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Surgical Infections 2018We aim to update a meta-analysis to evaluate the efficiency of polymerase chain reaction (PCR) for diagnosis of periprosthetic joint infection (PJI) because different... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We aim to update a meta-analysis to evaluate the efficiency of polymerase chain reaction (PCR) for diagnosis of periprosthetic joint infection (PJI) because different types of PCR assays have yielded variable diagnostic efficiency from 2013.
METHODS
We conducted our systematic review by searching for keywords in online databases from 2013 to May 2017. Studies were chosen based on inclusion and exclusion criteria and the quality of included studies was assessed. Pooled sensitivity and specificity were compared with other synovial fluid biomarkers. A total of 20 studies, comprising 2,526 participants were assessed.
RESULTS
The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.76 (95% confidence interval [CI]: 0.65-0.85), 0.94 (95% CI: 0.92-0.95), and 0.94 (95% CI: 0.92-0.96), respectively. Meta-regression analysis indicated that use of specific genes, fresh samples, and more than one sample per patient may improve sensitivity.
CONCLUSIONS
Although novel PCR assays have been developed, the sensitivity of PCR for the diagnosis of PJI had decreased compared with the previous meta-analysis (0.86, 95% CI: 0.77-0.92), whereas the high specificity is reliable for excluding PJI. Novel synovial fluid biomarker such as α-defensin, which possesses pooled sensitivity between 0.96 and 1.00, might be more efficient than PCR in PJI diagnosis.
Topics: Biomarkers; Humans; Joint Prosthesis; Polymerase Chain Reaction; Prosthesis-Related Infections; Reproducibility of Results; Sensitivity and Specificity; Synovial Fluid
PubMed: 29920159
DOI: 10.1089/sur.2018.014 -
PloS One 2020The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty...
Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty.
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Capsule; Joint Instability; Postoperative Complications
PubMed: 32101545
DOI: 10.1371/journal.pone.0229128 -
Evidence-based Complementary and... 2021Compound capsule (CTCC), an antitumor Chinese patent medicine, has been commonly prescribed as an adjunctive agent to chemotherapy for the management of non-small-cell...
BACKGROUND
Compound capsule (CTCC), an antitumor Chinese patent medicine, has been commonly prescribed as an adjunctive agent to chemotherapy for the management of non-small-cell lung cancer (NSCLC); however, the effects of CTCC added to chemotherapy for NSCLC patients have never been comprehensively evaluated or summarized.
PURPOSE
To assess the synergistic effects of CTCC and chemotherapy on NSCLC. . Evidence-based study, systematic review, and quantitative meta-analysis.
METHODS
This systematic review and meta-analysis was implemented in accordance with the PRISMA (Preferred Reported Items for Systematic Review and Meta-Analysis) guidelines. Eight databases including China National Knowledge Infrastructure, SINOMED, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Cochrane Library, and EMBASE were searched for relevant RCTs from their inception until May 24, 2021, and hand-searching was also carried out to identify additional studies. All randomized controlled trials (RCTs) that compared CTCC combined with chemotherapy versus chemotherapy alone were included in our study. The Cochrane Risk-of-Bias tool was used to determine the risk of bias and methodological quality of the included RCTs. Review Manager 5.3 software was used for comprehensive analysis. The primary outcome measure for this study was the disease control rate (DCR), and the secondary outcomes included the objective response rate (ORR), adverse reactions, and quality of life (QOL).
RESULTS
Six RCTs with a total sample size of 410 were finally included. The pooled data showed that, compared with chemotherapy alone, CTCC combined with chemotherapy significantly improved DCR (RR = 1.15, 95% CI: 1.06-1.25, = 0.006), ORR (RR = 1.38, 95% CI: 1.18-1.63, 0.00001), and QOL (MD = 8.69, 95% CI: 7.26-10.13, < 0.006) and reduced the incidence of total adverse reactions (RR = 0.48, 95% CI: 0.38-0.60, < 0.00001). The subgroup analyses indicated that CTCC plus chemotherapy significantly improved gastrointestinal reactions ( = 0.004), leukopenia ( = 0.0009), thrombocytopenia ( = 0.01), rash ( = 0.002), and fever ( = 0.007).
CONCLUSION
Based on the available evidence, compared with chemotherapy alone, CTCC used as an adjunctive agent to chemotherapy for NSCLC can improve the clinical efficacy and quality of life and decrease the likelihood of adverse reactions, suggesting that CTCC might be an effective and safe adjunctive medicine to chemotherapy for NSCLC. However, considering the relatively small sample size and the inherent imperfections of the included randomized controlled trials, more high-quality clinical trials with longer follow-up time are needed to further assess the efficacy and safety of this combined treatment regimen.
PubMed: 34956388
DOI: 10.1155/2021/9535061 -
Knee Surgery, Sports Traumatology,... Mar 2012Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures.... (Review)
Review
PURPOSE
Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures. The aim of this review is to highlight the molecular basis and histopathological features of early OA.
METHODS
Selective review of literature.
RESULTS
Risk factors for developing early OA include, but are not limited to, a genetic predisposition, mechanical factors such as axial malalignment, and aging. In early OA, the articular cartilage surface is progressively becoming discontinuous, showing fibrillation and vertical fissures that extend not deeper than into the mid-zone of the articular cartilage, reflective of OARSI grades 1.0-3.0. Early changes in the subchondral bone comprise a progressive increase in subchondral plate and subarticular spongiosa thickness. Early OA affects not only the articular cartilage and the subchondral bone but also other structures of the joint, such as the menisci, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad. Genetic markers or marker combinations may become useful in the future to identify early OA and patients at risk.
CONCLUSION
The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease.
LEVEL OF EVIDENCE
Systematic review, Level II.
Topics: Animals; Biomechanical Phenomena; Bone and Bones; Cartilage, Articular; Chemokines; Chondrocytes; Collagen; Disease Models, Animal; Disease Progression; Extracellular Matrix; Genetic Predisposition to Disease; Humans; Interleukins; Menisci, Tibial; Osteoarthritis; Proteoglycans; Synovial Membrane
PubMed: 22009557
DOI: 10.1007/s00167-011-1705-8 -
Rheumatology (Oxford, England) Jul 2012To present the published data concerning the US assessment of tendon lesions as well as the US metric properties investigated in inflammatory arthritis. (Review)
Review
A systematic literature review of US definitions, scoring systems and validity according to the OMERACT filter for tendon lesion in RA and other inflammatory joint diseases.
OBJECTIVE
To present the published data concerning the US assessment of tendon lesions as well as the US metric properties investigated in inflammatory arthritis.
METHODS
A systematic literature search of PubMed, Embase and the Cochrane Library was performed. Selection criteria were original articles in the English language reporting US, Doppler, tenosynovitis and other tendon lesions in patients with RA and other inflammatory arthritis. Data extraction focused on the definition and quantification of US-detected tenosynovitis and other tendon abnormalities and the metric properties of US according to the OMERACT filter for evaluating the above tendon lesions.
RESULTS
Thirty-three of 192 identified articles were included in the review. Most articles were case series (42%) or case-control (33%) studies describing hand and/or foot tenosynovitis in RA patients. The majority of older articles used only B-mode, whereas the most recent studies have incorporated Doppler mode. Definition of tenosynovitis or other tendon lesion was provided in 70% of the evaluated studies. Most of the studies (61%) used a binary score for evaluating tendon abnormalities. Concerning the OMERACT filter, 24 (73%) articles dealt with construct validity. The comparator most commonly used was clinical assessment and MRI. There were few studies assessing criterion validity. Some studies evaluated reliability (36%), responsiveness (21%) and feasibility (12%).
CONCLUSION
US seems a promising tool for evaluating inflammatory tendon lesions. However, further validation is necessary for implementation in clinical practice and trials.
Topics: Arthritis, Rheumatoid; Diagnosis, Differential; Humans; Joint Diseases; Reproducibility of Results; Severity of Illness Index; Synovial Membrane; Tendons; Tenosynovitis; Ultrasonography, Doppler
PubMed: 22378717
DOI: 10.1093/rheumatology/kes018 -
Chinese Medical Journal Aug 2016Periprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein (CRP), can provide high value in the diagnosis of PJI remains unanswered and, therefore, was the aim of the study.
METHODS
First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as "periprosthetic joint infection", "synovial fluid", and "C-reactive protein". Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve, and the area under the SROC (AUSROC) were pooled together and used to evaluate overall diagnostic performance.
RESULTS
Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 (95% confidence interval [CI]: 0.86-0.96), 0.90 (95% CI: 0.87-0.93), and 101.40 (95% CI: 48.07-213.93), respectively. The AUSROC was 0.9663 (standard error, 0.0113).
CONCLUSIONS
Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; C-Reactive Protein; Female; Humans; Male; Prosthesis-Related Infections; Synovial Fluid
PubMed: 27503025
DOI: 10.4103/0366-6999.187857 -
Clinical Biomechanics (Bristol, Avon) Jan 2023Residual horizontal instability after surgical treatment for acromioclavicular joint injuries is seen as a potential cause of suboptimal clinical outcomes. Biomechanical... (Review)
Review
BACKGROUND
Residual horizontal instability after surgical treatment for acromioclavicular joint injuries is seen as a potential cause of suboptimal clinical outcomes. Biomechanical studies have demonstrated that the acromioclavicular capsule/ligaments are the primary restraints for anteroposterior translation. However, limited studies have addressed the biomechanics of a reconstruction of the acromioclavicular capsule/ligaments. The aim of this systematic review was to evaluate the biomechanical role of acromioclavicular capsule/ligament reconstruction techniques after an acromioclavicular joint injury.
METHODS
A search was carried out on the databases Medline and EMBASE, and was conducted according to the PRISMA guidelines. Biomechanical studies addressing horizontal and vertical displacement or joint stiffness after reconstructing the acromioclavicular capsule/ligament with or without coracoclavicular ligament reconstruction, were included.
FINDINGS
Nineteen studies were included in this review after screening and eligibility assessment. Five of them investigated different sole acromioclavicular capsule/ligament reconstruction techniques. In 10 studies, a sole coracoclavicular ligament reconstruction was compared to a coracoclavicular ligament reconstruction with additional acromioclavicular capsule/ligament reconstruction. The remaining 4 studies compared different acromioclavicular capsule/ligament with coracoclavicular reconstruction techniques with each other.
INTERPRETATION
Several testing protocols to evaluate acromioclavicular capsule/ligament reconstruction have been described and can make it difficult to compare the results of the different studies. Acromioclavicular capsule/ligament reconstruction may provide increased anteroposterior and rotational stability but an optimal reconstruction technique, which mimics all biomechanical characteristics of the native joint is not yet available.
Topics: Humans; Acromioclavicular Joint; Cadaver; Plastic Surgery Procedures; Ligaments, Articular; Biomechanical Phenomena; Joint Dislocations
PubMed: 36521410
DOI: 10.1016/j.clinbiomech.2022.105847 -
The Bone & Joint Journal Jun 2018The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems... (Review)
Review Meta-Analysis
AIMS
The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI).
MATERIALS AND METHODS
Studies using alpha-defensin or Synovasure (Zimmer Biomet, Warsaw, Indiana) to diagnose PJI were identified from systematic searches of electronic databases. The quality of the studies was evaluated using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) tool. Meta-analysis was completed using a bivariate model.
RESULTS
A total of 11 eligible studies were included. The median QUADAS score was 13 (interquartile range 13 to 13) out of 14. Significant conflicts of interest were identified in five studies. The pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% confidence interval (CI) 0.91 to 0.98) and the pooled specificity was 0.97 (95% CI 0.95 to 0.98) for four studies with a threshold level of 5.2 mgl The pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74 to 0.92) and the pooled specificity was 0.90 (95% CI 0.91 to 0.98). There was a statistically significant difference in sensitivity (p = 0.019), but not specificity (p = 0.47).
CONCLUSION
Laboratory-based alpha-defensin testing remains a promising tool for diagnosing PJI. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are required before the widespread adoption of the lateral flow cassette alpha-defensin test. Cite this article: Bone Joint J 2018;100-B:703-11.
Topics: Arthroplasty; Biomarkers; Enzyme-Linked Immunosorbent Assay; Humans; Predictive Value of Tests; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid; alpha-Defensins
PubMed: 29855233
DOI: 10.1302/0301-620X.100B6.BJJ-2017-1563.R1 -
The American Journal of Sports Medicine Sep 2020Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences...
BACKGROUND
Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear.
PURPOSE
To systematically review and compare the outcomes of GB and SCR for large to massive RCT.
STUDY DESIGN
Systematic review.
METHODS
A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically ( < .05).
RESULTS
A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB.
CONCLUSION
In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
Topics: Arthroscopy; Humans; Joint Capsule; Middle Aged; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Tendon Transfer; Treatment Outcome
PubMed: 31766858
DOI: 10.1177/0363546519889040 -
Knee Surgery, Sports Traumatology,... Oct 2016There are few evidence-based recommendations on the most effective methods for diagnosing prosthetic joint infections (PJIs), and the potency of tests in relation to... (Review)
Review
PURPOSE
There are few evidence-based recommendations on the most effective methods for diagnosing prosthetic joint infections (PJIs), and the potency of tests in relation to each other also remains vague. This systematic review aimed to (1) identify systematic reviews reporting accuracies of available approaches for diagnosing PJI, (2) critically appraise their quality and bias, and (3) compare the available approaches in terms of accuracy for diagnosing PJI.
METHODS
PubMed and EMBASE databases were searched for meta-analyses reporting accuracies of different diagnostic modalities for PJIs. Thirteen systematic reviews met the inclusion and exclusion criteria, and their data were extracted and tabulated by two reviewers in duplicate and independent manners.
RESULTS
The 13 articles reported diagnostic accuracy from 278 clinical studies comprising 27,754 patients and evaluating 13 diagnostic tests grouped into 7 broad categories. Implant sonication had the highest positive likelihood ratio (17.2), followed by bacteriology (15.3) and synovial fluid differentiated cytology (13.3). The highest negative likelihood ratio was for interleukin (IL)-6 serum marker (0.03) followed by synovial fluid cytology and differentiation (0.12 and 0.13, respectively).
CONCLUSION
The diagnostic tests that are most likely to rule out PJI include serum IL-6, serum C-reactive protein, and synovial fluid cytology. On the other hand, the diagnostic test that is most likely to confirm PJI is implant sonication. Nuclear imaging showed low overall accuracy as diagnostic tests for PJI. The findings of this study could enable clinicians to confirm or rule out PJIs using the most accurate, rapid, least invasive, and cost-effective tools available, thereby enabling fast treatment before formation of resistant biofilms and degradation of patient conditions.
LEVEL OF EVIDENCE
Systematic review, Level IV.
Topics: Arthroplasty, Replacement; Bacterial Typing Techniques; C-Reactive Protein; Humans; Interleukin-6; Joint Prosthesis; Likelihood Functions; Prosthesis-Related Infections; Synovial Fluid
PubMed: 27377905
DOI: 10.1007/s00167-016-4230-y