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Frontiers in Pediatrics 2024Urethral multiplicity is a rare congenital anomaly characterized by the presence of two or more urethral channels. It is more common in males and can cause double...
INTRODUCTION
Urethral multiplicity is a rare congenital anomaly characterized by the presence of two or more urethral channels. It is more common in males and can cause double urinary stream, incontinence, obstruction, and recurrent urinary infections. Diagnosis is difficult due to diverse clinical manifestations. Implementing an evidence-based treatment plan is challenging due to the need for more concise and informative summary publications. Our paper provides a comprehensive review of the management of this pathology and might serve as a valuable resource for pediatric urologists and specialists in the field.
METHODS
A comprehensive search in four electronic databases, PubMed®, PubMed Central® (PMC), Scopus, and Clarivate Analytics's Web of Science (WoS), was conducted to identify case reports and series published between 2008 and 2023 on urethral multiplicities. The quality of the articles was assessed using qualified instruments. Covidence® tool-guided synthesis was followed by individual patient data extraction. Further classifications and analysis were made using Microsoft Excel®.
RESULTS
Out of the 90 papers included in the review, 62 were case presentations, and 28 were case series. We found 250 boys with urethral multiplicity. Based on Effman's classification, there were 38 cases of type I (15.3%), 21 type IIA1 (8.4%), 55 type IIA2 (22.1%), 91 type IIA2Y (36.5%), 4 type IIB (1.6%), and 6 type III (2.4%) urethral duplications. There were 19 cases of prepubic sinuses (7.6%), 9 triplications (3.6%), and 6 unknown forms (2.4%). We have provided data for each type, including clinical presentation, investigations, surgical management, and outcomes.
CONCLUSIONS
Urethral multiplicities are a rare and varied group of malformations that require high-quality imaging examination for successful management. Treatment is specific to each patient and may depend on the surgeon's preference or skill.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42023471685, identifier (CRD42023471685).
PubMed: 38919842
DOI: 10.3389/fped.2024.1404947 -
Critical Care Explorations Jul 2024Older adults may be under-represented in critical care research, and results may not apply to this specific population. Our primary objective was to evaluate the...
OBJECTIVES
Older adults may be under-represented in critical care research, and results may not apply to this specific population. Our primary objective was to evaluate the prevalence of inclusion of older adults across critical care trials focused on common ICU conditions or interventions. Our secondary objective was to evaluate whether older age was used as a stratification variable for randomization or outcome analysis.
DESIGN SETTING AND SUBJECTS
We performed a systematic review of previously published systematic reviews of randomized controlled trials (RCTs) in critical care. We searched PubMed, Ovid, CENTRAL, and Cochrane from 2009 to 2022. Systematic reviews of any interventions across five topics: acute respiratory distress syndrome (ARDS), sepsis/shock, nutrition, sedation, and mobilization were eligible.
MAIN RESULTS
We identified 216 systematic reviews and included a total of 253 RCTs and 113,090 patients. We extracted baseline characteristics and the reported proportion of older adults. We assessed whether any upper age limit was an exclusion criterion for trials, whether age was used for stratification during randomization or data analysis, and if age-specific subgroup analysis was present. The most prevalent topic was sepsis (78 trials, 31%), followed by nutrition (62 trials, 25%), ARDS (39 trials, 15%), mobilization (38 trials, 15%), and sedation (36 trials, 14%). Eighteen trials (7%) had exclusion criteria based on older age. Age distribution with information on older adults prevalence was given in six trials (2%). Age was considered in the analysis of ten trials (5%) using analytic methods to evaluate the outcome stratified by age.
CONCLUSIONS
In this systematic review, the proportion of older critically ill patients is undetermined, and it is unclear how age is or is not an effect modifier or to what extent the results are valid for older adult groups. Reporting age is important to guide clinicians in personalizing care. These results highlight the importance of incorporating older critically ill patients in future trials to ensure the results are generalizable to this growing population.
Topics: Humans; Critical Illness; Aged; Randomized Controlled Trials as Topic; Critical Care; Aged, 80 and over; Sepsis; Respiratory Distress Syndrome; Patient Selection; Age Factors; Intensive Care Units
PubMed: 38919511
DOI: 10.1097/CCE.0000000000001107 -
Frontiers in Bioengineering and... 2024Musculoskeletal simulations can be used to estimate biomechanical variables like muscle forces and joint torques from non-invasive experimental data using inverse and...
Musculoskeletal simulations can be used to estimate biomechanical variables like muscle forces and joint torques from non-invasive experimental data using inverse and forward methods. Inverse kinematics followed by inverse dynamics (ID) uses body motion and external force measurements to compute joint movements and the corresponding joint loads, respectively. ID leads to residual forces and torques (residuals) that are not physically realistic, because of measurement noise and modeling assumptions. Forward dynamic simulations (FD) are found by tracking experimental data. They do not generate residuals but will move away from experimental data to achieve this. Therefore, there is a gap between reality (the experimental measurements) and simulations in both approaches, the sim2real gap. To answer (patho-) physiological research questions, simulation results have to be accurate and reliable; the sim2real gap needs to be handled. Therefore, we reviewed methods to handle the sim2real gap in such musculoskeletal simulations. The review identifies, classifies and analyses existing methods that bridge the sim2real gap, including their strengths and limitations. Using a systematic approach, we conducted an electronic search in the databases Scopus, PubMed and Web of Science. We selected and included 85 relevant papers that were sorted into eight different solution clusters based on three aspects: how the sim2real gap is handled, the mathematical method used, and the parameters/variables of the simulations which were adjusted. Each cluster has a distinctive way of handling the sim2real gap with accompanying strengths and limitations. Ultimately, the method choice largely depends on various factors: available model, input parameters/variables, investigated movement and of course the underlying research aim. Researchers should be aware that the sim2real gap remains for both ID and FD approaches. However, we conclude that multimodal approaches tracking kinematic and dynamic measurements may be one possible solution to handle the sim2real gap as methods tracking multimodal measurements (some combination of sensor position/orientation or EMG measurements), consistently lead to better tracking performances. Initial analyses show that motion analysis performance can be enhanced by using multimodal measurements as different sensor technologies can compensate each other's weaknesses.
PubMed: 38919383
DOI: 10.3389/fbioe.2024.1386874 -
Frontiers in Neurology 2024Arteriovenous malformations (AVMs) are rare vascular anomalies involving a disorganization of arteries and veins with no intervening capillaries. In the past 10 years,...
BACKGROUND
Arteriovenous malformations (AVMs) are rare vascular anomalies involving a disorganization of arteries and veins with no intervening capillaries. In the past 10 years, radiomics and machine learning (ML) models became increasingly popular for analyzing diagnostic medical images. The goal of this review was to provide a comprehensive summary of current radiomic models being employed for the diagnostic, therapeutic, prognostic, and predictive outcomes in AVM management.
METHODS
A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, in which the PubMed and Embase databases were searched using the following terms: (cerebral OR brain OR intracranial OR central nervous system OR spine OR spinal) AND (AVM OR arteriovenous malformation OR arteriovenous malformations) AND (radiomics OR radiogenomics OR machine learning OR artificial intelligence OR deep learning OR computer-aided detection OR computer-aided prediction OR computer-aided treatment decision). A radiomics quality score (RQS) was calculated for all included studies.
RESULTS
Thirteen studies were included, which were all retrospective in nature. Three studies (23%) dealt with AVM diagnosis and grading, 1 study (8%) gauged treatment response, 8 (62%) predicted outcomes, and the last one (8%) addressed prognosis. No radiomics model had undergone external validation. The mean RQS was 15.92 (range: 10-18).
CONCLUSION
We demonstrated that radiomics is currently being studied in different facets of AVM management. While not ready for clinical use, radiomics is a rapidly emerging field expected to play a significant future role in medical imaging. More prospective studies are warranted to determine the role of radiomics in the diagnosis, prediction of comorbidities, and treatment selection in AVM management.
PubMed: 38915798
DOI: 10.3389/fneur.2024.1398876 -
Photodiagnosis and Photodynamic Therapy Jun 2024This study aimed to assess the effectiveness of photobiomodulation therapy (PBM) in enhancing bone integration with dental implants. (Review)
Review
AIM
This study aimed to assess the effectiveness of photobiomodulation therapy (PBM) in enhancing bone integration with dental implants.
METHOD
PubMed, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar were searched. Studies assessing PBM effectiveness with defined intervention/control groups were included, while those lacking specified laser types, involving severe maxillofacial defects or surgery, and not reporting outcomes related to dental implant osseointegration post-PBM therapy were excluded. The studies' risk of bias was assessed using Robvis for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. The meta-analysis was conducted utilizing a random-effects model at a significance level of 0.01.
RESULTS
The study reviewed 26 papers involving 571 patients undergoing dental implant procedures with PBM/Low-Level Laser Therapy (LLLT) or placebo/control. Implant stability quotients (ISQ) analysis showed a non-significant difference (p = 0.06, mean difference: 1.02, 95 % CI: 0.28 to 1.75, I=28 %), while the Periotest method indicated significant improvement in stability (p < 0.01, mean difference: -0.51, 95 % CI: -0.78 to -0.24, I=71 %). PBM resulted in a significant bone density increase (p < 0.01, mean difference: 26, 95 % CI: 6.93 to 45.06, I=91 %), but marginal bone loss showed no significant difference (p = 0.11, mean difference: 0.00, 95 % CI: -0.06 to 0.05, I=45 %). Implant survival rate did not significantly differ (p = 0.73, mean difference: 1.56, 95 % CI: 0.38 to 6.46, I=0 %). Most studies raised concerns regarding randomization.
CONCLUSION
PBM could improve implant stability, as assessed with Periotest, and increase bone density, enhancing osseointegration. However, implant stability assessed with ISQ, marginal bone loss, and implant survival rate were comparable between the study groups.
PubMed: 38914185
DOI: 10.1016/j.pdpdt.2024.104256 -
Journal of Breast Imaging Jun 2024High mammographic density increases breast cancer risk and reduces mammographic sensitivity. We reviewed evidence on accuracy of supplemental MRI for women with dense...
BACKGROUND
High mammographic density increases breast cancer risk and reduces mammographic sensitivity. We reviewed evidence on accuracy of supplemental MRI for women with dense breasts at average or increased risk.
METHODS
PubMed and Embase were searched 1995-2022. Articles were included if women received breast MRI following 2D or tomosynthesis mammography. Risk of bias was assessed using QUADAS-2. Analysis used independent studies from the articles. Fixed-effect meta-analytic summaries were estimated for predefined groups (PROSPERO: 230277).
RESULTS
Eighteen primary research articles (24 studies) were identified in women aged 19-87 years. Breast density was heterogeneously or extremely dense (BI-RADS C/D) in 15/18 articles and extremely dense (BI-RADS D) in 3/18 articles. Twelve of 18 articles reported on increased-risk populations. Following 21 440 negative mammographic examinations, 288/320 cancers were detected by MRI. Substantial variation was observed between studies in MRI cancer detection rate, partly associated with prevalent vs incident MRI exams (prevalent: 16.6/1000 exams, 12 studies; incident: 6.8/1000 exams, 7 studies). MRI had high sensitivity for mammographically occult cancer (20 studies with at least 1-year follow-up). In 5/18 articles with sufficient data to estimate relative MRI detection rate, approximately 2 in 3 cancers were detected by MRI (66.3%, 95% CI, 56.3%-75.5%) but not mammography. Positive predictive value was higher for more recent studies. Risk of bias was low in most studies.
CONCLUSION
Supplemental breast MRI following negative mammography in women with dense breasts has breast cancer detection rates of ~16.6/1000 at prevalent and ~6.8/1000 at incident MRI exams, considering both high and average risk settings.
PubMed: 38912622
DOI: 10.1093/jbi/wbae019 -
ACS Omega Jun 2024Heavy metal ions (HMIs) are very harmful to the ecosystem when they are present in excess of the recommended limits. They are carcinogenic in nature and can cause... (Review)
Review
Heavy metal ions (HMIs) are very harmful to the ecosystem when they are present in excess of the recommended limits. They are carcinogenic in nature and can cause serious health issues. So, it is important to detect the metal ions quickly and accurately. The metal ions arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), and mercury (Hg) are considered to be very toxic among other metal ions. Standard analytical methods like atomic absorption spectroscopy, atomic fluorescence spectroscopy, and X-ray fluorescence spectroscopy are used to detect HMIs. But these methods necessitate highly technical equipment and lengthy procedures with skilled personnel. So, electrochemical sensing methods are considered to be more advantageous because of their quick analysis with precision and simplicity to operate. They can detect a wide range of heavy metals providing real-time monitoring and are cost-effective and enable multiparametric detection. Various sensing applications necessitate severe regulation regarding the modification of electrode surfaces. Numerous nanomaterials such as graphene, carbon nanotubes, and metal nanoparticles have been extensively explored as interface materials in electrode modifiers. These nanoparticles offer excellent electrical conductivity, distinctive catalytic properties, and high surface area resulting in enhanced electrochemical performance. This review examines different HMI detection methods in an aqueous medium by an electrochemical sensing approach and studies the recent developments in interface materials for altering the electrodes.
PubMed: 38911761
DOI: 10.1021/acsomega.4c00933 -
International Journal of Food... Jun 2024Cronobacter sakazakii is a potentially pathogenic bacterium that is resistant to osmotic stress and low a, and capable of persisting in a desiccated state in powdered... (Review)
Review
Cronobacter sakazakii is a potentially pathogenic bacterium that is resistant to osmotic stress and low a, and capable of persisting in a desiccated state in powdered infant milks. It is widespread in the environment and present in various products. Despite the low incidence of cases, its high mortality rates of 40 to 80 % amongst neonates make it a microorganism of public health interest. This current study performed a comparative assessment between current reduction methods applied for C. sakazakii in various food matrices, indicating tendencies and relevant parameters for process optimization. A systematic review and meta-analysis were conducted, qualitatively identifying the main methods of inactivation and control, and quantitatively evaluating the effect of treatment factors on the reduction response. Hierarchical clustering dendrograms led to conclusions on the efficiency of each treatment. Review of recent research trend identified a focus on the potential use of alternative treatments, with most studies related to non-thermal methods and dairy products. Using random-effects meta-analysis, a summary effect-size of 4-log was estimated; however, thermal methods and treatments on dairy matrices displayed wider dispersions - of τ = 8.1, compared with τ = 4.5 for vegetal matrices and τ = 4.0 for biofilms. Meta-analytical models indicated that factors such as chemical concentration, energy applied, and treatment time had a more significant impact on reduction than the increase in temperature. Non-thermal treatments, synergically associated with heat, and treatments on dairy matrices were found to be the most efficient.
PubMed: 38909488
DOI: 10.1016/j.ijfoodmicro.2024.110777 -
Journal of Affective Disorders Jun 2024We conducted a meta-analysis and qualitative review on the randomized controlled trials investigating the effects of transcranial direct current stimulation and... (Review)
Review
BACKGROUND
We conducted a meta-analysis and qualitative review on the randomized controlled trials investigating the effects of transcranial direct current stimulation and transcranial magnetic stimulation on fear extinction and the return of fear in non-primate animals and humans.
METHODS
The meta-analysis was conducted by searching PubMed, Web of science, PsycINFO, and Cochrane Library and extracting fear response in the active and sham groups in the randomized controlled trials. The pooled effect size was quantified by Hedges' g using a three-level meta-analytic model in R.
RESULTS
We identified 18 articles on the tDCS effect and 5 articles on the TMS effect, with 466 animal subjects and 621 human subjects. Our findings show that tDCS of the prefrontal cortex significantly inhibit fear retrieval in animal models (Hedges' g = -0.50). In human studies, TMS targeting the dorsolateral/ventromedial prefrontal cortex has an inhibiting effect on the return of fear (Hedges' g = -0.24).
LIMITATIONS
The limited number of studies and the heterogeneous designs of the selected studies made cross-study and cross-species comparison difficult.
CONCLUSIONS
Our findings shed light on the optimal non-invasive brain stimulation protocols for targeting the neural circuitry of threat extinction in humans.
PubMed: 38908557
DOI: 10.1016/j.jad.2024.06.060 -
PloS One 2024COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and...
BACKGROUND
COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and increasing risk factors. These challenges were expected to be more severe in sub-Saharan Africa due to the lack of physical infrastructure and inadequate resources. The quantity of studies conducted was limited, and there was a lack of published systematic reviews in the specified region. This systematic review aimed to assess the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries.
METHOD
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and is registered with PROSPERO (ID CRD42023387755). Extensive searches were conducted in MEDLINE, EMBASE, and CINAHL databases in December 2023, supplemented by a manual search of references, grey literature, and the WHO COVID-19 database. Inclusion criteria encompassed studies that reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries, focusing on access to care, health outcomes, and factors related to NCDs. Critical appraisal of study quality was performed using the Joanna Briggs Institute (JBI) analytical cross-sectional studies critical appraisal tool. Data were extracted and synthesized, highlighting the main findings and relevant limitations.
FINDINGS
This review included 30 primary studies with a cumulative sample size of 25634 participants, conducted in seven sub-Saharan African countries. These studies demonstrated that the COVID-19 pandemic significantly disrupted regular NCD patient care provision, with regional variations. The studies also identified a reduction in patient health-seeking behavior and reduced medication adherence, leading to poor treatment outcome. Furthermore, the pandemic and related lockdowns have been implicated in the increased prevalence of substance use, decreased physical exercise, and increased mental health problems.
CONCLUSION
This systematic review identified the complex challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic. It also underlines the need to consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. The main limitation of this review was the study design and setting. All of the studies included in this review employed a cross-sectional design, which may result in a low quality of evidence. This study identified research conducted in only seven countries among the 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result.
Topics: COVID-19; Humans; Africa South of the Sahara; Noncommunicable Diseases; SARS-CoV-2; Pandemics
PubMed: 38905254
DOI: 10.1371/journal.pone.0293376