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Narra J Apr 2024Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic... (Meta-Analysis)
Meta-Analysis Comparative Study
Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic reviews or meta-analyses have compared the efficacy and safety of open proximal ureterolithotomy and laparoscopic approaches. The aim of this study was to compare the efficacy and safety between open and laparoscopic proximal ureterolithotomy for ureteral stone management. Following the PRISMA guidelines, systematic searches were conducted in five databases (PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest) to identify articles comparing those two surgical approaches. Operative time, blood loss, pain score, hospital stay, recovery time, and complications were collected and compared. Heterogeneity-based meta-analysis with random-effects or fixed-effects models were conducted. Two randomized controlled trials and four observational cohort studies with 386 participants met the criteria. Open surgery had significantly less time than laparoscopic ureterolithotomy (mean difference (MD): 26.63 minutes, 95%CI: 14.32, 38.94; <0.0001). Intraoperative blood loss (MD: -1.27 ml; 95%CI: -6.64, 4.09; =0.64) and overall complications (OR: 0.68; 95%CI: 0.41, 1.15; =0.16) were not significantly different between two approaches. Laparoscopic ureterolithotomy reduced visual analogue scale (VAS) pain scores (MD: -2.53; 95%CI: -3.47, -2.03; <0.00001), hospital stays (MD: -2.40 days; 95%CI: -3.42 to -1.38 days; =0.03), and recovery time (MD: -9.67 days; 95%CI: -10.81 to -8.53 days; <0.00001). In conclusion, open proximal ureterolithotomy had less time, but laparoscopic surgery reduced postoperative pain, hospital stay, and recovery time. Both methods had comparable intraoperative bleeding and complications.
Topics: Humans; Laparoscopy; Ureteral Calculi; Length of Stay; Operative Time; Treatment Outcome; Blood Loss, Surgical; Pain, Postoperative; Postoperative Complications; Urologic Surgical Procedures
PubMed: 38798848
DOI: 10.52225/narra.v4i1.679 -
BMC Musculoskeletal Disorders May 2024This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or without cement augmentation.
METHODS
The databases of PubMed, Embase, and Cochrane Library were searched in August 2023 for literature comparing the clinical outcomes of patients with PHFs treated with locked plate alone and locked plate augmented with cement. Data describing study design; level of evidence; inclusion criteria; demographic information; final follow-up; revision rate; implant failure rate; avascular necrosis rate; total complication rate; constant score; and disability of arm, shoulder, and hand (DASH) score were collected.
RESULTS
Eight studies (one randomized-controlled trial and seven observational studies), involving 664 patients, were identified. Compared with locked plates alone, using cement-augmented locked plates reduced the implant failure rate (odds ratio (OR) = 0.19; 95% confidence interval (CI) 0.10-0.39; P < 0.0001) and total complication rate (OR = 0.45; 95% CI 0.29-0.69; P = 0.0002) and improved DASH scores (mean difference (MD) = 2.99; 95% CI 1.00-4.98; P = 0.003). However, there was no significant difference in clinical outcomes, including revision rate, avascular necrosis rate, and constant score.
CONCLUSION
In this review and meta-analysis, fixation of the PHFs in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. Good results are expected for most patients treated with this technique.
TRIAL REGISTRATION
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)21 guidelines were followed to conduct this systematic review and meta-analysis and was registered as a protocol in PROSPERO (CRD42022318798).
Topics: Humans; Bone Plates; Shoulder Fractures; Fracture Fixation, Internal; Bone Cements; Aged; Treatment Outcome; Aged, 80 and over; Postoperative Complications; Reoperation
PubMed: 38730497
DOI: 10.1186/s12891-024-07502-1 -
Clinical Psychology Review Mar 2024Internalized sexual stigma is a well-established risk factor for poor mental health among sexual minority individuals. However, there has been no synthesis of the... (Review)
Review
Internalized sexual stigma is a well-established risk factor for poor mental health among sexual minority individuals. However, there has been no synthesis of the literature pertaining to risk and protective factors that influence the development of internalized sexual stigma over time. This systematic review presents findings from 31 studies addressing this question (n = 9192); 23 studies examined psychosocial and sociodemographic predictors of internalized sexual stigma among sexual minority individuals, and eight studies tested the effects of psychological interventions on internalized sexual stigma. Longitudinal studies highlight the stability of internalized sexual stigma over time, and the role of stigma and discrimination, proximal minority stressors (e.g., outness, concealment), and psychological factors (e.g., depressive and anxious symptoms, coping styles, and demoralization) in predicting subsequent internalized sexual stigma. Demographic factors appear to play only a limited role in predicting subsequent internalized sexual stigma. Finally, most intervention studies found no significant effects in reducing internalized sexual stigma, with three exceptions finding significant intervention effects among young sexual minority individuals. We conclude by outlining a theory-driven model of internalized stigma and a research agenda to test more nuanced models of internalized stigma that include multifactorial risk indices.
Topics: Humans; Sexual and Gender Minorities; Sexual Behavior; Social Stigma; Mental Health; Longitudinal Studies
PubMed: 38218122
DOI: 10.1016/j.cpr.2023.102376 -
The Journal of Nutrition, Health & Aging Apr 2024Stroke survivors frequently encounter physical complications. This study aimed to evaluate the impact of stroke on bone mineral density (BMD) and assess the risk of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Stroke survivors frequently encounter physical complications. This study aimed to evaluate the impact of stroke on bone mineral density (BMD) and assess the risk of post-stroke osteoporosis or osteoporotic fractures.
DESIGN
Systematic review and meta-analysis.
SETTING AND PARTICIPANTS
We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews to identify longitudinal studies reporting the influence of stroke on BMD, osteoporosis, and osteoporotic fractures. Pooled analyses were performed utilizing random-effects models.
RESULTS
This study included 21 studies with 1,029,742 participants. The mean difference of BMD in the paretic femoral neck between follow-up and initial measurements was -0.07 g/cm (95% CI, -0.09 to -0.04), and -0.03 g/cm (95% CI, -0.05 to -0.01) in the non-paretic femoral neck. A follow-up length exceeding six months was associated with a more pronounced decrease compared to a follow-up of under six months (MD, -0.08; 95% CI, -0.11 to -0.05 vs MD, -0.04; 95% CI, -0.06 to -0.02; P = 0.03). No significant change in lumbar spine BMD was detected post-stroke (MD, -0.00; 95% CI, -0.03 to 0.02), nor was significant change observed in the non-paretic distal radius, proximal humerus, tibia, trochanter, and total hip. Stroke was not associated with an increased risk of osteoporosis or osteoporotic fractures (HR, 1.43; 95% CI, 0.95-2.13).
CONCLUSION
Stroke survivors undergo significant BMD loss in paralyzed limbs, most notably in the femoral neck. However, BMD in the lumbar spine does not exhibit a significant decrease post-stroke. The risk of post-stroke osteoporosis or osteoporotic fractures should be interpreted with caution and needs further investigation.
Topics: Humans; Bone Density; Stroke; Osteoporosis; Osteoporotic Fractures; Femur Neck; Female; Male; Aged
PubMed: 38350301
DOI: 10.1016/j.jnha.2024.100189 -
Frontiers in Cellular Neuroscience 2023Limb-girdle muscular dystrophies (LGMD) constitute a heterogeneous group of neuromuscular disorders in which there are alterations in proteins responsible for the... (Review)
Review
Limb-girdle muscular dystrophies (LGMD) constitute a heterogeneous group of neuromuscular disorders in which there are alterations in proteins responsible for the preservation of muscle architecture and function, leading to proximal and progressive muscle weakness. There is, however, significant phenotypic and genotypic variation, as well as difficulty in establishing biomarkers that help to define pathogenic mechanisms and assess disease severity and progression. In this field, there is special attention to microRNAs, small non-coding RNA molecules related to the regulation of gene expression and, consequently, the production of proteins. Thus, this research aimed to verify the correlation between the expression of microRNAs and the severity, progression, and therapeutic response of LGMD animal models. A search was carried out in the PubMed, Embase, Scopus, ScienceDirect, Cochrane, and SciELO databases, with articles in English and without a time limit. The PRISMA 2020 checklist was used, and the protocol of this review was submitted to PROSPERO. The bibliographic survey of the 434 records found that 5 original articles met the inclusion criteria. The studies explored myomicroRNAs or miRNA panels with gene expression analysis. The analysis demonstrates that miR-1, 133a, and 206 are differentially expressed in serum and muscle. They change according to the degree of inflammation, fibrosis, muscle regeneration, and progression of the dystrophic process. MicroRNAs are up-regulated in dystrophic muscles, which are reversed after treatment in a dose-dependent manner. The present study inferred that miRs are essential in severity, progression, and therapeutic response in LGMD models and may be a useful biomarker in clinical research and prognosis. However, the practical application of these findings should be further explored.
PubMed: 38130868
DOI: 10.3389/fncel.2023.1233181 -
Hand (New York, N.Y.) Jan 2024Proximal row carpectomy (PRC) with soft tissue interposition arthroplasty (STIA) presents an alternative approach to addressing wrist arthritis patterns involving the... (Review)
Review
Proximal row carpectomy (PRC) with soft tissue interposition arthroplasty (STIA) presents an alternative approach to addressing wrist arthritis patterns involving the capitate and/or lunate fossa, in lieu of wrist arthrodesis. This systematic review aimed to evaluate clinical outcomes and techniques associated with PRC-STIA in patients with advanced wrist arthritis. We conducted a systematic review using databases including PubMed, Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved articles reporting outcomes of patients who underwent PRC-STIA with at least 1 relevant outcome. The analysis encompassed 8 studies involving 106 patients (108 wrists) meeting the inclusion criteria. A majority of patients were men (69%, n = 88), with a mean age of 54.4 ± 12.7 years and an average follow-up of 4.8 ± 6.3 years. Dorsal capsule was the most commonly interposed tissue (63%, 5 out of 8 studies). Patients receiving STIA achieved comparable patient-reported outcome measures scores to those undergoing PRC alone. Postoperative pain, measured by the Visual Analog Scale, averaged 3.7 ± 0.6. The Disabilities of the Arm, Shoulder, and Hand score averaged 27.8 ± 8, while the Patient-Rated Wrist Evaluation score averaged 41.5 ± 25.9. Five complications were reported in three studies. The addition of STIA into PRC for patients with capitate and/or lunate fossa cartilage degeneration yielded outcomes akin to traditional PRC, improving wrist function, pain, and grip strength in a safe and straightforward manner. Future research should prioritize high-quality comparative studies, extended follow-up periods, and standardized core outcome measures for a more comprehensive understanding of its role in wrist arthritis treatment.
PubMed: 38288722
DOI: 10.1177/15589447231221245 -
Journal of Orthopaedic Surgery and... Apr 2024To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). (Meta-Analysis)
Meta-Analysis
AIM
To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS).
METHODS
PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV).
RESULTS
Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD - 2.72, 95% CI (- 4.69, - 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI-LL (WMD - 9.57, 95% CI (- 17.42, - 1.71), P = 0.02), larger follow-up PI-LL (WMD - 12.62, 95% CI (- 17.62, - 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD - 3.43, 95% CI (- 4.71, - 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (- 0.46, 0.60), P = 0.04), larger preoperative PT (WMD - 3.04, 95% CI (- 5.27, - 0.81), P = 0.008, larger follow-up PT (WMD - 3.69, 95% CI (- 6.66, - 0.72), P = 0.02) were identified as risk factors for PJK.
CONCLUSION
Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.
Topics: Humans; Adolescent; Scoliosis; Lordosis; Retrospective Studies; Kyphosis; Sacrum; Risk Factors; Spinal Fusion; Postoperative Complications; Thoracic Vertebrae
PubMed: 38566085
DOI: 10.1186/s13018-024-04638-7 -
EClinicalMedicine May 2024Gastro-oesophageal reflux disease (GORD) mechanisms are well described, but the aetiology is uncertain. Coeliac disease (CD), a gluten enteropathy with increased...
BACKGROUND
Gastro-oesophageal reflux disease (GORD) mechanisms are well described, but the aetiology is uncertain. Coeliac disease (CD), a gluten enteropathy with increased duodenal eosinophils overlaps with GORD. Functional dyspepsia is a condition where duodenal eosinophilia is featured, and a 6-fold increased risk of incident GORD has been observed. Perturbations of the duodenum can alter proximal gastric and oesophageal motor function. We performed a systematic review and meta-analysis assessing the association between CD and GORD.
METHODS
A systematic search of studies reporting the association of GORD and CD was conducted. CD was defined by combined serological and histological parameters. GORD was defined based on classical symptoms, oesophagitis (endoscopic or histologic) or abnormal 24-h pH monitoring; studies reporting oesophageal motility abnormalities linked with GORD were also included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model.
FINDINGS
31 papers were included. Individuals with CD on a gluten containing diet were 3 times more likely to have GORD than controls (OR: 3.37, 95% CI: 2.09-5.44), and over 10 times more likely when compared to those on a gluten free diet (GFD) (OR: 10.20, 95% CI: 6.49-16.04). Endoscopic oesophagitis was significantly associated with CD (OR: 4.96; 95% CI: 2.22-11.06). One year of a GFD in CD and GORD was more efficacious in preventing GORD symptom relapse than treatment with 8 weeks of PPI in non-CD GORD patients (OR: 0.18, 95% CI: 0.08-0.36). Paediatric CD patients were more likely to develop GORD (OR: 3.29, 95% CI: 1.46-7.43), compared to adult CD patients (OR: 2.55, 95% CI: 1.65-3.93).
INTERPRETATION
CD is strongly associated with GORD but there was high heterogeneity. More convincingly, a GFD substantially improves GORD symptoms, suggesting a role for duodenal inflammation and dietary antigens in the aetiology of a subset with GORD. Ruling out CD in patients with GORD may be beneficial.
FUNDING
The study was supported by an Investigator Grant from the NHMRC to Dr. Talley.
PubMed: 38659976
DOI: 10.1016/j.eclinm.2024.102577 -
Archives of Orthopaedic and Trauma... Oct 2023Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical...
INTRODUCTION
Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur.
MATERIALS AND METHODS
A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants.
RESULTS
For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6-2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either.
CONCLUSIONS
The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.
Topics: Humans; Fracture Fixation, Intramedullary; Bone Nails; Femoral Fractures; Femur; Postoperative Complications; Fracture Healing; Treatment Outcome; Retrospective Studies
PubMed: 37405462
DOI: 10.1007/s00402-023-04950-7 -
Biomedizinische Technik. Biomedical... Dec 2023Proximal humeral shaft fractures can be treated with helically deformed bone plates to reduce the risk of iatrogenic nerve lesion. Controversially to this common... (Review)
Review
Proximal humeral shaft fractures can be treated with helically deformed bone plates to reduce the risk of iatrogenic nerve lesion. Controversially to this common surgical technique that was first established in 1999, no biomechanical investigation on humeral helical plating is recorded by other reviews, which focus on proximal fractures exclusively. Does an additional scope for shaft fractures reveal findings of helical testing? The present systematic literature review was performed based on guidelines by Kitchenham et al. to systematically search and synthesize literature regarding biomechanical testing of osteosynthetic systems for proximal humeral shaft fractures. Therefore, a systematic approach to search and screen literature was defined beforehand and applied on the findings of the database PubMed. Synthesized information of the included literature was categorized, summarized and analyzed via descriptive statistics. Out of 192 findings, 22 publications were included for qualitative synthesis. A wide range of different test methods was identified, leading to a suboptimal comparability of specific results between studies. Overall, 54 biomechanical test scenarios were identified and compared. Physiological based boundary conditions (PB-BC) were referenced in 7 publications only. One study of testing straight and helical dynamic compression plates without PB-BCs was identified, showing significant differences under compressional loading. The absence of test standards of specific fields like humeral fractures lead to a high variance in biomechanical testing of osteosynthetic locking plates for proximal humeral shaft fractures. Physiological approaches offer realistic test scenarios but need to be uniformed for enhanced comparability between studies. The impact of helically deformed locking plates under PB-BC was not identified in literature.
Topics: Humans; Fracture Fixation, Internal; Humeral Fractures; Bone Plates; Databases, Factual; Humerus; Treatment Outcome
PubMed: 37406349
DOI: 10.1515/bmt-2023-0039