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The Cochrane Database of Systematic... Dec 2014A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies,... (Review)
Review
BACKGROUND
A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies, such as negative pressure wound therapy (NPWT), which, by means of a suction force that drains excess fluids from the burn, tries to promote the wound healing process and minimise progression of the burn wound.
OBJECTIVES
To assess the effectiveness of NPWT for people with partial-thickness burns.
SEARCH METHODS
We searched the Cochrane Wounds Group Specialised Register (searched 04 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8).
SELECTION CRITERIA
All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that evaluated the safety and effectiveness of NPWT for partial-thickness burns.
DATA COLLECTION AND ANALYSIS
Two review authors used standardised forms, and extracted the data independently. We assessed each trial for risk of bias, and resolved differences by discussion.
MAIN RESULTS
One RCT, that was an interim report, satisfied the inclusion criteria. We undertook a narrative synthesis of results, as the absence of data and poor reporting precluded us from carrying out any formal statistical analysis. The trial was at high risk of bias.
AUTHORS' CONCLUSIONS
There was not enough evidence available to permit any conclusions to be drawn regarding the use of NPWT for treatment of partial-thickness burn wounds.
Topics: Burns; Humans; Negative-Pressure Wound Therapy; Occlusive Dressings; Randomized Controlled Trials as Topic; Suction; Wound Healing
PubMed: 25500895
DOI: 10.1002/14651858.CD006215.pub4 -
Bioscience Trends Oct 2015This meta-analysis aimed to review the regeneration rate of future liver remnant (FLR) and perioperative outcomes after associating liver partition and portal vein... (Comparative Study)
Comparative Study Meta-Analysis Review
A systematic review and meta-analysis of feasibility, safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus two-stage hepatectomy (TSH).
This meta-analysis aimed to review the regeneration rate of future liver remnant (FLR) and perioperative outcomes after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two-stage hepatectomy (TSH). A web search was performed in "MEDLINE", "EMBASE", and "SCIENCE DIRECT" databases using both subject headings (MeSH) and truncated word to identify all the articles published that related to this topic. Pooled risk ratios were calculated for categorical variables and mean differences for continuous variables using the fixed-effects and random-effects models for meta-analysis. Three studies involved 282 patients, of whom 234 were in the TSH group and 48 in the ALPPS group. Morbidity was experienced in 56.3% patients in the ALPPS group and 36.1% in the TSH group. There was a statistical difference (RR = 1.08; Z = 3.24; 95% CI, p = 0.001). Second surgeries were performed successfully in 79.1% patients in the portal vein embolization (PVE) group and 100% in the ALPPS group. There was a statistical difference (Z = 2.48; 95% CI, p = 0.01). The mean regeneration rate of FLR in the ALPPS group was 56.4% compared with 52.8% in the TSH group. There was no statistical difference (95% CI, p = 0.34). So from the outcome of this meta-analysis, TSH had a similar remnant liver regeneration ability compared to ALPPS while the morbidity and mortality rates were relatively low. Cancer progression while waiting for the staged liver resection after portal vein embolization was a drawback for TSH.
Topics: Feasibility Studies; Hepatectomy; Humans; Ligation; Liver Neoplasms; Liver Regeneration; Portal Vein
PubMed: 26559020
DOI: 10.5582/bst.2015.01139 -
Journal of Clinical and Experimental... Apr 2019The main objective is to evaluate the way to graft the dental pulp stem cells (DPSC) in periodontal defects that best regenerate periodontal tissues. Numerous procedures... (Review)
Review
BACKGROUND
The main objective is to evaluate the way to graft the dental pulp stem cells (DPSC) in periodontal defects that best regenerate periodontal tissues. Numerous procedures have been done to promote periodontal regeneration. Bone grafts show good gains clinically and radiographically but histologically seem to have minimal osteoinductive capacity. Another option that exceeds conventional surgery in reducing probing depth and increasing insertion is guided tissue regeneration and tissue engineering that could be an alternative approach to help in the regeneration of living functional bone and peri-dental structures.
MATERIAL AND METHODS
A search was carried out in Cochrane, PubMed-MEDLINE and Scopus databases with keywords: "dental pulp stem cells", "periodontal regeneration", "guided tissue regeneration, periodontal", "tissue regeneration", "periodontal bone defects", "periodontal tissue engineering" and "periodontal defect". Inclusion criteria were articles in English, maximum 10 years old, in which DPSC were used to regenerate a periodontal defect. Exclusion criteria were studies not published in English, case reports, case series, literature reviews, and studies in which periodontal defect was caused by dental extraction.
RESULTS
Out of the 185 articles identified, 101 after excluding duplicates, of which 94 were discarded when reading the title and abstract. 7 articles were obtained for the full text reading: a case report and a case series were eliminated. The systematic review is performed with 5 animal testing studies . The DPSC sheets regenerate a greater amount of bone than the injection. If HGF (hepatocyte growth factor) is added, the maximum bone volume regenerated (69.3 ± 3.9 mm3; <0.01) is achieved. Similar results were obtained in all carriers tested except in the controls. The periodontal ligament stem cells (PDLSC) formed more new bone, compared to DPSC (<0.001). The presence of new cementum and periodontal ligament induced by CMLPs, was detected histologically but DPSC cannot achieve it alone.
CONCLUSIONS
Cementum or PDL regeneration does not depend only on DPSC but on other unknown factors. PDLSC has better periodontal regeneration than DPSC. DPSC significantly favours the regeneration of periodontal bone tissue but has few advantages over other grafts. It is necessary to study which growth factors or matrices can enhance their capacity for periodontal regeneration. Dental pulp, stem cells, periodontal guided tissue regeneration, periodontal bone loss.
PubMed: 31110618
DOI: 10.4317/jced.55574 -
The Cochrane Database of Systematic... Jul 2015Leg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called... (Review)
Review
BACKGROUND
Leg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called stasis or varicose ulcers) comprise 80% to 85% of all leg ulcers. Electromagnetic therapy (EMT) is sometimes used as a treatment to assist the healing of chronic wounds such as venous leg ulcers.
OBJECTIVES
To assess the effects of EMT on the healing of venous leg ulcers.
SEARCH METHODS
For this fourth update, we searched The Cochrane Wounds Group Specialised Register (searched 30 January 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 12).
SELECTION CRITERIA
Randomised controlled trials comparing EMT with sham-EMT or other treatments.
DATA COLLECTION AND ANALYSIS
Standard Cochrane Collaboration methods were employed. At least two review authors independently scrutinised search results and obtained full reports of potentially eligible studies for further assessment. We extracted and summarised details of eligible studies using a data extraction sheet, and made attempts to obtain missing data by contacting study authors. A second review author checked data extraction, and we resolved disagreements after discussion between review authors.
MAIN RESULTS
Three randomised controlled trials (RCTs) of low or unclear risk of bias, involving 94 people, were included in the original review; subsequent updates have identified no new trials. All the trials compared the use of EMT with sham-EMT. Meta-analysis of these trials was not possible due to heterogeneity. In the two trials that reported healing rates; one small trial (44 participants) reported that significantly more ulcers healed in the EMT group than the sham-EMT group however this result was not robust to different assumptions about the outcomes of participants who were lost to follow up. The second trial that reported numbers of ulcers healed found no significant difference in healing. The third trial was also small (31 participants) and reported significantly greater reductions in ulcer size in the EMT group however this result may have been influenced by differences in the prognostic profiles of the treatment groups.
AUTHORS' CONCLUSIONS
It is not clear whether electromagnetic therapy influences the rate of healing of venous leg ulcers. Further research would be needed to answer this question.
Topics: Humans; Magnetic Field Therapy; Randomized Controlled Trials as Topic; Varicose Ulcer; Wound Healing
PubMed: 26134172
DOI: 10.1002/14651858.CD002933.pub6 -
Frontiers in Endocrinology 2023With the increasing incidence of diabetes, diabetic foot ulcer(DFU) has become one of the most common and serious complications in people with diabetes. DFU is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With the increasing incidence of diabetes, diabetic foot ulcer(DFU) has become one of the most common and serious complications in people with diabetes. DFU is associated with significant morbidity and mortality, and can also result in significant economic, social and public health burdens. Due to peripheral neuropathy, peripheral vascular disease, hyperglycemic environment, inflammatory disorders and other factors, the healing of DFU is impaired or delayed, resulting in the formation of diabetic chronic refractory ulcer. Because of these pathological abnormalities in DFU, it may be difficult to promote wound healing with conventional therapies or antibiotics, whereas platelet-rich plasma(PRP) can promote wound healing by releasing various bioactive molecules stored in platelets, making it more promising than traditional antibiotics. Therefore, the purpose of this systematic review is to summarize and analyze the efficacy of PRP in the treatment of DFU.
METHODS
A literature search was undertaken in PubMed, CNKI, EMB-ASE, the Cochrane Library, the WanFang Database and the WeiPu Database by computer. Included controlled studies evaluating the efficacy of PRP in the treatment of diabetic foot ulcers. The data extraction and assessment are on the basis of PRISMA.
RESULTS
Twenty studies were evaluated, and nineteen measures for the evaluation of the efficacy of PRP in DFU treatment were introduced by eliminating relevant duplicate measures. The efficacy measures that were repeated in various studies mainly included the rate of complete ulcer healing, the percentage of ulcer area reduction, the time required for ulcer healing, wound complications (including infection rate, amputation rate, and degree of amputation), the rate of ulcer recurrence, and the cost and duration of hospitalization for DFU, as well as subsequent survival and quality of life scores. One of the most important indicators were healing rate, ulcer area reduction and healing time. The meta-analysis found that PRP was significantly improve the healing rate(OR = 4.37, 95% CI 3.02-6.33, P < 0.001) and shorten the healing time(MD = -3.21, 95% CI -3.83 to -2.59,P < 0.001)of patients with DFU when compared to the conventional treatment, but there was no significant difference in reducing the of ulcer area(MD = 5.67, 95% CI -0.77 to 12.11,P =0.08>0.05 ).
CONCLUSION
The application of PRP to DFU can improve ulcer healing rate and shorten ulcer healing time, but more clinical data are needed to clarify some efficacy measures. At the same time, a standardized preparation process for PRP is essential.
Topics: Humans; Diabetic Foot; Quality of Life; Anti-Bacterial Agents; Platelet-Rich Plasma; Wound Healing; Diabetes Mellitus
PubMed: 38169990
DOI: 10.3389/fendo.2023.1256081 -
The Cochrane Database of Systematic... Jan 2023Keloid scarring is one of the most common types of pathological scarring. Keloid scars that fail to heal can affect a person's physical and psychological function by... (Review)
Review
BACKGROUND
Keloid scarring is one of the most common types of pathological scarring. Keloid scars that fail to heal can affect a person's physical and psychological function by causing pain, pruritus, contractures, and cosmetic disfigurement. Silicone gel sheeting (SGS) is made from medical-grade silicone reinforced with a silicone membrane backing and is one of the most commonly used treatments for keloid scars. However, there is no up-to-date systematic review assessing the effectiveness of SGS for keloid scars. A clear and rigorous review of current evidence is required to guide clinicians, healthcare managers and people with keloid scarring.
OBJECTIVES
To assess the effectiveness of silicone gel sheeting for the treatment of keloid scars compared with standard care or other therapies.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was December 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that recruited people with any keloid scars and assessed the effectiveness of SGS.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence. We resolved initial disagreements by discussion, or by consulting a third review author when necessary.
MAIN RESULTS
Two studies met the inclusion criteria. Study sample sizes were 16 and 20 participants. The trials were clinically heterogeneous with differences in causes for scarring (e.g. surgery, infected wounds, and trauma), site (e.g. chest and back), and ages of scars. The duration of follow-up was three and four and a half months. The included studies reported three comparisons; SGS compared with no treatment, SGS compared with non-silicone gel sheeting (a dressing similar to SGS but which does not contain silicone), and SGS compared with intralesional injections of triamcinolone acetonide. One trial had a split-body design and one trial had an unclear design (resulting in a mix of paired and clustered data). The included studies reported limited outcome data for the primary review outcome of scar severity measured by health professionals and no data were reported for severity of scar measured by patients or adverse events. For secondary outcomes some data on pain were reported, but health-related quality of life and cost-effectiveness were not reported. Both trials had suboptimal outcome reporting, thus many domains in the risk of bias were assessed as unclear. All evidence was rated as being very low-certainty, mainly due to risk of bias, indirectness, and imprecision. SGS compared with no treatment Two studies with 33 participants (76 scars) reported the severity of scar assessed by health professionals, and we are uncertain about the effect of SGS on scar severity compared with no treatment (very low-certainty evidence, downgraded once for risk of bias, once for inconsistency, once for indirectness, and once for imprecision). We are uncertain about the effect of SGS on pain compared with no treatment (21 participants with 40 scars; very low-certainty evidence, downgraded once for risk of bias, once for inconsistency, once for indirectness, and once for imprecision). No data were reported for other outcomes including scar severity assessed by patients, adverse events, adherence to treatment, health-related quality of life and cost-effectiveness. SGS compared with non-SGS One study with 16 participants (25 scars) was included in this comparison. We are uncertain about the effect of SGS on scar severity assessed by health professionals compared with non-SGS (very low-certainty evidence, downgraded once for risk of bias, once for indirectness, and once for imprecision). We are also uncertain about the effect of SGS on pain compared with non-SGS (very low-certainty evidence, downgraded once for risk of bias, once for indirectness, and once for imprecision). No data were reported for other outcomes including scar severity assessed by patients, adverse events, adherence to treatment, health-related quality of life and cost-effectiveness. SGS compared with intralesional injections of triamcinolone acetonide One study with 17 participants (51 scars) reported scar severity assessed by health professionals, and we are uncertain about the effect of SGS on scar severity compared with intralesional injections of triamcinolone acetonide (very low-certainty evidence, downgraded once for risk of bias, once for indirectness, and once for imprecision). This study also reported pain assessed by health professionals among 5 participants (15 scars) and we are uncertain about the effect of SGS on pain compared with intralesional injections of triamcinolone acetonide (very low-certainty evidence, downgraded once for risk of bias, once for indirectness, and twice for imprecision). No data were reported for other outcomes including scar severity assessed by patients, adverse events, adherence to treatment, health-related quality of life and cost-effectiveness.
AUTHORS' CONCLUSIONS
There is currently a lack of RCT evidence about the clinical effectiveness of SGS in the treatment of keloid scars. From the two studies identified, there is insufficient evidence to demonstrate whether the use of SGS compared with no treatment, non-SGS, or intralesional injections of triamcinolone acetonide makes any difference in the treatment of keloid scars. Evidence from the included studies is of very low certainty, mainly driven by the risk of bias, indirectness, and imprecision due to small sample size. Further well-designed studies that have good reporting methodologies and address important clinical, quality of life and economic outcomes are required to reduce uncertainty around decision-making in the use of SGS to treat keloid scars.
Topics: Humans; Bandages; Keloid; Silicone Gels; Triamcinolone Acetonide; Wound Healing; Randomized Controlled Trials as Topic
PubMed: 36594476
DOI: 10.1002/14651858.CD013878.pub2 -
Cells Oct 2022Spinal cord injury (SCI) is characterized by a complex and prolonged injury process that exacerbates the damage induced by the primary injury and inhibits the potential... (Meta-Analysis)
Meta-Analysis Review
Spinal cord injury (SCI) is characterized by a complex and prolonged injury process that exacerbates the damage induced by the primary injury and inhibits the potential for regeneration. SCI frequently results in the devastating loss of neurological functions and thus has serious consequences on patient quality of life. Current treatments are limited and focus on early interventions for the acute management of complications. Therefore, the development of novel treatments targeting ongoing injury processes is required to improve SCI outcomes. We aimed to systematically review studies published in the last 10 years that examined experimental treatments with neuroregenerative and neuroprotective capabilities for the improvement of SCI. We analyzed treatments from 44 studies that were identified through a systematic literature search using three databases: PubMed, Web of Science and EMBASE (searched through Ovid). We performed a meta-analysis for Basso-Beattie-Bresnahan (BBB) locomotion test data and collected immunohistochemistry results to demonstrate neuroregenerative and neuroprotective properties of the treatments, respectively. The two treatments that illustrated the most significant improvements in functional recovery using the BBB test were the combined use of tetrahedral framework nucleic acid (tFNA) with neural stem cells (NSCs) and Fortasyn Connect (FC) supplementation. Both treatments also attenuated secondary injury processes as demonstrated through immunohistochemistry. Combined tFNA with NSCs and FC supplementation are promising treatments for the improvement of SCI as they both demonstrate neuroregenerative and neuroprotective properties. Further pre-clinical testing is required to validate and determine the long-term efficacies of these treatments for the improvement of SCI.
Topics: Animals; Humans; Quality of Life; Disease Models, Animal; Spinal Cord Injuries; Recovery of Function; Nerve Regeneration
PubMed: 36359804
DOI: 10.3390/cells11213409 -
Journal of Nanobiotechnology Dec 2022Critical-sized bone defects are always difficult to treat, and they are associated with a significant burden of disease in clinical practice. In recent decades, due to... (Meta-Analysis)
Meta-Analysis Review
Critical-sized bone defects are always difficult to treat, and they are associated with a significant burden of disease in clinical practice. In recent decades, due to the fast development of biomaterials and tissue engineering, many bioinspired materials have been developed to treat large bone defects. Due to the excellent osteoblastic ability of black phosphorous (BP), many BP-based biomaterials have been developed to treat bone defects. Therefore, there are abundant studies as well as a tremendous amount of research data. It is urgent to conduct evidence-based research to translate these research data and results into validated scientific evidence. Therefore, in our present study, a qualitative systematic review and a quantitative meta-analysis were performed. Eighteen studies were included in a systematic review, while twelve studies were included in the meta-analysis. Our results showed that the overall quality of experimental methods and reports of biomaterials studies was still low, which needs to be improved in future studies. Besides, we also proved the excellent osteoblastic ability of BP-based biomaterials. But we did not find a significant effect of near-infrared (NIR) laser in BP-based biomaterials for treating bone defects. However, the quality of the evidence presented by included studies was very low. Therefore, to accelerate the clinical translation of BP-based biomaterials, it is urgent to improve the quality of the study method and reporting in future animal studies. More evidence-based studies should be conducted to enhance the quality and clinical translation of BP-based biomaterials.
Topics: Animals; Biocompatible Materials; Phosphorus; Bone Regeneration; Tissue Engineering
PubMed: 36496422
DOI: 10.1186/s12951-022-01735-9 -
Journal of Periodontology Aug 2016Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus augmentation. Hence, this systematic review aims at studying the mean SMT and further investigating patient-related factors that may affect SMT. As a secondary goal, the association between SMT and membrane perforation rate was studied.
METHODS
Three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, conducted electronic and manual literature searches. This review was written and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MECIR (Methodological Expectations of Cochrane Intervention Reviews) guidelines. Quantitative assessment was performed for articles that met the inclusion criteria to investigate the mean SMT, its contributing factors, and the influence on membrane damage and surgical complications.
RESULTS
Thirty-one studies that reported maxillary SMT were considered for qualitative analysis. Nineteen were further meta-analyzed. Overall mean ± SE SMT was 1.17 ± 0.1 mm (95% confidence interval [CI] = 0.89 to 1.44). Although mean SMT for the three-dimensional radiography (3DR) group was 1.33 mm (95% CI = 1.06 to 1.60), for the histology group, it was 0.48 mm (95% CI = 0.12 to 1.1). Random-effects model showed that, although there is a trend for thicker SMT as determined using 3DR compared with histologic analysis, such difference did not reach statistical significance (P = 0.15). Also, regression analyses demonstrated that the variables periodontitis (P = 0.13) and smoking (P = 0.11) showed thicker SMT. Inconclusive data were obtained when correlating SMT and perforation rate, although it seems that thicker SMT might be more prone to perforation (P = 0.14).
CONCLUSIONS
SMT is, on average, 1 mm in patients seeking sinus augmentation. Three-dimensional technologies overestimate approximately 2.5 times SMT when compared with histologic analysis. Periodontitis and smoking may result in thickening of the sinus membrane. However, current data were inconclusive to link SMT to the rate of membrane damage.
Topics: Alveolar Bone Loss; Bone Regeneration; Bone Transplantation; Dental Prosthesis Design; Humans; Maxilla; Maxillary Sinus; Nasal Mucosa; Regression Analysis
PubMed: 27086614
DOI: 10.1902/jop.2016.160041 -
Cells Aug 2021Despite the progressive advances, current standards of treatments for peripheral nerve injury do not guarantee complete recovery. Thus, alternative therapeutic...
Despite the progressive advances, current standards of treatments for peripheral nerve injury do not guarantee complete recovery. Thus, alternative therapeutic interventions should be considered. Complementary and alternative medicines (CAMs) are widely explored for their therapeutic value, but their potential use in peripheral nerve regeneration is underappreciated. The present systematic review, designed according to guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, aims to present and discuss the current literature on the neuroregenerative potential of CAMs, focusing on plants or herbs, mushrooms, decoctions, and their respective natural products. The available literature on CAMs associated with peripheral nerve regeneration published up to 2020 were retrieved from PubMed, Scopus, and Web of Science. According to current literature, the neuroregenerative potential of , , , , and are the most widely studied. Various CAMs enhanced proliferation and migration of Schwann cells , primarily through activation of MAPK pathway and FGF-2 signaling, respectively. Animal studies demonstrated the ability of CAMs to promote peripheral nerve regeneration and functional recovery, which are partially associated with modulations of neurotrophic factors, pro-inflammatory cytokines, and anti-apoptotic signaling. This systematic review provides evidence for the potential use of CAMs in the management of peripheral nerve injury.
Topics: Animals; Biological Products; Complementary Therapies; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Signal Transduction
PubMed: 34571842
DOI: 10.3390/cells10092194