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Polski Przeglad Chirurgiczny Feb 2023This systematic review and meta-analysis analysed was set up to compare totally extraperitoneal mesh repair (TEP) and intraperitoneal onlay mesh placement (IPOM) in... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analysis comparing ventral hernia repair using minimally-invasive extended totally extraperitoneal repair versus intraperitoneal onlay mesh repair.
BACKGROUND
This systematic review and meta-analysis analysed was set up to compare totally extraperitoneal mesh repair (TEP) and intraperitoneal onlay mesh placement (IPOM) in patients undergoing minimally invasive ventral hernia mesh surgery (MIS-VHMS).
METHODS
A systematic literature searches of three major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies that compared two techniques of MIS-VHMS: TEP and IPOM. Primary outcome of interest was major complications post-operatively, defined as a composite outcome of surgical-site occurrences requiring procedural intervention (SSOPI), readmission to hospital, recurrence, reoperation or death. Secondary outcomes were intraoperative complications, duration of surgery, surgical site occurrence (SSO), SSOPI, postoperative ileus, post-operative pain. The risk of bias was assessed using Cohranes Risk of Bias tool 2 for randomized controlled trials (RCTs) and Newcastle-Ottawa score for observational studies (OSs).
RESULTS
Five OSs and two RCTs al including total number of 553 patients were included. There was no difference in primary outcome (RD 0.00 [-0.05, 0.06], p=0.95), incidence of postoperative ileus. Operative time was longer in TEP (MD 40.10 [27.28, 52.91], p<0.01). TEP was found to be associated with less postoperative pain at 24h and 7days after surgery.
CONCLUSIONS
Both TEP and IPOM were detected to have equal safety profile and do not differ in SSO or SSOPI rates, incidence of postoperative ileus. TEP has longer operative time but provides better early postoperative pain outcomes. Further high-quality studies with long follow up evaluating recurrence and patient reported outcomes are needed. Comparison of other transabdominal and extraperitoneal MIS-VHMS techniques is another direction of future research. PROSPERO registration: CRD4202121099.
Topics: Humans; Laparoscopy; Surgical Mesh; Hernia, Ventral; Postoperative Complications; Pain, Postoperative; Herniorrhaphy; Hernia, Inguinal; Recurrence; Treatment Outcome
PubMed: 36808055
DOI: 10.5604/01.3001.0016.2728 -
Hernia : the Journal of Hernias and... Feb 2022Hernia repair is a common procedure; however, an overview is lacking regarding the impact of annual surgeon volume and total surgical experience on the outcome of hernia... (Review)
Review
PURPOSE
Hernia repair is a common procedure; however, an overview is lacking regarding the impact of annual surgeon volume and total surgical experience on the outcome of hernia repair. We aimed to explore the impact of annual surgeon volume and total surgical experience on outcomes of groin and primary ventral hernia repair.
METHODS
This systematic review followed the Prefered Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A protocol was registered at PROSPERO (CRD42020176140). PubMed, EMBASE, and Cochrane CENTRAL were searched. We investigated recurrence rates after groin and primary ventral hernia repair reported according to annual surgeon volume or total surgical experience with at least 6 months follow-up. Surgeons were pooled in three overlapping categories: high-volume (> 50 cases/year), medium-volume (11-50 cases/year) and low-volume (≤ 25 cases/year).
RESULTS
Ten records for groin hernia and one for primary ventral hernia were included. The median (range) recurrence rates after laparoscopic groin hernia repair for high, medium, and low-volume surgeons were 2.6% (2.3-3.0), 2.4% (0.7-4.6), and 4.2% (1.0-6.8), respectively. The median (range) recurrence rate after open groin hernia repair for high, medium, and low-volume surgeons were 2.1% (2.0-2.2), 1.7% (1.6-2.3), and 2.4% (2.2-5.0). The groin hernia recurrence rate seemed to increase when annual surgeon volume decreased below 25 cases/year. For primary ventral hernia, increased annual surgeon volume was associated with decreased reoperation rate.
CONCLUSION
High-volume surgeons seemed to have lower rates of hernia recurrence after groin as well as primary ventral hernia repair and our data supports the need for centralization of groin hernia repair on individual surgeons.
Topics: Groin; Hernia, Inguinal; Hernia, Ventral; Herniorrhaphy; Humans; Laparoscopy; Recurrence; Surgeons; Surgical Mesh
PubMed: 33404970
DOI: 10.1007/s10029-020-02359-4 -
Cureus Jul 2021Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery... (Review)
Review
Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery occlusion, can often lead to LIS. LIS has three subtypes: classical, partial, and total. There is loss of motion in the four extremities in classical LIS, loss of horizontal gaze, and aphasia. In partial LIS, the patient still has some motor function. Complete LIS has the worst outcome because patients cannot blink or have vertical gaze, thus rendering them incapable of communicating. Most cases of LIS occur due to ischemic infarcts. These patients require a great deal of physical rehabilitation to regain partial motor ability and a means to communicate. While the clinical features and pathophysiology are known, the prognosis and long-term treatment remain unknown. We conducted a systematic review using the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) protocol. We use an advanced PubMed strategy using the inclusion criteria of observational studies or clinical trials conducted in the last 20 years, written in English, and conducted on humans. We excluded systematic reviews, literature reviews, metanalysis, and studies that did not meet the outcomes of our objectives. The prognosis of LIS is not good, and most patients remain locked in, with poor quality of life, especially motor functions. Respiratory failure and depression are big comorbidities. In the acute setting, patients benefit from rapid intervention. The subacute treatment needs to manage aggressively to improve functional scores best. The long-term treatment focus is on the quality of life and managing comorbidities.
PubMed: 34471579
DOI: 10.7759/cureus.16727 -
Hernia : the Journal of Hernias and... Apr 2023Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's.
METHODS
A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE.
RESULTS
Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission.
CONCLUSION
The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.
Topics: Humans; Incisional Hernia; Robotic Surgical Procedures; Activities of Daily Living; Quality of Life; Retrospective Studies; Prospective Studies; Herniorrhaphy; Hernia, Ventral; Pain, Postoperative; Laparoscopy; Surgical Mesh; Patient Reported Outcome Measures
PubMed: 36607459
DOI: 10.1007/s10029-022-02733-4 -
Applied Neuropsychology. Child 2023A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer... (Review)
Review
A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.
PubMed: 36065486
DOI: 10.1080/21622965.2022.2119142 -
Neural Regeneration Research Nov 2023Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging...
Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
PubMed: 37282452
DOI: 10.4103/1673-5374.371349 -
Parkinsonism & Related Disorders Nov 2022Orthostatic tremor is a rare and debilitating movement disorder. Its first-line treatment is pharmacological. For pharmaco-refractory patients, surgical treatment... (Review)
Review
BACKGROUND
Orthostatic tremor is a rare and debilitating movement disorder. Its first-line treatment is pharmacological. For pharmaco-refractory patients, surgical treatment options such as deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been investigated recently.
OBJECTIVES
We conducted a systematic review of all published outcome and safety data on DBS and SCS for orthostatic tremor patients.
METHODS
We searched Pubmed and Embase for studies describing orthostatic tremor patients treated with DBS or SCS. We collected all available outcome and safety data and our primary endpoint was the change in unsupported stance duration 1 year postoperatively (±6 months).
RESULTS
We included 15 studies, reporting on 32 orthostatic tremor patients who underwent DBS, 4 patients SCS and 2 both. The ventral intermediate nucleus and the zona incerta were targeted in 25/34 and 9/34 DBS cases, respectively. The median stance time at 1 year follow-up was 240 s compared to 30 s pre-operatively (p < 0.001). Stimulation-induced side effects occurred in the majority of patients, but were often transient. Bilateral stimulation appeared more effective than unilateral and stimulation settings were comparable to thalamic DBS for essential tremor. There were insufficient data available to draw meaningful conclusions on the long-term effects of DBS. Due to insufficient data, no conclusions could be drawn on the effects of SCS on orthostatic tremor.
CONCLUSION
DBS may be effective to increase stance time in orthostatic tremor patients in the first year, but further research is necessary to evaluate the long-term effects and the role of spinal cord stimulation.
Topics: Humans; Tremor; Deep Brain Stimulation; Spinal Cord Stimulation; Zona Incerta; Essential Tremor; Treatment Outcome
PubMed: 36243552
DOI: 10.1016/j.parkreldis.2022.10.001 -
Journal of Neurosurgery Feb 2023The nucleus accumbens (NAcc) of the ventral striatum is critically involved in goal- and reward-based behavior. Structural and functional abnormalities of the NAcc or... (Review)
Review
OBJECTIVE
The nucleus accumbens (NAcc) of the ventral striatum is critically involved in goal- and reward-based behavior. Structural and functional abnormalities of the NAcc or its associated neural systems are involved in neurological and psychiatric disorders. Studies of neural circuitry have shed light on the subtleties of the structural and functional derangements of the NAcc across various diseases. In this systematic review, the authors sought to identify human studies involving the NAcc and provide a synthesis of the literature on the known circuity of the NAcc in healthy and diseased states, as well as the clinical outcomes following neuromodulation.
METHODS
A systematic review was conducted using the PubMed, Embase, and Scopus databases. Neuroimaging studies that reported on neural circuitry related to the human NAcc with sample sizes greater than 5 patients were included. Demographic data, aim, design and duration, participants, and clinical and neurocircuitry details and outcomes of the studies were extracted.
RESULTS
Of 3591 resultant articles, 123 were included. The NAcc and its corticolimbic connections to other brain regions, such as the prefrontal cortex, are largely involved in reward and pain processes, with distinct functional circuitry between the shell and core in healthy patients. There is heterogeneity between clinical studies with regard to the NAcc indirect targeting coordinates, methods for postoperative confirmation, and blinded trial design. Neuromodulation studies provided promising clinical results in the context of addiction and substance misuse, obsessive-compulsive disorder, and mood disorders. The most common complications were impaired memory or concentration, and a notable serious complication was hypomania.
CONCLUSIONS
The functional diversity of the NAcc highlights the importance of studying the NAcc in healthy and pathological states. The results of this review suggest that NAcc neuromodulation has been attempted in the management of diverse psychiatric indications. There is promising, emerging evidence that the NAcc may be an effective target for specific reward- or pain-based pathologies with a reasonable risk profile.
Topics: Humans; Nucleus Accumbens; Brain; Prefrontal Cortex; Reward; Pain; Magnetic Resonance Imaging
PubMed: 35901682
DOI: 10.3171/2022.5.JNS212548 -
European Spine Journal : Official... Oct 2019Cervical spondylotic amyotrophy (CSA) is characterized by upper limb muscle weakness and atrophy, without sensory deficits. The pathophysiology of CSA has been...
PURPOSE
Cervical spondylotic amyotrophy (CSA) is characterized by upper limb muscle weakness and atrophy, without sensory deficits. The pathophysiology of CSA has been attributed to selective injury to the ventral nerve root and/or anterior horn of the spinal cord. This review aimed to delineate the history of CSA and to describe the epidemiology, etiology, pathophysiology, classification, clinical features, radiological and electrophysiological assessment, diagnosis, differential diagnosis, natural history and treatment of CSA.
METHODS
A comprehensive search of PubMed, EMBASE, Cochrane library and Web of Science databases was conducted, from their inception to April 3, 2018.
RESULTS
Clinically, CSA is classified into three types: a proximal-type (involving the scapular muscles, deltoid and biceps), a distal-type (involving the triceps and muscles of the forearm and hand) and a diffuse-type (involving features of both the distal- and proximal-type). Diagnosis requires documentation of muscle atrophy, without significant sensory deficits, supported by careful neurological, radiological and neurophysiological assessments, with amyotrophic lateral sclerosis, Parsonage-Turner syndrome, rotator cuff tear and Hirayama disease being the principle differential diagnoses. Conservative management of CSA includes cervical traction, neck immobilization and physical therapy, with vitamin B12 or E administration being useful in some patients. Surgical treatment, including anterior decompression and fusion or laminoplasty, with or without foraminotomy, is indicated after conservative treatment failure. Factors associated with a poor outcome include the distal-type CSA, long symptom duration, older age and greater preoperative muscle weakness.
CONCLUSION
Although the disease process of CSA is self-limited, treatment remains challenging, leaving scope for future studies. These slides can be retrieved under Electronic Supplementary Material.
Topics: Cervical Vertebrae; Conservative Treatment; Decompression, Surgical; Diagnosis, Differential; Humans; Immobilization; Physical Therapy Modalities; Prognosis; Spinal Fusion; Spondylosis; Traction
PubMed: 31037421
DOI: 10.1007/s00586-019-05990-7 -
JCPP Advances Jun 2022Peer adversity and aggression are common experiences in childhood and adolescence which lead to poor mental health outcomes. To date, there has been no review conducted...
BACKGROUND
Peer adversity and aggression are common experiences in childhood and adolescence which lead to poor mental health outcomes. To date, there has been no review conducted on the neurobiological changes associated with relational peer-victimisation, bullying and cyberbullying.
METHODS
This systematic review assessed structural and functional brain changes associated with peer-victimisation, bullying, and cyberbullying from 1 January 2000 to April 2021. A systematic search of Psychoinfo, Pubmed, and Scopus was performed independently by two reviewers using predefined criteria. Twenty-six studies met the selection criteria and were considered for review.
RESULTS
The data collected shows altered brain activation of regions implicated in processing reward, social pain, and affect; and heightened sensitivity and more widespread activation of brain regions during acute social exclusion, most notably in the amygdala, left parahippocampal gyrus, and fusiform gyrus, associated with victimisation exposure. In addition, victimised youths also demonstrated greater risk-taking behaviours following acute social exclusion showing greater ventral striatum-inferior frontal gyrus coupling, activation in the bilateral amygdala, orbital frontal cortex (OFC), medial prefrontal cortex (MPFC), temporoparietal junction (TPJ), medial posterior parietal cortex (MPPC) and dorsomedial prefrontal cortex (dmPFC), suggesting greater social monitoring, seeking of inclusion, and more effortful cognitive control. The studies included participants from a very broad developmental age range, mostly using cross-sectional measure of peer-victimisation exposure, at varying developmental stages.
CONCLUSIONS
This review highlights the need for more neuroimaging studies in cyberbullying, as well as longitudinal studies across more diverse samples for investigating gender, age, and developmental interactions with peer-victimising. This also brings to attention the importance of addressing bullying victimisation particularly in adolescence, given the evidence for social stress in heightening developmentally sensitive processes which are associated with depression, anxiety, and externalising symptoms.
PubMed: 37431463
DOI: 10.1002/jcv2.12081