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Annals of Cardiothoracic Surgery Sep 2020The treatment of aortic valve disease is the most common valvular surgery in industrialized nations, with 3-9% of the population over the age of eighty having at least...
BACKGROUND
The treatment of aortic valve disease is the most common valvular surgery in industrialized nations, with 3-9% of the population over the age of eighty having at least moderate aortic stenosis. As transcatheter aortic valve replacement (TAVR) has become more established, newer surgical prostheses have been developed with a variety of anchoring systems that do not rely solely on sutures to hold the valve in an appropriate position. The Edwards Intuity valve is a bovine pericardial prosthesis that is modelled on the widely implanted Perimount MagnaEase aortic prosthesis. The Perceval valve is a bovine pericardial valve attached to a self-expanding nitinol stent, which uses the radial force exerted on the patient's aortic annulus and aortic root by the stent portion to hold the valve in position. This meta-analysis compares the outcomes of comparative studies of these two valve systems.
METHODS
This systematic review and meta-analysis compares the outcomes of rapid deployment valves (RDV) and sutureless valves (SURD) and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and guidance. The search strategy interrogated six electronic databases. Outcomes measured included all-cause mortality at latest follow up, stroke, cross-clamp and cardiopulmonary bypass (CPB) times, pacemaker implantation rates, paravalvular leak and post-operative transvalvular gradient.
RESULTS
The search strategy identified 407 unique papers for initial assessment with seven studies qualifying for inclusion in the analysis. The outcomes of 4,076 patients (1,650 RDV, 2,426 SURD) were included. There was no difference in mortality, stroke or moderate or worse paravalvular regurgitation between the two groups. SURD had significantly shorter CPB time by 15.7 minutes [95% confidence interval (CI): 4.2-27.1; P=0.007] and a shorter cross-clamp time by 11.3 minutes (95% CI: 6.3-16.3; P<0.001) compared to RDV. RDV had a lower post-operative transvalvular gradient by 2.5 mmHg (95% CI: 1.2-3.8; P<0.001) and a lower rate of mild paravalvular regurgitation (OR 2.51; 95% CI: 1.435-4.768; P=0.004).
CONCLUSIONS
Both valve types have an adequate safety profile and are comparable to conventional sutured prostheses. There was a significant reduction in cross-clamp and CPB times associated with SURD. This may be of benefit for patients requiring multiple concomitant procedures and increases the utility of minimally invasive valve replacement. However, SURD was associated with higher post-operative transvalvular gradients and a higher incidence of paravalvular regurgitation.
PubMed: 33102175
DOI: 10.21037/acs-2020-surd-27 -
Journal of Traditional Chinese Medicine... Dec 2022To systematically review and analyze the effect of acupuncture and acupoint catgut embedding in treatment of abdominal obesity to provide a more reasonable clinical... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review and analyze the effect of acupuncture and acupoint catgut embedding in treatment of abdominal obesity to provide a more reasonable clinical treatment regimen.
METHODS
Ten databases were searched as of August 2022: the English databases PubMed, Embase, Cochrane Library, Web of Science, Wiley, and Scopus and the Chinese databases China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang, and SinoMed/Chinese Biomedical Literature Database. Randomized controlled trials (RCTs) of acupuncture and acupoint catgut embedding as the main interventions to treat abdominal obesity were extracted. The investigators imported the citations into EndNote version X9.1 for deduplication, screening, extraction, and integration. The risk of bias in the included RCTs was assessed according to the Cochrane Handbook. RevMan 5.4 software was used to conduct a Meta-analysis of RCTs that met the inclusion criteria.
RESULTS
Thirteen RCTs (1069 patients) were included in this study, and the data of eleven RCTs (966 patients) were include in the Meta-analysis. The results showed that acupoint catgut embedding can significantly change the weight and waist circumference of patients with abdominal obesity when compared to sham acupuncture or no treatment [mean difference () = 2.32, 95% confidence interval () (1.88, 2.76), < 0.000 01], [ = 3.47, 95% (1.99, 4.94), < 0.000 01]. The change in hip circumference after acupuncture was also significant [ = 0.89, 95% (0.12, 1.66), = 0.02].
CONCLUSION
This study found that acupuncture and acupoint catgut embedding can effectively treat abdominal obesity, therefore, these interventions can be used as clinical supplements and alternative therapies. The diagnostic criteria of the existing studies and the intervention measures of the control group are not unified. It will be necessary to improve the clinical study protocols and expand the sample size to further validate the reliability of the results obtained of this study.
Topics: Humans; Catgut; Acupuncture Points; Obesity, Abdominal; Acupuncture Therapy; Obesity
PubMed: 36378041
DOI: 10.19852/j.cnki.jtcm.2022.06.002 -
In Vivo (Athens, Greece) 2021This systematic review aimed to identify all published evidence on teaching suturing skills for medical students. We aimed to outline significant positive teaching... (Review)
Review
AIM
This systematic review aimed to identify all published evidence on teaching suturing skills for medical students. We aimed to outline significant positive teaching outcomes and devise a comprehensive framework for the optimal teaching of suturing skills for medical students.
MATERIALS AND METHODS
We searched MEDLINE (via Ovid), EMBASE and SCOPUS databases until July 2019 with no language restriction using predefined 'Population, Intervention, Comparison, Outcome (PICO)' criteria. Data were summarised in discrete thematic axes using a qualitative synthesis approach.
RESULTS
Our search yielded a total of 2,562 articles, out of which 25 were included in the final data synthesis. We provide a structured breakdown of educational interventions including participants, instructors and nature of teaching intervention. We also describe discrete means for assessment of performance and retention of suturing skills. Based on those we propose a standardised framework on teaching suturing skills for novices.
CONCLUSION
To our knowledge this is the first systematic review investigating teaching interventions used to teach suturing skills in medical students. After extraction of individual positive teaching outcomes and utilising widely known learning theories and principles, we devised a comprehensive framework for more efficient and cost-effective teaching of suturing skills to medical students in the future.
Topics: Humans; Students, Medical
PubMed: 33402444
DOI: 10.21873/invivo.12226 -
Digestion 2023With the development of endoscopic technology and devices, endoscopic full-thickness resection (EFTR) has been challengingly introduced for gastric subepithelial tumors... (Review)
Review
BACKGROUND
With the development of endoscopic technology and devices, endoscopic full-thickness resection (EFTR) has been challengingly introduced for gastric subepithelial tumors (SETs). The resection and closure strategies are under investigation. This systematic review was performed to assess the current status and limitations of EFTR for gastric SETs.
SUMMARY
MEDLINE was searched using the keywords "endoscopic full-thickness resection" or "gastric endoscopic full-thickness closure" AND "gastric" or "stomach" from January 2001 to July 2022. The outcome variables were the complete resection rate, major adverse event (AE) rate including delayed bleeding and delayed perforation, and closure-associated outcomes. Among 288 studies, 27 eligible studies involving 1,234 patients were included in this review. The complete resection rate was 99.7% (1,231/1,234). The major AE rate was 1.13% (14/1,234), with delayed bleeding in two (0.16%) patients, delayed perforation in one (0.08%), panperitonitis or abdominal abscess in three (0.24%), and other AEs in eight (0.64%). Surgical interventions were required intraoperatively or postoperatively in 7 patients (0.56%). Three patients underwent intraoperative conversion to surgery, due to intraoperative massive bleeding, technical difficulty of closure, and retrieval of falling tumor in the peritoneal cavity. Postoperative surgical rescues for AEs were required in four (0.32%). Subgroup analysis of AE outcomes showed no significant differences among closure techniques consisting of endoclips, purse-string suturing, and over-the-scope clips.
KEY MESSAGES
This systematic review demonstrated acceptable outcomes of EFTR and closure for gastric SETs, indicating that EFTR is a promising forthcoming procedure.
Topics: Humans; Stomach Neoplasms; Endoscopy; Wound Closure Techniques; Gastrectomy; Endoscopic Mucosal Resection; Retrospective Studies; Treatment Outcome; Gastroscopy
PubMed: 37423206
DOI: 10.1159/000530679 -
Orthopaedic Journal of Sports Medicine Apr 2022Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the... (Review)
Review
Functional Outcomes and Subsequent Surgical Procedures After Arthroscopic Suture Versus Screw Fixation for ACL Tibial Avulsion Fractures: A Systematic Review and Meta-analysis.
BACKGROUND
Although arthroscopic screw fixation and suture fixation are mainstream interventions for displaced anterior cruciate ligament avulsion fractures of the tibia, the differences in clinical outcomes between them remain inconclusive.
PURPOSE
To conduct a meta-analysis comparing the clinical and functional outcomes between arthroscopic screw fixation and suture fixation for tibial avulsion fractures.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Inclusion criteria were English-language articles that compared functional outcomes after screw fixation versus suture fixation for tibial avulsion fractures and had at least 1-year follow-up. Relevant data were extracted and analyzed statistically using the Mantel-Haenszel method and variance-weighted means. Random-effects models were used to generate pooled relative risk (RR) estimates with confidence intervals (CIs).
RESULTS
Of 1395 articles initially identified, we included 5 studies with 184 patients (91 patients with screw fixations and 93 patients with suture fixations). The pooled results indicated similar postoperative outcomes for screw fixation and suture fixation: Lysholm score (mean difference [MD], -0.32 [95% CI, -6.08 to 5.44]; = .91), proportion of International Knee Documentation Committee score grade A (74% vs 74%; RR, 0.63 [95% CI, 0.10-3.95]; = .63), Tegner score (MD, 0.10 [95% CI: -1.73 to 1.92]; = .92), and Lachman test results (stable knee joint, 82% vs 82%; RR, 0.99; 95% CI: 0.85-1.16; = .90). Patients in the screw fixation group had a significantly higher overall subsequent surgery rate (46% vs 19%; RR, 2.33; 95% CI,1.51-3.60; = .0001) and implant removal rate (44% vs 3%; RR, 8.52; 95% CI, 3.58-20.29; < .00001) compared with those in the suture fixation group. Nonimplant-related subsequent surgery rates were similar for the 2 groups.
CONCLUSION
The findings indicated a higher risk of subsequent surgery (RR, 2.33) and implant removal (RR, 8.52) after screw fixation when compared with suture fixation for tibial avulsion fractures. However, there were no significant differences in clinical outcome scores between the 2 techniques.
PubMed: 35400137
DOI: 10.1177/23259671221085945 -
Journal of Pediatric Surgery Sep 2021Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement... (Review)
Review
BACKGROUND
Laparoscopic surgery is increasingly used to repair paediatric inguinal hernias and can be divided into intra- or extra-corporeal closing techniques. No statement regarding the superiority of one of the two techniques can be made. This study aims to provide evidence supporting the superiority of intra- or extra-corporeal suturing technique.
METHODS
A systematic literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases. Randomised controlled trials and prospective studies comparing different laparoscopic techniques were eligible for inclusion. Data were pooled using a random-effects model, comparing single-port extra-peritoneal closure to intra-peritoneal purse string suture closing. Primary outcome was recurrence rate. Secondary outcomes were duration of surgery (min), peri‑ and post-operative complications (i.e. injury of spermatic vessels or spermatic cord, tuba lesions, bleeding and apnoea, haematoma/scrotal oedema, hydrocele, wound infection, iatrogenic ascent of the testis and testicular atrophy), contralateral patent processus vaginalis (CPPV) rate, post-operative pain, length of hospital stay and cosmetic appearance of the wound.
RESULTS
Fifteen studies (n = 3680 patients, age range 0.5-12 years, follow-up range 3-10 months) were included is this systematic review. Intra-corporeal hernia repair was performed in 738 children and extra-corporeal repair was performed in 2942 children. A pooled data analysis could only be performed for the single port extra-corporeal closing technique and the three port intra-corporeal closing technique. We found that recurrence rate was lower in the single-port extra-corporeal closing technique compared to the intra-corporeal purse suture closing technique (0.6% vs 5.5%, 95% CI 0.107 (0.024-0.477); p < 0.001). Operation time was shorter for extra-corporeal unilateral and bilateral inguinal hernia repair compared with intra-corporeal approach, but no pooled data analysis could be performed. Due to the presence of substantial heterogeneity, it was not possible to assess other outcome measures.
CONCLUSION
Single-port extra-corporeal closure seems to result in less recurrent hernias and a shorter operative time compared to intra-corporeal purse suture closing technique. No difference regarding peri‑ and post-operative complications could be found and no statements regarding the length of hospital admission, post-operative pain and cosmetics could be made due to substantial heterogeneity.
LEVEL OF EVIDENCE
Level II.
Topics: Child; Data Analysis; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Infant, Newborn; Laparoscopy; Male; Prospective Studies; Treatment Outcome
PubMed: 33674123
DOI: 10.1016/j.jpedsurg.2021.01.049 -
Arthroscopy, Sports Medicine, and... Oct 2023To review the Kerlan-Jobe Orthopaedic Clinic (KJOC) scores, return-to-play rates, and complications after ulnar collateral ligament (UCL) repair with suture augmentation. (Review)
Review
Elbow Ulnar Collateral Ligament Repair With Suture Augmentation Results in Good Clinical Results, a Return-to-Play Rate Between 67% and 93%, and a Postoperative Complication Rate Up to 11.9%: A Systematic Review.
PURPOSE
To review the Kerlan-Jobe Orthopaedic Clinic (KJOC) scores, return-to-play rates, and complications after ulnar collateral ligament (UCL) repair with suture augmentation.
METHODS
A literature search of the PubMed and Scopus databases was conducted on February 17, 2023, using the terms "ulnar collateral ligament," "repair," "internal brace," and "suture augmentation." The search strategy was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol and included 4 articles published from 2019 to 2022. The inclusion criteria included studies reporting outcomes, return-to-play rates, and/or complications after UCL repair with suture augmentation. The exclusion criteria consisted of non-English language studies, case reports, cadaveric studies, animal studies, letters to the editor, studies with overlapping cohorts, and review articles. The risk of bias was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
RESULTS
The final analysis included 4 studies with 510 patients (457 male and 53 female patients), ranging in age between 17.8 and 27.5 years, treated with repair and suture augmentation for UCL tears. In this review, we found a mean postoperative KJOC score ranging from 87.9 to 92.6. The overall rate of return to play at the preinjury level or at a higher level than the preinjury level ranged from 67% to 93%; the mean time to return to play ranged from 6.7 to 17.6 months. The postoperative complication rate in this review ranged from 0% to 11.9%. Among the complications, the most common were ulnar nerve paresthesia (range, 0%-8.2%) and postoperative medial elbow pain (range, 0%-3.1%). Overall, the reoperation rate ranged from 0% to 3.4%. No reruptures were reported.
CONCLUSIONS
UCL repair with the use of suture augmentation results in postoperative KJOC scores ranging from 87.9 to 92.6, a return-to-play rate between 67% and 93%, and a postoperative complication rate up to 11.9%.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
PubMed: 37546384
DOI: 10.1016/j.asmr.2023.100761 -
Eplasty 2023The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds. (Review)
Review
BACKGROUND
The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds.
METHODS
A literature search was conducted using the following keywords: and
RESULTS
In total, 715 studies were retrieved. After abstract review, 13 articles fit the criteria. A total of 2627 repairs were carried out, including nerve grafts (n = 953), suture (n = 482), and neurolysis (n = 1192). Six studies reported good motor outcome, and good sensory outcome was reported across 2 studies. The thigh region accounted for 81.5% of lesions. Sciatic, peroneal, and tibial nerves were all equally affected. Gunshot wounds were the most common mechanism of injury (22.6%).
CONCLUSIONS
The cumulative evidence demonstrates sciatic nerve injury repair has poor motor and sensory outcomes. This study shows there is a lack of standardized outcome measures, making comparisons very difficult. Graft lengths of <4 cm within the intermediate region yielded more successful outcomes. Further higher quality studies of nerve transfers in the lower limbs are needed to determine the optimal repair to restore sciatic nerve function.
PubMed: 37664809
DOI: No ID Found -
Orthopaedic Journal of Sports Medicine Nov 2022In conventional double-row repair for rotator cuff tears, tying the medial row of anchor sutures can strangulate the tendon. The knotless medial row technique has been... (Review)
Review
BACKGROUND
In conventional double-row repair for rotator cuff tears, tying the medial row of anchor sutures can strangulate the tendon. The knotless medial row technique has been recommended to improve vascularity and reduce retear rates. The researchers divided the retear pattern into 2 categories: type 1 (failure at the tendon-bone interface) and type 2 (failure at the musculotendinous junction with healed footprint).
PURPOSE
To compare studies on knot-tying versus knotless double-row repair for rotator cuff tears according to retear type and clinical and radiological outcomes.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
A search of the PubMed, Embase, Scopus, and Cochrane databases was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included were studies that directly compared the knot-tying and knotless double-row techniques and provided postoperative patient-reported outcomes and retear rates. The Methodology Index for Non-Randomized Studies (MINORS) criteria were used for methodological quality assessment of the included studies. Odds ratios (ORs) were calculated for dichotomous outcomes, and mean differences (MDs) were calculated for continuous outcomes.
RESULTS
Included were 12 studies (n = 1411 shoulders); 1 study had level 1 evidence, 3 studies had level 2 evidence, and 8 studies had level 3 evidence. The MINORS score ranged from 15 to 19, indicating that the methodology was fair to good. There was no statistically significant difference in retear rate between techniques (OR, 0.99; 95% CI, 0.67-1.47; = .96); however, more type 1 retears were seen in the knotless technique (OR, 0.42; 95% CI, 0.23-0.77; = .005), and more type 2 retears were seen in the knot-tying technique (OR, 3.15; 95% CI, 1.70-5.83; = .0003). Higher postoperative Constant scores were seen in the knot-tying technique (MD, 1.28; 95% CI, 0.03-2.53; = .04); however, there were no significant differences between techniques regarding other postoperative outcomes.
CONCLUSION
There was no significant difference in overall retear rates between the knotless and knot-tying techniques, and both techniques demonstrated similar clinical outcomes. However, type 2 retear rates were significantly greater after knot-tying repair, and type 1 retear rates were significantly greater after knotless repair.
PubMed: 36452341
DOI: 10.1177/23259671221135604 -
Journal of Experimental Orthopaedics Apr 2023Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and... (Review)
Review
Biomechanical comparison of different suture anchors used in rotator cuff repair surgery-all-suture anchors are equivalent to other suture anchors: a systematic review and network meta-analysis.
PURPOSE
Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair.
METHODS
The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones.
RESULTS
The polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes.
CONCLUSIONS
All-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density.
LEVEL OF EVIDENCE
Level IV.
PubMed: 37067646
DOI: 10.1186/s40634-023-00608-w