-
Injury Apr 2022Achilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Achilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early functional rehabilitation or cast immobilization. The aim of the present systematic review and meta-analysis was to provide an update about the role of early weightbearing (WB) versus late WB on the clinical outcomes of adults with acute ATR.
METHODS
We performed a systematic literature search in Web of Science, Ovid, Medline/PubMed, and CENTRAL. We included randomized controlled trials (RCTs) that compared early WB, defined as weight-bearing within 4 weeks of treatment, to late WB for individuals with acute (<14 days) ATR. We sought to evaluate the following outcomes: re-rupture rate, Achilles Tendon Rupture Score (ATRS), return to pre-injury sport activity, time to return to work, and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes.
RESULTS
A total of 9 RCTs that enrolled 1046 participants were deemed eligible. There was no significant difference between early WB and late WB in terms of re-rupture rate (RR=0.75, 95% CI 0.49 to 1.16), ATRS (SMD=0.06, 95% CI -0.03 to 0.16), return to pre-injury sport activity (RR=1.05, 95% CI 0.86 to 1.28), time to return to work (SMD=0.03, 95% CI -0.20 to 0.26), or adverse event rate (RR=1.87, 95% CI 0.53 to 6.63).
CONCLUSION
This meta-analysis shows no difference in the functional outcomes and patient-reported outcomes between early functional rehabilitation and cast immobilization for conservatively treat individuals with acute ATR.
Topics: Achilles Tendon; Adult; Conservative Treatment; Humans; Randomized Controlled Trials as Topic; Rupture; Treatment Outcome; Weight-Bearing
PubMed: 35115168
DOI: 10.1016/j.injury.2022.01.028 -
Neuro-Chirurgie Dec 2022Both microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both... (Review)
Review
BACKGROUND
Both microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both treatment options in terms of both clinical and radiological outcomes.
METHODS
The PRISMA method was used to identify related articles. Data collected from each article and the two treatment approaches were compared in terms of favorable clinical outcome and complete/near complete occlusion rate. Subgroup analysis was done based on the size and the rupture status of BAA.
RESULTS
Fifty-nine (59) and 32 articles reported a measurable clinical and radiological outcome respectively. The weighted average favorable clinical outcome was significantly higher in the endovascular group (86.4% vs 79.6%, P<0.0001), while the weighted average complete/near complete occlusion rate was significantly higher in the surgical group (92.6% vs 83.8%, P<0.0001). In the subgroup analysis, the favorable clinical outcome remained significantly higher in the endovascular group for the ruptured, unruptured and giant/large BAA (P<0.001), but not in the small BAA subgroup (P=0.26). The occlusion rate remained significantly higher in the surgical group for all subgroups (P<0.001).
CONCLUSION
Treatment of BAA remains in a trade-off between favorable clinical outcome and complete or near-complete occlusion depending on the treatment modality selected. Careful selection of cases and judicial discussion between open surgical and endovascular team is warranted for treatment optimization.
Topics: Humans; Aneurysm; Endovascular Procedures
PubMed: 35965246
DOI: 10.1016/j.neuchi.2022.07.007 -
Progress in Biophysics and Molecular... Oct 2023The risk of discovering an intracranial aneurysm during the initial screening and follow-up screening are reported as around 11%, and 7% respectively (Zuurbie et al.,... (Review)
Review
The risk of discovering an intracranial aneurysm during the initial screening and follow-up screening are reported as around 11%, and 7% respectively (Zuurbie et al., 2023) to these mass effects, unruptured aneurysms frequently generate symptoms, however, the real hazard occurs when an aneurysm ruptures and results in a cerebral hemorrhage known as a subarachnoid hemorrhage. The objective is to study the multiple kinds of hemorrhage and aneurysm detection problems and develop machine and deep learning models to recognise them. Due to its early stage, subarachnoid hemorrhage, the most typical symptom after aneurysm rupture, is an important medical condition. It frequently results in severe neurological emergencies or even death. Although most aneurysms are asymptomatic and won't burst, because of their unpredictable growth, even small aneurysms are susceptible. A timely diagnosis is essential to prevent early mortality because a large percentage of hemorrhage cases present can be fatal. Physiological/imaging markers and the degree of the subarachnoid hemorrhage can be used as indicators for potential early treatments in hemorrhage. The hemodynamic pathomechanisms and microcellular environment should remain a priority for academics and medical professionals. There is still disagreement about how and when to care for aneurysms that have not ruptured despite studies reporting on the risk of rupture and outcomes. We are optimistic that with the progress in our understanding of the pathophysiology of hemorrhages and aneurysms and the advancement of artificial intelligence has made it feasible to conduct analyses with a high degree of precision, effectiveness and reliability.
Topics: Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage; Artificial Intelligence; Deep Learning; Reproducibility of Results; Aneurysm, Ruptured; Machine Learning
PubMed: 37499766
DOI: 10.1016/j.pbiomolbio.2023.07.001 -
Frontiers in Neurology 2022Aneurysms of the cerebral vasculature are relatively common, which grow unpredictably, and even small aneurysms carry a risk of rupture. Rupture of intracranial... (Review)
Review
BACKGROUND
Aneurysms of the cerebral vasculature are relatively common, which grow unpredictably, and even small aneurysms carry a risk of rupture. Rupture of intracranial aneurysms (IA) is a catastrophic event with a high mortality rate. Pieces of evidence have demonstrated that smoking is closely related to the formation and rupture of IA. However, the biological effect of smoking cigarettes on the formation and rupture of IA is still underrepresented.
METHODS
The study protocol was prospectively registered in PROSPERO, registration number CRD42020203634. We performed a systematic search in PubMed and CNKI for studies exploring the biological effects of smoking on intracranial aneurysms published up to December 2021, and all studies were included in the analysis. The RevMan software was used for data analysis.
RESULTS
A total of 6,196 patients were included in 14 original articles in this meta-analysis. The risk of ruptured IA in the current smoking group was significantly higher than that in the non-smoking group, with statistical significance (RR = 1.23, 95% : 1.11-1.37). After heterogeneity among cohorts was removed by the sensitivity analysis, there was still a statistically significant difference in the risk of ruptured IA between the smoking and non-smoking groups (RR total = 1.26, 95% : 1.18-1.34). There was no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RR = 1.09, 95% : 0.50-2.38). After heterogeneity among cohorts was removed by sensitivity analysis, there was still no statistically significant difference in the risk of ruptured IA between the former smoking (smoking cessation) group and the non-smoking group (RRtotal = 0.75, 95% : 0.47-1.19). The risk of the ruptured IA in the current smoking group was significantly higher than that in the former smoking (smoking cessation) group, with a statistically significant difference (RR=1.42, 95%: 1.27-1.59).
CONCLUSION
Although the biological effects of smoking on the formation and rupture of IA are unknown, this study suggests that current smoking is a risk factor for ruptured IA. Quitting smoking is very important for patients with IA.
PubMed: 35903120
DOI: 10.3389/fneur.2022.862916 -
American Journal of Obstetrics and... Aug 2022This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management... (Review)
Review
OBJECTIVE
This study aimed to present a case of first-trimester uterine rupture and perform a systematic review to identify common presentations, risk factors, and management strategies.
DATA SOURCES
Searches were performed in PubMed, Ovid, and Scopus using a combination of key words related to "uterine rupture," "first trimester," and "early pregnancy" from database inception to September 30, 2020.
STUDY ELIGIBILITY CRITERIA
English language descriptions of uterine rupture at ≤14 weeks of gestation were included, and cases involving pregnancy termination and ectopic pregnancy were excluded.
METHODS
Outcomes for the systematic review included maternal demographics, description of uterine rupture, and specifics of uterine rupture diagnosis and management. Data were extracted to custom-made reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports and case series.
RESULTS
Overall, 61 cases of first-trimester uterine rupture were identified, including our novel case. First-trimester uterine ruptures occurred at a median gestation of 11 weeks. Most patients (59/61 [97%]) had abdominal pain as a presenting symptom, and previous uterine surgery was prevalent (44/61 [62%]), usually low transverse cesarean delivery (32/61 [52%]). The diagnosis of uterine rupture was generally made after surgical exploration (37/61 [61%]), with rupture noted in the fundus in 26 of 61 cases (43%) and in the lower segment in 27 of 61 cases (44%). Primary repair of the defect was possible in 40 of 61 cases (66%), whereas hysterectomy was performed in 18 of 61 cases (30%). Continuing pregnancy was possible in 4 of 61 cases (7%).
CONCLUSION
Uterine rupture is an uncommon occurrence but should be considered in patients with an acute abdomen in early pregnancy, especially in women with previous uterine surgery. Surgical exploration is typically needed to confirm the diagnosis and for management. Hysterectomy is not always necessary; primary uterine repair is sufficient in more than two-thirds of the cases to achieve hemostasis. Continuing pregnancy, although uncommon, is also possible.
Topics: Cesarean Section; Female; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy, Ectopic; Uterine Rupture
PubMed: 35487324
DOI: 10.1016/j.ajog.2022.04.035 -
BMC Musculoskeletal Disorders Dec 2023The timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated early versus delayed passive and active ROM protocols following arthroscopic rotator cuff repair. The aim of this study is to systematically review the literature on the outcomes of early active/passive versus delayed active/passive postoperative arthroscopic rotator cuff repair rehabilitation protocols.
METHODS
A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2022 comparing early motion (EM) versus delayed motion (DM) rehabilitation protocols after arthroscopic rotator cuff repair for partial and full-thickness tear was conducted. The primary outcome was range of motion (anterior flexion, external rotation, internal rotation, abduction) and the secondary outcomes were Constant-Murley score (CMS), Simple Shoulder Test Score (SST score) and Visual Analogue Scale (VAS).
RESULTS
Thirteen RCTs with 1,082 patients were included in this study (7 RCTs for early passive motion (EPM) vs. delayed passive motion (DPM) and 7 RCTs for early active motion (EAM) vs. delayed active motion (DAM). Anterior flexion (1.40, 95% confidence interval (CI), 0.55-2.25) and abduction (2.73, 95%CI, 0.74-4.71) were higher in the EPM group compared to DPM. Similarly, EAM showed superiority in anterior flexion (1.57, 95%CI, 0.62-2.52) and external rotation (1.59, 95%CI, 0.36-2.82), compared to DAM. There was no difference between EPM and DPM for external rotation, retear rate, CMS and SST scores. There was no difference between EAM and DAM for retear rate, abduction, CMS and VAS.
CONCLUSION
EAM and EPM were both associated with superior ROM compared to the DAM and DPM protocols. EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for the patients with small to large sized tears.
Topics: Humans; Rotator Cuff Injuries; Rotator Cuff; Arthroscopy; Treatment Outcome; Randomized Controlled Trials as Topic; Shoulder Joint; Range of Motion, Articular
PubMed: 38049792
DOI: 10.1186/s12891-023-07075-5 -
Journal of Shoulder and Elbow Surgery Aug 2023Calcific tendinitis is a relatively common shoulder disorder, with 7%-17% of individuals with shoulder pain having rotator cuff calcium deposits. Several nonoperative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Calcific tendinitis is a relatively common shoulder disorder, with 7%-17% of individuals with shoulder pain having rotator cuff calcium deposits. Several nonoperative interventions, extracorporeal shockwave therapy (ESWT) and ultrasonography-guided needling (UGN), and surgical techniques have been described to treat calcific tendonitis with satisfactory outcomes. Clinical guidelines are lacking for surgical excision in cases refractory to nonoperative treatment. Several arthroscopic and open operative techniques have been described to treat calcific tendonitis with satisfactory clinical outcomes. The purpose of this systematic review of randomized controlled trials is to compare outcomes and complications of nonoperative vs. operative management of chronic calcific tendinitis of the rotator cuff, to provide evidence-based treatment guidelines for practitioners.
METHODS
EMBASE, PubMed, and OVID [MEDLINE] were searched from database inception until February 20, 2022, for randomized controlled trials reporting outcomes related to operative or nonoperative management for calcific tendonitis of the shoulder. Clinical outcomes including pain on visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS), and resolution of calcific deposits were evaluated. Continuous data at last follow-up was pooled into mean differences using a random effects model for meta-analysis.
RESULTS
A total of 27 studies (2212 nonoperative patients and 140 operative patients) met the final inclusion criteria. Pooled mean difference in VAS for ESWT was -3.83 (95% confidence interval [CI] -5.38, -2.27); P < .001), compared to -4.83 (95% CI -5.44, -4.22; P < .001) for UGN, and -4.65 (95% CI -5.47, -3.82; P < .001) for the operative interventions. Pooled mean difference in CMS score after ESWT was 18.30 (95% CI 10.95, 25.66; P < .001) compared to 22.01 (95% CI 8.17, 35.84; P = .002) for UGN, and 38.35 (95% CI 31.68, 45.02; P < .001) for the operative interventions. Eighty-five percent of patients receiving operative and 67% of patients receiving UGN management had complete radiographic resolution of calcific deposit.
CONCLUSIONS
Surgical treatment of chronic calcific tendonitis of the rotator cuff results in larger improvement in functional outcome scores and comparable pain reduction to nonoperative interventions, particularly UGN. Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain, and thus it is reasonable to trial UGN and ESWT as first-line treatment. Cost-effectiveness analyses will be needed to support one treatment over the other. High-quality randomized controlled trials directly comparing nonoperative interventions to operative interventions in patients prior to failing conservative treatment are needed to establish high-quality evidence-based guidelines.
Topics: Humans; Rotator Cuff; Randomized Controlled Trials as Topic; Tendinopathy; Shoulder; Shoulder Pain; Rotator Cuff Injuries; Treatment Outcome
PubMed: 37080421
DOI: 10.1016/j.jse.2023.03.017 -
Medicine Dec 2022Contemporary techniques for repair of acute anterior cruciate ligament (ACL) rupture have been receiving renewed interest recently because of reports of good outcomes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Contemporary techniques for repair of acute anterior cruciate ligament (ACL) rupture have been receiving renewed interest recently because of reports of good outcomes.
METHODS
A literature search of PUBMED, MEDLINE, EMBASE, and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs published in English and comparing clinical outcomes of ACL repair versus reconstruction were included. Outcomes were evaluated using the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity scale, visual analog scale pain score, anterior laxity, Lachman test, hop tests, knee injury and osteoarthritis outcome score, extension deficit, revision rate, and re-rupture rate. Statistical analysis was performed with Review Manager 5.4 and Stata 14.0. Two-tailed P < .05 was considered statistically significant.
RESULTS
Four RCTs (with a total of 293 patients) that met the eligibility criteria were included in this review. Over short-term follow-up, none of the studies found significant differences between the repair groups and reconstruction groups with respect to International Knee Documentation Committee, Lysholm, Tegner, visual analog scale, anterior laxity, Lachman test, re-rupture rate, extension deficit, and performance of 3 hop tests (P > .05). In both groups, the hop tests scores were >90%.
CONCLUSION
ACL repair and ACL reconstruction appear to provide comparable short-term outcomes. The low revision rate after primary repair is encouraging. For patients with ACL injury, current repair techniques such as dynamic intraligamentary stabilization and bridge-enhanced ACL repair may be an effective alternative to reconstruction.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Treatment Outcome; Knee Joint; Lysholm Knee Score; Rupture
PubMed: 36595828
DOI: 10.1097/MD.0000000000032411 -
PloS One 2020Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36%... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia.
METHODS
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I2 statistic and Egger's tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval.
RESULTS
Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture.
CONCLUSION
Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.
Topics: Cesarean Section; Ethiopia; Female; Humans; Pregnancy; Prenatal Care; Prevalence; Risk Factors; Rural Population; Uterine Rupture
PubMed: 33137135
DOI: 10.1371/journal.pone.0240675 -
Journal of Vascular Surgery Feb 2023Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life... (Review)
Review
BACKGROUND
Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs.
METHODS
A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes.
RESULTS
Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months.
CONCLUSIONS
This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
Topics: Humans; Male; Middle Aged; Aged; Female; Endoleak; Aorta, Thoracic; Subclavian Artery; Aortic Rupture; Endovascular Procedures; Diverticulum; Treatment Outcome
PubMed: 35850164
DOI: 10.1016/j.jvs.2022.07.010