Library, EMBASE, Scopus and CINAHL databases for publications between 1960 and December 2015. Publications before 1950-journals of plastic and maxillofacial surgery-were hand searched. Additional hand searches were performed on studies mentioned in the reference lists of relevant articles. Search terms included unilateral, cleft lip and/or palate and palatoplasty. Two reviewers assessed eligibility for inclusion, extracted data, applied quality indicators and graded level of evidence.
RESULTS
Twenty-six studies met the inclusion criteria. All were retrospective and non-randomized comparisons of one- and two-stage palatoplasty. The methodological quality of most of the studies was graded moderate to low. The outcomes concerned the comparison of one- and two-stage palatoplasty with respect to growth of the mandible, maxilla and cranial base, and speech and fistula formation.
CONCLUSIONS
Due to the lack of high-quality studies there is no conclusive evidence of a relationship between one- or two-stage palatoplasty and facial growth, speech and fistula formation in patients with unilateral cleft lip and palate.
Topics: Cleft Lip; Cleft Palate; Humans; Maxillofacial Development; Orthognathic Surgical Procedures; Speech
PubMed: 28427835
DOI: 10.1016/j.jcms.2017.03.006 -
Clinical Implant Dentistry and Related... Jan 2015The aim of this systematic review was to evaluate clinical and safety data for recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge... (Review)
Review
PURPOSE
The aim of this systematic review was to evaluate clinical and safety data for recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier when used for alveolar ridge/maxillary sinus augmentation in humans.
MATERIALS AND METHODS
Clinical studies/case series published 1980 through June 2012 using rhBMP-2/ACS were searched. Studies meeting the following criteria were considered eligible for inclusion: >10 subjects at baseline and maxillary sinus or alveolar ridge augmentation not concomitant with implant placement.
RESULTS
Seven of 69 publications were eligible for review. rhBMP-2/ACS yielded clinically meaningful bone formation for maxillary sinus augmentation that would allow placement of regular dental implants without consistent differences between rhBMP-2 concentrations. Nevertheless, the statistical analysis showed that sinus augmentation following autogenous bone graft was significantly greater (mean bone height: 1.6 mm, 95% CI: 0.5-2.7 mm) than for rhBMP-2/ACS (rhBMP-2 at 1.5 mg/mL). In extraction sockets, rhBMP-2/ACS maintained alveolar ridge height while enhancing alveolar ridge width. Safety reports did not represent concerns for the proposed indications.
CONCLUSIONS
rhBMP-2/ACS appears a promising alternative to autogenous bone grafts for alveolar ridge/maxillary sinus augmentation; dose and carrier optimization may expand its efficacy, use, and clinical application.
Topics: Absorbable Implants; Alveolar Ridge Augmentation; Bone Morphogenetic Protein 2; Collagen; Humans; Osteogenesis; Recombinant Proteins; Sinus Floor Augmentation; Transforming Growth Factor beta
PubMed: 24102703
DOI: 10.1111/cid.12156 -
The American Journal of Sports Medicine Apr 2024Approximately 90% of patients who undergo arthroscopic rotator cuff repair (RCR) are satisfied with their pain levels and function after surgery. However, a subset of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Approximately 90% of patients who undergo arthroscopic rotator cuff repair (RCR) are satisfied with their pain levels and function after surgery. However, a subset of patients experience continued symptoms that warrant revision surgery. Preoperative risk factors for RCR failure requiring revision surgery have not been clearly defined.
PURPOSE
To (1) determine the rate of RCR failure requiring revision surgery and (2) identify risk factors for revision surgery, which will help surgeons to determine patients who are at the greatest risk for RCR failure.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
A systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were performed. The initial search resulted in 3158 titles, and 533 full-text articles were assessed for eligibility. A total of 10 studies met the following inclusion criteria: (1) human clinical studies, (2) arthroscopic RCR, (3) original clinical research, and (4) evaluation of preoperative risk factors for revision.
RESULTS
After a full-text review, a total of 16 risk factors were recorded and analyzed across 10 studies. Corticosteroid injection was the most consistent risk factor for revision surgery, reaching statistical significance in 4 of 4 studies, followed by workers' compensation status (2/3 studies). Patients with corticosteroid injections had a pooled increased risk of revision surgery by 47% (odds ratio, 1.44 [95% CI, 1.36-1.52]). Patients with workers' compensation had a pooled increased risk of revision surgery by 133% (odds ratio, 2.33 [95% CI, 2.09-2.60]). Age, smoking status, diabetes, and obesity were found to be risk factors in half of the analyzed studies.
CONCLUSION
Corticosteroid injections, regardless of the frequency of injections, and workers' compensation status were found to be significant risk factors across the literature based on qualitative analysis and pooled analysis. Surgeons should determine ideal candidates for arthroscopic RCR by accounting for corticosteroid injection history, regardless of the frequency, and insurance status of the patient.
Topics: Humans; Rotator Cuff; Rotator Cuff Injuries; Reoperation; Incidence; Adrenal Cortex Hormones; Risk Factors; Arthroscopy; Treatment Outcome
PubMed: 38251854
DOI: 10.1177/03635465231182993 -
Nutrients Oct 2022The non-classical role of vitamin D has been investigated in recent decades. One of which is related to its role in skeletal muscle. Satellite cells are skeletal muscle... (Review)
Review
The non-classical role of vitamin D has been investigated in recent decades. One of which is related to its role in skeletal muscle. Satellite cells are skeletal muscle stem cells that play a pivotal role in skeletal muscle growth and regeneration. This systematic review aims to investigate the effect of vitamin D on satellite cells. A systematic search was performed in Scopus, MEDLINE, and Google Scholar. In vivo studies assessing the effect of vitamin D on satellite cells, published in English in the last ten years were included. Thirteen in vivo studies were analyzed in this review. Vitamin D increases the proliferation of satellite cells in the early life period. In acute muscle injury, vitamin D deficiency reduces satellite cells differentiation. However, administering high doses of vitamin D impairs skeletal muscle regeneration. Vitamin D may maintain satellite cell quiescence and prevent spontaneous differentiation in aging. Supplementation of vitamin D ameliorates decreased satellite cells' function in chronic disease. Overall, evidence suggests that vitamin D affects satellite cells' function in maintaining skeletal muscle homeostasis. Further research is needed to determine the most appropriate dose of vitamin D supplementation in a specific condition for the optimum satellite cells' function.
Topics: Satellite Cells, Skeletal Muscle; Vitamin D; Regeneration; Muscle Development; Muscle Fibers, Skeletal; Cell Differentiation; Muscle, Skeletal; Vitamins
PubMed: 36364820
DOI: 10.3390/nu14214558 -
Journal of Investigative Surgery : the... Mar 2022To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF)... (Meta-Analysis)
Meta-Analysis Review
Comparative Effectiveness and Safety of Anterior Cervical Corpectomy with Fusion, Laminoplasty, and Laminectomy and Instrumented Fusion for Ossification of the Posterior Longitudinal Ligament: A Systematic Review and Network Meta-Analysis.
BACKGROUND
To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF) in the treatment of ossification of the posterior longitudinal ligament (OPLL).
METHODS
Embase, Pubmed, and Cochrane library were searched from their date of inception to June 13, 2020. Relevant randomized controlled trials (RCTs) and cohort studies comparing different procedures among ACCF, LP, and LF were identified, data were extracted to perform a network meta-analysis (NMA). The outcomes were the Japanese Orthopedic Association (JOA) score and complications.
RESULTS
We deemed 14 trials eligible, including 877 patients. In NMA, ACCF showed a significant improvement of JOA score compared with LP [MD= -0.89, 95% CI (-1.73, -0.18)], but no significant difference was found when compared LF with ACCF or LP. No significant differences in complications were found when compared LF with LP or ACCF, while ACCF showed significantly higher in complications than LP [OR = 1.99, 95% CI (1.10, 3.35)]. The surface under the cumulative ranking curves (SUCRA) showed that the rank of JOA score improvement is as follows: ACCF (82.5%), LF (79.5%), and LP (2.3%). And the rank of complication rate is as follows: LF (65.8%), ACCF (68.4%), and LP (2.1%).
LIMITATION
The biggest limitation was that none of the included studies were RCTs.
CONCLUSIONS
Despite the higher probability of complications than LP, ACCF was the more recommended procedure for its highest ranking spectrums of JOA score improvement to treat the OPLL.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Laminectomy; Laminoplasty; Longitudinal Ligaments; Network Meta-Analysis; Osteogenesis; Treatment Outcome
PubMed: 33472478
DOI: 10.1080/08941939.2020.1871535 -
International Journal of Molecular... Dec 2023There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to... (Review)
Review
Magnesium Alloys in Orthopedics: A Systematic Review on Approaches, Coatings and Strategies to Improve Biocompatibility, Osteogenic Properties and Osteointegration Capabilities.
There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to their rapid degradation have been issued by developing biodegradable micro- and nanostructured coatings to enhance corrosion resistance and limit the release of hydrogen during degradation. This systematic review based on four databases (PubMed, Embase, Web of Science™ and ScienceDirect) aims to present state-of-the-art strategies, approaches and materials used to address the critical factors currently impeding the utilization of Mg alloy devices. Forty studies were selected according to PRISMA guidelines and specific PECO criteria. Risk of bias assessment was conducted using OHAT and SYRCLE tools for in vitro and in vivo studies, respectively. Despite limitations associated with identified bias, the review provides a comprehensive analysis of preclinical in vitro and in vivo studies focused on manufacturing and application of Mg alloys in orthopedics. This attests to the continuous evolution of research related to Mg alloy modifications (e.g., AZ91, LAE442 and WE43) and micro- and nanocoatings (e.g., MAO and MgF2), which are developed to improve the degradation rate required for long-term mechanical resistance to loading and excellent osseointegration with bone tissue, thereby promoting functional bone regeneration. Further research is required to deeply verify the safety and efficacy of Mg alloys.
Topics: Magnesium; Orthopedic Procedures; Orthopedics; Osteogenesis; Alloys
PubMed: 38203453
DOI: 10.3390/ijms25010282 -
European Spine Journal : Official... Apr 2023Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
BACKGROUND CONTEXT
Thoracic ossification of the ligamentum flavum (TOLF) has become the principal cause of thoracic spinal stenosis. Dural ossification (DO) was a common clinical feature accompanying with TOLF. However, on account of the rarity, we know little about the DO in TOLF so far.
PURPOSE
This study was conducted to elucidate the prevalence, diagnostic measures, and impact on the clinical outcomes of DO in TOLF by integrating the existing evidence.
METHODS
PubMed, Embase, and Cochrane Database were comprehensively searched for studies relevant to the prevalence, diagnostic measures, or impact on the clinical outcomes of DO in TOLF. All retrieved studies meeting the inclusion and criterion were included into this systematic review.
RESULTS
The prevalence of DO in TOLF treated surgically was 27% (281/1046), ranging from 11 to 67%. Eight diagnostic measures have been put forward to predict the DO in TOLF using the CT or MRI modalities, including "tram track sign", "comma sign", "bridge sign", "banner cloud sign", "T2 ring sign", TOLF-DO grading system, CSAOR grading system, and CCAR grading system. DO did not affect the neurological recovery of TOLF patients treated with the laminectomy. The rate of dural tear or CSF leakage in TOLF patients with DO was approximately 83% (149/180).
CONCLUSION
The prevalence of DO in TOLF treated surgically was 27%. Eight diagnostic measures have been put forward to predict the DO in TOLF. DO did not affect the neurological recovery of TOLF treated with laminectomy but was associated with high risk of complications.
Topics: Humans; Osteogenesis; Ossification, Heterotopic; Ligamentum Flavum; Prevalence; Thoracic Vertebrae; Retrospective Studies
PubMed: 36877368
DOI: 10.1007/s00586-023-07625-4 -
International Orthodontics Jun 2022The aim of this study was to perform an updated review of the in vivo methods to evaluate human midpalatal suture maturation and ossification, since this evaluation... (Review)
Review
OBJECTIVES
The aim of this study was to perform an updated review of the in vivo methods to evaluate human midpalatal suture maturation and ossification, since this evaluation process remains an unsolved and critical problem in orthodontic treatment.
MATERIALS AND METHODS
PubMed, Embase, Cochrane Library, Scopus and Web of Science databases were searched up to November 30, 2021. Literature selection was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020 Edition) statement and was based on predetermined inclusion criteria. The overall and methodological characteristics of the selected studies were collected. The risk of bias was evaluated mainly through inter- and intra-evaluator agreement outcomes reported in each study. As there was a high heterogeneity among methodological studies, meta-analysis of the included studies was not applicable, and results were analysed descriptively.
RESULTS
Nine articles met the inclusion criteria. Maxillary occlusal radiograph and computed tomography (CT), especially cone beam CT (CBCT), were reported. The occlusal radiograph is not adequate for evaluating the status of midpalatal suture maturation, and has been replaced by CBCT. Qualitative and quantitative CBCT evaluation methods provide limited evidence; however, opinions differ regarding the efficacy of these methods.
CONCLUSIONS
For midpalatal suture maturation and ossification status evaluation, evidence for the current methods is still limited. Further methodological studies should use image information comprehensively and provide verification evidence on larger samples.
Topics: Cone-Beam Computed Tomography; Cranial Sutures; Humans; Osteogenesis; Palatal Expansion Technique; Sutures
PubMed: 35589538
DOI: 10.1016/j.ortho.2022.100634 -
Neuroscience Research Oct 2014Aerobic exercise (AE) enhances neuroplasticity and improves functional outcome in animal models of stroke, however the optimal parameters (days post-stroke, intensity,... (Review)
Review
Aerobic exercise (AE) enhances neuroplasticity and improves functional outcome in animal models of stroke, however the optimal parameters (days post-stroke, intensity, mode, and duration) to influence brain repair processes are not known. We searched PubMed, CINAHL, PsychInfo, the Cochrane Library, and the Central Register of Controlled Clinical Trials, using predefined criteria, including all years up to July 2013 (English language only). Clinical studies were included if participants had experienced an ischemic or hemorrhagic stroke. We included animal studies that utilized any method of global or focal ischemic stroke or intracerebral hemorrhage. Any intervention utilizing AE-based activity with the intention of improving cardiorespiratory fitness was included. Of the 4250 titles returned, 47 studies (all in animal models) met criteria and measured the effects of exercise on brain repair parameters (lesion volume, oxidative damage, inflammation and cell death, neurogenesis, angiogenesis and markers of stress). Our synthesized findings show that early-initiated (24-48h post-stroke) moderate forced exercise (10m/min, 5-7 days per week for about 30min) reduced lesion volume and protected perilesional tissue against oxidative damage and inflammation at least for the short term (4 weeks). The applicability and translation of experimental exercise paradigms to clinical trials are discussed.
Topics: Animals; Apoptosis; Brain; Brain Ischemia; Cardiovascular Diseases; Cardiovascular System; Disease Models, Animal; Exercise Therapy; Female; Gerbillinae; Male; Mice; Neurogenesis; Neurons; Oxidative Stress; Rats; Stroke Rehabilitation; Time Factors
PubMed: 24997243
DOI: 10.1016/j.neures.2014.06.007