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Rheumatology (Oxford, England) May 2023Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility of synovial fluid (SF) and serum tests in differentiating causes of acute hot joints.
METHODS
We performed a systematic literature review of diagnostic testing for acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity, and areas under the curves.
RESULTS
A total of 8443 articles were identified, and 49 were ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leucocyte esterase had the highest pooled sensitivity [0.94 (0.70, 0.99)] with good pooled specificity [0.74 (0.67, 0.81)].
CONCLUSION
Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests with or without a stratification score is required for optimizing rapid assessment of the hot joint.
Topics: Humans; Sensitivity and Specificity; Arthritis, Infectious; Biomarkers; Predictive Value of Tests; Leukocyte Count; Synovial Fluid
PubMed: 36264140
DOI: 10.1093/rheumatology/keac606 -
Evidence-based Complementary and... 2023To systematically evaluate the efficacy and safety of the Shuangdan Mingmu capsule in the treatment of diabetic retinopathy (DR). (Review)
Review
OBJECTIVE
To systematically evaluate the efficacy and safety of the Shuangdan Mingmu capsule in the treatment of diabetic retinopathy (DR).
METHODS
Common Chinese and English databases, including PubMed, Medline, Embase, VIP, Wanfang, and the Chinese National Knowledge Infrastructure (CNKI), were searched from their inception to May 31, 2022. According to the Cochrane Handbook, two reviewers independently evaluated and collected data on the included studies. Meta-analysis was performed by RevMan software 5.4.
RESULTS
Seven trials with a total of 835 patients were included. The clinical effectiveness rate was defined as the primary outcome, and the TCM symptom score, Chinese-Version Low Vision Quality of Life Questionnaire (CLVQOL) scores, macular thickness, hemorrhagic spot area, vascular endothelial growth factor levels, platelet-derived growth factor levels, and the incidence of adverse effects were the secondary outcome. The results of the meta-analysis showed that, compared with conventional medical treatment alone, the Shuangdan Mingmu capsule combined with conventional treatment could significantly improve the clinical effectiveness rate of treating DR (OR = 4.07, 95% CI (2.10, 7.89), < 0.0001), and reduce the incidence of adverse reactions in DR patients (OR = 0.47, 95% CI (0.26, 0.86), =0.01). In addition, other results showed that TCM symptom score(OR = -3.47, 95% CI (-3.84, -3.10), < 0.00001); CLVQOL scores (OR = 23.93, 95% CI (21.37, 26.49), < 0.00001); macular thickness (OR = -47.34, 95% CI (-50.67, 44.00), < 0.00001); hemorrhagic spot area (OR = -0.91, 95% CI (-1.01, -0.81), < 0.00001); vascular endothelial growth factor levels (OR = -45.76, 95% CI (-49.74, 41.79), < 0.00001); platelet-derived growth factor levels (OR = -1.73, 95% CI (-2.15, -1.31), < 0.00001).
CONCLUSION
Compared with conventional treatment alone, the Shuangdan Mingmu capsule combined with conventional treatment is more effective and safer in the treatment of diabetic retinopathy. However, due to the limitations of the included studies, more high-quality studies are still needed to further assess the efficacy and safety of the Shuangdan Mingmu capsule in the treatment of diabetic retinopathy.
PubMed: 36743463
DOI: 10.1155/2023/4655109 -
Clinical Biomechanics (Bristol, Avon) Jan 2023Residual horizontal instability after surgical treatment for acromioclavicular joint injuries is seen as a potential cause of suboptimal clinical outcomes. Biomechanical... (Review)
Review
BACKGROUND
Residual horizontal instability after surgical treatment for acromioclavicular joint injuries is seen as a potential cause of suboptimal clinical outcomes. Biomechanical studies have demonstrated that the acromioclavicular capsule/ligaments are the primary restraints for anteroposterior translation. However, limited studies have addressed the biomechanics of a reconstruction of the acromioclavicular capsule/ligaments. The aim of this systematic review was to evaluate the biomechanical role of acromioclavicular capsule/ligament reconstruction techniques after an acromioclavicular joint injury.
METHODS
A search was carried out on the databases Medline and EMBASE, and was conducted according to the PRISMA guidelines. Biomechanical studies addressing horizontal and vertical displacement or joint stiffness after reconstructing the acromioclavicular capsule/ligament with or without coracoclavicular ligament reconstruction, were included.
FINDINGS
Nineteen studies were included in this review after screening and eligibility assessment. Five of them investigated different sole acromioclavicular capsule/ligament reconstruction techniques. In 10 studies, a sole coracoclavicular ligament reconstruction was compared to a coracoclavicular ligament reconstruction with additional acromioclavicular capsule/ligament reconstruction. The remaining 4 studies compared different acromioclavicular capsule/ligament with coracoclavicular reconstruction techniques with each other.
INTERPRETATION
Several testing protocols to evaluate acromioclavicular capsule/ligament reconstruction have been described and can make it difficult to compare the results of the different studies. Acromioclavicular capsule/ligament reconstruction may provide increased anteroposterior and rotational stability but an optimal reconstruction technique, which mimics all biomechanical characteristics of the native joint is not yet available.
Topics: Humans; Acromioclavicular Joint; Cadaver; Plastic Surgery Procedures; Ligaments, Articular; Biomechanical Phenomena; Joint Dislocations
PubMed: 36521410
DOI: 10.1016/j.clinbiomech.2022.105847 -
Cureus Oct 2023The pathology of the shoulder is among the most widespread medical presentations and may be a result of existing anatomical variations. Therefore, the knowledge of the... (Review)
Review
The pathology of the shoulder is among the most widespread medical presentations and may be a result of existing anatomical variations. Therefore, the knowledge of the variations is vital for physicians and clinicians, tasked with treating patients presenting similar complaints to minimize misdiagnosis and prevent iatrogenic injuries. Therefore, the main objective of the present systematic review the variations in pectoralis minor muscle origin and insertion/attachment point. The study also seeks to better inform physicians and clinicians of the task of treating patients with various pathology problems and to ascertain that, upon identification, the pectoralis minor muscle variants are aptly appreciated. The search method used in this systematic review entails the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and the searching of several online databases, for studies focusing on variations in pectoralis minor muscles. The author reviewer evaluated the studies for eligibility, and the selection criteria for the studies used are described below. This systematic review has disclosed that, in some individuals, the pectoralis minor muscles have their origins in the second, third, and fourth ribs, even as others have their origin in the third and fourth ribs. Still, the systematic review has disclosed that, in certain individuals, the insertion of the pectoralis minor muscle occurs at the supraspinatus tendon, even as there are anomalies in the pectoralis minor insertion points linked to subacromial impingement, possible compression of the brachial plexus anteromedial and the axillary artery, and the subcoracoid impingement.
PubMed: 37916251
DOI: 10.7759/cureus.46329 -
EFORT Open Reviews Oct 2019Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and... (Review)
Review
Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals.Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. A high prevalence is present in Asian, Caucasian, Mediterranean and American populations, with females being more frequently affected. We evaluated a variety of genetic studies indexed in the PubMed database.Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. Moreover, genetic association has also been reported between hip dysplasia and other comorbidities. Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation.The purpose of this review is to present current literature evidence regarding genes responsible for DDH development. Cite this article: 2019;4:595-601. DOI: 10.1302/2058-5241.4.190006.
PubMed: 31754465
DOI: 10.1302/2058-5241.4.190006 -
The Journal of Arthroplasty Dec 2023Different synovial fluid biomarkers have emerged to improve periprosthetic joint infection (PJI) diagnosis. The goals of this paper were (i) to assess their diagnostic... (Meta-Analysis)
Meta-Analysis
Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection-A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions.
BACKGROUND
Different synovial fluid biomarkers have emerged to improve periprosthetic joint infection (PJI) diagnosis. The goals of this paper were (i) to assess their diagnostic accuracy and (ii) to evaluate their performance according to different PJI definitions.
METHODS
A systematic review and meta-analysis was performed using studies that reported diagnostic accuracy of synovial fluid biomarkers using validated PJI definitions published from 2010 to March 2022. A database search was performed through PubMed, Ovid MEDLINE, Central, and Embase. The search identified 43 different biomarkers with four being the more commonly studied, with 75 papers overall: alpha-defensin; leukocyte esterase; synovial fluid C-reactive protein; and calprotectin.
RESULTS
Overall accuracy was higher for calprotectin, followed by alpha-defensin, leukocyte esterase, and synovial fluid C-reactive protein with sensitivities of 78 to 92% and specificities of 90 to 95%. Their diagnostic performance was different according to which definition was adopted as the reference. Specificity was consistently high across definitions for all four biomarkers. Sensitivity varied the most with lower values for the more sensitive European Bone and Joint Infection Society or Infectious Diseases Society of America definitions with higher values for the Musculoskeletal Infection Society definition. The International Consensus Meeting 2018 definition showed intermediate values.
CONCLUSION
All evaluated biomarkers had good specificity and sensitivity, making their use acceptable in the diagnosis of PJI. Biomarkers perform differently according to the selected PJI definitions.
Topics: Humans; C-Reactive Protein; Sensitivity and Specificity; Synovial Fluid; alpha-Defensins; Prosthesis-Related Infections; Biomarkers; Arthritis, Infectious; Leukocyte L1 Antigen Complex
PubMed: 37321521
DOI: 10.1016/j.arth.2023.06.017 -
BMC Musculoskeletal Disorders May 2022Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is...
BACKGROUND
Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into question recently. The purpose of this study was to conduct a systematic review investigating the value of joint aspiration and serum markers in the diagnosis of native shoulder joint sepsis.
METHODS
PubMed/MEDLINE, Scopus, and the Cochrane Library were used in the systematic literature search from January 1, 1960, through January 23, 2021. The primary outcome was to report on the synovial white cell count of patients with native shoulder sepsis. Descriptive statistics using percentages, means, and intraclass correlation coefficient (ICC) values were used to summarize the results.
RESULTS
Thirty-one studies, including 25 case series, one case-control, and five cohort studies with a total of 7434 native shoulder joints, were included. There was no standardized approach to diagnosing septic arthritis of the shoulder. Only 10 studies (32%) reported on synovial white cell count with the majority yielding aspiration counts greater than 50,000 cells/mm, although one study was as low as 30,000 cells/mm.
CONCLUSIONS
The diagnosis of native shoulder joint sepsis lacks uniformity. Methods used to evaluate shoulder sepsis are heterogeneous and may lead to delays or misdiagnosis with devastating sequelae. Synovial white cell count is underutilized and may also present with a lower value than expected, which is likely related to the time interval between symptom onset and diagnosis.
Topics: Arthritis, Infectious; Biomarkers; Humans; Retrospective Studies; Sepsis; Shoulder; Shoulder Joint; Synovial Fluid
PubMed: 35590311
DOI: 10.1186/s12891-022-05385-8 -
Arthritis Research & Therapy Apr 2021Osteoarthritis (OA) has long been regarded as a disease of cartilage degeneration, whereas mounting evidence implies that low-grade inflammation contributes to OA. Among... (Review)
Review
OBJECTIVE
Osteoarthritis (OA) has long been regarded as a disease of cartilage degeneration, whereas mounting evidence implies that low-grade inflammation contributes to OA. Among inflammatory cells involved, macrophages play a crucial role and are mediated by the local microenvironment to exhibit different phenotypes and polarization states. Therefore, we conducted a systematic review to uncover the phenotypic alterations of macrophages during OA and summarized the potential therapeutic interventions via modulating macrophages.
METHODS
A systematic review of multiple databases (PubMed, Web of Science, ScienceDirect, Medline) was performed up to February 29, 2020. Included articles were discussed and evaluated by two independent reviewers. Relevant information was analyzed with a standardized and well-designed template.
RESULTS
A total of 28 studies were included. Results were subcategorized into two sections depending on sources from human tissue/cell-based studies (12 studies) and animal experiments (16 studies). The overall observation indicated that M1 macrophages elevated in both synovium and circulation during OA development, along with lower numbers of M2 macrophages. The detailed alterations of macrophages in both synovium and circulation were listed and analyzed. Furthermore, interventions against OA via regulating macrophages in animal models were highlighted.
CONCLUSION
This study emphasized the importance of the phenotypic alterations of macrophages in OA development. The classical phenotypic subcategory of M1 and M2 macrophages was questionable due to controversial and conflicting results. Therefore, further efforts are needed to categorize macrophages in an exhaustive manner and to use advanced technologies to identify the individual roles of each subtype of macrophages in OA.
Topics: Animals; Humans; Inflammation; Macrophages; Osteoarthritis; Phenotype; Synovial Membrane
PubMed: 33838669
DOI: 10.1186/s13075-021-02457-3 -
International Journal of Molecular... Jun 2022Extensive angiogenesis is a characteristic feature in the synovial tissue of rheumatoid arthritis (RA) from a very early stage of the disease onward and constitutes a... (Review)
Review
Extensive angiogenesis is a characteristic feature in the synovial tissue of rheumatoid arthritis (RA) from a very early stage of the disease onward and constitutes a crucial event for the development of the proliferative synovium. This process is markedly intensified in patients with prolonged disease duration, high disease activity, disease severity, and significant inflammatory cell infiltration. Angiogenesis is therefore an interesting target for the development of new therapeutic approaches as well as disease monitoring strategies in RA. To this end, nuclear imaging modalities represent valuable non-invasive tools that can selectively target molecular markers of angiogenesis and accurately and quantitatively track molecular changes in multiple joints simultaneously. This systematic review summarizes the imaging markers used for single photon emission computed tomography (SPECT) and/or positron emission tomography (PET) approaches, targeting pathways and mediators involved in synovial neo-angiogenesis in RA.
Topics: Arthritis, Rheumatoid; Biomarkers; Humans; Molecular Imaging; Neovascularization, Pathologic; Positron-Emission Tomography; Synovial Membrane
PubMed: 35806074
DOI: 10.3390/ijms23137071 -
Frontiers in Cellular and Infection... 2022A prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasties with poor prognosis. Identifying an accurate and prompt diagnostic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasties with poor prognosis. Identifying an accurate and prompt diagnostic method is particularly important for PJI. Recently, the diagnostic value of metagenomic next-generation sequencing (mNGS) in detecting PJI has attracted much attention, while the evidence of its accuracy is quite limited. Thus, this study aimed to evaluate the accuracy of mNGS for the diagnosis of PJI.
METHODS
We summarized published studies to identify the potential diagnostic value of mNGS for PJI patients by searching online databases using keywords such as "prosthetic joint infection", "PJI", and "metagenomic sequencing". Ten of 380 studies with 955 patients in total were included. The included studies provided sufficient data for the completion of 2-by-2 tables. We calculated the sensitivity, specificity, and area under the SROC curve (AUC) to evaluate mNGS for PJI diagnosis.
RESULTS
We found that the pooled diagnostic sensitivity and specificity of mNGS for PJI were 0.93 (95% CI, 0.83 to 0.97) and 0.95 (95% CI, 0.92 to 0.97), respectively. Positive and negative likelihood ratios were 18.3 (95% CI, 10.9 to 30.6) and 0.07 (95% CI, 0.03 to 0.18), respectively. The area under the curve was 0.96 (95% CI, 0.93 to 0.97).
CONCLUSION
Metagenomic next-generation sequencing displays high accuracy in the diagnosis of PJI, especially for culture-negative cases.
Topics: Arthritis, Infectious; High-Throughput Nucleotide Sequencing; Humans; Metagenomics; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid
PubMed: 35755833
DOI: 10.3389/fcimb.2022.875822