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Frontiers in Pharmacology 2024Osteoking (OK) is prescribed in traditional Chinese medicine to accelerate fracture healing. Although some studies suggest the potential efficacy of OK for fracture...
BACKGROUND
Osteoking (OK) is prescribed in traditional Chinese medicine to accelerate fracture healing. Although some studies suggest the potential efficacy of OK for fracture healing, the evidence remains inconclusive.
AIM
To systematically evaluate the safety of OK and its effect on fracture healing.
METHODS
Relevant authoritative databases were searched until 25 August 2023. Randomized controlled trials (RCTs) of patients with fractures treated with Osteoking were included. We evaluated the risk of bias using the Cochrane tool and performed a meta-analysis using the Review Manager 5.4 software package.
RESULTS
13 studies involving 1123 participants were included. This meta-analysis showed that compared with observations in the control group, the OK group showed a shortened fracture healing time, increased fracture healing rate, reduced swelling regression time and ecchymosis regression time, and improved bone metabolism. In addition, the included studies did not report any serious side effects associated with the use of OK, and the mild side effects resolved without treatment.
CONCLUSION
OK therapy is beneficial and safe for accelerating fracture healing, reducing swelling, eliminating ecchymosis, and improving bone metabolism. However, the meta-analysis results do not support OK treatment for improving the fracture healing rate at all fracture sites and reducing pain across all fracture sites. Further original, high-quality studies are needed to validate these findings.
UNLABELLED
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=452430, identifier CRD42023452430.
PubMed: 38915474
DOI: 10.3389/fphar.2024.1363421 -
Cureus Jan 2024Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting... (Review)
Review
Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren's Disease: A Systematic Review and Meta-Analysis.
Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.
PubMed: 38420076
DOI: 10.7759/cureus.53147 -
Cureus Dec 2023The off-label use of botulinum toxin type-A (BoNT-A) in treating rosacea seems encouraging, but the evidence is still lacking regarding its efficacy and safety. This... (Review)
Review
The off-label use of botulinum toxin type-A (BoNT-A) in treating rosacea seems encouraging, but the evidence is still lacking regarding its efficacy and safety. This study was conducted to summarize the evidence regarding the efficacy and safety of BoNT-A in the treatment of rosacea patients. A comprehensive literature search was conducted in several databases, and 17 studies were included. Before-after and split-face comparisons showed that BoNT-A significantly alleviated the symptoms of facial erythema and flushing and improved the patient's quality of life/satisfaction. However, the symptoms recurred three to six months post-injection, requiring repeated treatments in some patients. The pooled rates of post-injection localized erythema, ecchymosis, and facial muscle affection represented 24.6%, 5.1%, and 4.3%, respectively. BoNT-A seems to be effective in alleviating the symptoms of rosacea with a low rate of adverse events. However, the recurrence of the symptoms a few months after the injection requires repeated sessions, which may raise cost-effectiveness issues. Large-scale clinical trials are required to confirm the effectiveness and define the optimal dosing regimen and the rate of recurrence. Future studies should allow for an adequate follow-up after the treatment, with repeated measurements of the outcomes.
PubMed: 38288198
DOI: 10.7759/cureus.51304 -
Frontiers in Pharmacology 2023venous thromboembolism (VTE) is one of the most common complications after major orthopaedic surgery. Recent studies have suggested that aspirin may also be effective...
Comparison of efficacy and safety between aspirin and oral anticoagulants for venous thromboembolism prophylaxis after major orthopaedic surgery: a meta-analysis of randomized clinical trials.
venous thromboembolism (VTE) is one of the most common complications after major orthopaedic surgery. Recent studies have suggested that aspirin may also be effective in preventing VTE, but it is still controversial whether it can be routinely used. To compare the efficacy and safety of aspirin against oral anticoagulants in the prevention of VTE following total hip arthroplasty (THA), total knee arthroplasty (TKA) or hip fracture surgery (HFS). Relevant publications have been obtained using electronic search databases such as PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials. gov. from inception to 20 July 2023. Only RCTs evaluating the efficacy and safety of aspirin compared with oral anticoagulants undergoing major orthopaedic surgery were included in the meta-analysis. The primary outcome reported was any VTE event (including deep vein thrombosis (DVT) and pulmonary embolism (PE)). Secondary outcomes included mortality, major bleeding (including gastrointestinal bleed, cerebrovascular hemorrhage, or any bleeding requiring a return to the theater), minor bleeding (ecchymosis, epistaxis, hematuria), and wound complications. The risk of bias for all included studies was assessed according to the Cochrane Collaboration's tool. After screening 974 studies, 12 randomized clinical trials (RCTs) were included, involving 5,088 participants, including 2,540 participants in aspirin, 2,205 participants in rivaroxaban, and 323 participants in warfarin. Aspirin was found to be less effective than oral anticoagulants in thromboprophylaxis after major orthopedic surgery (RR = 1.206, 95% CI 1.053-1.383). After subgroup analysis according to the type of oral anticoagulant, the results showed that aspirin was similar to rivaroxaban and inferior to warfarin. Considering that the studies in the warfarin group were all conducted before 2000, our results need to be further confirmed. In addition, the aspirin group had a higher risk of VTE than the control group in other subgroups, including a follow-up time of ≤3 months, type of procedure as TKA, high-dose aspirin (≥650 mg qd), and no combined use of mechanical prophylaxis. In terms of safety events, aspirin did not show significant differences in major bleeding (RR = 0.952, 95% CI 0.499-1.815), all-cause mortality (RR = 1.208, 95% CI 0.459-3.177), and wound-related events (RR = 0.618, 95% CI 0.333-1.145) compared with oral anticoagulants, and aspirin was associated with a reduction in the risk of minor bleeding (RR = 0.685, 95% CI 0.552-0.850) events and total bleeding (RR = 0.726, 95% CI 0.590-0.892). Aspirin reduces bleeding risk after major orthopedic surgery compared with oral anticoagulants, but may sacrifice VTE prevention to some extent. Updated evidence is needed to analyze the thromboprophylaxis effects of aspirin in patients undergoing major orthopedic surgery. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463481, identifier CRD42023463481.
PubMed: 38259284
DOI: 10.3389/fphar.2023.1326224 -
International Wound Journal Apr 2024This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation... (Meta-Analysis)
Meta-Analysis
Comparative efficacy of silver alginate dressings versus standard gauze in enhancing wound healing post-mastectomy for triple-negative breast cancer: A systematic review and meta-analysis.
This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation post-mastectomy in patients with triple-negative breast cancer. From an initial pool of 1245 articles, five studies met the inclusion criteria. The analysis revealed that SAD significantly improve early wound healing 1 week post-mastectomy, as indicated by lower Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scales (I = 85%; Random: SMD: -7.08, 95% CI: -8.26 to -5.98, p < 0.01), compared to SG. Additionally, long-term scar outcomes measured by the Manchester Scar Scale (MSS) 5 months post-mastectomy showed a notable reduction in scar formation (I = 95%; Random: SMD: -12.97, 95% CI: -16.20 to -9.75, p < 0.01)) in the silver alginate group. The findings support the use of SAD in post-mastectomy care for triple-negative breast cancer patients but highlight the need for further research on long-term safety and cost-effectiveness.
Topics: Humans; Alginates; Bandages; Burns; Cicatrix; Mastectomy; Silver; Triple Negative Breast Neoplasms; Wound Healing
PubMed: 38155417
DOI: 10.1111/iwj.14558 -
International Wound Journal Mar 2024This meta-analysis aimed to evaluate the efficacy of Traditional Chinese Medicine (TCM) in enhancing surgical site wound healing following colorectal surgery. We... (Meta-Analysis)
Meta-Analysis
This meta-analysis aimed to evaluate the efficacy of Traditional Chinese Medicine (TCM) in enhancing surgical site wound healing following colorectal surgery. We systematically reviewed and analysed randomized controlled trials (RCTs) that investigated the outcomes of TCM interventions in postoperative wound management, adhering to the PRISMA guidelines. The primary outcome was the assessment of wound healing through the REEDA (redness, oedema, ecchymosis, discharge and approximation) scale at two different time points: the 10th day and 1-month post-surgery. Seven RCTs involving 1884 patients were included. The meta-analysis revealed a statistically significant improvement in wound healing in the TCM-treated groups compared to the control groups at both time intervals. On the 10th day post-surgery, the TCM groups exhibited a significant reduction in REEDA scale scores (I = 98%; random: SMD: -2.25, 95% CI: -3.52 to -0.98, p < 0.01). A similar trend was observed 1-month post-surgery, with the TCM groups showing a substantial decrease in REEDA scale scores (I = 98%; random: SMD: -3.39, 95% CI: -4.77 to -2.01, p < 0.01). Despite the promising results, the majority of the included studies were of suboptimal quality, indicating a need for further high-quality RCTs to substantiate the findings. The results suggest that TCM interventions can potentially enhance wound healing post-colorectal surgery, paving the way for further research in this area to validate the efficacy of TCM in postoperative management.
Topics: Humans; Medicine, Chinese Traditional; Colorectal Surgery; Wound Healing; Digestive System Surgical Procedures
PubMed: 37953697
DOI: 10.1111/iwj.14444 -
JMIR Dermatology Sep 2023Psychogenic purpura is an idiopathic psychodermatologic condition of recurrent, painful purpura precipitated by psychological stress, predominantly affecting young... (Review)
Review
BACKGROUND
Psychogenic purpura is an idiopathic psychodermatologic condition of recurrent, painful purpura precipitated by psychological stress, predominantly affecting young females. Little consensus exists on the diagnostic guidelines for this rare condition, often resulting in costly, unnecessary, and stressful investigations as well as prolonged hospital admissions.
OBJECTIVE
With this first up-to-date systematic review of 134 cases of psychogenic purpura in over a decade, we aim to thoroughly investigate the diagnostic strategy and treatment regimens used in the last decade. With a sooner diagnosis, patient stress and nosocomial ecchymoses can be minimized, and treatment can be expedited.
METHODS
We conducted a literature review of 4 databases (PubMed, Ovid Embase, Ovid MEDLINE, and Web of Science) on October 5, 2022 that yielded 46 full-text articles, which were reviewed and extracted by 2 independent reviewers.
RESULTS
We analyzed a total of 134 cases, consisting largely of females (125/134, 93.3%) with purpura on the upper (103/134, 76.9%) or lower limbs (112/134, 83.6%). Apart from a paresthesia prodrome, patients commonly experienced headaches, malaise, and arthralgia or myalgia. Approximately 70% (95/134) of patients reported a physiological or psychological stressor or psychiatric diagnosis before the development of the purpura. Laboratory testing almost always revealed unremarkable results. The intradermal washed autoerythrocyte sensitization test was positive in 98% (42/43) of cases. Histopathology biopsy findings commonly revealed dermal erythrodiapedesis or hemorrhage (n=34) and perivascular inflammatory infiltrates (n=17). Approximately 42% (56/134) of patients received a novel psychiatric diagnosis, with depression being the most common (40/72, 56%). In both patients with and those without a novel psychiatric diagnosis, observation, counseling, treatment with antidepressants (ie, selective serotonin reuptake inhibitors), and psychotherapy (ie, cognitive behavioral therapy) prevailed in the resolution of the purpura.
CONCLUSIONS
Due to the unclear etiology and infrequent presentation of this condition, it remains a diagnosis of exclusion based on clinical suspicion evaluating the presence of stressors or psychiatric comorbidities and exclusion of systemic conditions. Clinical confirmation can be sought through a positive autoerythrocyte sedimentation test, characteristic histopathology findings, and remission of purpura after psychiatric treatment.
PubMed: 37703091
DOI: 10.2196/48153 -
International Wound Journal Jan 2024Caesarean section (C-section) is a prevalent obstetric surgical procedure, with the choice of analgesic agents playing a pivotal role in postoperative recovery. This... (Meta-Analysis)
Meta-Analysis
Caesarean section (C-section) is a prevalent obstetric surgical procedure, with the choice of analgesic agents playing a pivotal role in postoperative recovery. This systematic meta-analysis aimed to compare the effects of sufentanil (ST) and remifentanil (RT) on postoperative wound healing in caesarean section primiparas undergoing epidural anaesthesia. A comprehensive search was conducted across multiple databases, adhering to PRISMA guidelines, yielding eight randomized controlled trials (RCTs) for inclusion. The primary outcome was wound healing assessment using the REEDA (redness, edema, ecchymosis, discharge, approximation) scale on the third, fifth and tenth postoperative days. The meta-analysis encompassed 691 primiparas. A significant difference in wound healing was observed between ST and RT on the third (I = 99%; Random: SMD: 6.75, 95% CIs: 3.11-10.39, p < 0.01) and fifth days (I = 99%; Random: SMD: 3.63, 95% CIs: 1.56-5.70, p < 0.01) postcaesarean section. However, no significant difference was noted on the tenth day (I = 5%; Random: SMD: 0.00, 95% CIs: -0.45-0.45, p = 0.35). Sufentanil and remifentanil exhibit differential effects on early postoperative wound healing in caesarean section primiparas undergoing epidural anaesthesia. While both opioids are effective analgesics, sufentanil demonstrates a more pronounced impact on wound healing during the immediate postoperative days. Clinicians should consider these findings when selecting an opioid for pain management in this patient population.
Topics: Female; Humans; Pregnancy; Analgesics, Opioid; Anesthesia, Epidural; Cesarean Section; Remifentanil; Sufentanil; Wound Healing; Randomized Controlled Trials as Topic
PubMed: 37697689
DOI: 10.1111/iwj.14377 -
World Journal of Urology Jul 2023False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of... (Meta-Analysis)
Meta-Analysis
PURPOSE
False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of dorsal penile vein. Their presentation is often indistinguishable from true penile fractures (TPF). This overlapping of clinical presentation, and lack of knowledge about FPF, can lead surgeons often to proceed directly to surgical exploration without further examinations. The aim of this study was to define a typical presentation of false penile fractures (FPF) emergency, identifying in absence of "snap" sound, slow detumescence, penile shaft ecchymosis, and penile deviation main clinical signs.
METHODS
We performed a systematic review and meta-analysis based on Medline, Scopus and Cochrane following a protocol designed a priori, to define sensitivity of "snap" sound absence, slow detumescence and penile deviation.
RESULTS
Based on the literature search of 93 articles, 15 were included (73 patients). All patients referred pain, most of them during coitus (n = 57; 78%). Detumescence occurred in 37/73 (51%), and all patients described detumescence occurrence as "slow". The results show that single anamnestic item have a high-moderate sensibility in the diagnosis of FPF, and the highest sensitive item was penile deviation (sensibility = 0.86). However, when more than one item is present, overall sensitivity increases greatly, closing to 100% (95% Confidence Interval 92-100).
CONCLUSION
Surgeons can consciously decide between additional exams, a conservative approach, and rapid intervention using these indicators to detect FPF. Our findings identified symptoms with excellent specificity for FPF diagnosis, giving clinicians more useful tools for making decisions.
Topics: Male; Humans; Rupture; Penile Diseases; Penis; Coitus; Pelvis
PubMed: 37326652
DOI: 10.1007/s00345-023-04456-2 -
Plastic and Reconstructive Surgery.... Jun 2023Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains...
UNLABELLED
Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, especially in Asian skin types. We aimed to compare the Colorado needle electrocautery pure cutting mode and the traditional scalpel to determine their efficacy, complications, and cosmetic outcomes.
METHODS
A systematic review was performed to review the outcome with the conventional method (scalpel) and other methods in upper blepharoplasty procedures. Further, a prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in upper blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis.
RESULTS
Five articles met the inclusion criteria for this systematic review. The prospective randomized controlled trial study included 30 patients; the average incisional time on the electrocautery side was significantly longer than that on the scalpel side, and the electrocautery side had less blood loss during incision than the scalpel side (2.4 versus 3.27 using average cotton bud sticks, respectively) ( < 0.001). Hypopigmented scarring occurred more frequently on the scalpel side; however, the difference was not statistically significant.
CONCLUSIONS
Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for upper eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site. However, the incision time on the electrocautery side was significantly longer than the scalpel side, which may be owing to an adaptation of surgical technique.
PubMed: 37305197
DOI: 10.1097/GOX.0000000000005045