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Hernia : the Journal of Hernias and... Jun 2024We primary aimed to synthesise the available data, assess the effectiveness of different mesh materials in prophylactic mesh placement, and rank these materials... (Review)
Review
PURPOSE
We primary aimed to synthesise the available data, assess the effectiveness of different mesh materials in prophylactic mesh placement, and rank these materials according to the incidence of parastomal hernia (PSH) and other stoma complications.
METHOD
This network meta-analysis performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Four databases were searched for randomised controlled trials of prophylactic mesh placement. The aggregated results were performed in the STATA routine for Bayesian hierarchical random effects models.
RESULT
Thirteen randomised controlled trials from 1203 articles, met the inclusion criteria, including 681 cases without meshes, 65 cases with mesh material of xenogeneic acellular dermis (porcine/bovine), 27 cases with polypropylene/PG910, 114 cases with polypropylene/polyglecaprone (Monocryl), 117 cases with polypropylene/cellulose (ORC), 233 cases with polypropylene, and 35 cases with polypropylene/PVDF. In network A, compared with no mesh, only polypropylene (RR 0.24, 95% CI 0.04-0.80) were significantly associated with a reduction in the incidence of PSH. In network B, no statistical difference regarding stoma complications was found between mesh and no mesh.
CONCLUSION
Based on the network meta-analysis and ranking results, the polypropylene mesh material exhibited the best performance. However, this conclusion needs to be confirmed with larger sample sizes and high-quality randomised controlled trials.
PubMed: 38878219
DOI: 10.1007/s10029-024-03068-y -
Archives of Dermatological Research Jun 2024Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities.
METHODS
A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates.
RESULTS
Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01).
CONCLUSION
If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.
Topics: Humans; Sutures; Dermatologic Surgical Procedures; Suture Techniques; Tissue Adhesives; Polypropylenes; Cicatrix; Randomized Controlled Trials as Topic; Cyanoacrylates; Wound Healing
PubMed: 38850366
DOI: 10.1007/s00403-024-02973-7 -
Hernia : the Journal of Hernias and... May 2024Use of mesh is essential in hernia repair. A common complication after hernia repair is surgical site infection (SSI), which poses a risk in spreading to the mesh,... (Review)
Review
PURPOSE
Use of mesh is essential in hernia repair. A common complication after hernia repair is surgical site infection (SSI), which poses a risk in spreading to the mesh, possibly causing mesh infection. Topical antimicrobial pretreatment of mesh may potentially reduce SSI risk in hernia repair and has shown promising results in in vitro and in vivo studies. Clinical evidence, however, is more important. This systematic review aims to provide an overview of available clinical evidence for antimicrobial pretreated mesh in hernia repair surgery to reduce SSI.
METHODS
We report in accordance with PRISMA guidelines. CENTRAL, EMBASE, CINAHL and PubMed were searched up to October 2023 for studies that investigated the use of antimicrobial pretreated mesh on SSI incidence in adults undergoing hernia repair. The primary outcome was SSI incidence. We also collected data on pathogen involvement, hernia recurrence, and mesh infection. A meta-analysis on SSI risk and GRADE-assessment was performed of eligible studies.
RESULTS
We identified 11 eligible studies (n = 2660 patients); 5 randomized trials and 6 cohort studies. Investigated interventions included pre-coated mesh, antibiotic carriers, mesh soaked or irrigated with antibiotic or antiseptic solution. Meta-analysis showed no significant reduction in SSI for antibiotic pretreated polypropylene mesh (RR 0.76 [95% CI 0.27; 2.09]; I 50%).
CONCLUSION
Data on topical mesh pretreatment to reduce SSI risk after hernia repair is limited. Very low certainty evidence from randomized trials in hernia repair surgery shows no significant benefit for antibiotic mesh pretreatment for SSI reduction, but data are imprecise due to optimal information size not being met.
PubMed: 38722398
DOI: 10.1007/s10029-024-02987-0 -
Water Environment Research : a Research... May 2024Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a... (Review)
Review
A systematic review on microplastic contamination in marine Crustacea and Mollusca of Asia: Current scenario, concentration, characterization, polymeric risk assessment, and future Prospectives.
Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a decline in biodiversity. The present review comprehended the current knowledge of MP contamination in Crustacea and Mollusca from 75 peer-reviewed articles published in Asia between 2015 and 2023. A total of 79 species (27 Crustacea and 52 Mollusca) have been recorded to be contaminated with MPs. Out of the total 27 species of Crustacea, Metopograpsus quadridentatus (327.56 MPs/individual) and Balanus albicostatus (0.42 MPs/individual) showed the highest and lowest contamination, respectively. Out of the total 52 species of Mollusca, Dolabella auricularia (2325 MPs/individual) and Crassostrea gigas and Mytilus edulis (0.2 MPs/individual) showed the highest and lowest contamination, respectively. In terms of country-wise MP contamination, China has the highest number of contaminated species in both phylums among Asia. Findings of pollution indices revealed a very high risk of MP contamination in all the countries. Fiber was reported predominantly in both groups. Blue and black-colored MPs having <500 μm and <500 μm-1 mm size were found dominantly in Crustacea and Mollusca, respectively. Polypropylene was recorded as the dominant plastic polymer in both Crustacea and Mollusca. In essence, this review has provided a comprehensive insight into MP concentration in Crustacea and Mollusca of Asia, highlighting variations among species and geographic locations. This understanding is crucial for tackling urgent environmental challenges, safeguarding human health, and promoting global sustainability initiatives amid the escalating issue of plastic pollution. PRACTITIONER POINTS: Microplastic pollution has created havoc on biodiversity and food safety. A total of 27 and 52 species of crustaceans and Mollusca have been recorded to be contaminated with MPs. Metopograpsus quadridentate and Dolabella auricularia have shown higher MPs contamination. Polypropylene was recorded as the dominant plastic polymer in both crustacean and Mollusca. Findings of pollution indices revealed a very high risk of MP contamination in all the countries.
Topics: Animals; Mollusca; Water Pollutants, Chemical; Risk Assessment; Asia; Microplastics; Crustacea; Environmental Monitoring
PubMed: 38708452
DOI: 10.1002/wer.11029 -
Environmental Pollution (Barking, Essex... May 2024Microplastics pose a significant environmental threat, with potential implications for toxic chemical release, aquatic life endangerment, and human food chain... (Review)
Review
Microplastics pose a significant environmental threat, with potential implications for toxic chemical release, aquatic life endangerment, and human food chain contamination. In Asia, rapid economic growth coupled with inadequate waste management has escalated plastic pollution in rivers, positioning them as focal points for environmental concern. Despite Asia's rivers being considered the most polluted with plastics globally, scholarly attention to microplastics in the region's freshwater environments is a recent development. This study undertakes a systematic review of 228 scholarly articles to map microplastic hotspots in Asian freshwater systems and synthesize current research trends within the continent. Findings reveal a concentration of research in China and Japan, primarily investigating riverine and surface waters through net-based sampling methods. Polyethylene (PE), polypropylene (PP), and polyethylene terephthalate (PET) emerge as the predominant microplastic types, frequently observed as fibers or fragments. However, the diversity of sampling methodologies and reporting metrics complicates data synthesis, underscoring the need for standardized analytical frameworks to facilitate comparative analysis. This paper delineates the distribution of microplastic hotspots and outlines the prevailing challenges and prospects in microplastic research within Asian freshwater contexts.
Topics: Microplastics; Rivers; Environmental Monitoring; Water Pollutants, Chemical; Asia; China; Japan; Plastics
PubMed: 38621450
DOI: 10.1016/j.envpol.2024.123985 -
Journal of Pharmacy & Bioallied Sciences Feb 2024This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G),...
Effectiveness and Biocompatibility of Tooth Aligners Made from Polyethylene Terephthalate Glycol (PeT-G), Polypropylene (PP), Polycarbonate (PC), Thermoplastic Polyurethanes (TPUs), and Ethylene-Vinyl Acetate (EVA): A Systematic Review.
OBJECTIVE
This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G), polypropylene (PP), polycarbonate (PC), thermoplastic polyurethanes (TPUs), and ethylene-vinyl acetate (EVA).
MATERIALS AND METHODS
To find relevant papers published through September 2021, PubMed was searched extensively. Randomized clinical trials (RCTs) and observational studies assessing the effectiveness and biocompatibility of the aligner materials were included. Data were extracted independently, and the quality of included research was appraised using relevant procedures. The research variability necessitated a narrative synthesis.
RESULTS
Five studies were included for comparison. All materials were biocompatible; however, PeT-G and EVA aligners caused the least tissue irritation. Patients preferred TPU aligners for initial comfort and PeT-G aligners for transparency and endurance.
CONCLUSION
Biocompatible PeT-G, PP, PC, TPU, and EVA tooth aligners fix malocclusions. Aligner materials should be chosen based on patient preferences, treatment goals, and material qualities. For stronger proof, a longer-term study is needed.
PubMed: 38595485
DOI: 10.4103/jpbs.jpbs_883_23 -
Environmental Pollution (Barking, Essex... May 2024Microplastics in drinking water captured widespread attention following reports of widespread detection around the world. Concerns have been raised about the potential... (Review)
Review
Microplastics in drinking water captured widespread attention following reports of widespread detection around the world. Concerns have been raised about the potential adverse effects of microplastics in drinking water on human health. Given the widespread interest in this research topic, there is an urgent need to compile existing data and assess current knowledge. This paper provides a systematic review of studies on microplastics in drinking water, their evidence, key findings, knowledge gaps, and research needs. The data collected show that microplastics are widespread in drinking water, with large variations in reported concentrations. Standardized methodologies of sampling and analysis are urgently needed. There were more fibrous and fragmented microplastics, with the majority being <10 μm in size and composed of polyester, polyethylene, polypropylene, and polystyrene. Little attention has been paid to the color of microplastics. More research is needed to understand the occurrence and transfer of microplastics throughout the water supply chain and the treatment efficiency of drinking water treatment plants (DWTPs). Methods capable of analyzing microplastics <10 μm and nanoplastics are urgently needed. Potential ecological assessment models for microplastics currently in use need to be improved to take into account the complexity and specificity of microplastics.
Topics: Humans; Microplastics; Plastics; Drinking Water; Water Pollutants, Chemical; Environmental Monitoring
PubMed: 38537794
DOI: 10.1016/j.envpol.2024.123857 -
Journal of Orthopaedics Jun 2024Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the... (Review)
Review
Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature.
BACKGROUND
Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature.
METHODS
During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%).
RESULTS
The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %).
CONCLUSIONS
The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
PubMed: 38404696
DOI: 10.1016/j.jor.2024.02.019 -
Journal of Abdominal Wall Surgery : JAWS 2023Groin hernia literature often uses the terms light- and heavyweight and small or large pores to describe meshes. There is no universal definition of these terms, and... (Review)
Review
Groin hernia literature often uses the terms light- and heavyweight and small or large pores to describe meshes. There is no universal definition of these terms, and the aim of this scoping review was to assess how mesh weight and pore sizes are defined in the groin hernia literature. In this systematic scoping review, we searched PubMed, Embase, and Cochrane CENTRAL. We included randomised controlled trials with adults undergoing groin hernia repair with the Lichtenstein or laparoscopic techniques using a flat permanent polypropylene or polyester mesh. Studies had to use the terms lightweight, mediumweight, or heavyweight to be included, and the outcome was to report how researchers defined these terms as well as pore sizes. We included 48 studies with unique populations. The weight of lightweight meshes ranged from 28 to 60 g/m with a median of 39 g/m, and the pore size ranged from 1.0 to 4.0 mm with a median of 1.6 mm. The weight of heavyweight meshes ranged from 72 to 116 g/m with a median of 88 g/m, and the pore size ranged from 0.08 to 1.8 mm with a median of 1.0 mm. Only one mediumweight mesh was used weighing 55 g/m with a pore size of 0.75 mm. There seems to be a consensus that meshes weighing less than 60 g/m are defined as lightweight and meshes weighing more than 70 g/m are defined as heavyweight. The weight terms were used independently of pore sizes, which slightly overlapped between lightweight and heavyweight meshes.
PubMed: 38312405
DOI: 10.3389/jaws.2023.11179 -
The Cochrane Database of Systematic... Oct 2023Stress urinary incontinence imposes a significant health and economic burden on individuals and society. Single-incision slings are a minimally-invasive treatment option... (Review)
Review
BACKGROUND
Stress urinary incontinence imposes a significant health and economic burden on individuals and society. Single-incision slings are a minimally-invasive treatment option for stress urinary incontinence. They involve passing a short synthetic device through the anterior vaginal wall to support the mid-urethra. The use of polypropylene mesh in urogynaecology, including mid-urethral slings, is restricted in many countries. This is a review update (previous search date 2012).
OBJECTIVES
To assess the effects of single-incision sling operations for treating urinary incontinence in women, and to summarise the principal findings of relevant economic evaluations.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register, which contains trials identified from: CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, and two trials registers. We handsearched journals, conference proceedings, and reference lists of relevant articles to 20 September 2022.
SELECTION CRITERIA
We included randomised or quasi-randomised controlled trials in women with stress (or stress-predominant mixed) urinary incontinence in which at least one, but not all, trial arms included a single-incision sling.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodological procedures. The primary outcome was subjective cure or improvement of urinary incontinence.
MAIN RESULTS
We included 62 studies with a total of 8051 women in this review. We did not identify any studies comparing single-incision slings to no treatment, conservative treatment, colposuspension, or laparoscopic procedures. We assessed most studies as being at low or unclear risk of bias, with five studies at high risk of bias for outcome assessment. Sixteen trials used TVT-Secur, a single-incision sling withdrawn from the market in 2013. The primary analysis in this review excludes trials using TVT-Secur. We report separate analyses for these trials, which did not substantially alter the effect estimates. We identified two cost-effectiveness analyses and one cost-minimisation analysis. Single-incision sling versus autologous fascial sling One study (70 women) compared single-incision slings to autologous fascial slings. It is uncertain if single-incision slings have any effect on risk of dyspareunia (painful sex) or mesh exposure, extrusion or erosion compared with autologous fascial slings. Subjective cure or improvement of urinary incontinence at 12 months, patient-reported pain at 24 months or longer, number of women with urinary retention, quality of life at 12 months and the number of women requiring repeat continence surgery or sling revision were not reported for this comparison. Single-incision sling versus retropubic sling Ten studies compared single-incision slings to retropubic slings. There may be little to no difference between single-incision slings and retropubic slings in subjective cure or improvement of incontinence at 12 months (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.07; 2 trials, 297 women; low-certainty evidence). It is uncertain whether single-incision slings increase the risk of mesh exposure, extrusion or erosion compared with retropubic minimally-invasive slings; the wide confidence interval is consistent with both benefit and harm (RR 1.55, 95% CI 0.24 to 9.82; 3 trials, 267 women; low-certainty evidence). It is uncertain whether single-incision slings lead to fewer women having postoperative urinary retention compared with retropubic slings; the wide confidence interval is consistent with possible benefit and harm (RR 0.47, 95% CI 0.12 to 1.84; 2 trials, 209 women; low-certainty evidence). The effect of single-incision slings on the risk of repeat continence surgery or mesh revision compared with retropubic slings is uncertain (RR 4.19, 95% CI 0.31 to 57.28; 2 trials, 182 women; very low-certainty evidence). One study reported quality of life, but not in a suitable format for analysis. Patient-reported pain at more than 24 months and the number of women with dyspareunia were not reported for this comparison. We downgraded the evidence due to concerns about risks of bias, imprecision and inconsistency. Single-incision sling versus transobturator sling Fifty-one studies compared single-incision slings to transobturator slings. The evidence ranged from high to low certainty. There is no evidence of a difference in subjective cure or improvement of incontinence at 12 months when comparing single-incision slings with transobturator slings (RR 1.00, 95% CI 0.97 to 1.03; 17 trials, 2359 women; high-certainty evidence). Single-incision slings probably have a reduced risk of patient-reported pain at 24 months post-surgery compared with transobturator slings (RR 0.12, 95% CI 0.02 to 0.68; 2 trials, 250 women; moderate-certainty evidence). The effect of single-incision slings on the risk of dyspareunia is uncertain compared with transobturator slings, as the wide confidence interval is consistent with possible benefit and possible harm (RR 0.78, 95% CI 0.41 to 1.48; 8 trials, 810 women; moderate-certainty evidence). There are a similar number of mesh exposures, extrusions or erosions with single-incision slings compared with transobturator slings (RR 0.61, 95% CI 0.39 to 0.96; 16 trials, 2378 women; high-certainty evidence). Single-incision slings probably result in similar or reduced cases of postoperative urinary retention compared with transobturator slings (RR 0.68, 95% CI 0.47 to 0.97; 23 trials, 2891 women; moderate-certainty evidence). Women with single-incision slings may have lower quality of life at 12 months compared to transobturator slings (standardised mean difference (SMD) 0.24, 95% CI 0.09 to 0.39; 8 trials, 698 women; low-certainty evidence). It is unclear whether single-incision slings lead to slightly more women requiring repeat continence surgery or mesh revision compared with transobturator slings (95% CI consistent with possible benefit and harm; RR 1.42, 95% CI 0.94 to 2.16; 13 trials, 1460 women; low-certainty evidence). We downgraded the evidence due to indirectness, imprecision and risks of bias.
AUTHORS' CONCLUSIONS
Single-incision sling operations have been extensively researched in randomised controlled trials. They may be as effective as retropubic slings and are as effective as transobturator slings for subjective cure or improvement of stress urinary incontinence at 12 months. It is uncertain if single-incision slings lead to better or worse rates of subjective cure or improvement compared with autologous fascial slings. There are still uncertainties regarding adverse events and longer-term outcomes. Therefore, longer-term data are needed to clarify the safety and long-term effectiveness of single-incision slings compared to other mid-urethral slings.
Topics: Female; Humans; Urinary Incontinence, Stress; Urinary Retention; Quality of Life; Dyspareunia; Urinary Incontinence; Postoperative Complications; Pain; Randomized Controlled Trials as Topic
PubMed: 37888839
DOI: 10.1002/14651858.CD008709.pub4