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Asia-Pacific Journal of Ophthalmology... 2020The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral...
PURPOSE
The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty.
DESIGN
Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years.
METHODS
A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018).
RESULTS
After screening 1456 abstracts from search results, 1377 were eliminated due to irrelevant content. Full text of the remaining 79 articles and relevant cross-references were reviewed and summarized. Studies on cosmetic epicanthoplasty reported Z-plasty or modifications (n=8), advancement flap (n=4) or skin redraping procedures (n=1), removal or release of the orbicularis muscle (n = 14), with (n = 6) or without (n = 11) tightening medial canthal tendon. In lateral canthoplasty, approaches to preserve continuity of eyelid margin prevent lateral canthal deformity with inconspicuous incision via gray line (n = 2) or upper eyelid (n = 2) were described. Techniques of upper blepharoplasties described included open incision method (n = 9) with (n = 5) or without (n = 3) orbicularis resection, subbrow approach (n = 1), nonincisional suture blepharoplasty (n = 2), or partial incision blepharoplasty (n = 1). For lower blepharoplasties, techniques described included blepharoplasty with fat transposition (n = 7), transconjunctival blepharoplasty (n = 3), transcutaneous blepharoplasty and canthopexy (n = 1) or orbicularis flap (n = 2), minimally invasive or laser-assisted blepharoplasty (n = 2).
CONCLUSIONS
The recent trend of periocular surgical rejuvenation focuses on preserving soft tissue volume, avoiding skin or use hidden incision, taking the eyebrow and midface position into account, and measures to minimize iatrogenic eyelid malposition.
Topics: Blepharoplasty; Eyelids; Humans; Surgical Flaps
PubMed: 32804712
DOI: 10.1097/APO.0000000000000311 -
PeerJ 2020The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels....
BACKGROUND
The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes.
METHODS
We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison.
RESULTS
In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4-10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8-6.8]; for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, for heterogeneity = 0.023) than was TAx TAVR.
CONCLUSIONS
DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
PubMed: 32435538
DOI: 10.7717/peerj.9102 -
European Journal of Orthopaedic Surgery... Oct 2023The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify areas for improvement in surgical technique and patient selection.
METHODS
PubMed/Medline, Web of Science, Embase, Ovid, Cochrane library, and Google Scholar were systematically searched for original human studies reporting on complications of conventional percutaneous sacroiliac fixation in traumatic pelvic ring injuries from January 1, 2000, to April 30, 2022. The main meta-analysis was based on the random effect model to pool all complications reported in the included studies. The results were reported as weighted proportions with 95% confidence intervals. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
A total of 56 studies with 3644 screws (2871 procedures) met the inclusion criteria, with a mean age of 40.5 years. The most frequently reported complications were screw malposition with a weighted proportion of 6% (95% CI: 5-9%) and involved 189 out of 3644 screws, persistent pain following the procedure with a weighted proportion of 3% (95% CI: 2-4%) and affected 98 out of 2871 patients, and nerve injury, which had a weighted proportion of 2% (95% CI: 1-3%) and was observed in 41 out of 2871 procedures. The L5 and S1 nerve roots were more frequently affected. Revision surgery was required for 184 out of 2871 patients with a weighted proportion of 5% (95% CI: 3-7%). The primary reason for the revision was persistent pain after the initial procedure, which affected 74 out of 184 patients, with a weighted proportion of 2.0% (95% CI: 1.2-2.8%).
CONCLUSIONS
This study showed that screw malposition, the need for revision surgery, persistent pain, and nerve injuries were the most frequent complications following conventional percutaneous sacroiliac screw fixation. However, these results must be interpreted in context due to confounding factors, including the lack of high-quality studies and the absence of uniformity in defining some complications across studies.
Topics: Humans; Adult; Pelvic Bones; Fracture Fixation, Internal; Sacrum; Fractures, Bone; Bone Screws; Pain; Retrospective Studies
PubMed: 37031332
DOI: 10.1007/s00590-023-03543-9 -
Plastic and Reconstructive Surgery Jun 2024Breast augmentation is the most commonly performed procedure for gender affirmation in transfeminine individuals. Although adverse events among breast augmentation in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast augmentation is the most commonly performed procedure for gender affirmation in transfeminine individuals. Although adverse events among breast augmentation in cisgender women are well described, their relative incidence in transfeminine patients is less elucidated. This study aims to compare complication rates after breast augmentation between cisgender women and transfeminine patients and to evaluate the safety and efficacy of breast augmentation in transfeminine individuals.
METHODS
PubMed, the Cochrane Library, and other resources were queried for studies published up to January of 2022. A total of 1864 transfeminine patients from 14 studies were included in this project. Primary outcomes including complications (capsular contracture, hematoma or seroma, infection, implant asymmetry/malposition, hemorrhage, skin or systemic complications), patient satisfaction, and reoperation rates were pooled. A direct comparison of these rates was performed against historical rates in cisgender women.
RESULTS
Within the transfeminine group, the pooled rate of capsular contracture was 3.62% (95% CI, 0.0038 to 0.0908); the hematoma/seroma rate was 0.63% (95% CI, 0.0014 to 0.0134); the infection incidence was 0.08% (95% CI, 0.0000 to 0.0054); and implant asymmetry rate was 3.89% (95% CI, 0.0149 to 0.0714). There was no statistical difference between rates of capsular contracture ( P = 0.41) and infection ( P = 0.71) between the transfeminine versus cisgender groups, whereas there were higher rates of hematoma/seroma ( P = 0.0095) and implant asymmetry/malposition ( P < 0.00001) in the transfeminine group.
CONCLUSION
Breast augmentation is an important procedure for gender affirmation and, in transfeminine individuals, carries relatively higher rates of postoperative hematoma and implant malposition relative to cisgender women.
Topics: Humans; Female; Postoperative Complications; Breast Implantation; Male; Breast Implants; Mammaplasty; Transgender Persons; Incidence; Reoperation; Hematoma; Patient Satisfaction; Sex Reassignment Surgery
PubMed: 37189242
DOI: 10.1097/PRS.0000000000010691 -
European Spine Journal : Official... Oct 2022To determine whether the open or the minimally invasive transforaminal lumbar interbody fusion (O-TLIF, MI-TLIF) is the favored treatment, we provide first meta-analyses... (Meta-Analysis)
Meta-Analysis
One-level open vs. minimally invasive transforaminal lumbar interbody fusion: a systematic review and advanced meta-analytic assessment of prospective studies with at least two years follow-up.
PURPOSE
To determine whether the open or the minimally invasive transforaminal lumbar interbody fusion (O-TLIF, MI-TLIF) is the favored treatment, we provide first meta-analyses using prospective studies with at least two years follow-up only and present the clinical relevance of statistical results for the first time.
METHODS
After a systematic review of six databases, we conducted 10 meta-analyses of randomized controlled trials (RCTs) and 10 meta-analyses of eligible prospective studies (EPSs) to compare fusion rate, patient-reported outcome measures (back pain (B-VAS), leg pain, Oswestry Disability Index (ODI)), for the first time safety outcome measures as operative and postoperative complications per case, and the perioperative outcome measures estimated blood loss (EBL), operation time and length of hospital stay (LOS). The clinical relevance was assessed by overall effect sizes (OESs) of statistically significant meta-analytic results.
RESULTS
In our meta-analyses of RCTs, MI-TLIF is statistically significantly superior in ODI, EBL and LOS, with clinically meaningful OESs only in EBL and LOS. In meta-analyses of EPSs, MI-TLIF is statistically significantly superior in B-VAS, postoperative complications per case, EBL and LOS, all with clinically meaningful OESs except for B-VAS. The meta-analyses of remaining outcome measures present statistically nonsignificant results. In a descriptive analysis of complications, postoperative wound infections predominate in O-TLIF and hardware malposition in MI-TLIF.
CONCLUSION
After at least two years, O-TLIF and MI-TLIF can be considered equally efficacious, which simplifies surgeons' decision between both treatments, however, with the safety outcome measure postoperative complications per case and the perioperative outcome measures EBL and LOS in favor of MI-TLIF. LEVEL OF EVIDENCE I: Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias.
Topics: Back Pain; Follow-Up Studies; Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Prospective Studies; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35699832
DOI: 10.1007/s00586-022-07223-w -
Arthroscopy : the Journal of... Apr 2024To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of... (Review)
Review
Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review.
PURPOSE
To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up.
METHODS
A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I.
RESULTS
Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%).
CONCLUSION
Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III-IV studies.
Topics: Humans; Shoulder Joint; Osteolysis; Joint Instability; Shoulder; Shoulder Dislocation; Osteoarthritis; Fractures, Bone; Coracoid Process
PubMed: 37827435
DOI: 10.1016/j.arthro.2023.09.032 -
American Journal of Critical Care : An... Nov 2019To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes.
OBJECTIVE
To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes.
METHODS
PubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, "Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?" Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence. Data were abstracted, cross-checked for accuracy, and synthesized.
RESULTS
Of the 160 studies identified, 13 met inclusion criteria, including 6 clinical studies (104 patients), 6 case reports (13 patients), and 1 nationwide clinician survey. The primary indications for a tracheostomy were chronic ventilator dependence (83%) and airway protection (17%). Indications for fenestrated tracheostomy included inaudible phonation and poor voice intelligibility. Patients with fenestrated tubes achieved robust voice outcomes. Complications included granulation tissue (6 patients [5%]), malpositioning (1 patient [0.9%]), decreased oxygen saturation (3 patients [2.6%]), increased blood pressure (1 patient [0.9%]), increased peak pressures (2 patients [1.7%]), and air leakage (1 patient [0.9%]); subcutaneous emphysema also occurred frequently. Patient-reported symptoms included shortness of breath (4 patients [3.4%]), anxiety (3 patients [2.6%]), and chest discomfort (1 patient [0.9%]).
CONCLUSIONS
Fenestrated devices afford benefits for speech and decannulation but carry risks of granulation, aberrant airflow, and acclimation challenges. Findings highlight the need for continued innovation, education, and quality improvement around the use of fenestrated devices.
Topics: Adult; Aged; Aged, 80 and over; Airway Extubation; Critical Care Nursing; Female; Humans; Male; Middle Aged; Patient Safety; Phonation; Practice Guidelines as Topic; Respiration, Artificial; Tracheostomy
PubMed: 31676519
DOI: 10.4037/ajcc2019892 -
Midwifery Aug 2021Foetal occipto-posterior position during labour can contribute to negative outcomes. Encouraging women to adopt positions utilising thigh flexion with the aim of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Foetal occipto-posterior position during labour can contribute to negative outcomes. Encouraging women to adopt positions utilising thigh flexion with the aim of increasing pelvic diameters and promoting foetal rotation to the occpito-anterior position are often used. However, the efficacy of these strategies has not yet been determined.
OBJECTIVE
To compare the effects of maternal hands and knees or lateral positions with flexed thighs versus control in rotating foetal occipito-posterior to occipito-anterior in the first stage of labour.
METHODS
The databases such as MEDLINE/PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase were searched with dates ranging from 1947 to 2019. We included randomised controlled trials (RCTs) that compared maternal hands and knees, and lateral positions incorporating flexed thighs (spine-femur angle of ≥ 90°) versus control to rotate foetal malposition in the first stage of labour and published in English. Methodological quality was assessed based on Cochrane's Risk of Bias 2 for randomized controlled trials. Two teams of researchers completed the study selection, quality assessment, data extraction and meta-analysis.
RESULTS
Seven RCTs met our inclusion criteria (n = 1422). Whilst there was an increase in the rate of spontaneous foetal rotation from the occipito-posterior to the anterior position, particularly in the first hour after the intervention was adopted, this did not reach statistical significance (RR, 1.15; 95% CI, 0.96-1.39, p = 0.13). The effect was insufficient to influence rates of spontaneous vaginal birth (RR, 1.04; 95% CI, 0.85-1.26, p = 0.72) whilst there was a reduction in the duration of first stage labour (Mean-difference, -27.34; 95% CI, -45.96, -8.72, p = 0.004).
CONCLUSION
This systematic review reports no significant correlation between maternal positioning with flexed thighs and foetal rotation from occipito-posterior to occipito-anterior position during first stage labour. The specific maternal positions tested did not impact on the majority of other labour and birth outcomes. Given that the majority of fetuses will rotate spontaneously to an occipito-anterior position it may be that maternal posturing facilitates earlier rotation in this group but has no effect on the subset of infants that would otherwise persist in the occipito-posterior position to birth.
Topics: Delivery, Obstetric; Female; Fetus; Humans; Labor, Obstetric; Pregnancy; Prenatal Care; Thigh
PubMed: 33895659
DOI: 10.1016/j.midw.2021.103008 -
Ophthalmic Plastic and Reconstructive...To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special... (Meta-Analysis)
Meta-Analysis
PURPOSE
To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety.
METHODS
A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates.
RESULTS
Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95% CI, 1.33-1.77; p < 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p < 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups.
CONCLUSIONS
The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors' additional analyses provide a relative comparison of the impact of various treatment parameters on safety.
Topics: Humans; Botulinum Toxins, Type A; Face; Injections; Rejuvenation; Randomized Controlled Trials as Topic
PubMed: 35353777
DOI: 10.1097/IOP.0000000000002169 -
Journal of Neurosurgery. Pediatrics Jan 2024The goal of this systematic review and meta-analysis was to provide an updated analysis of studies investigating outcomes, morbidity, and mortality associated with... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The goal of this systematic review and meta-analysis was to provide an updated analysis of studies investigating outcomes, morbidity, and mortality associated with MR-guided laser interstitial thermal therapy (MRgLITT) corpus callosum ablation (CCA).
METHODS
Study inclusion criteria for screening required that studies report on human subjects only, including patients aged 1-52 years diagnosed with drug-resistant epilepsy who underwent CCA. Sixteen articles published between 2016 and 2023 were included for the systematic review and analysis, including 4 case reports, 11 case series, and 1 case-control study. Altogether, 85 pediatric and adult patients undergoing CCA were included in the systematic review (46 patients younger and 39 patients older than 21 years). The main outcome of seizure freedom was measured using the decrease in the frequency of atonic seizures following surgery, percentage of atonic seizure freedom following surgery, and percentage of overall seizure freedom following surgery. These measurements were made using data from the last follow-up for patients with at least 6 months of follow-up post-CCA.
RESULTS
The extent of CCA differed across the pooled cohorts, including anterior two-thirds CCA (38.89%, n = 35) and posterior one-third CCA for completion of a prior partial CCA (22.22%, n = 20), complete CCA (27.78%, n = 25), or CCA of residual white matter in the case of subtotal initial ablation (5.56%, n = 5). Overall, 12.94% of the patients undergoing CCA experienced operational complications. The most common operative complications across 90 CCA operations were probe malpositioning (n = 6), hemorrhage (n = 5), off-target extension of splenium ablation to the thalamus (n = 1), infection (n = 1), and postoperative CSF leak (n = 1). Neurological deficits following CCA were reported as transient in 18.82% and permanent in 4.71% of patients across all studies. The most common neurological deficits were disconnection syndrome (n = 4) or transient hemiplegia (supplementary motor area-like syndrome; n = 4). The 6-month overall seizure freedom rate was 18.87% of 53 patients, and the atonic seizure freedom rate was 46.28% of 52 patients postoperatively. CCA resulted in an average decrease in atonic seizure rate from 8.30 to 1.65 atonic seizures per day (average decrease 80.12%).
CONCLUSIONS
CCA is associated with an acceptable complication profile, and most patients experience a meaningful reduction in target seizure semiologies. Accurate MRgLITT probe placement is likely important for maximizing CCA while avoiding collateral damage. Avoidable complications of CCA include off-target ablation (and associated deficits), hemorrhage, and future surgery for residual CCA to palliate continued seizures.
Topics: Adult; Child; Humans; Case-Control Studies; Corpus Callosum; Drug Resistant Epilepsy; Epilepsy, Generalized; Hemorrhage; Laser Therapy; Lasers; Magnetic Resonance Imaging; Retrospective Studies; Treatment Outcome
PubMed: 37856385
DOI: 10.3171/2023.9.PEDS23326