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Oral Health & Preventive Dentistry 2017To evaluate in a systematic review whether the use of dental floss in primary teeth is associated with a reduction in incidence of proximal caries. (Review)
Review
PURPOSE
To evaluate in a systematic review whether the use of dental floss in primary teeth is associated with a reduction in incidence of proximal caries.
MATERIALS AND METHODS
Searches were performed using the following databases: PubMed MEDLINE, Web of Science, Bireme, Scopus and The Cochrane Library. Only 5 studies were eligible for inclusion. The quality assessment and bias control of the studies were carried out based on the Fowkes and Fulton Guideline. The study concept was first registered in the international prospective register of systematic reviews (PROSPERO).
RESULTS
Flossing was professionally performed in one study and self-reported (by parents or by the children) through questionnaires in all other 4 studies. In the first study, the authors concluded that daily interdental flossing resulted in a significant reduction in the incidence of proximal caries in deciduous teeth during a 20-month period. Two cross-sectional studies found that the use of interdental floss did not show any relevant association with the prevalence of caries; one study found that a higher the frequency of flossing was associated with higher caries experience, and the other found an association between severe caries and the use of dental floss, independently of the flossing frequency.
CONCLUSION
There is only one study in the current literature showing evidence of an association between the use of dental floss and proximal caries reduction on primary dentition. However, the use of dental floss should never be discouraged. Healthy habits acquired in childhood continue throughout adult life, with numerous oral- and general-health benefits.
Topics: Child; Child, Preschool; Dental Caries; Dental Devices, Home Care; Humans; Incidence; Infant; Oral Hygiene; Tooth, Deciduous
PubMed: 28785751
DOI: 10.3290/j.ohpd.a38780 -
JAMA Apr 2015Acute ischemic stroke is a major cause of mortality and morbidity in the United States. We review the latest data and evidence supporting catheter-directed treatment for... (Review)
Review
IMPORTANCE
Acute ischemic stroke is a major cause of mortality and morbidity in the United States. We review the latest data and evidence supporting catheter-directed treatment for proximal artery occlusion as an adjunct to intravenous thrombolysis in patients with acute stroke.
OBJECTIVE
To review the pathophysiology of acute brain ischemia and infarction and the evidence supporting various stroke reperfusion treatments.
EVIDENCE REVIEW
Systematic literature search of MEDLINE databases published between January 1, 1990, and February 11, 2015, was performed to identify studies addressing the role of thrombolysis and mechanical thrombectomy in acute stroke management. Studies included randomized clinical trials, observational studies, guideline statements, and review articles. Sixty-eight articles (N = 108,082 patients) were selected for review.
FINDINGS
Intravenous thrombolysis is the mainstay of acute ischemic stroke management for any patient with disabling deficits presenting within 4.5 hours from symptom onset. Randomized trials have demonstrated that more patients return to having good function (defined by being independent and having slight disability or less) when treated within 4.5 hours after symptom onset with intravenous recombinant tissue plasminogen activator (IV rtPA) therapy. Mechanical thrombectomy in select patients with acute ischemic stroke and proximal artery occlusions has demonstrated substantial rates of partial or complete arterial recanalization and improved outcomes compared with IV rtPA or best medical treatment alone in multiple randomized clinical trials. Regardless of mode of reperfusion, earlier reperfusion is associated with better clinical outcomes.
CONCLUSIONS AND RELEVANCE
Intravenous rtPA remains the standard of care for patients with moderate to severe neurological deficits who present within 4.5 hours of symptom onset. Outcomes for some patients with acute ischemic stroke and moderate to severe neurological deficits due to proximal artery occlusion are improved with endovascular reperfusion therapy. Efforts to hasten reperfusion therapy, regardless of the mode, should be undertaken within organized stroke systems of care.
Topics: Brain; Brain Infarction; Brain Ischemia; Endovascular Procedures; Fibrinolytic Agents; Humans; Infusions, Intravenous; Reperfusion; Stroke; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator
PubMed: 25871671
DOI: 10.1001/jama.2015.3058 -
Orthopaedic Journal of Sports Medicine Nov 2021Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe... (Review)
Review
BACKGROUND
Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes.
PURPOSE
To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS).
RESULTS
Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, "popping" sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured.
CONCLUSION
Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.
PubMed: 34888392
DOI: 10.1177/23259671211053833 -
International Journal of Sports... Apr 2021Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and...
BACKGROUND
Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management.
PURPOSE/HYPOTHESIS
To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy.
STUDY DESIGN
Systematic review.
METHODS
Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines.
RESULTS
Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term.
CONCLUSIONS
There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies.
LEVEL OF EVIDENCE
Level 2a.
PubMed: 33842025
DOI: 10.26603/001c.21250 -
Revista Brasileira de Psiquiatria (Sao... 2021Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing...
OBJECTIVE
Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior.
METHODS
A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched.
RESULTS
Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors.
CONCLUSION
Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.
Topics: Adolescent; Adolescent Behavior; Child; Humans; Risk Factors; Risk-Taking; Sexual Behavior; Substance-Related Disorders; Suicidal Ideation
PubMed: 32756805
DOI: 10.1590/1516-4446-2019-0835 -
Sports (Basel, Switzerland) Feb 2023Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating... (Review)
Review
Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.
PubMed: 36976939
DOI: 10.3390/sports11030053 -
The Japanese Dental Science Review Nov 2022There has been a debate about the use of Hall Technique (HT), whether it can be considered as a standard technique for the management of carious primary molars. (Review)
Review
BACKGROUND
There has been a debate about the use of Hall Technique (HT), whether it can be considered as a standard technique for the management of carious primary molars.
AIM
To summarise the evidence on HT for managing dentine caries in primary teeth.
DESIGN
MEDLINE, Embase, CENTRAL and Epistemonikos databases were searched for clinical studies conducted from 2007 to 2021 evaluating HT in primary teeth. Two reviewers independently screened, data extracted and quality assessed the studies.
RESULTS
Eleven publications from eight unique studies were included. Four were of low risk of bias overall and five studies were included in a meta-analysis. Overall, HT was 49 % (RR 1.49 [95 % CI: 1.15-1.93], I =89.5 %, p < 0.001) more likely to succeed. When compared to direct restorations, HT was 80 % more likely to succeed; while similar success was found when compared to conventional preformed metal crowns. HT was also over 6 times (RR 0.16 [95 %CI: 0.10-0.27], I =0 %, p < 0.001) less likely to fail. Most of the studies included proximal or multi-surface lesions.
CONCLUSIONS
HT is successful option for the management of caries in primary teeth, particularly for proximal or multi-surface dentine lesions. It is well-tolerated by children and acceptable to parent, with mild adverse effects reported.
PubMed: 36185501
DOI: 10.1016/j.jdsr.2022.09.003 -
The Cochrane Database of Systematic... Nov 2015Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012.
OBJECTIVES
To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014.
SELECTION CRITERIA
We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults.
DATA COLLECTION AND ANALYSIS
Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed.
MAIN RESULTS
We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and fracture displacement and non-union (2/52 versus 1/54; 2 trials).One quasi-randomised trial (28 participants) found the Gilchrist-type sling was generally more comfortable than the Desault-type sling (body bandage). One trial (48 participants) testing pulsed electromagnetic high-frequency energy provided no evidence. Two trials (62 participants) provided evidence indicating little difference in outcome between instruction for home exercises versus supervised physiotherapy. One trial (48 participants) reported, without presentable data, that home exercise alone gave better early and comparable long-term results than supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two-year follow-up between surgical (primarily locking plate fixation or hemiarthroplasty) and non-surgical treatment (sling immobilisation) for the majority of displaced proximal humeral fractures; and moderate quality evidence of no clinically important difference between the two groups in quality of life at two years (and at interim follow-ups at six and 12 months). There was moderate quality evidence of little difference between groups in mortality in the surgery group (17/248 versus 12/248; risk ratio (RR) 1.40 favouring non-surgical treatment, 95% confidence interval (CI) 0.69 to 2.83; P = 0.35; 6 trials); only one death was explicitly linked with the treatment. There was moderate quality evidence of a higher risk of additional surgery in the surgery group (34/262 versus 16/261; RR 2.06, 95% CI 1.18 to 3.60; P = 0.01; 7 trials). Although there was moderate evidence of a higher risk of adverse events after surgery, the 95% confidence intervals for adverse events also included the potential for a greater risk of adverse events after non-surgical treatment.Different methods of surgical management were tested in 12 trials. One trial (57 participants) comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of slightly better function after plate fixation but also of a higher rate of surgically-related complications. One trial (61 participants) comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary K-wires found little difference between the two implants at two years. Compared with hemiarthroplasty, one trial (32 participants) found similar results with locking plate fixation in function and re-operation rates, whereas another trial (30 participants) reported all five re-operations occurred in the tension-band fixation group. One trial (62 participants) found better patient-rated (Quick DASH) and composite shoulder function scores at a minimum of two years follow-up and a lower incidence of re-operation and complications after reverse shoulder arthroplasty (RSA) compared with hemiarthroplasty.No important between-group differences were found in one trial (120 participants) comparing the deltoid-split approach versus deltopectoral approach for non-contact bridging plate fixation, and two trials (180 participants) comparing 'polyaxial' and 'monaxial' screws in locking plate fixation. One trial (68 participants) produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial (54 participants) found fewer adverse events, including re-operations, for the newer of two types of intramedullary nail. One trial (35 participants) found better functional results for one of two types of hemiarthroplasty. One trial (45 participants) found no important effects of tenodesis of the long head of the biceps for people undergoing hemiarthroplasty.Very limited evidence suggested similar outcomes from early versus later mobilisation after either surgical fixation (one trial: 64 participants) or hemiarthroplasty (one trial: 49 participants).
AUTHORS' CONCLUSIONS
There is high or moderate quality evidence that, compared with non-surgical treatment, surgery does not result in a better outcome at one and two years after injury for people with displaced proximal humeral fractures involving the humeral neck and is likely to result in a greater need for subsequent surgery. The evidence does not cover the treatment of two-part tuberosity fractures, fractures in young people, high energy trauma, nor the less common fractures such as fracture dislocations and head splitting fractures.There is insufficient evidence from RCTs to inform the choices between different non-surgical, surgical, or rehabilitation interventions for these fractures.
Topics: Adult; Bandages; Early Ambulation; Fracture Fixation; Humans; Immobilization; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Self Care; Shoulder Fractures; Treatment Outcome
PubMed: 26560014
DOI: 10.1002/14651858.CD000434.pub4 -
The Bone & Joint Journal May 2020Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It...
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: 2020;102-B(5):556-567.
Topics: Combined Modality Therapy; Diagnosis, Differential; Diagnostic Imaging; Electrodiagnosis; Humans; Medical History Taking; Physical Examination; Piriformis Muscle Syndrome; Pudendal Nerve; Sciatic Nerve; Sciatica
PubMed: 32349600
DOI: 10.1302/0301-620X.102B5.BJJ-2019-1212.R1 -
The Knee Mar 2022Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique.
METHODS
All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity.
RESULTS
Nine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm.
CONCLUSIONS
This systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Follow-Up Studies; Humans; Knee Joint; Treatment Outcome
PubMed: 35366618
DOI: 10.1016/j.knee.2022.03.009