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Foot & Ankle Orthopaedics Oct 2023Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic...
BACKGROUND
Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic resonance imaging (MRI), and conventional computed tomography (CT) scan to differentiate Lisfranc instability, but they focused on a healthy/injured scale without differentiating subtle injury. Weightbearing CT (WBCT) has emerged as a diagnostic tool for detecting subtle Lisfranc injuries. This systematic review aimed to compare WBCT with conventional CT in diagnosing Lisfranc injury, and the ability to differentiate injuries of varying severities.
METHODS
The review encompassed PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases from inception until July 5, 2023. Inclusion criteria involved studies on CT and/or WBCT for Lisfranc injuries and nonoperative studies. Exclusion criteria composed case reports, commentaries, postoperative imaging studies, pediatric patients, studies with nonobjective radiographic measurements, studies exclusively focused on injury classification, and studies with fewer than 5 patients because of poor statistical power. Data extraction focused on radiographic measurements of the Lisfranc complex, categorized into conventional CT, partial WBCT, and total WBCT.
RESULTS
Out of the initially retrieved 489 articles, 9 met the inclusion criteria. Several studies consistently demonstrate that WBCT provides a higher level of accuracy in measuring the Lisfranc area, offering enhanced sensitivity to detect subtle alterations in joint structure. Moreover, WBCT exhibits superior sensitivity in distinguishing between healthy Lisfranc joints and those with injuries, particularly when identifying dorsal ligament damage. This imaging modality allows for the detection of significant variations in critical measurements like first-second metatarsal (M1-M2) distance, first cuneiform (C1)-M2 distance, and joint volumes, enabling a more comprehensive assessment of Lisfranc joint health especially with subtle instability.
CONCLUSION
This review evaluates the extant literature on WBCT's utility in diagnosing Lisfranc injuries and compares its effectiveness to CT in distinguishing between injuries of varying severity. WBCT, with reliable measurement techniques, appears more adept at detecting subtle Lisfranc instability compared to CT, likely by allowing the assessment of injury under load.
PubMed: 38027457
DOI: 10.1177/24730114231209767 -
Autoimmunity Reviews Feb 2024Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by an elusive etiology and pathophysiology. This study aims to... (Meta-Analysis)
Meta-Analysis
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by an elusive etiology and pathophysiology. This study aims to evaluate the pathological role of neuroinflammation in ME/CFS by conducting an exhaustive analysis of 65 observational studies. Four neuroimaging techniques, including magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), electroencephalography (EEG), and positron emission tomography (PET), were employed to comparatively assess brain regional structure, metabolite profiles, electrical activity, and glial activity in 1529 ME/CFS patients (277 males, 1252 females) and 1715 controls (469 males, 1246 females). Clinical characteristics, including sex, age, and fatigue severity, were consistent with established epidemiological patterns. Regional alterations were most frequently identified in the cerebral cortex, with a notable focus on the frontal cortex. However, our meta-analysis data revealed a significant hypoactivity in the insular and thalamic regions, contrary to observed frequencies. These abnormalities, occurring in pivotal network hubs bridging reason and emotion, disrupt connections with the limbic system, contributing to the hallmark symptoms of ME/CFS. Furthermore, we discuss the regions where neuroinflammatory features are frequently observed and address critical neuroimaging limitations, including issues related to inter-rater reliability. This systematic review serves as a valuable guide for defining regions of interest (ROI) in future neuroimaging investigations of ME/CFS.
Topics: Female; Humans; Male; Brain; Electroencephalography; Fatigue Syndrome, Chronic; Magnetic Resonance Imaging; Neuroimaging; Neuroinflammatory Diseases; Positron-Emission Tomography
PubMed: 38016575
DOI: 10.1016/j.autrev.2023.103484 -
Developmental Cognitive Neuroscience Dec 2023Resting-state functional connectivity (rsFC) has the potential to shed light on how childhood abuse and neglect relates to negative psychiatric outcomes. However, a... (Review)
Review
Resting-state functional connectivity (rsFC) has the potential to shed light on how childhood abuse and neglect relates to negative psychiatric outcomes. However, a comprehensive review of the impact of childhood maltreatment on the brain's resting state functional organization has not yet been undertaken. We systematically searched rsFC studies in children and youth exposed to maltreatment. Nineteen studies (total n = 3079) met our inclusion criteria. Two consistent findings were observed. Childhood maltreatment was linked to reduced connectivity between the anterior insula and dorsal anterior cingulate cortex, and with widespread heightened amygdala connectivity with key structures in the salience, default mode, and prefrontal regulatory networks. Other brain regions showing altered connectivity included the ventral anterior cingulate cortex, dorsolateral prefrontal cortex, and hippocampus. These patterns of altered functional connectivity associated with maltreatment exposure were independent of symptoms, yet comparable to those seen in individuals with overt clinical disorder. Summative findings indicate that rsFC alterations associated with maltreatment experience are related to poor cognitive and social functioning and are prognostic of future symptoms. In conclusion, maltreatment is associated with altered rsFC in emotional reactivity, regulation, learning, and salience detection brain circuits. This indicates patterns of recalibration of putative mechanisms implicated in maladaptive developmental outcomes.
Topics: Adolescent; Humans; Child; Brain; Amygdala; Brain Mapping; Gyrus Cinguli; Child Abuse; Magnetic Resonance Imaging
PubMed: 37952287
DOI: 10.1016/j.dcn.2023.101322 -
Journal of Personalized Medicine Oct 2023Intraoral orthodontic elastics (IOE), typically referred to as rubber bands, are important tools for correcting malocclusion, and they are classified into latex and... (Review)
Review
Evaluation of the Loss of Strength, Resistance, and Elasticity in the Different Types of Intraoral Orthodontic Elastics (IOE): A Systematic Review of the Literature of In Vitro Studies.
BACKGROUND
Intraoral orthodontic elastics (IOE), typically referred to as rubber bands, are important tools for correcting malocclusion, and they are classified into latex and synthetic (elastomeric-based) elastics. They have different strengths and sizes, depending on their intended use, that provide clinicians with the ability to correct both anteroposterior and vertical discrepancies. Clinical use, together with saliva, alters the physical characteristics of both latex and synthetic elastics, causing declines in strength over time.
AIM
The aim of the study was to assess, through a systematic review of in vitro studies, the properties of intraoral elastics. The primary goal was to evaluate how IOEs behave in terms of tension strength and duration. The secondary goal was to investigate the force loss during the first hours of wear. The tertiary goal was to assess how these forces decayed.
MATERIALS AND METHODS
The following electronic databases were searched from December 2020 to April 2021: Medline Full Text, PubMed, Cochrane Clinical Trials Register, Science Direct, and Literature Review. Out of 8505 initial articles, 10 were selected for the systematic review.
RESULTS
The force-degradation property was found in all types of IOEs. The loss of strength was directly proportional to time, with the highest value during the first 3 h after extension, regardless of the elastic band size and manufacturer. The forces generated by the latex bands were higher than in those of the elastomeric-based elastics, but they did not consistently correspond to the loads specified by the manufacturers. The retention forces in the latex IOEs were significantly higher than those in the nonlatex bands, suggesting that elastomeric-based bands need to be changed more frequently and at regular intervals throughout a 24 h period.
CONCLUSION
This systematic review indicates that intraoral orthodontic elastics have the greatest loss of force during the first 3 h, that latex rubber bands have the highest strength during the first hour, that the forces generated are not always consistent with the manufacturer's specifications, and that nonlatex (elastomeric-based) IOEs need to be changed frequently and regularly during a 24-h cycle.
PubMed: 37888106
DOI: 10.3390/jpm13101495 -
Cureus Oct 2023This study aims to compare the outcomes and advantages of total knee arthroplasty (TKA) performed using conventional surgical techniques with those conducted using... (Review)
Review
This study aims to compare the outcomes and advantages of total knee arthroplasty (TKA) performed using conventional surgical techniques with those conducted using robotic-assisted methods in terms of operation time, Oxford knee score, range of motion, tourniquet time, and Western Ontario and McMaster Universities Arthritis index. We performed a literature search through five databases, namely, PubMed, Cochrane Central, Scopus, Embase, and Web of Science, from inception until July 3, 2023. Randomized clinical trials (RCTs) and cohorts comparing conventional TKA with robotic-assisted TKA were included. The risk of bias of the included RCTs was determined using the Cochrane risk of bias tool and the National Institutes of Health tool for cohort studies. We conducted a meta-analysis using Review Manager 5.4. To analyze continuous data, we calculated the mean difference (MD) along with its corresponding 95% confidence interval (CI). By synthesizing data from a comprehensive analysis, the study unveiled noteworthy distinctions between robotic-assisted arthroplasty and conventional arthroplasty across critical parameters. First, a substantial alteration in the hip-knee-ankle (HKA) angle was observed, with the robotic-assisted approach demonstrating a significant difference (MD = 0.84, 95% CI = 0.25-1.43, p = 0.005). Second, in terms of operative time, a notable reduction in surgical duration was noted with conventional TKA (MD = 16.85, 95% CI = 8.08-25.63, p = 0.0002). The assessment of tourniquet time exhibited a significantly longer duration for robotic-assisted arthroplasty (MD = 35.70, 95% CI = 27.80-43.61, p < 0.001). Our findings indicate that conventional TKA outperforms robotic-assisted TKA, primarily due to its shorter operative and tourniquet times, along with a more favorable change in the HKA angle. However, it is worth noting that robotic-assisted TKA showed a slight advantage in pain outcomes, although this advantage was not statistically significant. To gain a more comprehensive understanding, we recommend conducting a large-scale randomized controlled trial that directly compares both TKA methods. This trial should evaluate costs and long-term outcomes while ensuring consistent follow-up durations among studies. Such an approach would greatly assist orthopedic decision-making and contribute to improved TKA outcomes.
PubMed: 37869051
DOI: 10.7759/cureus.46845 -
Epilepsia Open Feb 2024Adenylosuccinate lyase (ADSL) deficiency is a rare inherited metabolic disorder with a wide phenotypic presentation, classically grouped into three types (neonatal, type...
Electroclinical features and phenotypic differences in adenylosuccinate lyase deficiency: Long-term follow-up of seven patients from four families and appraisal of the literature.
OBJECTIVE
Adenylosuccinate lyase (ADSL) deficiency is a rare inherited metabolic disorder with a wide phenotypic presentation, classically grouped into three types (neonatal, type I, and type II). We aim to better delineate the pathological spectrum, focusing on the electroclinical characteristics and phenotypic differences of patients with ADSL deficiency.
PATIENTS AND METHODS
Seven patients, from four different families, underwent serial electroencephalogram (EEG), clinical assessment, and neuroimaging. We also performed a systematic review of the cases published in the literature, summarizing the available clinical, neurophysiological, and genetic data.
RESULTS
We report seven previously unreported ADSL deficiency patients with long-term follow-up (10-34 years). From the literature review, we collected 81 previously reported cases. Of the included patient population, 58 % (51/88) were classified as having ADSL deficiency type I, 28% (25/88) as having type II, and 14% (12/88) as having neonatal. The most frequently reported pathogenic variants are p.R426H homozygous (19 patients), p.Y114H in compound heterozygosity (13 patients), and p.D430N homozygous (6 patients). In the majority (89.2%), disease onset was within the first year of life. Epilepsy is present in 81.8% of the patients, with polymorphic and often intractable seizures. EEG features seem to display common patterns and developmental trajectories: (i) poor general background organization with theta-delta activity; (ii) hypsarrhythmia with spasms, usually adrenocorticotropic hormone-responsive; (iii) generalized epileptic discharges with frontal or frontal temporal predominance; and (iv) epileptic discharge activation in sleep with an altered sleep structure. Imaging features present consistent findings of cerebral atrophy with frontal predominance, cerebellar atrophy, and white matter abnormalities among the three types.
SIGNIFICANCE
ADSL deficiency presents variable phenotypic expression, whose severity could be partially attributed to residual activity of the mutant protein. Although a precise phenotype-genotype correlation was not yet feasible, we delineated a common pattern of clinical, neuroradiological, and neurophysiological features.
Topics: Infant, Newborn; Humans; Adenylosuccinate Lyase; Follow-Up Studies; Autistic Disorder; Epilepsy; Atrophy; Purine-Pyrimidine Metabolism, Inborn Errors
PubMed: 37842880
DOI: 10.1002/epi4.12837 -
Nutrients Sep 2023Constipation-predominant irritable bowel syndrome (IBS-C) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Conventional... (Review)
Review
BACKGROUND
Constipation-predominant irritable bowel syndrome (IBS-C) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Conventional treatments for IBS-C often provide limited efficiency, leading to an increasing interest in exploring herbal remedies. This systematic review aims to evaluate the efficacy and safety of herbal remedies in the management of IBS-C.
MATERIALS AND METHODS
A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and the Cochrane Library was conducted to identify relevant studies published up to July 2023 and data extraction was performed independently by two reviewers.
RESULTS
Overall, the included studies demonstrated some evidence of the beneficial effects of herbal remedies on IBS-C symptoms, including improvements in bowel frequency, stool consistency, abdominal pain, and quality of life. However, the heterogeneity of the interventions and outcome measures limited the ability to perform a meta-analysis.
CONCLUSION
This systematic review suggests that herbal remedies may have potential benefits in the management of IBS-C. However, the quality of evidence is limited, and further well-designed, large-scale RCTs are needed to establish the efficacy and safety of specific herbal remedies for IBS-C. Clinicians should exercise caution when recommending herbal remedies and consider individual patient characteristics and preferences.
Topics: Humans; Abdominal Pain; Constipation; Irritable Bowel Syndrome; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 37836500
DOI: 10.3390/nu15194216 -
Journal of Sport and Health Science May 2024B cells represent a crucial component of adaptive immunity that ensures long-term protection from infection by generating pathogen-specific immunoglobulins. Exercise...
BACKGROUND
B cells represent a crucial component of adaptive immunity that ensures long-term protection from infection by generating pathogen-specific immunoglobulins. Exercise alters B cell counts and immunoglobulin levels, but evidence-based conclusions on potential benefits for adaptive immunity are lacking. This systematic review assessed current literatures on the impact of acute exercise and exercise training on B cells, immunoglobulins, and markers of secretory immunity in human biofluids.
METHODS
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE, Web of Science, and Embase were searched on March 8, 2023. Non-randomized controlled trials and crossover trials investigating the impact of acute exercise or exercise training on B cell counts and proportions, immunoglobulin levels, salivary flow rate, or secretory immunoglobulin A secretion rate were included. Quality and reporting of exercise training studies were assessed using the Tool for the Assessment of Study Quality and reporting in Exercise. Study characteristics, outcome measures, and statistically significant changes were summarized tabularly.
RESULTS
Of the 67 eligible studies, 22 applied acute exercise and 45 applied exercise training. All included outcomes revealed significant alterations over time in acute exercise and exercise training context, but only a few investigations showed significant differences compared to control conditions. Secretory and plasma immunoglobulin A levels were most consistently increased in response to exercise training.
CONCLUSION
B cell-related outcomes are altered by acute exercise and exercise training, but evidence-based conclusions cannot be drawn with high confidence due to the large heterogeneity in populations and exercise modalities. Well-designed trials with large sample sizes are needed to clarify how exercise shapes B cell-related immunity.
Topics: Humans; Adaptive Immunity; B-Lymphocytes; Biomarkers; Exercise; Immunoglobulin A, Secretory; Saliva
PubMed: 37832643
DOI: 10.1016/j.jshs.2023.10.002 -
Journal of Psychopharmacology (Oxford,... Nov 2023Major depressive disorder (MDD) is a leading cause of global disability. Several lines of evidence implicate the dopamine system in its pathophysiology. However, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Major depressive disorder (MDD) is a leading cause of global disability. Several lines of evidence implicate the dopamine system in its pathophysiology. However, the magnitude and consistency of the findings are unknown. We address this by systematically reviewing in vivo imaging evidence for dopamine measures in MDD and meta-analysing these where there are sufficient studies.
METHODS
Studies investigating the dopaminergic system using positron emission tomography or single photon emission computed tomography in MDD and a control group were included. Demographic, clinical and imaging measures were extracted from each study, and meta-analyses and sensitivity analyses were conducted.
RESULTS
We identified 43 studies including 662 patients and 801 controls. Meta-analysis of 38 studies showed no difference in mean or mean variability of striatal D receptor availability ( = 0.06, = 0.620), or combined dopamine synthesis and release capacity ( = 0.19, = 0.309). Dopamine transporter (DAT) availability was lower in the MDD group in studies using DAT selective tracers ( = -0.56, = 0.006), but not when tracers with an affinity for serotonin transporters were included ( = -0.21, = 0.420). Subgroup analysis showed greater dopamine release ( = 0.49, = 0.030), but no difference in dopamine synthesis capacity ( = -0.21, = 0.434) in the MDD group. Striatal D receptor availability was lower in patients with MDD in two studies.
CONCLUSIONS
The meta-analysis indicates striatal DAT availability is lower, but D receptor availability is not altered in people with MDD compared to healthy controls. There may be greater dopamine release and lower striatal D receptors in MDD, although further studies are warranted. We discuss factors associated with these findings, discrepancies with preclinical literature and implications for future research.
Topics: Humans; Dopamine; Depressive Disorder, Major; Tomography, Emission-Computed, Single-Photon; Positron-Emission Tomography; Receptors, Dopamine D2; Dopamine Plasma Membrane Transport Proteins
PubMed: 37811803
DOI: 10.1177/02698811231200881 -
Frontiers in Psychology 2023Diffusion Tensor Imaging (DTI) indicators of different white matter (WM) fibers and brain region lesions for post-stroke aphasia (PSA) are inconsistent in existing...
INTRODUCTION
Diffusion Tensor Imaging (DTI) indicators of different white matter (WM) fibers and brain region lesions for post-stroke aphasia (PSA) are inconsistent in existing studies. Our study examines the consistency and differences between PSA tests performed with DTI. In addition, obtaining consistent and independent conclusions between studies was made possible by utilizing DTI in PSA assessment.
METHODS
In order to gather relevant studies using DTI for diagnosing PSA, we searched the Web of Science, PubMed, Embase, and CNKI databases. Based on the screening and evaluation of the included studies, the meta-analysis was used to conduct a quantitative analysis. Narrative descriptions were provided for studies that met the inclusion criteria but lacked data.
RESULTS
First, we reported on the left hemisphere. The meta-analysis showed that fractional anisotropy (FA) of the arcuate fasciculus (AF) and superior longitudinal fasciculus (SLF), inferior frontal-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), and uncinate fasciculus (UF) were decreased in the PSA group in comparison with the healthy controls ( < 0.00001). However, in the comparison of axial diffusivity (AD), there was no statistically significant difference in white matter fiber tracts in the dual-stream language model of the PSA group. Elevated radial diffusivity (RD) was seen only in the IFOF and ILF ( = 0.01; = 0.05). In the classic Broca's area, the FA of the PSA group was decreased ( < 0.00001) while the apparent diffusion coefficient was elevated ( = 0.03). Secondly, we evaluated the white matter fiber tracts in the dual-stream language model of the right hemisphere. The FA of the PSA group was decreased only in the IFOF ( = 0.001). AD was elevated in the AF and UF ( < 0.00001; PUF = 0.009). RD was elevated in the AF and UF ( = 0.01; = 0.003). The other fiber tracts did not undergo similar alterations.
CONCLUSION
In conclusion, DTI is vital for diagnosing PSA because it detects WM changes effectively, but it still has some limitations. Due to a lack of relevant language scales and clinical manifestations, diagnosing and differentiating PSA independently remain challenging.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=365897.
PubMed: 37790217
DOI: 10.3389/fpsyg.2023.1140588