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Journal of Orthopaedic Surgery and... Dec 2019Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI.
METHODS
We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis.
RESULTS
After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84-90%), 96% (95% CI 95-97%), and 170.09 (95% CI 97.63-296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83-90%), 97% (95% CI 96-98%), and 158.18 (95% CI 74.26-336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively.
CONCLUSION
Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.
Topics: Carboxylic Ester Hydrolases; Hip Prosthesis; Humans; Knee Prosthesis; Prosthesis-Related Infections; Reproducibility of Results; Shoulder Prosthesis; Synovial Fluid; alpha-Defensins
PubMed: 31856885
DOI: 10.1186/s13018-019-1395-3 -
BMC Medical Genetics Sep 2019Rotator cuff disease is a widespread musculoskeletal pathology and a major cause of shoulder pain. Studies on familial predisposition suggest that genetic plays a role... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rotator cuff disease is a widespread musculoskeletal pathology and a major cause of shoulder pain. Studies on familial predisposition suggest that genetic plays a role in the pathogenesis of rotator cuff disease. Several genes are responsible for rotator cuff disease. The aim of this study was to perform a systematic review on genetic association between rotator cuff disease and genes variations.
METHODS
A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases were searched comprehensively using the keywords: "Rotator cuff", "Gene", "Genetic", "Predisposition", "Single-nucleotide polymorphism" and "Genome-wide association".
RESULTS
8 studies investigating genes variations associated with rotator cuff tears were included in this review. 6 studies were case-control studies on candidate genes and 2 studies were GWASs. A significant association between SNPs and rotator cuff disease was found for DEFB1, FGFR1, FGFR3, ESRRB, FGF10, MMP-1, TNC, FCRL3, SASH1, SAP30BP, rs71404070 located next to cadherin8. Contradictory results were reported for MMP-3.
CONCLUSION
Further investigations are warranted to identify complete genetic profiles of rotator cuff disease and to clarify the complex interaction between genes, encoded proteins and environment. This may lead to individualized strategies for prevention and treatment of rotator cuff disease.
LEVEL OF EVIDENCE
Level IV, Systematic Review.
Topics: Cadherins; Databases, Factual; Fibroblast Growth Factor 10; Genetic Variation; Genome-Wide Association Study; Humans; Matrix Metalloproteinase 1; Nuclear Proteins; Polymorphism, Single Nucleotide; Receptor, Fibroblast Growth Factor, Type 1; Receptor, Fibroblast Growth Factor, Type 3; Receptors, Estrogen; Receptors, Immunologic; Rotator Cuff; Rotator Cuff Injuries; Tenascin; Transcription Factors; Tumor Suppressor Proteins; beta-Defensins
PubMed: 31477042
DOI: 10.1186/s12881-019-0883-y -
Archives of Orthopaedic and Trauma... Mar 2020Two methods are currently available for the assay of α-defensin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test. We aimed to assess the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Two methods are currently available for the assay of α-defensin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test. We aimed to assess the diagnostic accuracy of synovial fluid α-defensin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection.
MATERIALS AND METHODS
We searched (from inception to May 2018) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on α-defensin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed using the bivariate diagnostic random-effects model. The receiver-operating curve for each method was calculated.
RESULTS
We included 13 articles in our meta-analysis, including 1170 patients who underwent total hip and knee arthroplasties revision; 368 (31%) had a joint infection according to MSIS and MSIS-modified criteria. Considering the false-positive result rate of 8% and false-negative result rate of 3%, pooled sensitivity and specificity were 0.90 (95% CI 0.83-0.94) and 0.95 (0.92-0.96), respectively. The area under the curve (AUC) was 0.94 (0.92-0.94). No statistical differences in terms of sensitivity and specificity were found between the laboratory-based and qualitative test. The pooled sensitivity and specificity of the two alpha-defensin assessment methods were: laboratory-based test 0.97 (95% CI 0.93-0.99) and 0.96 (95% CI 0.94-0.98), respectively; qualitative test 0.83 (95% CI 0.73-0.91) and 0.94 (95% CI 0.89-0.97), respectively. The diagnostic odds ratio of the α-defensin laboratory based was superior to that of the qualitative test (1126.085, 95% CI 352.172-3600.702 versus 100.9, 95% CI 30.1-338.41; p < 0.001). The AUC for immunoassay and qualitative tests was 0.97 (0.95-0.99) and 0.91 (0.88-0.99), respectively.
CONCLUSION
Detection of α-defensin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two alpha-defensin assessment methods is comparable. The lateral flow assay is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.
Topics: Biomarkers; Hip Joint; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid; alpha-Defensins
PubMed: 31300864
DOI: 10.1007/s00402-019-03232-5 -
Die Pharmazie Jul 2019Previous studies showed that gene polymorphisms may impact the development and progression of periodontitis; nevertheless, inconsistent conclusions were described. This... (Meta-Analysis)
Meta-Analysis
Previous studies showed that gene polymorphisms may impact the development and progression of periodontitis; nevertheless, inconsistent conclusions were described. This study meta-analytically explored the association between periodontitis the gene polymorphisms and periodontitis. We searched PubMed, Embase, Springer and Cochrane Library for the relevant case-control studies of periodontitis up to February 13, 2019. Two reviewers selected studies according to the predefined inclusion and exclusion criteria. Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies, and the combined effect size was calculated using R 3.12 software. A total of 9 studies involving 4113 patients and 2373 controls were included. Meta-analysis of -G1654A gene polymorphisms showed that there were significant differences in model A G (OR = 3.7876, 95%CI = 2.9051-4.9382, < 0.001), AA GG (OR = 4.6743, 95%CI = 3.0900-7.0710, < 0.001), AA GG AG (OR = 3.5131, 95%CI = 2.4496-5.0384, < 0.001), AA + AG GG (OR = 4.3087, 95%CI = 2.8827-6.4402, < 0.001) and AG GG (OR = 3.0639, 95%CI = 1.6804-5.5863, = 0.003). However, no significant differences were found between rs11362, rs1799946 and rs1800972 and periodontitis. Sensitivity analysis implied that our results were robust and no publication bias was noticed. Our meta-analysis showed that the -G1654A polymorphism may be a genetic susceptibility factor for periodontitis.
Topics: Genetic Predisposition to Disease; Humans; Periodontitis; Polymorphism, Single Nucleotide; beta-Defensins
PubMed: 31288894
DOI: 10.1691/ph.2019.9459 -
Journal of Periodontal Research Dec 2019The purpose of this systematic review was to establish if patients suffering from periodontal diseases present differences in the expression or production of cationic...
The purpose of this systematic review was to establish if patients suffering from periodontal diseases present differences in the expression or production of cationic antimicrobial peptides in saliva, gingival fluid, and periodontal tissues. Periodontal diseases are among the most common chronic diseases worldwide and share similar etiological or risk factors (genetic and/or environmental) with other systemic disorders. Over the last decade, an increasing number of publications have suggested the implication of antimicrobial peptides (AMPs) in periodontal and oral tissues conditions. Literature searches were conducted through MEDLINE-PubMed and EMBASE databases which identified 1267 publications. Only clinical studies that focused on assays of the expression and/or production of AMPs in human adult oral fluids (gingival crevicular fluid or saliva) or in oral tissues were retained and finally seventy-four publications meeting inclusion criteria were included. Cathelicidin, α- and β-defensins 1-3 are the most documented AMPs regarding periodontal status. Significant correlations between clinical periodontal indexes (PD, CAL) and/or bacteriological index and LL37 level were retrieved. Data remain inconsistent between the studies for hBDs mainly due to heterogeneity of the results, periodontal disease diagnostic criteria and assaying technique employed. Given their role in innate immunity and their antimicrobial functions, LL-37 and α-defensins may be eligible as periodontal clinical biomarkers and could be an interesting way for therapeutic development.
Topics: Antimicrobial Cationic Peptides; Gingival Crevicular Fluid; Humans; Periodontal Diseases; Periodontal Index; Saliva
PubMed: 31215656
DOI: 10.1111/jre.12676 -
The Journal of Bone and Joint Surgery.... Apr 2019Chronic periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint replacement. Patients with chronic PJI report a...
BACKGROUND
Chronic periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint replacement. Patients with chronic PJI report a substantially lower quality of life and face a higher risk of short-term mortality. Establishing a diagnosis of chronic PJI is challenging because of conflicting guidelines, numerous tests, and limited evidence. Delays in diagnosing PJI are associated with poorer outcomes and morbid revision surgery. The purpose of this systematic review was to compare the diagnostic accuracy of serum, synovial, and tissue-based tests for chronic PJI.
METHODS
This review adheres to the Cochrane Collaboration's diagnostic test accuracy methods for evidence searching and syntheses. A detailed search of MEDLINE, Embase, the Cochrane Library, and the grey literature was performed to identify studies involving the diagnosis of chronic PJI in patients with hip or knee replacement. Eligible studies were assessed for quality and bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analyses were performed on tests with sufficient data points. Summary estimates and hierarchical summary receiver operating characteristic (HSROC) curves were obtained using a bivariate model.
RESULTS
A total of 12,616 citations were identified, and 203 studies met the inclusion criteria. Of these 203 studies, 170 had a high risk of bias. Eighty-three unique PJI diagnostic tests were identified, and 17 underwent meta-analyses. Laboratory-based synovial alpha-defensin tests and leukocyte esterase reagent (LER) strips (2+) had the best performance, followed by white blood-cell (WBC) count, measurement of synovial C-reactive protein (CRP) level, measurement of the polymorphonuclear neutrophil percentage (PMN%), and the alpha-defensin lateral flow test kit (Youden index ranging from 0.78 to 0.94). Tissue-based tests and 3 serum tests (measurement of interleukin-6 [IL-6] level, CRP level, and erythrocyte sedimentation rate [ESR]) had a Youden index between 0.61 to 0.75 but exhibited poorer performance compared with the synovial tests mentioned above.
CONCLUSIONS
The quality of the literature pertaining to chronic PJI diagnostic tests is heterogeneous, and the studies are at a high risk for bias. We believe that greater transparency and more complete reporting in studies of diagnostic test results should be mandated by peer-reviewed journals. The available literature suggests that several synovial fluid-based tests perform well for diagnosing chronic PJI and their use is recommended in the work-up of any suspected case of chronic PJI.
LEVEL OF EVIDENCE
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chronic Disease; Hematologic Tests; Histological Techniques; Humans; Prosthesis-Related Infections; Synovial Fluid
PubMed: 30946198
DOI: 10.2106/JBJS.18.00632 -
Frontiers in Genetics 2019Chronic periodontitis (CP) is a growing problem that affects the worldwide population, having significant impacts on people's daily lives and economic development....
Chronic periodontitis (CP) is a growing problem that affects the worldwide population, having significant impacts on people's daily lives and economic development. Genetics is an important component in the determination of individual susceptibility to periodontal diseases. Numerous studies have been performed to investigate the association between beta defensin 1 () rs11362 polymorphism and risk of CP, but the results are still inconclusive. Therefore, we conducted this meta-analysis to ascertain whether this variation in is associated with CP susceptibility. The relevant studies were searched in PubMed and Chinese National Knowledge Infrastructure (CNKI) databases up to January 9, 2018. Two independent authors selected citations and extracted the data from eligible studies. Odds ratios (ORs) with their 95% confidence intervals (95% CIs) were used to assess the strength of the association. Seven case-control studies were included in this meta-analysis. Based on unadjusted data, there was no obvious association between rs11362 polymorphism and CP risk in all genetic models (A vs. G: OR = 0.86, 95%CI = 0.61-1.20; AA vs. GG: OR = 0.83, 95% CI = 00.50-1.39; AG vs. GG: OR = 1.01, 95%CI = 0.73-1.39; AG+AA vs. GG: OR = 0.91, 95% CI = 00.74-1.11; and AA vs. AG+GG: OR = 0.83, 95% CI = 00.57-1.21); the results of adjusted data also showed no significant relationship. Subgroup analyses based on ethnicity, participants' smoking status, HWE in controls and severity of CP all revealed similar results to that of the overall analysis. Sensitivity analysis indicated the results were robust and no evidence of publication bias was found. Our meta-analysis suggests that rs11362 polymorphism may not have an important effect on the risk of CP. Further large-scale and well-designed studies are necessary to validate our conclusion in the future.
PubMed: 30915104
DOI: 10.3389/fgene.2019.00179 -
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 -
Clinical Orthopaedics and Related... Jul 2018
PubMed: 29912808
DOI: 10.1097/CORR.0000000000000362 -
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