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African Journal of Disability 2019Many patients with Down syndrome (PWDS) have poor cardiometabolic risk profiles, aerobic capacities and weak hypotonic muscles, primarily because of physical inactivity... (Review)
Review
BACKGROUND
Many patients with Down syndrome (PWDS) have poor cardiometabolic risk profiles, aerobic capacities and weak hypotonic muscles, primarily because of physical inactivity and poor diet.
OBJECTIVES
This study discusses the benefits of exercise therapy on body composition, aerobic capacity, muscle strength, proprioception and cardiometabolic profiles of PWDS.
METHODS
A literature review using the Crossref metadatabase, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), focusing on the period 2007-2018, was undertaken. Each record was judged adopting the modified Downs and Black Appraisal Scale. The literature investigation identified 15 701 records. Records were excluded if they were published before 2007, pertained to the impact of exercise on intellectual disabilities beyond Down syndrome or the impact of medical, pharmaceutical, nutrition and psychological interventions among PWDS and were published in languages besides English. Nineteen articles were synthesised into this commentary.
RESULTS
PWDS have a heightened cardiometabolic risk profile and high oxidative stress associated with elevated insulin resistance, poor insulin sensitivity, atherosclerosis and hypertension. PWDS have low aerobic capacity (VO), peak heart rates, muscle strength, agility and balance. Regular physical activity is beneficial to improve their VO and muscle strength. Moreover, regular physical activity reduces lipid peroxidation and arterial cell wall damage, the pathogenesis of atheroma is limited.
CONCLUSION
Exercise therapy compliance seems to have a positive impact on the cardiometabolic risk profile, muscle strength and aerobic work capacity of PWDS. Nonetheless, additional vigorous experimental investigations are necessary to better understand the effect of exercise therapy on the aerobic, strength, proprioception and cardiometabolic risk profile of PWDS.
PubMed: 31745461
DOI: 10.4102/ajod.v8i0.576 -
American Journal of Respiratory Cell... Mar 2023Microorganisms colonize the human body. The lungs and respiratory tract, previously believed to be sterile, harbor diverse microbial communities and the genomes of...
Microorganisms colonize the human body. The lungs and respiratory tract, previously believed to be sterile, harbor diverse microbial communities and the genomes of bacteria (bacteriome), viruses (virome), and fungi (mycobiome). Recent advances in amplicon and shotgun metagenomic sequencing technologies and data-analyzing methods have greatly aided the identification and characterization of microbial populations from airways. The respiratory microbiome has been shown to play roles in human health and disease and is an area of rapidly emerging interest in pulmonary medicine. In this review, we provide updated information in the field by focusing on four lung conditions, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, and idiopathic pulmonary fibrosis. We evaluate gut, oral, and upper airway microbiomes and how they contribute to lower airway flora. The discussion is followed by a systematic review of the lower airway microbiome in health and disease. We conclude with promising research avenues and implications for evolving therapeutics.
Topics: Humans; Lung; Asthma; Pulmonary Disease, Chronic Obstructive; Microbiota; Cystic Fibrosis
PubMed: 36476129
DOI: 10.1165/rcmb.2022-0208TR -
The Journals of Gerontology. Series A,... Sep 2019There is increasing use of computed tomography (CT) in sarcopenia research using a wide variety of techniques. We performed a systematic review of the CT literature to...
BACKGROUND/OBJECTIVE
There is increasing use of computed tomography (CT) in sarcopenia research using a wide variety of techniques. We performed a systematic review of the CT literature to identify the differences between approaches used.
METHODS
A comprehensive search of PubMed from 1983 to 2017 was performed to identify studies that used CT muscle measurements to assess muscle mass and myosteatosis. The CT protocols were evaluated based on anatomic landmark(s), thresholding, muscle(s) segmented, key measurement (ie, muscle attenuation, cross-sectional area, volume), derived variables, and analysis software. From the described search, 657 articles were identified and 388 studies met inclusion criteria for this systematic review.
RESULTS
Muscle mass was more commonly assessed than myosteatosis (330 vs. 125). The most commonly assessed muscle or muscle groups were total abdominal wall musculature (142/330 and 49/125 for muscle mass and myosteatosis, respectively) and total thigh musculature (90/330 and 48/125). The most commonly used landmark in the abdomen was the L3 vertebra (123/142 and 45/49 for muscle mass and myosteatosis, respectively). Skeletal muscle index and intermuscular adipose tissue were the most commonly used measures of abdominal wall muscle mass (114/142) and myosteatosis (27/49), respectively. Cut points varied across studies. A significant majority of studies failed to report important CT technical parameters, such as use of intravenous contrast and slice thickness (94% and 63%, respectively).
CONCLUSIONS
There is considerable variation in the CT approaches used for the assessment of muscle mass and myosteatosis. There is a need to develop consensus for CT-based evaluation of sarcopenia and myosteatosis.
Topics: Adipose Tissue; Body Composition; Humans; Muscle, Skeletal; Sarcopenia; Tomography, X-Ray Computed
PubMed: 30726878
DOI: 10.1093/gerona/glz034 -
The Breast Journal 2022Less than 1% of all breast cancers are diagnosed in males. In females, postmastectomy breast reconstruction is associated with increased patient satisfaction. However,... (Review)
Review
INTRODUCTION
Less than 1% of all breast cancers are diagnosed in males. In females, postmastectomy breast reconstruction is associated with increased patient satisfaction. However, there is a paucity of literature describing reconstructive options for postmastectomy deformity in the male chest. The purpose of this systematic review was to evaluate postmastectomy reconstruction outcomes in males with breast cancer.
METHODS
A systematic review was performed in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, Cochrane, and Web of Science were queried for records pertaining to the study question using medical subject heading (MeSH) terms such as "male breast cancer," "mastectomy," and "reconstruction." No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes of interest included postoperative complications, recurrence rate, and mortality rate.
RESULTS
A total of 11 articles examining 29 male patients with breast cancer who underwent postmastectomy reconstruction were included for analysis. Literature was most commonly available in the form of case reports. The average age was 59.6 +/-11.4 years. Reconstruction methods included fat grafting ( = 1, 3.4%), silicone implants ( = 1, 3.4%), and autologous chest wall reconstruction with local flaps ( = 26, 89.7%). Postoperative complications occurred in two patients (6.8%), including partial nipple necrosis ( = 1) and hypertrophic scarring ( = 1). Of the studies reporting patient satisfaction, all patients were pleased with the aesthetic appearance of their chest.
CONCLUSION
This systematic review revealed the limited availability of research regarding postmastectomy chest reconstruction in males with breast cancer. Nevertheless, the evidence available suggests that reconstruction can restore a patient's body image and, thus, should be regularly considered and discussed with male patients. Larger studies are warranted to further shed light on this population.
Topics: Aged; Breast Implants; Breast Neoplasms; Breast Neoplasms, Male; Female; Humans; Male; Mammaplasty; Mastectomy; Middle Aged; Postoperative Complications; Surgical Flaps
PubMed: 35711890
DOI: 10.1155/2022/5482261 -
Surgical Neurology International 2021Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous... (Review)
Review
BACKGROUND
Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous metaplastic meningioma of the left medial wall and orbital roof with the left frontal sinus invasion and left ethmoidal body bone substitution. The authors also conducted a systematic review concerning diagnosis and management of patients affected by purely calvarial intradiploic meningiomas along with a focus on fronto-orbito-ethmoidal ones.
METHODS
A literature search was conducted using PubMed and Scopus databases according to preferred reporting items for systematic reviews and meta-analysis statement and with the following Mesh terms: Intradiploic, intraosseous, calvarial, and meningioma. Eligibility criteria were limited by the nature of existing literature on intradiploic meningiomas, consisting of only case series, and case reports.
RESULTS
A total of 128 published studies were identified through our search. 41 studies were included in this systematic review, 59 patients with a female/male ratio of 1.2/1. The mean age of the patients is of 47.69 years (range 3-84 years). Only seven out of 59 patients (11.9%) presented a complex intradiploic meningioma located in fronto-orbito-ethmoidal region like our case. In almost all patients, a gross-total resection was performed (96.6%) and only in two patients (3.4%) a subtotal resection was achieved.
CONCLUSION
The authors shared this successfully treated case to add to the overall clinical experience in the management of this rare subtype tumor, with the hope that more studies are conducted to further address the mechanism of intradiploic meningiomas development.
PubMed: 34754535
DOI: 10.25259/SNI_386_2021 -
Cureus Dec 2022The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the... (Review)
Review
The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the sum of the two preceding ones. The ratio of two consecutive Fibonacci numbers, also called the golden proportion, approximately equals 1.618. We analyzed the existence of Fibonacci numbers and golden ratios in the field of hernia and abdominal wall reconstruction. We found substantial evidence of the use of the golden ratio in siting of the umbilicus. The Fibonacci numbers also showed up frequently in the anatomy of the abdominal wall. However, this was not as appropriate as the other instances in the human body or in nature.
PubMed: 36721618
DOI: 10.7759/cureus.33072 -
European Radiology Aug 2022Research on computed tomography (CT) bronchial parameter measurements shows that there are conflicting results on the values for bronchial parameters in the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Research on computed tomography (CT) bronchial parameter measurements shows that there are conflicting results on the values for bronchial parameters in the never-smoking, smoking, asthma, and chronic obstructive pulmonary disease (COPD) populations. This review assesses the current CT methods for obtaining bronchial wall parameters and their comparison between populations.
METHODS
A systematic review of MEDLINE and Embase was conducted following PRISMA guidelines (last search date 25th October 2021). Methodology data was collected and summarised. Values of percentage wall area (WA%), wall thickness (WT), summary airway measure (Pi10), and luminal area (Ai) were pooled and compared between populations.
RESULTS
A total of 169 articles were included for methodologic review; 66 of these were included for meta-analysis. Most measurements were obtained from multiplanar reconstructions of segmented airways (93 of 169 articles), using various tools and algorithms; third generation airways in the upper and lower lobes were most frequently studied. COPD (12,746) and smoking (15,092) populations were largest across studies and mostly consisted of men (median 64.4%, IQR 61.5 - 66.1%). There were significant differences between populations; the largest WA% was found in COPD (mean SD 62.93 ± 7.41%, n = 6,045), and the asthma population had the largest Pi10 (4.03 ± 0.27 mm, n = 442). Ai normalised to body surface area (Ai/BSA) (12.46 ± 4 mm, n = 134) was largest in the never-smoking population.
CONCLUSIONS
Studies on CT-derived bronchial parameter measurements are heterogenous in methodology and population, resulting in challenges to compare outcomes between studies. Significant differences between populations exist for several parameters, most notably in the wall area percentage; however, there is a large overlap in their ranges.
KEY POINTS
• Diverse methodology in measuring airways contributes to overlap in ranges of bronchial parameters among the never-smoking, smoking, COPD, and asthma populations. • The combined number of never-smoking participants in studies is low, limiting insight into this population and the impact of participant characteristics on bronchial parameters. • Wall area percent of the right upper lobe apical segment is the most studied (87 articles) and differentiates all except smoking vs asthma populations.
Topics: Asthma; Bronchi; Humans; Male; Pulmonary Disease, Chronic Obstructive; Smoking; Tomography, X-Ray Computed
PubMed: 35192013
DOI: 10.1007/s00330-022-08600-1 -
Journal of Clinical Medicine Dec 2021Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the... (Review)
Review
The Role of Rehabilitative Ultrasound Imaging Technique in the Lumbopelvic Region as a Diagnosis and Treatment Tool in Physiotherapy: Systematic Review, Meta-Analysis and Meta-Regression.
Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I heterogeneity indexes for multifidus muscle thickness (I = 95%), low back pain (I = 92%) and abdominal pain (I = 95%), not important for transversus abdominis muscle thickness (I = 22%), significant heterogenity (I = 69%) depending on the subgroup and not important internal oblique muscle thickness (I = 0%) and external oblique muscle thickness (I = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area.
PubMed: 34884401
DOI: 10.3390/jcm10235699 -
Asian Journal of Surgery Sep 2022To achieve a tension-free repair and reduce the recurrence rate of abdominal wall hernias (AWHs), various kinds of meshes have been applied in surgery. However, these... (Meta-Analysis)
Meta-Analysis Review
To achieve a tension-free repair and reduce the recurrence rate of abdominal wall hernias (AWHs), various kinds of meshes have been applied in surgery. However, these meshes are reported to have problems with adhesion, infection, chronic pain and foreign body sensation. Recently, the introduction of cellular components on meshes seems to provide a new alternative to resolve these problems. This study aimed to evaluate the treatment efficacy of meshes seeded with cells (mesh-cell group) for AWHs, compared to meshes without cells (mesh group). Cochrane Library, Web of Science and PubMed were searched for studies that provided data about meshes, cells and AWHs. Twenty-six studies involving 578 animals were included. We found that the mesh-cell group could better control hernia recurrent than the mesh group (OR = 0.25, 95% CI = 0.15-0.42). Although the mesh-cell group did not reduce the incidence of adhesions (OR = 0.67, 95% CI = 0.26-1.74), it alleviated the extent of adhesions (WMD = -1.48, 95% CI = -1.86 to -1.10). In addition, the capillary density of mesh-cell group was also higher than that of mesh group (WMD = 26.27, 95% CI = 14.45-38.09). For incidence of infection, the two groups had no significant differences (OR = 0.94, 95% CI = 0.39-2.31). On the basis of our current evidence, AWHs were likely to receive a satisfied outcome in animal models when treated by meshes seeded with cells. Future studies with human trial data are needed to validate these findings.
Topics: Animals; Hernia, Abdominal; Herniorrhaphy; Humans; Recurrence; Surgical Mesh; Treatment Outcome
PubMed: 34635415
DOI: 10.1016/j.asjsur.2021.09.019 -
The Cochrane Database of Systematic... Jun 2020Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to a primary cardiac disorder. For people with refractory CS despite maximal vasopressors,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to a primary cardiac disorder. For people with refractory CS despite maximal vasopressors, inotropic support and intra-aortic balloon pump, mortality approaches 100%. Mechanical assist devices provide mechanical circulatory support (MCS) which has the ability to maintain vital organ perfusion, to unload the failing ventricle thus reduce intracardiac filling pressures which reduces pulmonary congestion, myocardial wall stress and myocardial oxygen consumption. This has been hypothesised to allow time for myocardial recovery (bridge to recovery) or allow time to come to a decision as to whether the person is a candidate for a longer-term ventricular assist device (VAD) either as a bridge to heart transplantation or as a destination therapy with a long-term VAD.
OBJECTIVES
To assess whether mechanical assist devices improve survival in people with acute cardiogenic shock.
SEARCH METHODS
We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and Web of Science Core Collection in November 2019. In addition, we searched three trials registers in August 2019. We scanned reference lists and contacted experts in the field to obtain further information. There were no language restrictions.
SELECTION CRITERIA
Randomised controlled trials on people with acute CS comparing mechanical assist devices with best current intensive care management, including intra-aortic balloon pump and inotropic support.
DATA COLLECTION AND ANALYSIS
We performed data collection and analysis according to the published protocol. Primary outcomes were survival to discharge, 30 days, 1 year and secondary outcomes included, quality of life, major adverse cardiovascular events (30 days/end of follow-up), dialysis-dependent (30 days/end of follow-up), length of hospital stay and length of intensive care unit stay and major adverse events. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of a body of evidence as it relates to the studies which contribute data to the meta-analyses for the prespecified outcomes Summary statistics for the primary endpoints were risk ratios (RR), hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs).
MAIN RESULTS
The search identified five studies from 4534 original citations reviewed. Two studies included acute CS of all causes randomised to treatment using TandemHeart percutaneous VAD and three studies included people with CS secondary to acute myocardial infarction who were randomised to Impella CP or best medical management. Meta-analysis was performed only to assess the 30-day survival as there were insufficient data to perform any further meta-analyses. The results from the five studies with 162 participants showed mechanical assist devices may have little or no effect on 30-day survival (RR of 1.01 95% CI 0.76 to 1.35) but the evidence is very uncertain. Complications such as sepsis, thromboembolic phenomena, bleeding and major adverse cardiovascular events were not infrequent in both the MAD and control group across the studies, but these could not be pooled due to inconsistencies in adverse event definitions and reporting. We identified four randomised control trials assessing mechanical assist devices in acute CS that are currently ongoing.
AUTHORS' CONCLUSIONS
There is no evidence from this review of a benefit from MCS in improving survival for people with acute CS. Further use of the technology, risk stratification and optimising the use protocols have been highlighted as potential reasons for lack of benefit and are being addressed in the current ongoing clinical trials.
Topics: Acute Disease; Coronary Care Units; Heart-Assist Devices; Humans; Length of Stay; Quality of Life; Renal Dialysis; Shock, Cardiogenic
PubMed: 32496607
DOI: 10.1002/14651858.CD013002.pub2