-
Otology & Neurotology : Official... Dec 2021To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI).
DATA SOURCES
PubMed, Web of Science, and Cochrane databases.
STUDY SELECTION
Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis.
DATA EXTRACTION
Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool.
DATA SYNTHESIS
Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03-13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16-4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92-3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28-7.18) were not associated with differences in wound complication rates following CI.
CONCLUSIONS
Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.
Topics: Cochlear Implantation; Humans; Prospective Studies; Seroma; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 34607994
DOI: 10.1097/MAO.0000000000003325 -
Journal of Bodywork and Movement... Jul 2021Dry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.
METHODS
Databases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.
RESULTS
Out of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.
CONCLUSION
Good quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.
Topics: Dry Needling; Humans; Myofascial Pain Syndromes; Osteoarthritis, Knee; Pain; Pain Measurement
PubMed: 34391253
DOI: 10.1016/j.jbmt.2021.02.015 -
Facial Plastic Surgery : FPS Jun 2022There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal...
There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were "tear trough" OR "infraorbital" AND "dermal filler" OR "hyaluronic acid" OR "poly-L-lactic acid" OR "calcium hydroxyapatite" OR "Restylane" OR "Radiesse" OR "Perlane" OR "Juvéderm" OR "Belotero." Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue-gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.
Topics: Cosmetic Techniques; Dermal Fillers; Eyelids; Humans; Rejuvenation; Skin Aging
PubMed: 34192769
DOI: 10.1055/s-0041-1731348 -
Animals : An Open Access Journal From... Apr 2021The objective of this systematic review was to synthesize all the preclinical studies carried out in periosteal distraction osteogenesis (PDO) in order to evaluate the... (Review)
Review
The objective of this systematic review was to synthesize all the preclinical studies carried out in periosteal distraction osteogenesis (PDO) in order to evaluate the quality using the ARRIVE guidelines. The animal models used, and the influence of the complications, were analysed in order to establish the most appropriate models for this technique. The PRISMA statements have been followed. Bibliographic sources have been consulted manually by two reviewers. Risk of bias was evaluated using the SYRCLE tool for animal studies, and the quality of the studies with the ARRIVE 2.0 guidelines. The selection criteria established by expert researchers were applied to decide which studies should be included in the review, that resulted in twenty-four studies. Only one achieved the maximum score according to the ARRIVE 2.0 guidelines. The rabbit as an animal model has presented good results in PDO, both for calvaria and jaw. Rats have shown good results for PDO in calvaria. The minipig should not be recommended as an animal model in PDO. Despite the increase in the quality of the studies since the implementation of the ARRIVE 2.0 guidelines, it would be necessary to improve the quality of the studies to facilitate the transparency, comparison, and reproducibility of future works.
PubMed: 33923253
DOI: 10.3390/ani11051233 -
Clinical Rheumatology Nov 2021Psoriatic onycho-pachydermo periostitis (POPP) is characterized by psoriatic onychodystrophy, connective tissue thickening, and periostitis of the distal phalanges... (Review)
Review
Psoriatic onycho-pachydermo periostitis (POPP): a case report treated successfully with IL-17 blockade and a literature review on characteristics, pathogenesis, and treatment.
Psoriatic onycho-pachydermo periostitis (POPP) is characterized by psoriatic onychodystrophy, connective tissue thickening, and periostitis of the distal phalanges (DPs), producing a drumstick-like deformity. Our aim was to present the first case of POPP treated successfully with an IL-17 inhibitor, perform a literature review of its characteristics and treatment, and explore the possible pathogenesis. We conducted a systematic review of previously presented POPP cases. We present a patient with methotrexate (MTX)-resistant treatment POPP, who had significant resolution of symptoms and inflammatory lesions on post-treatment MRI with secukinumab 150 mg. We also identified 31 cases of POPP (27 males; mean age 44.9 years) in the literature review. There was great toe involvement in 24 cases, and distal interphalangeal (DIP) involvement in 14 cases, with frequent radiographically evident damage. Seventeen of 31 patients received systematic treatment other than biologics, mostly MTX, with no satisfactory results. Anti-TNF agents were used successfully in 5 cases, mostly after disease modifying anti-rheumatic drug (DMARD) failure. Imaging studies in nail psoriasis and DIP psoriatic arthritis have shown an anatomical link among the nail, the DP bone, and the DIP joint entheses, suggesting that POPP may be a subtype of nail disease with excessive involvement of DP tissues (nail, soft tissue, enthesis, and bone). IL-17 inhibition could be an alternative therapeutic option in DMARD-resistant cases of POPP. Conventional treatment achieves modest success, but anti-TNF agents appear to be much more effective. Based on imaging studies, POPP may be a particular subtype of nail disease.
Topics: Adult; Arthritis, Psoriatic; Humans; Interleukin-17; Male; Middle Aged; Nail Diseases; Periostitis; Tumor Necrosis Factor Inhibitors
PubMed: 33830360
DOI: 10.1007/s10067-021-05729-0 -
Infection Oct 2021Implant-associated infections (IAI) remain a challenging complication in osteosynthesis. There is no consensus or clear evidence whether titanium offers a relevant... (Review)
Review
Evidence-based uncertainty: do implant-related properties of titanium reduce the susceptibility to perioperative infections in clinical fracture management? A systematic review.
BACKGROUND
Implant-associated infections (IAI) remain a challenging complication in osteosynthesis. There is no consensus or clear evidence whether titanium offers a relevant clinical benefit over stainless steel.
PURPOSE
In this systematic review, we sought to determine whether the implant properties of titanium reduce the susceptibility to IAI compared to stainless steel in fracture management.
METHODS
A systematic literature search in German and English was performed using specific search terms and limits. Studies published between 1995 and 1st June 2020 in the Cochrane library, MEDLINE and Web of Science databases were included. Only clinical studies comparing titanium and stainless steel implants regarding the susceptibility to infections were selected for detailed review.
RESULTS
Five studies out of 384 papers were identified and reviewed. From the studies meeting inclusion criteria one study was a systematic review, two studies were randomized controlled studies (RCT) and two studies were of retrospective comparative nature of level IV evidence.
CONCLUSION
Our results show that currently, no proven advantage for titanium implants in respect to IAI can be seen in contemporary literature. Implants preserving periosteal blood-flow and minimising soft-tissue trauma show statistically significant benefits in reducing the incidence of IAI. Clinical studies providing reliable evidence regarding the influence of titanium implants on IAI and investigating the susceptibility of titanium to infection are necessary.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Stainless Steel; Titanium; Uncertainty
PubMed: 33586124
DOI: 10.1007/s15010-021-01583-z -
Annals of Plastic Surgery May 2021Sternal cleft (SC) is a rare congenital deformity that results from failure of sternal bar fusion. Sternal cleft can be categorized as superior partial, inferior...
INTRODUCTION
Sternal cleft (SC) is a rare congenital deformity that results from failure of sternal bar fusion. Sternal cleft can be categorized as superior partial, inferior partial, or complete. Each form of SC can present as an isolated defect or in association with other congenital deformities, which presents a unique challenge for reconstructive surgeons. In our systematic review, we aim to summarize the published experience on repair of SCs and present a pragmatic approach to help guide reconstructive planning.
METHODS
A systematic review was performed to identify all reported SC cases in literature that underwent sternal reconstruction.
RESULTS
Seventy-one studies were identified from 1970 to 2019, which included a total of 115 patients. Superior partial SC was the most common SC variant, accounting for 65.2% (75/115) of all reported cases. There were 31 cases of complete SC (27.0%) and 9 cases (7.8%) of inferior partial SC; 49.6% of the patients (57/115) in our review had isolated SC without any other congenital deformities. Sixty-seven patients (60.3%) were treated with primary closure, with or without secondary maneuvers, such as chondrotomies, cartilage resection, or periosteal flaps. Alternative methods included interposition grafts, with autologous rib graft in 18 patients (15.8%), permanent mesh in 8 patients (7.0%), acellular dermal matrix in 5 patients (4.4%), sternal plate flap in 5 patients (4.4%), and nonthoracic autologous bone grafts in 4 patients (3.5%).
CONCLUSIONS
Our review supports that primary closure should be attempted regardless of patient age. For wider sternal gap, reconstruction with an autologous local graft or flap should be considered. When the patient does not have sufficient autologous tissue for a successful sternal reconstruction, alloplastic or allograft interposition options are a reasonable choice.
Topics: Bone Transplantation; Humans; Musculoskeletal Abnormalities; Sternum; Surgical Flaps
PubMed: 33470621
DOI: 10.1097/SAP.0000000000002724 -
Supportive Care in Cancer : Official... Jun 2021Bisphosphonates and denosumab are both antiresorptive medications, each with their own mechanism of action; yet both may result in the same adverse effect:...
OBJECTIVE
Bisphosphonates and denosumab are both antiresorptive medications, each with their own mechanism of action; yet both may result in the same adverse effect: medication-related osteonecrosis of the jaw (ONJ). The present systematic review aims to answer the following question: "Are bisphosphonate-related ONJ and denosumab-related ONJ any different, regarding clinical and imaging aspects?"
METHODS
This review followed the Joanna Briggs Review's Manual, and the searches were performed on PubMed, Cochrane, Scopus, Web of Science, and Lilacs databases and on the grey literature (ProQuest, Open Grey, and Google Scholar).
RESULTS
The searches resulted in 7535 articles that were critically assessed. Based on the selection criteria, seven studies were included in the review: five cross-sectional studies and two randomized clinical trials. A total of 7755 patients composed the final population. An increase in bone sequestra, cortical bone lysis, and bone density was observed in bisphosphonate-related ONJ, while larger bone sequestra, more frequent periosteal reactions, and mandibular canal enhancement were noted in denosumab-related ONJ.
CONCLUSION
This systematic review demonstrated that the imaging characteristics of bisphosphonate-related and denosumab-related ONJ are not similar. Although clinically similar conditions, they were found to be radiographically distinct. More studies are necessary to further elucidate these differences.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Cross-Sectional Studies; Denosumab; Diphosphonates; Humans
PubMed: 33140246
DOI: 10.1007/s00520-020-05855-6 -
Der Unfallchirurg Mar 2021The use of a cerclage for osteosynthesis is a controversially discussed topic. They are said to damage the periosteal blood circulation and therefore impair bony...
INTRODUCTION
The use of a cerclage for osteosynthesis is a controversially discussed topic. They are said to damage the periosteal blood circulation and therefore impair bony healing. This article examines the available evidence on whether cerclages actually lead to a relevant reduction in periosteal perfusion.
METHODS
A systematic review of the literature was performed in the PubMed library, searching for experimental studies concerning the influence of cerclages on periosteal blood supply.
RESULTS
No experimental study exists which used a fracture model to investigate the influence of cerclages on the periosteal blood supply of fractured bones. A total of seven experimental studies could be identified. Of these studies two used human cadaver femora, which showed no relevant impairment of the blood supply. The other five investigations were animal experiments carried out on live animals. In rabbit femora the blood perfusion was shown by scintigraphy to be postoperatively decreased by 45-56% . In contrast, three other studies using dog femora and one using equine radii showed no relevant impairment of the periosteal blood supply. One study used an osteotomy model, the others used intact bones.
CONCLUSION
Only one study using a rabbit model could demonstrate a relevant reduction of the periosteal blood supply by cerclages. In four other investigations on animal models over longer postoperative time periods the blood perfusion of the bones showed no impairment. In two series of experiments on human cadaveric femora no negative effects were also found. At least in the mid-term and long-term run the fear that cerclages could impair the blood supply of intact bone or postosteotomy cannot be confirmed by experimental studies. There is no experimental study using a fractured bone model.
Topics: Animals; Dogs; Femur; Fracture Fixation, Internal; Fractures, Bone; Horses; Osteotomy; Rabbits; Radius
PubMed: 32813053
DOI: 10.1007/s00113-020-00847-x -
Current Stem Cell Research & Therapy 2020There is still a lack of consensus about the best treatment of chondral defects of the knee. We conducted a systematic PRISMA review to evaluate clinical outcomes of...
BACKGROUND
There is still a lack of consensus about the best treatment of chondral defects of the knee. We conducted a systematic PRISMA review to evaluate clinical outcomes of Autologous Chondrocyte Implantation (ACI) and Mesenchymal Stem Cell (MSC) injections for the treatment of focal chondral defects of the knee.
METHODS
A systematic review of literature was performed according to the PRISMA guidelines. All the articles reporting data on ACI and MSC treatments for chondral defects of the knee were considered for inclusion. The main databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar. The statistical analysis was performed using the Review Manager Software.
RESULTS
In the p-ACI group (987 knees), the Cincinnati Score improved by 18.94% (p=0.1), VAS by 38% (p=0.01), Tegner score by 19.11% (p=0.03), Lysholm score by 22.40% (p=0.01), IKCD by 27.36% (p=0.003). In the c-ACI group (444 knees), the Cincinnati Score improved by 23.80% (p=0.08), KOOS by 23.48% (p=0.03), VAS by 33.2% (p=0.005), IKDC by 33.30% (p=0.005). In the m-ACI group (599 knees), the Cincinnati Score improved by 26.80% (p=0.08), KOOS by 31.59% (p=0.1), VAS by 30.43% (p=0.4), Tegner score by 23.1% (p=0.002), Lysholm score by 31.14% (p=0.004), IKCD by 30.57% (p<0.001). In the MSCs group (291 knees), the KOOS improved by 29.7% (p=0.003), VAS by 41.89% (p<0.001), Tegner score by 25.81% (p=0.003), Lysholm score by 36.96% (p<0.001), IKCD by 30.57% (p=0.001).
CONCLUSION
Both ACI and MSC therapies can be considered as a concrete solution to treat focal chondral defects of the knee.
Topics: Adolescent; Adult; Chondrocytes; Humans; Knee Joint; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Middle Aged; Transplantation, Autologous
PubMed: 32081109
DOI: 10.2174/1574888X15666200221122834