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Orthopaedic Journal of Sports Medicine Aug 2019Orthopaedic injuries of National Football League (NFL) players can have a deleterious effect on their health, with minimal to no high-level evidence on the management of... (Review)
Review
BACKGROUND
Orthopaedic injuries of National Football League (NFL) players can have a deleterious effect on their health, with minimal to no high-level evidence on the management of these injuries.
PURPOSE
To summarize all data published between January 1980 and March 2018 on orthopaedic injuries experienced by NFL candidates and professional players in the NFL.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A literature search of studies examining orthopaedic injuries in the NFL was performed through the PubMed, Embase, and CINAHL databases. The review included studies of orthopaedic injuries in college football recruits attending the NFL Combine as well as professional NFL players. Excluded were studies of nonorthopaedic injuries, such as concussions, traumatic brain injury, facial injuries, and vascular injuries, as well as case reports.
RESULTS
A total of 147 articles met the inclusion criteria and were divided into 11 topics based on anatomic site: general (16%), spine (13%), shoulder (13%), elbow (3%), hand and wrist (3%), trunk (0.7%), hip and pelvis (7%), thigh (3%), knee (24%), ankle (5%), and foot (12%). Of these studies, 74% were of level 4 evidence. Most studies obtained data from the NFL Combine database (26%), by searching the internet (24%), and via the NFL Injury Surveillance System (22%). Studies using internet search methods to identify injuries consistently found fewer participants than studies using the NFL Injury Surveillance System.
CONCLUSION
This systematic review provides National Collegiate Athletic Association and NFL team physicians with a single source of the most current literature regarding orthopaedic injuries in NFL players. Most research was published on knee, spine, shoulder, and foot injuries and consisted of level 4 evidence. A substantial portion of the published literature was based on data obtained from internet searches and may not accurately represent the NFL population.
PubMed: 31457068
DOI: 10.1177/2325967119864356 -
Journal of Endourology Apr 2022To perform a systematic review (SR) and meta-analysis (MA) of outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction (UPJ) obstruction in... (Meta-Analysis)
Meta-Analysis
To perform a systematic review (SR) and meta-analysis (MA) of outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction (UPJ) obstruction in children. A SR of the English-language literature on surgical techniques and perioperative outcomes of RALP for UPJ obstruction in children was performed without time filters using the MEDLINE (through PubMed), EMBASE, and Cochrane databases in July 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement recommendations. Overall, 58 studies were selected for qualitative analysis, 46 of which were included in the MA. Nearly all studies included were observational and retrospective, either cohort or case-control. The quality of evidence was assessed using Modified Newcastle-Ottawa Scoring, with the majority of studies scoring medium or high quality. The mean success rate was 95.4% (confidence interval 91.0%-99.3%), over a wide age range. There was a noticeable heterogeneity in reported follow-up length and definitions of success rate. The majority of studies reported length of stay of ∼1 day. The mean overall complication rate was 12%. For studies that reported complication rate by grade, the mean low Clavien grade (Grade 2 or less) complication rate was 9.3% and the mean high Clavien grade (Grade 3 or more) complication rate was 6.5%. Robot-assisted surgery is technically feasible and has been shown to achieve very favorable outcomes for pyeloplasty in children. The evidence, however, is mostly retrospective and from single sites, which introduces potential biases. Further research is needed to further elucidate RALP benefits compared with the open and laparoscopic approach. As a randomized control trial may not be practical in this space, perhaps a prospective multi-institutional design with a uniform reporting system of pediatric RALP is the next step to define its benefits and limits.
Topics: Child; Female; Humans; Kidney Pelvis; Laparoscopy; Male; Prospective Studies; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome; Ureteral Obstruction; Urologic Surgical Procedures
PubMed: 34806401
DOI: 10.1089/end.2021.0363 -
International Braz J Urol : Official... 2023Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). We performed this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). We performed this meta-analysis to investigate whether PFME during the entire perioperative period, including before and after RP, can significantly improve the recovery of postoperative UI.
METHODS
We systematically reviewed randomized controlled trials (RCT) from PubMed, Medline, web of science, Cochrane library, and clinicalitrials.com prior to October 2022. Efficacy data were pooled and analyzed using Review Manager Version 5.3. Pooled analyses of urinary incontinence rates 1, 3, 6, and 12 months postoperatively were conducted, using odds ratio (OR) and 95% confidence intervals (CIs).
RESULTS
We included a total of 15 RCT studies involving 2178 patients received RP. Postoperative UI could be improved after 1 month, 3 months and 6 months, and the OR were 0.26 (95%CI:0.15-0.46) 0.30 (95%CI: 0.11-0.80) 0.20 (95%CI: 0.07- 0.56) in postoperative PFME group compared to no PFME group. However, there was no significant difference between the two groups in 12 months after surgery, and the OR was 0.85(95%CI: 0.48,1.51). There were similar results in perioperative PFME group compared to no PFME group with the OR of 0.35 (95%CI: 0.12, 0.98) and 0.40 (95%CI: 0.21, 0.75) in 1 and 3 months after surgery. Our results indicated no significant difference between perioperative PFME group and postoperative PFME group. The OR was 0.58 (95%CI: 0.20-1.71) 0.58 (95%CI:0.20-0.71) and 0.66 (95%CI: 0.32-1.38) in 1, 3 and 6 months after surgery.
CONCLUSION
Application of PFME after RP significantly reduced the incidence of early postoperative UI, and additional preoperative PFME had no significant improvement on the recovery of UI.
Topics: Humans; Male; Exercise Therapy; Pelvic Floor; Prostate; Prostatectomy; Treatment Outcome; Urinary Incontinence
PubMed: 37267610
DOI: 10.1590/S1677-5538.IBJU.2023.0053 -
International Journal of Clinical... Aug 2022Sentinel node navigation surgery (SNNS) is used in clinical practice for the treatment of cervical cancer. This study aimed to elucidate the appropriate sentinel lymph... (Meta-Analysis)
Meta-Analysis Review
Sentinel node navigation surgery (SNNS) is used in clinical practice for the treatment of cervical cancer. This study aimed to elucidate the appropriate sentinel lymph node (SLN) mapping method and assess the safety and benefits of SNNS. We searched the PubMed, Ichushi, and Cochrane Library databases for randomized controlled trials (RCT) and studies on SLN in cervical cancer from January 2012 to December 2020. Two authors independently assessed study quality and extracted data. We quantitatively analyzed the detection rate, sensitivity/specificity, and complications and reviewed information, including the survival data of SLN biopsy (SLNB) without pelvic lymphadenectomy (PLND). The detection rate of SLN mapping in the unilateral pelvis was median 95.7% and 100% and in the bilateral pelvis was median 80.4% and 90% for technetium-99 m (Tc) with/without blue dye (Tc w/wo BD) and indocyanine green (ICG) alone, respectively. The sensitivity and specificity of each tracer were high; the area under the curve of each tracer was 0.988 (Tc w/wo BD), 0.931 (BD w/wo Tc), 0.966 (ICG), and 0.977 (carbon nanoparticle). Morbidities including lymphedema, neurological symptoms and blood loss were associated with PLND. One RCT and five studies all showed SNNS without systematic PLND does not impair recurrence or survival in early-stage cervical cancer with a tumor size ≤ 2-4 cm. Both Tc w/wo BD and ICG are appropriate SLN tracers. SNNS can reduce the morbidities associated with PLND without affecting disease progression in early-stage cervical cancer.
Topics: Coloring Agents; Female; Humans; Indocyanine Green; Retrospective Studies; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Uterine Cervical Neoplasms
PubMed: 35612720
DOI: 10.1007/s10147-022-02178-w -
Sexual Medicine Apr 2023Endometriosis can lead to a state of chronic inflammation marked by the presence of scarring and adhesions within the pelvis and/or other parts of the body. Recent... (Review)
Review
INTRODUCTION
Endometriosis can lead to a state of chronic inflammation marked by the presence of scarring and adhesions within the pelvis and/or other parts of the body. Recent estimates suggest that globally this condition affects approximately 10% of women in the reproductive age group.
AIMS
In this study we sought updated evidence on the association between endometriosis and sexual function in female patients.
METHODS
We used standard assessment tools to conduct a systematic search of the PubMed, EMBASE, and Scopus databases for observational studies that documented the association of endometriosis with female sexual function. A random-effects model was used for the analysis, and effect sizes were reported as the weighted mean difference (WMD) or OR with 95% CIs.
RESULTS
A total of 13 studies were selected for inclusion in our investigation. All of the included studies were cross-sectional in design. The data on sexual function in most of the studies were collected by using the Female Sexual Function Index (FSFI) tool, for which higher scores suggest better sexual function. The risk of sexual dysfunction (based on specific cutoffs for the FSFI score) was higher in women with than in women without endometriosis (OR 1.71; 95% CI, 1.21-2.43). In addition, when we used continuous scores to examine the risk of sexual dysfunction, diagnosis of endometriosis was associated with significantly lower overall FSFI scores (WMD, -3.40; 95% CI, -5.13 to -1.66) and lower scores on all of its 6 domains, ie, desire (WMD, -0.27; 95% CI, -0.53 to -0.02), arousal (WMD, -0.43; 95% CI, -0.79 to -0.07), lubrication (WMD, -0.49; 95% CI, -0.66 to -0.31), orgasm (WMD, -0.65; 95% CI, -1.07 to -0.23), satisfaction (WMD, -0.52; 95% CI, -0.77 to -0.26), and pain (WMD, -1.06; 95% CI, -1.57 to -0.55).
CONCLUSION
The findings of this study suggest that female patients with endometriosis have suboptimal sexual function compared with healthy female subjects. Patients with endometriosis should be offered sexual counseling and supportive care by a multidisciplinary team of gynecologists, psychologists, and sexual therapists.
PubMed: 37256217
DOI: 10.1093/sexmed/qfad026 -
Journal of Orthopaedics and... Oct 2021Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the...
INTRODUCTION
Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery.
METHODS
Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement.
RESULTS
The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review.
CONCLUSIONS
The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage.
LEVEL OF EVIDENCE
Level 2.
Topics: Humans; Monitoring, Intraoperative; Neurosurgical Procedures; Orthopedics; Pelvis; Retrospective Studies
PubMed: 34647237
DOI: 10.1186/s10195-021-00605-8 -
Medicine Mar 2024Endometriosis (EMT) a common gynecological condition in women, an inflammatory disease characterized by the presence of endometrial tissue on organs and tissues in the...
BACKGROUND
Endometriosis (EMT) a common gynecological condition in women, an inflammatory disease characterized by the presence of endometrial tissue on organs and tissues in the pelvis, and is mainly associated with chronic pelvic pain and infertility. As the etiology has not been fully elucidated, current treatment is limited to surgery, hormones and painkillers, with more side effects and difficulty in achieving long-term relief. Oxidative stress manifests itself as an overproduction of reactive oxygen species, which has an integral impact in the pathology of female reproductive disorders. In this review, we evaluate the mechanisms of iron overload-induced oxidative stress and ferroptosis in EMT and their pathophysiological implications.
METHODS
Because the etiology has not been fully elucidated, current treatments are limited to surgery, hormones, and painkillers, which have many side effects and are difficult to achieve long-term relief.
RESULTS
We interpreted that antioxidants as well as ferroptosis inducers show promising results in the treatment of EMT, but their application in this population needs to be further investigated.
CONCLUSION
In combination with the interpretation of previous studies, it was shown that iron overload is present in the peritoneal fluid, endometriotic lesions, peritoneum and macrophages in the abdominal cavity. However, the programmed cellular ferroptosis associated with iron overload is resisted by endometriotic foci, which is critical to the pathophysiology of EMT with local iron overload and inflammation.
Topics: Female; Humans; Endometriosis; Ferroptosis; Oxidative Stress; Iron Overload; Hormones
PubMed: 38489713
DOI: 10.1097/MD.0000000000037421 -
Actas Urologicas Espanolas May 2024Stress urinary incontinence (SUI) is a common disorder in women that has a negative impact on quality of life. Pregnancy and childbirth are considered important risk... (Review)
Review
INTRODUCTION
Stress urinary incontinence (SUI) is a common disorder in women that has a negative impact on quality of life. Pregnancy and childbirth are considered important risk factors that directly affect the pelvic floor during pregnancy and labour, increasing the risk of pelvic floor dysfunction, with prevalence rates of SUI in the postpartum period ranging from 30 to 47% during the first 12 months.
OBJECTIVE
To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention of SUI in women during the antenatal and postnatal period by reviewing and evaluating the available scientific literature.
METHODS
This is a systematic review, using only randomised controlled trials. We searched the databases Pubmed, Scopus, Cochrane and PEDro. We reviewed 7 prospective studies in English and Portuguese, which included 1,401 pregnant women of legal age who underwent PFMT to prevent SUI.
RESULTS
The results allowed us to establish that PFMT is used for pelvic floor muscles and that this intervention, applied with the appropriate methodology, can prevent or cure SUI.
CONCLUSIONS
The application of PFMT in an early stage of pregnancy has positive effects on the continence capacity after delivery.
Topics: Humans; Urinary Incontinence, Stress; Female; Pelvic Floor; Exercise Therapy; Pregnancy; Randomized Controlled Trials as Topic; Pregnancy Complications
PubMed: 38556125
DOI: 10.1016/j.acuroe.2024.01.007 -
Journal of Pediatric Urology Oct 2022About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero pelvic junction obstruction (UPJO) making it an uncommon operation even in large... (Meta-Analysis)
Meta-Analysis Review
A systematic review and metaanalysis of open, conventional laparoscopic and robot-assisted laparoscopic techniques for re-do pyeloplasty for recurrent uretero pelvic junction obstruction in children.
OBJECTIVE
About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero pelvic junction obstruction (UPJO) making it an uncommon operation even in large volume centers. In this MA we have compared the outcomes of open (OP), laparoscopic (LP) and robot assisted LP (RALP) approaches in managing recurrent UPJO.
METHODS
Pubmed/Index medicus etc. were searched for re-do pyeloplasty (Open OR Laparoscopic OR Robot-assisted) AND (Redo OR Reoperative OR failed) AND (child OR pediatric OR paediatric), for articles published between 2001 and 2021. Duplicate publications were identified and removed. Articles with grossly incomplete data and errors in reporting were excluded, as were articles reporting <5 cases. The systematic review was carried out according to PRISMA guidelines and meta-analysis of proportions was carried out using MetaXL 5.3.
RESULTS
A total of 18 articles on re-do pyeloplasty were included in the analysis. In total, there were 87, 77 and 123 redo pyeloplasties in OP, LP and RALP groups respectively. The I2 statistics for OP, LP and RALP showed low heterogeneity with I2 of 24%, 0% and 20% respectively. LFK index was 0.88, 0.30 and 1.62 for OP, LP and RALP respectively, suggesting no or minor publication bias. The overall success rates of OP, LP and RALP re-do pyeloplasty were 93.1% (95% CI 86-98), 92.1% (95% CI 83-96) and 89.4% (95% CI 83-96) respectively (summary table). The success rate between the techniques was not significantly different, with p values (x) of 1 (OP vs LP), 0.5 (OP vs RALP) and 0.6 (LP vs RALP). Overall, redo RALP took significantly longer time than redo LP (p < 0.001, Fisher's). Overall, RALP had significantly shorter hospital stay than LP (p < 0.001) and LP had significantly shorter hospital stay than OP (p < 0.001). The complication rate was 9% in OP and LP and 16% in RALP, the difference being not statistically significant (p value 1, 0.26 and 0.27 for OP vs LP, OP vs RALP and LP vs RALP respectively, x).
CONCLUSIONS
In conclusion MIS techniques (LP and RALP) seem to be good alternatives to OP for redo pyeloplasty in children, with comparable success and complications. Redo RALP had longer duration of surgery but shorter hospital stay than redo LP. With comparable success & complication rate between RALP and LP, this MA could not favor one over the other for redo pyeloplasty.
Topics: Child; Humans; Ureteral Obstruction; Robotics; Urologic Surgical Procedures; Retrospective Studies; Treatment Outcome; Kidney Pelvis; Laparoscopy
PubMed: 36117037
DOI: 10.1016/j.jpurol.2022.08.025 -
The Cochrane Database of Systematic... Jul 2023Pelvic organ prolapse (POP) is the descent of a woman's uterus, bladder, or rectum into the vagina. It affects 50% of women over 50 years old who have given birth to at... (Review)
Review
BACKGROUND
Pelvic organ prolapse (POP) is the descent of a woman's uterus, bladder, or rectum into the vagina. It affects 50% of women over 50 years old who have given birth to at least one child, and recognised risk factors are older age, higher number of births, and higher body mass index. This review assesses the effects of oestrogen therapy, alone or in combination with other treatments, on POP in postmenopausal women.
OBJECTIVES
To assess the benefits and harms of local and systemic oestrogen therapy in the management of pelvic organ prolapse symptoms in postmenopausal women, and to summarise the principal findings of relevant economic evaluations.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register (up to 20 June 2022), which includes CENTRAL, MEDLINE, two trials registers, and handsearching of journals and conference proceedings. We also checked the reference lists of relevant articles for additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), quasi-RCTs, multi-arm RCTs, and cross-over RCTs that evaluated the effects of oestrogen therapy (alone or in combination with other treatments) versus placebo, no treatment, or other interventions in postmenopausal women with any grade of POP.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from the included trials using prespecified outcome measures and a piloted extraction form. The same review authors independently assessed the risk of bias of eligible trials using Cochrane's risk of bias tool. Had data allowed, we would have created summary of findings tables for our main outcome measures and assessed the certainty of the evidence using GRADE.
MAIN RESULTS
We identified 14 studies including a total of 1002 women. In general, studies were at high risk of bias in terms of blinding of participants and personnel, and there were also some concerns about selective reporting. Owing to insufficient data for the outcomes of interest, we were unable to perform our planned subgroup analyses (systemic versus topical oestrogen, parous versus nulliparous women, women with versus without a uterus). No studies assessed the effects of oestrogen therapy alone versus no treatment, placebo, pelvic floor muscle training, devices such as vaginal pessaries, or surgery. However, we did identify three studies that assessed oestrogen therapy in conjunction with vaginal pessaries versus vaginal pessaries alone and 11 studies that assessed oestrogen therapy in conjunction with surgery versus surgery alone.
AUTHORS' CONCLUSIONS
There was insufficient evidence from RCTs to draw any solid conclusions on the benefits or harms of oestrogen therapy for managing POP symptoms in postmenopausal women. Topical oestrogen in conjunction with pessaries was associated with fewer adverse vaginal events compared with pessaries alone, and topical oestrogen in conjunction with surgery was associated with reduced postoperative urinary tract infections compared with surgery alone; however, these findings should be interpreted with caution, as the studies that contributed data varied substantially in their design. There is a need for larger studies on the effectiveness and cost-effectiveness of oestrogen therapy, used alone or in conjunction with pelvic floor muscle training, vaginal pessaries, or surgery, for the management of POP. These studies should measure outcomes in the medium and long term.
Topics: Female; Humans; Middle Aged; Estrogens; Pelvis; Pessaries; Postmenopause; Urinary Bladder
PubMed: 37431855
DOI: 10.1002/14651858.CD014592.pub2