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Journal of Clinical Medicine Nov 2022The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the... (Review)
Review
The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the RoB 2.0 for randomized controlled trials (RCTs) and the modified Coleman Methodology Score (mCMS) for all studies. A total of 20 clinical studies (735 patients) was identified, 12 on PRP injections and eight on cell-based therapies (five from bone marrow, two from adipose tissue, and one from amniotic fluid). The publication trend increased over time, with over 50% of articles published from 2019. The literature analysis showed only six RCTs, all on PRP injections. The mCMS showed an overall fair methodology (mean score 59.4). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results, with the treatment success being inversely proportional to the severity of OA. Further high-level controlled trials are needed before drawing more definitive conclusions on the real potential of orthobiologics for the injective treatment of patients affected by hip OA.
PubMed: 36431138
DOI: 10.3390/jcm11226663 -
European Journal of Obstetrics,... Sep 2021Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. (Review)
Review
BACKGROUND
Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex.
OBJECTIVES
The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic).
SEARCH STRATEGY
Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science.
DATA COLLECTION AND ANALYSIS
Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively.
MAIN RESULTS
Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%.
CONCLUSIONS
Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well-designed, randomized, controlled trials are required to confirm this data.
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Operative Time; Pelvic Organ Prolapse; Surgical Mesh; Treatment Outcome; Vagina
PubMed: 34364019
DOI: 10.1016/j.ejogrb.2021.07.044 -
World Journal of Emergency Medicine 2021Suspension trauma syndrome is a life-threatening event that occurs when a person is "trapped" in a prolonged passive suspension. It is most commonly seen in people who... (Review)
Review
BACKGROUND
Suspension trauma syndrome is a life-threatening event that occurs when a person is "trapped" in a prolonged passive suspension. It is most commonly seen in people who engage in occupational or sport activities that require harness suspension. The aim of this study is to identify the predisposing factors, pathophysiology, and management of suspension trauma.
METHODS
A review and analysis of the literature published in English and Spanish from 1972 to 2020 on suspension trauma were performed. Search sources were PubMed, Medline, Cochrane Library, MeSH, UpToDate, and Google Scholar. Articles referring to suspension trauma associated with other injury mechanisms (traumatic impact injuries, drowning, asphyxiation, or bleeding), case reports, and pediatric population were excluded.
RESULTS
Forty-one articles were identified. Of these, 29 articles related to mechanism, pathophysiology, and management of individuals who suffered prolonged suspension trauma without associated traumatic injuries were included in the study. We encountered several controversies describing the putative pathophysiology, ranging from blood sequestration in the lower extremities versus accumulation of metabolic waste and hyperkalemia to dorsal hook-type harness as a trigger cause of positional asphyxia; to vascular compression of femoral vessels exerted by the harness causing decreased venous return. Pstients suspended in a full-body harness with dorsal hook showed more hemodynamic alterations in response to the compressive effect on the rib cage, causing a reduction in perfusion by presenting a decrease in pulse pressure. Management strategies varied across studies.
CONCLUSIONS
Progress has been made in individualizing the population at risk and in the management of suspension trauma. We recommend the formation of consensus definitions, larger cohort or registry studies to be conducted, and experimental animal models to better understand the mechanisms in order to develop management and life support guidelines from a trauma and emergency medicine perspective.
PubMed: 34512820
DOI: 10.5847/wjem.j.1920-8642.2021.04.001 -
Surgery Today May 2015(1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
(1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary according to the type of procedure.
METHODS
An electronic search of PubMed, Databases@Ovid, and SciVerse Scopus between 2003/01/01 and 2012/12/31 was performed.
RESULTS
The peak number of annually published articles was 70 in 2011. The most common procedures were single skin incision, the use of a SILS Port(®), suture suspension and a 5-mm oblique scope. The intraoperative complications rate was 1.69 %. Postoperative complications occurred in 213/5283 cases. According to the surgical procedure, five factors (approach; P = 0.0017, gallbladder anchorage; P < 0.001, size; P = 0.049 and type; P < 0.001 of the scope, and size of the clip applier; P = 0.074) significantly affected the incidence of wound infection. The incidence of wound seroma/bleeding was significantly influenced by gallbladder anchorage (P = 0.009), the use of curved/articulated instruments (P = 0.048), and the diameter of the clip applier (P < 0.001).
CONCLUSION
To determine the best operative procedure for SILC, an analysis of uniform operative procedures is needed.
Topics: Cholecystectomy, Laparoscopic; Databases, Bibliographic; Humans; Incidence; Intraoperative Complications; Postoperative Complications; Surgical Wound Infection; Treatment Outcome
PubMed: 24845737
DOI: 10.1007/s00595-014-0908-2 -
Journal of Orthopaedic Translation Jul 2020Osteosynthesis-associated infection is a challenging complication post fracture fixation, burdening the patients and the orthopaedic surgeons alike. A clinically... (Review)
Review
OBJECTIVE
Osteosynthesis-associated infection is a challenging complication post fracture fixation, burdening the patients and the orthopaedic surgeons alike. A clinically relevant animal model is critical in devising new therapeutic strategies. Our aim was to perform a systematic review to evaluate existing preclinical models and identify their applications in aspects of animal selection, bacterial induction, fracture fixation and complications.
METHODS
A systematic literature research was conducted in PubMed and Embase up to February 2020. A total of 31 studies were included. Information on the animal, bacterial induction, fracture fixation, healing result and complications were extracted.
RESULTS
Animals selected included murine (23), rabbit (6), ewe (1) and goat (1). Larger animals had enabled the use of human-sized implant, however small animals were more economical and easier in handling. was the most frequently chosen bacteria for induction. Bacterial inoculation dose ranged from 10 CFU. Consistent and replicable infections were observed from 10 CFU in general. Methods of inoculation included injections of bacterial suspension (20), placement of foreign objects (8) and pretreatment of implants with established biofilm (3). Intramedullary implants (13), plates and screws (18) were used in most models. Radiological (29) and histological evaluations (24) in osseous healing were performed. Complications such as instability of fracture fixation (7), unexpected surgical death (5), sepsis (1) and persistent lameness (1) were encountered.
CONCLUSION
The most common animal model is the infected open fracture internally fixated. Replicable infections were mainly from 10 CFU of bacteria. However, with the increase in antibiotic resistance, future directions should explore polymicrobial and antibiotic resistant strains, as these will no doubt play a major role in bone infection. Currently, there is also a lack of osteoporotic bone infection models and the pathophysiology is unexplored, which would be important with our aging population.
THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE
This systematic review provides an updated overview and compares the currently available animal models of osteosynthesis-associated infections. A discussion on future research directions and suggestion of animal model settings were made, which is expected to advance the research in this field.
PubMed: 32440511
DOI: 10.1016/j.jot.2020.03.002 -
Pediatric Neurology Jan 2023Hypotonia is considered a determinant factor in multiple developmental disorders and is associated with various characteristics and morbidities. It is necessary to... (Review)
Review
BACKGROUND
Hypotonia is considered a determinant factor in multiple developmental disorders and is associated with various characteristics and morbidities. It is necessary to perform a systematic review to know which characteristics are described as associated with hypotonia in children and which methods are used for its diagnosis.
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to develop the systematic review protocol. A search of databases (Pubmed, Cochrane, Web of Knowledge, among others) was performed in May 2021 to identify relevant studies. Those describing characteristics or tests of hypotonia assessment were included, excluding those that exclusively addressed peripheral hypotonia. Two reviewers evaluated the articles and collected the data in a table, noting the authors, date of publication, type of study, and characteristics or tests described in relation to hypotonia. The quality of the studies was also assessed, and data were extracted.
RESULTS
A total of 8778 studies were identified and analyzed, of which 45 met the inclusion criteria. Fifty-three characteristics associated with hypotonia and tests used for its evaluation were located, with pull to sit and vertical suspension being the most frequently referenced.
CONCLUSIONS
The characteristics associated with hypotonia, more highly debated by authors are muscle strength, hypermobility, or the maintenance of antigravity postures. The most used test in the diagnosis of hypotonia is observation, followed by the pull-to-sit test, and adoption of frog posture. A unanimous understanding of the term hypotonia would favor further research.
Topics: Child; Humans; Muscle Hypotonia; Databases, Genetic; Knowledge
PubMed: 36446164
DOI: 10.1016/j.pediatrneurol.2022.11.001 -
The Cochrane Database of Systematic... Sep 2016Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause... (Review)
Review
BACKGROUND
Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause psychological distress. The use of oral and topical treatments can be limited in some people due to ineffectiveness, inconvenience, poor tolerability or side-effects. Some studies have suggested promising results for light therapies.
OBJECTIVES
To explore the effects of light treatment of different wavelengths for acne.
SEARCH METHODS
We searched the following databases up to September 2015: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We searched ISI Web of Science and Dissertation Abstracts International (from inception). We also searched five trials registers, and grey literature sources. We checked the reference lists of studies and reviews and consulted study authors and other experts in the field to identify further references to relevant randomised controlled trials (RCTs). We updated these searches in July 2016 but these results have not yet been incorporated into the review.
SELECTION CRITERIA
We included RCTs of light for treatment of acne vulgaris, regardless of language or publication status.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included 71 studies, randomising a total of 4211 participants.Most studies were small (median 31 participants) and included participants with mild to moderate acne of both sexes and with a mean age of 20 to 30 years. Light interventions differed greatly in wavelength, dose, active substances used in photodynamic therapy (PDT), and comparator interventions (most commonly no treatment, placebo, another light intervention, or various topical treatments). Numbers of light sessions varied from one to 112 (most commonly two to four). Frequency of application varied from twice daily to once monthly.Selection and performance bias were unclear in the majority of studies. Detection bias was unclear for participant-assessed outcomes and low for investigator-assessed outcomes in the majority of studies. Attrition and reporting bias were low in over half of the studies and unclear or high in the rest. Two thirds of studies were industry-sponsored; study authors either reported conflict of interest, or such information was not declared, so we judged the risk of bias as unclear.Comparisons of most interventions for our first primary outcome 'Participant's global assessment of improvement' were not possible due to the variation in the interventions and the way the studies' outcomes were measured. We did not combine the effect estimates but rated the quality of the evidence as very low for the comparison of light therapies, including PDT to placebo, no treatment, topical treatment or other comparators for this outcome. One study which included 266 participants with moderate to severe acne showed little or no difference in effectiveness for this outcome between 20% aminolevulinic acid (ALA)-PDT (activated by blue light) versus vehicle plus blue light (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.04, low-quality evidence). A study (n = 180) of a comparison of ALA-PDT (activated by red light) concentrations showed 20% ALA was no more effective than 15% (RR 1.05, 95% CI 0.96 to 1.15) but better than 10% ALA (RR 1.22, 95% CI 1.05 to 1.42) and 5% ALA (RR 1.47, 95% CI 1.19 to 1.81). The number needed to treat for an additional beneficial outcome (NNTB) was 6 (95% CI 3 to 19) and 4 (95% CI 2 to 6) for the comparison of 20% ALA with 10% and 5% ALA, respectively.For our second primary outcome 'Investigator-assessed changes in lesion counts', we combined three RCTs, with 360 participants with moderate to severe acne and found methyl aminolevulinate (MAL) PDT (activated by red light) was no different to placebo cream plus red light with regard to change in inflamed lesions (ILs) (mean difference (MD) -2.85, 95% CI -7.51 to 1.81), percentage change in ILs (MD -10.09, 95% CI -20.25 to 0.06), change in non-inflamed lesions (NILs) (MD -2.01, 95% CI -7.07 to 3.05), or in percentage change in NILs (MD -8.09, 95% CI -21.51 to 5.32). We assessed the evidence as moderate quality for these outcomes meaning that there is little or no clinical difference between these two interventions for lesion counts.Studies comparing the effects of other interventions were inconsistent or had small samples and high risk of bias. We performed only narrative synthesis for the results of the remaining trials, due to great variation in many aspects of the studies, poor reporting, and failure to obtain necessary data. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold microparticle suspension to vehicle, and clindamycin/benzoyl peroxide combined with pulsed dye laser to clindamycin/benzoyl peroxide alone. There were also several other studies comparing MAL-PDT to light-only treatment, to adapalene and in combination with long-pulsed dye laser to long-pulsed dye laser alone. None of these showed any clinically significant effects.Our third primary outcome was 'Investigator-assessed severe adverse effects'. Most studies reported adverse effects, but not adequately with scarring reported as absent, and blistering reported only in studies on intense pulsed light, infrared light and photodynamic therapies. We rated the quality of the evidence as very low, meaning we were uncertain of the adverse effects of the light therapies.Although our primary endpoint was long-term outcomes, less than half of the studies performed assessments later than eight weeks after final treatment. Only a few studies assessed outcomes at more than three months after final treatment, and longer-term assessments are mostly not covered in this review.
AUTHORS' CONCLUSIONS
High-quality evidence on the use of light therapies for people with acne is lacking. There is low certainty of the usefulness of MAL-PDT (red light) or ALA-PDT (blue light) as standard therapies for people with moderate to severe acne.Carefully planned studies, using standardised outcome measures, comparing the effectiveness of common acne treatments with light therapies would be welcomed, together with adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.
PubMed: 27670126
DOI: 10.1002/14651858.CD007917.pub2 -
ACS Biomaterials Science & Engineering Jun 2023In recent years, bioactive ceramic bone scaffolds have drawn remarkable attention as an alternative method for treating and repairing bone defects. Vat... (Review)
Review
In recent years, bioactive ceramic bone scaffolds have drawn remarkable attention as an alternative method for treating and repairing bone defects. Vat photopolymerization (VP) is a promising additive manufacturing (AM) technique that enables the efficient and accurate fabrication of bioactive ceramic bone scaffolds. This review systematically reviews the research progress of VP-printed bioactive ceramic bone scaffolds. First, a summary and comparison of commonly used bioactive ceramics and different VP techniques are provided. This is followed by a detailed introduction to the preparation of ceramic suspensions and optimization of printing and heat treatment processes. The mechanical strength and biological performance of the VP-printed bioactive ceramic scaffolds are then discussed. Finally, current challenges and future research directions in this field are highlighted.
Topics: Bone and Bones; Ceramics; Tissue Scaffolds
PubMed: 37264613
DOI: 10.1021/acsbiomaterials.3c00051 -
Orthopaedic Journal of Sports Medicine Oct 2018Fixed- and adjustable-loop femoral cortical suspension devices are commonly used for femoral graft fixation during anterior cruciate ligament reconstruction (ACLR). (Review)
Review
Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies.
BACKGROUND
Fixed- and adjustable-loop femoral cortical suspension devices are commonly used for femoral graft fixation during anterior cruciate ligament reconstruction (ACLR).
PURPOSE
To compare the biomechanical results of fixed- versus adjustable-loop femoral cortical suspension devices in studies simulating ACLR with an isolated device and/or specimen setup using porcine femora and bovine flexor tendons.
STUDY DESIGN
Systematic review.
METHODS
Two independent reviewers searched PubMed, Embase, and the Cochrane Library databases to find studies comparing the biomechanical strength of fixed- and adjustable-loop cortical suspension devices for ACLR with isolated device and/or specimen setups using porcine femora and bovine flexor tendons. Studies that compared both devices with similar biomechanical methods were included. Data extracted included displacement during cyclic loading, ultimate load to failure, and mode of failure of the different cortical suspension devices for ACLR.
RESULTS
Six studies were identified that met the inclusion criteria, including a total of 76 fixed-loop devices and 120 adjustable-loop devices. Load to failure was significantly different ( < .0001), with the strongest fixation device being the ToggleLoc with ZipLoop adjustable-loop device (1443.9 ± 512.3 N), compared with the Endobutton CL fixed-loop device (1312.9 ± 258.1 N; = .04) and the TightRope RT adjustable-loop device (863.8 ± 64.7 N; = .01). Cyclic displacement was significantly different, with Endobutton CL (3.7 ± 3.9 mm) showing the least displacement, followed by ToggleLoc with ZipLoop (4.9 ± 2.3 mm) and TightRope RT (7.7 ± 11.1 mm) ( < .0001). Mode of failure was statistically different between the 3 groups ( = .01), with suture failure accounting for 83.8% of TightRope RT devices, 69.4% of ToggleLoc with ZipLoop devices, and 60.3% of Endobutton CL devices.
CONCLUSION
Current biomechanical data suggest that the ToggleLoc with ZipLoop device is the strongest fixation device at "time zero" in terms of ultimate load to mechanical failure. However, the Endobutton CL device demonstrated the least cyclic displacement, which may be a more clinically applicable measure of device superiority.
PubMed: 30364394
DOI: 10.1177/2325967118801762 -
Pharmacoepidemiology and Drug Safety Oct 2023Adverse effects of selective serotonin reuptake inhibitors (SSRIs) on sexual function have been an important area of research for many years. However, the duration of... (Review)
Review
PURPOSE
Adverse effects of selective serotonin reuptake inhibitors (SSRIs) on sexual function have been an important area of research for many years. However, the duration of SSRI-associated sexual adverse effects, and their possible persistence after treatment discontinuation, is still uncertain. The aims of the current systematic review were first to identify existing evidence of sexual dysfunction following SSRI discontinuation, and to provide an account of reported symptoms and proposed treatment options; and second, to establish whether current literature allows accurate estimates of the prevalence of such sexual dysfunction.
METHODS
A systematic review was conducted on PubMed, Embase, and Google Scholar; papers with clinical data regarding patients with persistent sexual dysfunction after SSRI treatment suspension were included.
RESULTS
Overall, two retrospective interventional studies, six observational studies and 11 case reports were judged eligible for inclusion. It was not possible to determine reliable estimates of prevalence. Similarly, a cause-effect relationship between SSRI exposure and persistent sexual impairment could not be ascertained. Nonetheless, the potential for continued sexual disturbances despite discontinuation could not be entirely ruled out.
CONCLUSIONS
There is a need to investigate a possible dose-response relationship between SSRI exposure and persistent sexual adverse effects. Treatment options for persistent dysfunctions remain limited, but novel therapeutic approaches may be required in order to address an otherwise neglected need for sexual well-being.
Topics: Humans; Selective Serotonin Reuptake Inhibitors; Retrospective Studies; Sexual Dysfunction, Physiological; Arousal; Drug-Related Side Effects and Adverse Reactions; Genitalia
PubMed: 37294623
DOI: 10.1002/pds.5653