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World Journal of Emergency Surgery :... Nov 2023An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC.
METHODS
A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
RESULTS
Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69-72%), a specificity of 85% (95% CI, 84-86%), and an accuracy of 0.83 (95% CI, 0.82-0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67-74%) and 92% (95% CI, 90-93%) performed by emergency physicians (EPs), 79% (95% CI, 71-85%) and 76% (95% CI, 69-81%) performed by surgeons, and 68% (95% CI 66-71%) and 87% (95% CI, 86-88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups.
CONCLUSION
US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.
Topics: Humans; Cholecystitis, Acute; Ultrasonography; Sensitivity and Specificity
PubMed: 38037062
DOI: 10.1186/s13017-023-00524-5 -
Plastic and Reconstructive Surgery.... Oct 2023Severe acute burn injuries represent a challenge to the reconstructive surgeon. Free flap reconstruction might be required in cases of significant critical structure...
BACKGROUND
Severe acute burn injuries represent a challenge to the reconstructive surgeon. Free flap reconstruction might be required in cases of significant critical structure exposure and soft tissue deficits, when local options are unavailable. This study aimed to determine the free flap complication rate in acute burn patients.
METHODS
A systematic review and meta-analysis were conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on the International Prospective Register of Systematic Reviews database (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was the free flap failure rate.
RESULTS
The study identified 31 articles for inclusion. A total of 427 patients (83.3% men, 16.7% women) accounting for 454 free flaps were included. The mean patient age was 36.21 [95% confidence interval (CI), 31.25-41.16]. Total free flap loss rate was 9.91% [95% CI, 7.48%-13.02%], and partial flap loss was 4.76% [95% CI, 2.66%-8.39%]. The rate of venous thrombosis was 6.41% [95% CI, 3.90%-10.36%] and arterial thrombosis was 5.08% [95% CI, 3.09%-8.26%]. Acute return to the operating room occurred in 20.63% [16.33%-25.71%] of cases. Stratified by body region, free flaps in the lower extremity had a failure rate of 8.33% [95% CI, 4.39%-15.24%], whereas in the upper extremity, the failure rate was 6.74% [95% CI, 3.95%-11.25%].
CONCLUSION
This study highlights the high risk of free flap complications and failure in acute burn patients.
PubMed: 37817922
DOI: 10.1097/GOX.0000000000005311 -
Sports Medicine (Auckland, N.Z.) Sep 2023Augmented feedback is often used during resistance training to enhance acute physical performance and has shown promise as a method of improving chronic physical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Augmented feedback is often used during resistance training to enhance acute physical performance and has shown promise as a method of improving chronic physical adaptation. However, there are inconsistencies in the scientific literature regarding the magnitude of the acute and chronic responses to feedback and the optimal method with which it is provided.
OBJECTIVE
This systematic review and meta-analysis aimed to (1) establish the evidence for the effects of feedback on acute resistance training performance and chronic training adaptations; (2) quantify the effects of feedback on acute kinematic outcomes and changes in physical adaptations; and (3) assess the effects of moderating factors on the influence of feedback during resistance training.
METHODS
Twenty studies were included in this systematic review and meta-analysis. This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched, and studies were included if they were peer-reviewed investigations, written in English, and involved the provision of feedback during or following dynamic resistance exercise. Furthermore, studies must have evaluated either acute training performance or chronic physical adaptations. Risk of bias was assessed using a modified Downs and Black assessment tool. Multilevel meta-analyses were performed to quantify the effects of feedback on acute and chronic training outcomes.
RESULTS
Feedback enhanced acute kinetic and kinematic outputs, muscular endurance, motivation, competitiveness, and perceived effort, while greater improvements in speed, strength, jump performance, and technical competency were reported when feedback was provided chronically. Furthermore, greater frequencies of feedback (e.g., following every repetition) were found to be most beneficial for enhancing acute performance. Results demonstrated that feedback improves acute barbell velocities by approximately 8.4% (g = 0.63, 95% confidence interval [CI] 0.36-0.90). Moderator analysis revealed that both verbal (g = 0.47, 95% CI 0.22-0.71) and visual feedback (g = 1.11, 95% CI 0.61-1.61) were superior to no feedback, but visual feedback was superior to verbal feedback. For chronic outcomes, jump performance might have been positively influenced (g = 0.39, 95% CI - 0.20 to 0.99) and short sprint performance was likely enhanced (g = 0.47, 95% CI 0.10-0.84) to a greater extent when feedback is provided throughout a training cycle.
CONCLUSIONS
Feedback during resistance training can lead to enhanced acute performance within a training session and greater chronic adaptations. Studies included in our analysis demonstrated a positive influence of feedback, with all outcomes showing superior results than when no feedback is provided. For practitioners, it is recommended that high-frequency, visual feedback is consistently provided to individuals when they complete resistance training, and this may be particularly useful during periods of low motivation or when greater competitiveness is beneficial. Alternatively, researchers must be aware of the ergogenic effects of feedback on acute and chronic responses and ensure that feedback is standardised when investigating resistance training.
Topics: Humans; Resistance Training; Muscle Strength; Exercise; Adaptation, Physiological; Acclimatization
PubMed: 37410360
DOI: 10.1007/s40279-023-01877-2 -
Molecular Psychiatry Oct 2023Adolescence represents a critical period for brain and behavioural health and characterised by the onset of mood, psychotic and anxiety disorders. In rodents,...
Adolescence represents a critical period for brain and behavioural health and characterised by the onset of mood, psychotic and anxiety disorders. In rodents, neurogenesis is very active during adolescence, when is particularly vulnerable to stress. Whether stress-related neurogenesis changes influence adolescence onset of psychiatric symptoms remains largely unknown. A systematic review was conducted on studies investigating changes in hippocampal neurogenesis and neuroplasticity, hippocampal-dependent cognitive functions, and behaviour, occurring after adolescence stress exposure in mice both acutely (at post-natal days 21-65) and in adulthood. A total of 37 studies were identified in the literature. Seven studies showed reduced hippocampal cell proliferation, and out of those two reported increased depressive-like behaviours, in adolescent rodents exposed to stress. Three studies reported a reduction in the number of new-born neurons, which however were not associated with changes in cognition or behaviour. Sixteen studies showed acutely reduced hippocampal neuroplasticity, including pre- and post-synaptic plasticity markers, dendritic spine length and density, and long-term potentiation after stress exposure. Cognitive impairments and depressive-like behaviours were reported by 11 of the 16 studies. Among studies who looked at adolescence stress exposure effects into adulthood, seven showed that the negative effects of stress observed during adolescence on either cell proliferation or hippocampal neuroplasticity, cognitive deficits and depressive-like behaviour, had variable impact in adulthood. Treating adolescent mice with antidepressants, glutamate receptor inhibitors, glucocorticoid antagonists, or healthy diet enriched in omega-3 fatty acids and vitamin A, prevented or reversed those detrimental changes. Future research should investigate the translational value of these preclinical findings. Developing novel tools for measuring hippocampal neurogenesis in live humans, would allow assessing neurogenic changes following stress exposure, investigating relationships with psychiatric symptom onset, and identifying effects of therapeutic interventions.
Topics: Animals; Mice; Brain; Cognition; Hippocampus; Neurogenesis; Rodentia; Stress, Psychological
PubMed: 37612364
DOI: 10.1038/s41380-023-02229-2 -
Neurological Sciences : Official... Sep 2023Mutations in FDXR gene, involved in mitochondrial pathway, cause a rare recessive neurological disorder with variable severity of phenotypes. The most common... (Review)
Review
BACKGROUND AND AIMS
Mutations in FDXR gene, involved in mitochondrial pathway, cause a rare recessive neurological disorder with variable severity of phenotypes. The most common presentation includes optic and/or auditory neuropathy, variably associated to developmental delay or regression, global hypotonia, pyramidal, cerebellar signs, and seizures. The review of clinical findings in previously described cases from literature reveals also a significant incidence of sensorimotor peripheral polyneuropathy (22.72%) and ataxia (43.18%). To date, 44 patients with FDXR mutations have been reported. We describe here on two new patients, siblings, who presented with a quite different phenotype compared to previously described patients.
METHODS
Clinical, neurophysiological, and genetic features of two siblings and a systematic literature review focused on the clinical spectrum of the disease are described.
RESULTS
Both patients presented with an acute-sub-acute onset of peripheral neuropathy and only in later stages of the disease developed the typical features of FDXR-associated disease.
INTERPRETATION
The peculiar clinical presentation at onset and the evolution of the disease in our patients and in some cases revised from the literature shed lights on a new possible phenotype of FDXR-associated disease: a peripheral neuropathy which can mimic an acute inflammatory disease.
Topics: Humans; Ataxia; Cerebellar Ataxia; Diagnosis, Differential; Mutation; Peripheral Nervous System Diseases; Phenotype; Ferredoxin-NADP Reductase
PubMed: 37046037
DOI: 10.1007/s10072-023-06790-0 -
European Journal of Orthopaedic Surgery... Oct 2023Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute total hip arthroplasty (THA), 'fix-and-replace', in patients considered to have a poor prognosis and likelihood of PTOA. Controversy remains between early fix-and-replace, versus delayed THA as required after initial ORIF. This systematic review included studies comparing functional and clinical outcomes between acute versus delayed THA after displaced acetabular fractures.
METHODS
Comprehensive searches following the PRISMA guideline were performed on six databases for articles in English published anytime up to 29 March 2021. Two authors screened articles and discrepancies were resolved by consensus. Patient demographics, fracture classification, functional and clinical outcomes were compiled and analysed.
RESULTS
The search yielded 2770 unique studies, of which five retrospective studies were identified with a total of 255 patients. Of them, 138 (54.1%) were treated with acute and 117 (45.9%) treated with delayed THA. Delayed THA group represented a younger cohort compared to the acute group (mean age, 64.3 vs 73.3). The mean follow-up time for the acute and delayed group was 23 and 50 months, respectively. There was no difference in functional outcomes between the two study groups. Complication and mortality rates were comparable. Delayed THA had a higher revision rate compared to the acute group (17.1 vs 4.3%; p = 0.002).
CONCLUSION
Fix-and-replace had functional outcomes and complication rates similar to ORIF and delayed THA, but lower revision rates. Although the quality of studies was mixed, sufficient equipoise now exists to justify randomised studies in this area. PROSPERO registration: CRD42021235730.
Topics: Humans; Middle Aged; Arthroplasty, Replacement, Hip; Retrospective Studies; Acetabulum; Fractures, Bone; Hip Fractures; Open Fracture Reduction; Fracture Fixation, Internal; Spinal Fractures; Osteoarthritis; Treatment Outcome
PubMed: 36810707
DOI: 10.1007/s00590-023-03489-y -
European Respiratory Review : An... Sep 2023Many individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience post-acute sequelae of SARS-CoV-2 infection (PASC),... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience post-acute sequelae of SARS-CoV-2 infection (PASC), sometimes referred to as "long COVID". Our objective was to conduct a systematic literature review and meta-analysis to identify PASC-associated symptoms in previously hospitalised patients and determine the frequency and temporal nature of PASC.
METHODS
Searches of MEDLINE, Embase, Cochrane Library (2019-2021), World Health Organization International Clinical Trials Registry Platform and reference lists were performed from November to December 2021. Articles were assessed by two reviewers against eligibility criteria and a risk of bias tool. Symptom data were synthesised by random effects meta-analyses.
RESULTS
Of 6942 records, 52 studies with at least 100 patients were analysed; ∼70% were Europe-based studies. Most data were from the first wave of the pandemic. PASC symptoms were analysed from 28 days after hospital discharge. At 1-4 months post-acute SARS-CoV-2 infection, the most frequent individual symptoms were fatigue (29.3% (95% CI 20.1-40.6%)) and dyspnoea (19.6% (95% CI 12.8-28.7%)). Many patients experienced at least one symptom at 4-8 months (73.1% (95% CI 44.2-90.3%)) and 8-12 months (75.0% (95% CI 56.4-87.4%)).
CONCLUSIONS
A wide spectrum of persistent PASC-associated symptoms were reported over the 1-year follow-up period in a significant proportion of participants. Further research is needed to better define PASC duration and determine whether factors such as disease severity, vaccination and treatments have an impact on PASC.
Topics: Humans; SARS-CoV-2; COVID-19; Post-Acute COVID-19 Syndrome; Disease Progression; Dyspnea
PubMed: 37437914
DOI: 10.1183/16000617.0254-2022 -
CNS Neuroscience & Therapeutics Aug 2023Rapid diagnosis of acute ischemic stroke (AIS) patients is still challenging, and reliable biomarkers are needed. Noncoding RNAs are important for many physiological... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rapid diagnosis of acute ischemic stroke (AIS) patients is still challenging, and reliable biomarkers are needed. Noncoding RNAs are important for many physiological activities, among which circular RNAs (circRNAs) have been proven to be more tissue-specific and conservative. Many recent studies found the potential of circRNAs as biomarkers for many diseases, including cardiovascular diseases, cancers, and ischemic stroke. This systemic review and meta-analysis aimed to identify circRNAs as potential biomarkers for AIS.
METHODS
This study has been prospectively registered in PROSPERO (Registration No. 11 CRD42021288033). Published literature comparing circRNA expression profiles between AIS and non-AIS in human and animal models were retrieved from the articles published by January 2023 in major databases. We descriptively summarized the included studies, conducted meta-analysis under a random effects model, and did bioinformatics analysis including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis.
RESULTS
Totally 23 studies were included, reporting 18 distinctive upregulated and 20 distinctive downregulated circRNAs. Diagnostic meta-analysis indicated discriminative ability of the circRNAs. Furthermore, circRNA HECTD1, circRNA DLGAP4, circRNA CDC14A, circRNA SCMH1, and circRNA TLK1 were reported with the same regulation trend in more than one study (animal studies included). GO and KEGG enrichment analyses indicated that the target genes of these five circRNAs were enriched in regulating cell proliferation, apoptosis, and oxidative stress.
CONCLUSIONS
This study demonstrates that circRNAs (circRNA HECTD1, circRNA DLGAP4, circRNA CDC14A, circRNA SCMH1, and circRNA TLK1) generally are promising as potential biomarkers for AIS. However, due to the limited number of studies, diagnostic value of individual circRNA could not be validated. More in vitro and in vivo functional studies are needed.
Topics: Animals; Humans; RNA, Circular; Ischemic Stroke; Stroke; Biomarkers; MicroRNAs; RNA; Gene Expression Profiling; Protein Serine-Threonine Kinases
PubMed: 37186176
DOI: 10.1111/cns.14220 -
Journal of Pharmaceutical Policy and... Aug 2023Acute coronary syndrome (ACS) is the principal cause of death in developing countries including Ethiopia. No study reports the overall patterns of risk factors and... (Review)
Review
BACKGROUND
Acute coronary syndrome (ACS) is the principal cause of death in developing countries including Ethiopia. No study reports the overall patterns of risk factors and burden of in-hospital mortality in Ethiopia. This study, therefore, aimed to assess the magnitude of risk factors, management, and in-hospital mortality of ACS in Ethiopia.
METHODS
Electronic searching of articles was conducted using PubMed, Science Direct, EMBASE, Scopus, Hinari, and Google Scholar to access articles conducted in Ethiopia. The Preferred Reporting Items for Systematic Reviews checklist was used for identification, eligibility screening, and selection of articles. Data were extracted with an abstraction form prepared with Microsoft Excel and exported to STATA for analysis. Funnel plot, Begg's test, and Egger's test were used to determine publication bias. Heterogeneity between the studies was checked by I statistic. The pooled prevalence of risk factors and in-hospital mortality of ACS were estimated using a random-effects meta-analysis model.
RESULTS
Most (59.367%) of the patients had ST-segment elevation myocardial infarction (STEMI). Hypertension (54.814%) was the leading risk factor for ACS followed by diabetes mellitus (38.549%). Aspirin (56.903%) and clopidogrel (55.266%) were most frequently used in patients with STEMI ACS, respectively. The pooled proportion of in-hospital mortality of ACS was 14.82% which was higher in patients with STEMI (16.116%).
CONCLUSION
The rate of in-hospital mortality is still high which was higher in patients with STEMI. Initiation of treatment must consider the heterogeneity of each patient's risk factor and reperfusion therapy should be implemented in our setting.
PubMed: 37550741
DOI: 10.1186/s40545-023-00603-7 -
Journal of Hand Surgery Global Online Sep 2023This review aims to compare recovery outcomes of conservative, early operative, and a combination of conservative and operative management for acute carpal tunnel...
PURPOSE
This review aims to compare recovery outcomes of conservative, early operative, and a combination of conservative and operative management for acute carpal tunnel syndrome (ACTS).
METHODS
A literature search of PubMed, Scopus, and CINAHL from 1970 to 2022 was conducted using the keywords carpal tunnel syndrome and acute nerve compression. ACTS was defined as a case within 12 weeks of symptom onset. Primary data extracted included causes (traumatic or atraumatic), symptom duration (<1 day, 1-7 days, or 8-84 days), intervention (surgical, conservative, or conservative then surgical), follow-up duration, and outcome (full recovery or non-full recovery). Logistic regression analyses and χ tests were performed to investigate associations among these variables.
RESULTS
A total of 197 patients involving 127 (64.5%) traumatic and 70 (35.3%) atraumatic cases were included. Forty-seven percent of patients were managed conservatively followed by surgery, 30% conservative only, and 23% surgery only. The traumatic group was associated with better recovery than the atraumatic group. Recovery outcomes were not associated with symptom duration or follow-up time. The choice of intervention was not associated with traumatic or atraumatic etiology, nor did it affect recovery outcomes in either group.
CONCLUSIONS
Traumatic ACTS is associated with better recovery outcomes than atraumatic etiologies. Surgical intervention was not found to be associated with better outcomes than conservative management, regardless of the etiologies. Further prospective studies are warranted to compare surgical versus conservative management.
CLINICAL RELEVANCE
Currently, there are no guidelines for the best management of ACTS, and it is not known if early or delayed surgical treatment is optimal. This review compiles the current evidence and identifies gaps in the literature, highlighting the need for further investigation to provide the best clinical practice.
PubMed: 37790823
DOI: 10.1016/j.jhsg.2023.06.012