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PloS One 2024In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric patients are limited. The objectives of this review were to determine the incidence of admission ionised hypocalcaemia in paediatric major trauma patients and to explore whether hypocalcaemia is associated with adverse outcomes.
METHODS
A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass' D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05.
RESULTS
Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane's Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80-6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane's Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27).
CONCLUSION
Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.
Topics: Hypocalcemia; Humans; Incidence; Child; Wounds and Injuries; Calcium; Adolescent; Retrospective Studies; Patient Admission
PubMed: 38805515
DOI: 10.1371/journal.pone.0303109 -
Bioengineering (Basel, Switzerland) May 2024(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage.... (Review)
Review
(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage. Despite the frequent occurrence of associated injuries including bone bruises, meniscus, and cartilage damage in patients with ACL injuries, a systematic review of the relationships between the presence of bone bruises and the extent of meniscus and cartilage injuries has yet to be conducted. (2) Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the relationship between bone bruises and meniscus or cartilage injuries following ACL injuries. Study selection, data extraction, and meta-analysis were performed. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessments, and Review Manager 5.3 was used for data analysis. (3) Results: Data were extracted from 22 studies encompassing a total of 2891 patients with ACL injuries. Among the included studies, six studies investigated the relationships between bone bruises and medial meniscus (MM) or lateral meniscus (LM) injuries, while three studies investigated the relationships between bone bruises and cartilage injuries. There were no significant correlations between the presence of bone bruises and MM injuries (relative risk (RR) = 1.32; = 0.61). A quantitative analysis indicated that individuals with bone bruises had a 2.71-fold higher likelihood of sustaining LM injuries than those without bone bruises (RR = 2.71; = 0.0003). The analysis confirmed a significant relationship between bone bruises and cartilage injuries (RR = 6.18; = 0.003). (4) Conclusions: Bone bruises occur most frequently in the lateral compartment. Bone bruises resulting from ACL injuries are related to accompanying LM injuries and cartilage injuries. Knowing these associations and the frequency of injuries may allow orthopedic surgeons to promptly address ACL-related meniscus and cartilage injuries on MRI results and in future clinical practice.
PubMed: 38790382
DOI: 10.3390/bioengineering11050515 -
American Journal of Health Promotion :... May 2024To identify environmental features of multi-family housing (MFH) and their surrounding neighborhoods that influence residents' physical activity (PA). (Review)
Review
OBJECTIVE
To identify environmental features of multi-family housing (MFH) and their surrounding neighborhoods that influence residents' physical activity (PA).
DATA SOURCE
Articles published between January 2000 and September 2023 were identified from major social science, medical, health, behavioral science, and urban studies databases.
STUDY INCLUSION AND EXCLUSION CRITERIA
Studies were included if they (a) were empirical studies published in peer-reviewed journals and written in English; (b) focused on the MFH environment or the surrounding neighborhood; and (c) had at least one PA outcome.
DATA EXTRACTION
Data was extracted regarding the study objective, location, study sample, research design, results related to MFH and neighborhood environment, and limitations.
DATA SYNTHESIS
Descriptive summary of study characteristics and analysis to identify emerging themes at three spatial scales (i.e., building, site and neighborhood).
RESULTS
Findings from 35 identified articles revealed factors influencing MFH residents' PA. On the building level, typology and tenure showed contrasting correlations with PA in different age groups. On the site level, the presence of PA facilities and safe, walking-friendly environments promoted PA. On the neighborhood level, safety, quality of PA and pedestrian infrastructure, upkeep, air quality, aesthetics, neighborhood satisfaction, street connectivity, walkability, land use mix, density, and public transport promoted PA.
CONCLUSION
Study findings highlight the importance of the MFH environments in promoting PA, especially in older adults and young children. With increasing housing demand, understanding diverse MFH typologies and the impact of interventions on multi-spatial scales can help promote healthy and activity-friendly communities.
PubMed: 38785111
DOI: 10.1177/08901171241254940 -
European Archives of Paediatric... May 2024Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors...
PURPOSE
Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors (CCS).
METHODS
A literature search was conducted for studies reporting on children aged 4-19 years treated for any type of malignancy up to the age of 15 years and for whom, at the time of the examination, more than 8 months have elapsed since the end of treatment. Data regarding dental late effects on teeth and craniofacial complex were collected and mean prevalence of each defect was reported.
RESULTS
From the 800 articles identified, 17 studies fulfilled inclusion criteria and were included. A total of 983 CCS were examined, with the total number of healthy controls being 1266 children. Haematological malignancy was the most prevalent diagnosis with the age at diagnosis ranging between 0-15 years. Multiple antineoplastic protocols were implemented with the elapsed time being 8 months up to 17 years. One-third of CCS experienced at least one late effect, with corresponding value for the control group being below 25%. Among the defects identified clinically, microdontia, hypodontia and enamel developmental defects were recorded in 1/4 of CCS. Impaired root growth and agenesis were the two defects mostly recorded radiographically. The effect on dental maturity and on salivary glands was unclear.
CONCLUSION
CCS are at risk of developing dental late effects because of their disease and its treatment and therefore, routine periodic examinations are essential to record their development and provide comprehensive oral healthcare.
PubMed: 38773051
DOI: 10.1007/s40368-024-00896-5 -
Clinical Oral Investigations May 2024To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR).
MATERIALS AND METHODS
A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC).
RESULTS
A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I = 80%).
CONCLUSIONS
Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid.
CLINICAL RELEVANCE
In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF.
Topics: Hyaluronic Acid; Humans; Gingival Recession; Surgical Flaps
PubMed: 38771388
DOI: 10.1007/s00784-024-05701-7 -
The Science of the Total Environment Jul 2024Offshore wind energy developments in European waters are rapidly expanding to meet the increasing global demand for renewable energy. These developments provide new... (Review)
Review
Offshore wind energy developments in European waters are rapidly expanding to meet the increasing global demand for renewable energy. These developments provide new substrates for species colonisation, but also introduce changes in electromagnetic fields, noise levels, and hydrological conditions. Understanding how these man-made structures affect marine biodiversity across various species groups is crucial, yet our knowledge in this field remains incomplete. In this synthesis paper, based on 14 case studies conducted in northeastern Atlantic (North, Irish and Baltic seas), we aggregated species-level data on abundance, biomass, and other quantity proxies spanning the entire food chain from invertebrates to mammals, and compared these variables between wind farms and nearby control sites. Overall, our analysis revealed that in wind farm areas, species tend to occur at higher quantities than in control areas. Additionally, we noticed a slight trend where the positive effect of wind farms was more pronounced in newly established ones, gradually diminishing as wind farms aged. None of the tested covariates (depth, distance from coastline, years in commission) nor species' characteristics (habitat and spawning types, trophic level) showed statistical significance. When examining species groups individually, there was a tendency for wind farm areas to harbour higher quantities of polychaetes, echinoderms and demersal fishes. These findings suggest that wind farms contribute to the so-called reef-effect, providing shelter and food supplies to their inhabitants and acting as no-take-zones. Our results support the idea that wind farms could serve as zones of increased local biodiversity, potentially facilitating spillover effects to nearby areas for certain species groups. Further studies are necessary to gain a more comprehensive understanding of the adverse effects of wind farms on associated biodiversity, while also exploring avenues to amplify their positive impacts.
Topics: Biodiversity; Wind; Animals; Aquatic Organisms; Environmental Monitoring; Renewable Energy; Ecosystem
PubMed: 38768731
DOI: 10.1016/j.scitotenv.2024.173241 -
Chinese Journal of Traumatology =... Apr 2024To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone...
Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis.
PURPOSE
To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.
METHODS
PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3.
RESULTS
This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 - 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95 % CI: -1.79 - -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95 % CI: -0.93 - -0.19, p = 0.003), less bleeding (SMD: -1.5, 95 % CI: -2.81 - -0.18), p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95 % CI: -0.27 - -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95 % CI: -3.28 - -0.61, p < 0.001; isthmal SMD: -1.08, 95 % CI: -1.64 - -0.52, p = 0.002).
CONCLUSION
In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.
PubMed: 38762419
DOI: 10.1016/j.cjtee.2024.04.004 -
Environment International Jun 2024The intensification of microplastics (MPs) pollution has emerged as a formidable environmental challenge, with profound global implications. The pervasive presence of... (Review)
Review
The intensification of microplastics (MPs) pollution has emerged as a formidable environmental challenge, with profound global implications. The pervasive presence of MPs across a multitude of environmental mediums, such as the atmosphere, soil, and oceans, extends to commonplace items, culminating in widespread human ingestion and accumulation via channels like food, water, and air. In the domestic realm, kitchens have become significant epicenters for MPs pollution. A plethora of kitchen utensils, encompassing coated non-stick pans, plastic cutting boards, and disposable utensils, are known to release substantial quantities of MPs particles in everyday use, which can then be ingested alongside food. This paper conducts a thorough examination of contemporary research addressing the release of MPs from kitchen utensils during usage and focuses on the health risks associated with MPs ingestion, as well as the myriad factors influencing the release of MPs in kitchen utensils. Leveraging the insights derived from this analysis, this paper proposes a series of strategic recommendations and measures targeted at mitigating the production of MPs in kitchen settings. These initiatives are designed not solely to diminish the release of MPs but also to enhance public awareness regarding this pressing environmental concern. By adopting more informed practices in kitchens, we can significantly contribute to the reduction of the environmental burden of MPs pollution, thus safeguarding both human health and the ecological system.
Topics: Microplastics; Humans; Cooking and Eating Utensils; Environmental Pollution; Environmental Exposure; Environmental Monitoring
PubMed: 38749117
DOI: 10.1016/j.envint.2024.108740 -
PloS One 2024The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures.
METHODS
We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2).
RESULTS
A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships.
CONCLUSION
Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
Topics: Bone Wires; Humans; Fracture Fixation, Internal; Fractures, Bone; Hand Bones; Forearm Injuries
PubMed: 38748687
DOI: 10.1371/journal.pone.0296149 -
Scandinavian Journal of Trauma,... May 2024Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher difficulty, longer times, and a higher failure rate. This study analyses if Helicopter Emergency Medical Services (HEMS) intubation (time-to) success are influenced by noise, light, and restricted space in comparison to ground intubation. Available literature reporting these parameters was very limited, thus the reported differences between ETI in helicopter vs. ground by confronting parameters such as time to secure airway, first pass success rate and Cormack-Lehane Score were analysed.
METHODS
A systematic review and meta-analysis were conducted using PUBMED, EMBASE, Cochrane Library, and Ovid on October 15th, 2022. The database search provided 2322 studies and 6 studies met inclusion and quality criteria. The research was registered with the International Prospective Register of Systematic Reviews (CRD42022361793).
RESULTS
A total of six studies were selected and analysed as part of the systematic review and meta-analysis. The first pass success rate of ETI was more likely to fail in the helicopter setting as compared to the ground (82,4% vs. 87,3%), but the final success rate was similar between the two settings (96,8% vs. 97,8%). The success rate of intubation in literature was reported higher in physician-staffed HEMS than in paramedic-staffed HEMS. The impact of aircraft type and location inside the vehicle on intubation success rates was inconclusive across studies. The meta-analysis revealed inconsistent results for the mean duration of intubation, with one study reporting shorter intubation times in helicopters (13,0s vs.15,5s), another reporting no significant differences (16,5s vs. 16,8s), and a third reporting longer intubation times in helicopters (16,1s vs. 15,0s).
CONCLUSION
Further research is needed to assess the impact of environmental factors on the quality of ETI on HEMS. While the success rate of endotracheal intubation in helicopters vs. on the ground is not significantly different, the duration and time to secure the airway, and Cormack-Lehane Score may be influenced by environmental factors. However, the limited number of studies reporting on these factors highlights the need for further research in this area.
Topics: Intubation, Intratracheal; Humans; Air Ambulances; Emergency Medical Services
PubMed: 38730289
DOI: 10.1186/s13049-024-01213-1