-
Journal of Indian Prosthodontic Society 2021This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss.
SETTING AND DESIGN
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA).
MATERIALS AND METHODS
The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool.
STATISTICAL ANALYSIS USED
Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software.
RESULTS
Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69).
CONCLUSION
In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.
Topics: Alveolar Bone Loss; Humans; Jaw, Edentulous; Maxilla; Mouth, Edentulous; Prostheses and Implants
PubMed: 34380808
DOI: 10.4103/jips.jips_79_21 -
Which traumatic spinal injury creates which degree of instability? A systematic quantitative review.The Spine Journal : Official Journal of... Jan 2022Traumatic spinal injuries often require surgical fixation. Specific three-dimensional degrees of instability after spinal injury, which represent criteria for optimum... (Review)
Review
BACKGROUND CONTEXT
Traumatic spinal injuries often require surgical fixation. Specific three-dimensional degrees of instability after spinal injury, which represent criteria for optimum treatment concepts, however, are still not well investigated.
PURPOSE
The aim of this review therefore was to summarize and quantify multiplanar instability increases due to spinal injury from experimental studies.
STUDY DESIGN/SETTING
Systematic review.
METHODS
A systematic review of the literature was performed using keyword-based search on PubMed and Web of Science databases in order to detect all in vitro studies investigating the destabilizing effect of simulated and provoked traumatic injury in human spine specimens. Together with the experimental designs, the instability parameters range of motion, neutral zone and translation were extracted from the studies and evaluated regarding type and level of injury.
RESULTS
A total of 59 studies was included in this review, of which 43 studies investigated the effect of cervical spine injury. Range of motion increase, which was reported in 58 studies, was generally lower compared to the neutral zone increase, given in 37 studies, despite of injury type and level. Instability increases were highest in flexion/extension for most injury types, while axial rotation was predominantly affected after cervical unilateral dislocation injury and lateral bending solely after odontoid fracture. Whiplash injuries and wedge fractures were found to increase instability equally in all motion planes.
CONCLUSIONS
Specific traumatic spinal injuries produce characteristic but complex three-dimensional degrees of instability, which depend on the type, level, and morphology of the injury. Future studies should expand research on the cervicothoracic, thoracic, and lumbosacral spine and should additionally investigate the destabilizing effects of the injury morphology as well as concomitant rib cage injuries in case of thoracic spinal injuries. Moreover, neutral zone and translation should be measured in addition to the range of motion, while mechanical injury simulation should be preferred to resection or transection of structures to ensure high comparability with the clinical situation.
Topics: Biomechanical Phenomena; Cadaver; Cervical Vertebrae; Fractures, Compression; Humans; Range of Motion, Articular; Spinal Injuries
PubMed: 34116217
DOI: 10.1016/j.spinee.2021.06.004 -
Clinical Biomechanics (Bristol, Avon) May 2021Pelvic injuries that disrupt the sacroiliac joints often require surgical intervention to restore stability. Quantitative characterization of sacroiliac motion in... (Review)
Review
BACKGROUND
Pelvic injuries that disrupt the sacroiliac joints often require surgical intervention to restore stability. Quantitative characterization of sacroiliac motion in response to physiologic loading provides important metrics of adequate fixation in the evaluation of newly emerged fixation techniques. The objective of this study was to systematically review and evaluate biomechanical evidence on the motion of the sacroiliac joint in its normal, destabilized, and stabilized states.
METHODS
We searched the PubMed database for studies available until June 2020 using keywords: sacroiliac, biomechanic*, and fixation. Publications of any in vivo or in vitro biomechanical study that included measurements of the range of motion at the sacroiliac joint were considered.
FINDINGS
We identified and screened 176 total records, and 13 articles of them met inclusion criteria and were used in this review. The average sacroiliac joint range of motion of the intact pelvis was 1.88° in flexion/extension, 0.85° in lateral bending, 1.26° in axial rotation. Of the 13 studies, four reported sacroiliac motion from a destabilized state, while seven reported the motion after stabilization. A forest plot of the stabilized data set in flexion/extension showed that while the heterogeneity was poor, the weighted effect size of the changes from the intact state to the stabilized state was 0.0%.
INTERPRETATION
Quantitative evidence on sacroiliac joint motion relating to pelvic injuries or fixation is limited. Our results indicate that the pooled intact range of motion from the literature may serve as a viable reference to quantify the effectiveness of new stabilization techniques.
LEVEL OF EVIDENCE
Level V, systematic review.
STUDY TYPE
Therapeutic- investigating the results of a treatment.
Topics: Biomechanical Phenomena; Bone Screws; Cadaver; Humans; Range of Motion, Articular; Rotation; Sacroiliac Joint
PubMed: 33940477
DOI: 10.1016/j.clinbiomech.2021.105368 -
Journal of Indian Prosthodontic Society 2021The aim of this review was to evaluate the survival rate of axial and tilted implants in rehabilitation of edentulous jaws using all on four concept.
AIM
The aim of this review was to evaluate the survival rate of axial and tilted implants in rehabilitation of edentulous jaws using all on four concept.
SETTING AND DESIGN
Systematic Review.
MATERIALS AND METHODS
A literature review was performed in MEDLINE, PubMed Central (PMC), Google scholar, Embase, Cochrane Central Register of Controlled Trials. Hand searches were conducted of the bibliographic of related journals and systematic reviews. A total of 380 articles were obtained from the intial screening process. Of these articles, 25 articles fulfilled the inclusion criteria. The authors performed evaluation of articles independently as well as data extraction and quality assessment.
STATISTICAL ANALYSIS USED
Qualitative analysis.
RESULTS
The major prosthetic complication was the fracture of the acrylic prosthesis. The mean cumulative survival rate of implants (72-132 months) were 94% to 98%. The prosthesis survival rate (12 months) was between 99% to 100%. The averaged bone loss was 1.3 ±0.4 mm (12-60 months). No Significant difference was found between survival rates of axial and tilted implants nor between maxilla and mandible.
CONCLUSION
All on four concept can be employed successfully in the edentulous patients with resorbed ridges while improving their quality of life and reducing morbidity. However,randomized clinical trials with large sampling size and long term follow up should be incorporated.
Topics: Humans; Jaw, Edentulous; Mandible; Prostheses and Implants; Quality of Life; Survival Rate
PubMed: 33835063
DOI: 10.4103/jips.jips_100_20 -
Clinical Rheumatology Aug 2021Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial...
Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial skeleton, peripheral joints, and entheses. It is estimated that 1 in every 200 people are affected by AS, making it an important healthcare and socioeconomic issue. In this review, we aim to explore the current understanding of AS risk factors and provide a comprehensive update. Multiple search strings were used to identify articles of interest published in PubMed between January 1, 2013, and February 1, 2021. On the basis of the literature review and analysis, we present up-to-date information on the risk factors of developing AS and our viewpoints on disease onset and progression. Multiple genetic and nongenetic risk factors have been suggested in the onset of AS. HLA-B27 is known to have a strong association with the disease, but other genes have been implicated in disease development. Aside from genetics, other factors are thought to be involved; up to 70% of patients with AS have subclinical intestinal inflammation, suggesting that the origin of the disease may be in the gut. The exact mechanism by which AS onset begins is most likely complex and multifactorial. Key Points • It remains unclear how interactions between genes, microbes, mechanical stress, gender, and other environmental and lifestyle factors predispose patients to the development of ankylosing spondylitis (AS). • The exact mechanisms of AS are complex and multifactorial which will require much future research • Recognizing the risk factors, as well as understanding gene-environment interactions, may offer valuable insights into the etiology of AS and have important implications for diagnosis and treatment strategies.
Topics: HLA-B27 Antigen; Humans; Inflammation; Risk Factors; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33754220
DOI: 10.1007/s10067-021-05679-7 -
European Cells & Materials Mar 2021For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential.... (Meta-Analysis)
Meta-Analysis
For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential. Therefore, the aim of the present meta-analysis was to summarise all in vitro measurements of human intradiscal pressure performed under defined boundary conditions, i.e. without external loading (intrinsic pressure), under axial loading (compression, traction, shear) and under single-planar bending loading (flexion, extension, lateral bending, axial rotation). Data were evaluated based on segmental level and normalised to force and moment. Regression analysis was performed to investigate coefficients of determination and statistical significance of relationships between intradiscal pressure and segmental level for the single loading conditions. 35 studies fulfilled the inclusion criteria, from which a total of 451 data points were collected for the meta-analysis. High coefficients of determination were found in axial compression (r2 = 0.875) and flexion (r2 = 0.781), while being low for intrinsic pressure (r2 = 0.266) and lateral bending (r2 = 0.385), all showing significant regression fitting (p < 0.01). Intradiscal pressure decreases from the upper cervical spine to the sacrum in all loading conditions, considering the same amount of loading for all segmental levels, while the intrinsic pressure exhibits a minimum of the regression curve in the mid-thoracic spine. Apart from its potential for numerical and experimental model validation, this dataset may help to understand the load distribution along the human spine.
Topics: Humans; Intervertebral Disc; Pressure; Rotation; Spine; Weight-Bearing
PubMed: 33745125
DOI: 10.22203/eCM.v041a25 -
Cancer Treatment Reviews Mar 2021This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs),... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs), inform diagnosis and treatment and standardise management between institutions.
METHODS
PubMed, Medline, EMBASE and meeting proceedings were searched for eligible studies reporting data on patients with BMs and NENs of any grade of differentiation and site; poorly-differentiated large/small cell lung cancer were excluded. Data were extracted and analysed using STATA v.12. Meta-analysis of proportions for calculation of estimated pooled prevalence of BM and calculation of weighted pooled frequency and weighted pooled mean for other variables of interest was performed .
RESULTS
A total of 149 studies met the eligibility criteria. Pooled prevalence of BMs was 18.4% (95% CI 15.4-21.5). BMs were mainly metachronous with initial diagnosis of NEN (61.2%) and predominantly osteoblastic; around 61% were multifocal, with a predisposition in axial skeleton. PET/CT seemed to provide (together with MRI) the highest sensitivity and specificity for BM detection. Almost half of patients (46.4%) reported BM-related symptoms: pain (66%) and skeletal-related events (SREs, fracture/spinal cord compression) (26.2%; weightedweighted mean time-to-SRE 9.9 months). Management of BMs was multimodal [bisphosphonates and bone-modifying agents (45.2%), external beam radiotherapy (34.9%), surgery (14.8%)] and supported by little evidence. Overall survival (OS) from the time of diagnosis of BMs was long [weighted mean 50.9 months (95% CI 40.0-61.9)]. Patients with BMs had shorter OS [48.8 months (95% CI 37.9-59.6)] compared to patients without BMs [87.4 months (95% CI 74.9-100.0); p = 0.001]. Poor performance status and BM-related symptoms were also associated with worse OS.
CONCLUSIONS
BMs in patients with NENs remain underdiagnosed and undertreated. Recommendations for management of BMs derived from current knowledge are provided. Prospective studies to inform management are required.
Topics: Bone Neoplasms; Humans; Neuroendocrine Tumors
PubMed: 33730627
DOI: 10.1016/j.ctrv.2021.102168 -
Neurosurgical Review Dec 2021Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between... (Meta-Analysis)
Meta-Analysis Review
Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between the initial injury leading to decompressive craniectomy (DC) and the rates and types of complications after subsequent CP. It specifically compared between traumatic brain injury (TBI) patients and patients undergoing CP after DC for other indications.A comprehensive search of PubMed, Scopus, and the Cochrane Library databases using PRISMA guidelines was performed to include case-control studies, cohorts, and clinical trials reporting complication data for CP after DC. Information about the patients' characteristics and the rates of overall and specific complications in TBI and non-TBI patients was extracted, summarized, and analyzed.A total of 59 studies, including the authors' institutional experience, encompassing 9264 patients (4671 TBI vs. 4593 non-TBI) met the inclusion criteria; this total also included 149 cases from our institutional series. The results of the analysis of the published series are shown both with and without our series 23 studies reported overall complications, 40 reported infections, 10 reported new-onset seizures, 13 reported bone flap resorption (BFR), 5 reported post-CP hydrocephalus, 10 reported intracranial hemorrhage (ICH), and 8 reported extra-axial fluid collections (EFC). TBI was associated with increased odds of BFR (odds ratio [OR] 1.76, p < 0.01) and infection (OR 1.38, p = 0.02). No difference was detected in the odds of overall complications, seizures, hydrocephalus, ICH, or EFC.Awareness of increased risks of BFR and infection after CP in TBI patients promotes the implementation of new strategies to prevent these complications especially in this category of patients.
Topics: Brain Injuries, Traumatic; Decompressive Craniectomy; Humans; Postoperative Complications; Retrospective Studies; Skull; Surgical Flaps
PubMed: 33686551
DOI: 10.1007/s10143-021-01511-7 -
Plastic and Reconstructive Surgery Mar 2021Management of suspected scaphoid fractures includes repeated evaluation and casting in symptomatic patients with nondiagnostic radiographs. In this systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Management of suspected scaphoid fractures includes repeated evaluation and casting in symptomatic patients with nondiagnostic radiographs. In this systematic review and meta-analysis, the authors compare the diagnostic accuracy of clinical examinations for scaphoid fractures and create a decision guide using Bayesian statistics.
METHODS
The MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases were queried for studies that evaluated clinical index tests and their diagnostic accuracies for scaphoid fracture. Summary estimates were achieved by a bivariate random effects model and used in Bayes' theorem. The authors varied the scaphoid fracture prevalence for sensitivity analysis.
RESULTS
Fourteen articles with 22 index tests and 1940 patients were included. Anatomical snuffbox pain/tenderness (11 studies, 1363 patients), pain with axial loading (eight studies, 995 patients), and scaphoid tubercle tenderness (five studies, 953 patients) had sufficient data for pooled analysis. Anatomical snuffbox pain/tenderness was the most sensitive test (0.93; 95 percent CI, 0.87 to 0.97), and pain with axial loading was the most specific test (0.66; 95 percent CI, 0.41 to 0.85), but all three tests had lower estimated specificities compared with sensitivities. In the base case, the probability of fracture was approximately 60 percent when a patient presented with all three findings after acute wrist injury.
CONCLUSIONS
The posttest probability of scaphoid fracture was sensitive to both prevalence and diagnostic accuracy of individual clinical index tests. In a population with a fracture prevalence of 20 percent, patients presenting with concurrent anatomical snuffbox pain/tenderness, pain on axial loading, and scaphoid tubercle tenderness may benefit from early advanced imaging to rule out scaphoid fractures if initial radiographs are nondiagnostic.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Diagnostic, II.
Topics: Bayes Theorem; Clinical Decision-Making; Fractures, Bone; Humans; Musculoskeletal Pain; Physical Examination; Prevalence; Risk Assessment; Risk Factors; Scaphoid Bone; Wrist Injuries
PubMed: 33620933
DOI: 10.1097/PRS.0000000000007627 -
Clinical Neurology and Neurosurgery Mar 2021Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and...
BACKGROUND AND OBJECTIVE
Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series.
METHOD
We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines.
RESULT
PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements.
CONCLUSION
Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
Topics: Adult; Back Pain; Female; Gait Disorders, Neurologic; Giant Cell Tumor of Tendon Sheath; Humans; Hypesthesia; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Muscle Weakness; Neck Pain; Neurosurgical Procedures; Sacrum; Spinal Fusion; Spinal Neoplasms; Synovitis, Pigmented Villonodular; Thoracic Vertebrae; Young Adult
PubMed: 33596487
DOI: 10.1016/j.clineuro.2021.106489