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Clinical Nutrition ESPEN Apr 2023Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains under-utilised in peri-operative care. This is despite purported advantages which includes avoiding the risks associated with central venous lines and preventing potential delays to the initiation of nutrition support. This systematic review and meta-analysis will detail the available evidence for PPN use in surgery.
METHODS
A comprehensive search of the EMBASE and Medline databases was undertaken to identify randomised control trials (RCTs) involving PPN use in surgical patients published until July 30th 2022. Three domains of PPN use were reviewed including: PPN compared to crystalloid intravenous fluids on nutritional and clinical outcomes; PPN compared to Central PN (CPN) on nutritional outcomes and complications; and strategies to prevent thrombophlebitis associated with PPN.
RESULTS
The meta-analysis included 8 studies which included 698 patients. Use of PPN led to reduced post-operative weight loss (% body weight change) with a mean difference of -1.45% (95% CI -2.9 to -0.01, p = 0.05). There was no statistically significant difference in terms of length of stay, infectious/non-infectious complications, surgical site infections or phlebitis. 42 RCTs were included in the systematic review. 14 RCTs compared PPN to crystalloid infusion. There was significant heterogeneity in the trial populations, interventions and measured outcomes. Most trials found that PPN may improve nitrogen balance and positively impact nutritional markers. Quality of life and post-operative complications were either improved or no difference found in trials assessing these outcomes. Four RCTs showed that PPN is a safe and feasible alternative to CPN. 22 RCTs reported on measures that may impact on thrombophlebitis rates associated with PPN. These included lower osmolality of PPN solution, cyclical PPN delivery, use of a small gauge polyurethane cannula in an upper limb vein, addition of heparin/hydrocortisone to PPN solutions and placement of a GTN patch over infusion sites.
CONCLUSION
PPN is a safe and effective mode of delivery of peri-operative nutrition. It is a feasible short-term alternative to central-line delivered PN. There are a number of strategies to reduce thrombophlebitis associated with PPN use. Further high-quality RCTs are required to assess the use of PPN in contemporary surgical practice.
Topics: Humans; Parenteral Nutrition; Nutritional Support; Parenteral Nutrition Solutions; Thrombophlebitis; Nutritional Status
PubMed: 36963880
DOI: 10.1016/j.clnesp.2023.02.004 -
Medicina Oral, Patologia Oral Y Cirugia... Jan 2023Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this...
BACKGROUND
Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this systematic review is to know the last treatment approaches and their effectivity.
MATERIAL AND METHODS
we compared the outcome of different kind of treatments in terms of the improvement of the lesions, reduction of the size of those lesions and the time needed for their healing. Inclusion criteria were: clinical trials, articles written in English or Spanish and published less than 5 years ago.
RESULTS
we used the following keywords: "treatment", "aphtous stomatitis", "canker sores"; combined with Boolean operators AND y OR. We selected 28 articles for reading the whole text, and after applying the eligibility criteria, we selected 17 articles for our revision. Among all the treatments, we emphasize the barrier method based in compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, with which the difference in the 3rd and 7th day was of -6,29 ± 0,14 points in the pain score. The treatment with insulin and chitosan gel, brought a pain suppression on the third day, with no reactivation of the pain during the whole study. The application of a film composed of polyurethane and sesame oil with chitosan, brought a reduction in the size of the lesions of 4,54 ± 2,84mm on the 6th day compared with the situation before the beginning of the treatment. The different kinds of laser, which produced a reduction in the pain score just at the beginning of the treatment up to 8,1 ± 1,6 points, and a reduction of the size of the lesions of 4,42 ± 1,02mm on the 7th day.
CONCLUSIONS
Besides the classic treatments for RAS, we have to take into account other treatment modalities, above all the different kinds of laser.
Topics: Humans; Chitosan; Stomatitis, Aphthous; Stomatitis; Mouth Mucosa; Pain
PubMed: 36173717
DOI: 10.4317/medoral.25604 -
Polymers Jul 2022Flame-retardant science and technology are sciences developed to prevent the occurrence of fire, meet the needs of social safety production, and protect people's lives... (Review)
Review
Flame-retardant science and technology are sciences developed to prevent the occurrence of fire, meet the needs of social safety production, and protect people's lives and property. Rigid polyurethane (PU) is a polymer formed by the additional polymerization reaction of a molecule with two or more isocyanate functional groups with a polyol containing two or more reactive hydroxyl groups under a suitable catalyst and in an appropriate ratio. Rigid polyurethane foam (RPUF) is a foam-like material with a large contact area with oxygen when burning, resulting in rapid combustion. At the same time, RPUF produces a lot of toxic gases when burning and endangers human health. Improving the flame-retardant properties of RPUF is an important theme in flame-retardant science and technology. This review discusses the development of flame-retardant RPUF through the lens of bibliometrics. A total of 194 articles are analyzed, spanning from 1963 to 2021. We describe the development and focus of this theme at different stages. The various directions of this theme are discussed through keyword co-occurrence and clustering analysis. Finally, we provide reasonable perspectives about the future research direction of this theme based on the bibliometric results.
PubMed: 35893975
DOI: 10.3390/polym14153011 -
Polymers Jul 2022Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has... (Review)
Review
Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has been seen, the wound-healing process is complex, which includes four different stages. So far, the design and evaluation of polyurethane for wound dressing has focused on achieving good properties (mechanical, physicochemical, and biological), but each of them separates from the others or even directed at only one of the stages of skin wound-healing. Therefore, the aim of this systematic review is to explore the applications of polyurethanes in wound dressings and to determine whether could be designed to cover more than one stage of skin wound-healing. The PRISMA guidelines were followed. The current research in this field does not consider each stage separately, and the design of polyurethane dressings is focused on covering all the stages of wound healing with a single material but is necessary to replace polyurethanes in short periods of time. Additionally, little emphasis is placed on the hemostasis stage and further characterization of polyurethanes is still needed to correlate mechanical and physicochemical properties with biological properties at each stage of the wound-healing. Current research demonstrates an effort to characterize the materials physiochemically and mechanically, but in terms of their biological properties, most of the literature is based on the performance of histological tests of explants morphologically probing the compromised tissues, which give an indication of the potential use of polyurethanes in the generation of wound-healing dressings.
PubMed: 35893955
DOI: 10.3390/polym14152990 -
Critical Reviews in Analytical Chemistry 2024Knowing the impacts of bisphenol A (BPA) on human health, this systematic review aimed to gather the analytical methods for the quantification of BPA release of BPA in... (Review)
Review
Knowing the impacts of bisphenol A (BPA) on human health, this systematic review aimed to gather the analytical methods for the quantification of BPA release of BPA in dental materials in and (biological fluids) studies. A brief critical discussion of the impacts of BPA on human health and the possible association with BPA in dental materials was also presented. The research was carried out by three independent researchers, (according to PRISMA guidelines) in PUBMED and SCOPUS databases, by searching for specific keywords and articles published between January 2011 and February 2022. Seventeen articles met the eligibility criteria and were included in this systematic review: 10 and 7 . In studies, the highest amounts of BPA released were from flowable to conventional resins, followed by resin-modified glass ionomer. In contrast, the smallest amount was released from "BPA-free" composites and CAD-CAM blocks. Regarding studies, a higher concentration of BPA were found in saliva than urine or blood. The best analytical method for trace quantifying BPA is LC-MS/MS (Liquid Chromatography with Tandem Mass Spectrometry) due to its selectivity, low quantification limits, and the unequivocal identification. However, further studies are required to develop faster and more sensitive methods, in order to obtain more reliable results.
Topics: Benzhydryl Compounds; Phenols; Composite Resins; Humans; Tandem Mass Spectrometry; Dental Materials; Chromatography, Liquid; Acrylic Resins; Polyurethanes
PubMed: 35776702
DOI: 10.1080/10408347.2022.2093097 -
The Cochrane Database of Systematic... May 2022Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily... (Review)
Review
BACKGROUND
Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds.
OBJECTIVES
To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting.
SEARCH METHODS
In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome.
MAIN RESULTS
We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low.
AUTHORS' CONCLUSIONS
At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.
Topics: Adult; Alginates; Bandages; Female; Humans; Hydrogels; Iodine; Male; Pilonidal Sinus; Young Adult; Zinc Oxide
PubMed: 35593897
DOI: 10.1002/14651858.CD013439.pub2 -
Cureus Nov 2021Herein, we compare the outcomes of polyurethane and calcium alginate dressings for split-thickness skin graft (STSG) donor sites. A systematic review and meta-analysis... (Review)
Review
Herein, we compare the outcomes of polyurethane and calcium alginate dressings for split-thickness skin graft (STSG) donor sites. A systematic review and meta-analysis were conducted with a search of electronic databases to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of polyurethane dressing versus calcium alginate for STSG donor sites. Primary outcomes were pain intensity, convenience for staff and patients, and adverse effects (namely, excessive exudate, infection rate, and hematoma). Secondary outcome measures included the assessment of healing, dressing changes, cosmetic appearance, and cost. Fixed and random-effect models were used for the analysis. Four RCTs enrolling 127 subjects were identified. There was no significant difference between polyurethane and calcium alginate in terms of pain intensity on Day 1 (mean difference (MD) 0.13, P = 0.80) and Day 5 (MD = 0.20, P = 0.38), as well as the ease of application (odds ratio (OR) = 3.08, P = 0.47). However, there was a statistically significant improvement in patient comfort, favouring the polyurethane group (OR = 44.11, P < 0.00001). In addition, no statistically significant differences were noted in terms of adverse effects between the two dressings. In terms of cost, the calcium gluconate dressing had an overall higher cost compared to polyurethane. Polyurethane is a more favourable dressing compared to calcium alginate for STSG donor sites in terms of patient comfort, healing, and cosmetic outcomes. However, comparable results were noted in terms of pain intensity, ease of application, and adverse effects profile. Cost-effectiveness analysis studies are required to justify its routine use.
PubMed: 34987912
DOI: 10.7759/cureus.20027 -
Polymers Oct 2021Layered double hydroxides (LDHs) have attracted interest as reinforcing fillers in elastomers due to their ease of synthesis and customisability. A systematic review was... (Review)
Review
Layered double hydroxides (LDHs) have attracted interest as reinforcing fillers in elastomers due to their ease of synthesis and customisability. A systematic review was performed on the effect of LDHs on the mechanical properties of elastomers using the Scopus database. Of the 61 articles relevant to the search criteria, the majority were published on polyurethane (PU) and nitrile butadiene rubber (NBR). Mg-Al LDH was used in most of the studies and Zn-Al LDH was used second most common. LDH can act as a reinforcing filler, typically increasing tensile strength even at low concentrations, so it could be used as an alternative to traditional reinforcing fillers for elastomers. LDH can also be made a functional filler by selecting the right metals and interlayer anions. It was found that Mg-Al LDH and Zn-Al LDH can both participate in crosslinking reactions and can replace MgO and ZnO, respectively. Less Zn ions are required for crosslinking when LDH is used than when ZnO is used, making LDH more environmentally friendly. Organic modification is usually required to improve compatibility with the elastomer matrix, especially in non-polar elastomers. It enables exfoliation of the LDH and intercalation of polymer chains into the LDH interlayer to occur. Organic modifiers can also be used to functionalise the LDH. Stearic acid used in crosslinking systems can be replaced by stearate anions from stearate-modified LDH.
PubMed: 34771273
DOI: 10.3390/polym13213716 -
The Cochrane Database of Systematic... Sep 2021Each year, in high-income countries alone, approximately 100 million people develop scars. Excessive scarring can cause pruritus, pain, contractures, and cosmetic... (Review)
Review
BACKGROUND
Each year, in high-income countries alone, approximately 100 million people develop scars. Excessive scarring can cause pruritus, pain, contractures, and cosmetic disfigurement, and can dramatically affect people's quality of life, both physically and psychologically. Hypertrophic scars are visible and elevated scars that do not spread into surrounding tissues and that often regress spontaneously. Silicone gel sheeting (SGS) is made from medical-grade silicone reinforced with a silicone membrane backing and is one of the most commonly used treatments for hypertrophic scars.
OBJECTIVES
To assess the effects of silicone gel sheeting for the treatment of hypertrophic scars in any care setting.
SEARCH METHODS
In April 2021 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that enrolled people with any hypertrophic scars and assessed the use of SGS.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, 'Risk of bias' assessment, data extraction and GRADE assessment of the certainty of evidence. We resolved initial disagreements by discussion, or by consulting a third review author when necessary.
MAIN RESULTS
Thirteen studies met the inclusion criteria. Study sample sizes ranged from 10 to 60 participants. The trials were clinically heterogeneous with differences in duration of follow-up, and scar site. We report 10 comparisons, SGS compared with no SGS treatment and SGS compared with the following treatments: pressure garments; silicone gel; topical onion extract; polyurethane; propylene glycol and hydroxyethyl cellulose sheeting; Kenalog injection; flashlamp-pumped pulsed-dye laser; intense pulsed light and Gecko Nanoplast (a silicone gel bandage). Six trials had a split-site design and three trials had an unclear design (resulting in a mix of paired and clustered data). Included studies reported limited outcome data for the primary review outcomes of severity of scarring measured by health professionals and adverse events (limited data reported by some included studies, but further analyses of these data was not possible) and no data were reported for severity of scarring reported by patients. For secondary outcomes some pain data were reported, but health-related quality of life and cost effectiveness were not reported. Many trials had poorly-reported methodology, meaning the risk of bias was unclear. We rated all evidence as being either of low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, all in single studies. SGS compared with no SGS Seven studies with 177 participants compared SGS with no SGS for hypertrophic scars. Two studies with 31 participants (32 scars) reported severity of scarring assessed by health professionals, and it is uncertain whether there is a difference in severity of scarring between the two groups (mean difference (MD) -1.83, 95% confidence interval (CI) -3.77 to 0.12; very low-certainty evidence, downgraded once for risk of bias, and twice for serious imprecision). One study with 34 participants suggests SGS may result in a slight reduction in pain level compared with no SGS treatment (MD -1.26, 95% CI -2.26 to -0.26; low-certainty evidence, downgraded once for risk of bias and once for imprecision). SGS compared with pressure garments One study with 54 participants was included in this comparison. The study reported that SGS may reduce pain levels compared with pressure garments (MD -1.90, 95% CI -2.99 to -0.81; low-certainty evidence, downgraded once for risk of bias and once for imprecision). SGS compared with silicone gel One study with 32 participants was included in this comparison. It is unclear if SGS impacts on severity of scarring assessed by health professionals compared with silicone gel (MD 0.40, 95% CI -0.88 to 1.68; very low-certainty evidence, downgraded once for risk of bias, twice for imprecision). SGS compared with topical onion extract One trial (32 participants) was included in this comparison. SGS may slightly reduce severity of scarring compared with topical onion extract (MD -1.30, 95% CI -2.58 to -0.02; low-certainty evidence, downgraded once for risk of bias, and once for imprecision). SGS compared with polyurethane One study with 60 participants was included in this comparison. It is unclear if SGS impacts on the severity of scarring assessed by health professionals compared with polyurethane (MD 0.50, 95% CI -2.96 to 3.96; very low-certainty evidence, downgraded once for risk of bias, and twice for imprecision). SGS compared with self-adhesive propylene glycol and hydroxyethyl cellulose sheeting One study with 38 participants was included in this comparison. It is uncertain if SGS reduces pain compared with self-adhesive propylene glycol and hydroxyethyl cellulose sheeting (MD -0.12, 95% CI -0.18 to -0.06). This is very low-certainty evidence, downgraded once for risk of bias, once for imprecision and once for indirectness. SGS compared with Gecko Nanoplast One study with 60 participants was included in this comparison. It is unclear if SGS impacts on pain compared with Gecko Nanoplast (MD 0.70, 95% CI -0.28 to 1.68; very low-certainty evidence, downgraded once for risk of bias and twice for imprecision. There was a lack of reportable data from the other three comparisons of SGS with Kenalog injection, flashlamp-pumped pulsed-dye laser or intense pulsed light.
AUTHORS' CONCLUSIONS
There is currently limited rigorous RCT evidence available about the clinical effectiveness of SGS in the treatment of hypertrophic scars. None of the included studies provided evidence on severity of scarring validated by participants, health-related quality of life, or cost effectiveness. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias. The limitations in current RCT evidence suggest that further trials are required to reduce uncertainty around decision-making in the use of SGS to treat hypertrophic scars.
Topics: Bandages; Cicatrix, Hypertrophic; Humans; Silicone Gels; Wound Healing
PubMed: 34564840
DOI: 10.1002/14651858.CD013357.pub2 -
Bioactive Materials Nov 2021Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term... (Review)
Review
Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term follow-up but significantly increases the risk of osteoarthritis. For this reason, preserving the meniscus is key, although it remains a challenge. Allograft transplants present many disadvantages, so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal scaffolds. The aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both and in clinical studies. Three databases were searched: 46 preclinical studies and 30 clinical ones were found. Sixteen natural, 15 synthetic, and 15 hybrid scaffolds were studied . Among them, only 2 were translated into clinic: the Collagen Meniscus Implant, used in 11 studies, and the polyurethane-based scaffold Actifit®, applied in 19 studies. Although positive outcomes were described in the short- to mid-term, the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical literature. Few studies also combined the use of cells or growth factors, but these augmentation strategies have not been applied in the clinical practice yet. Current solutions offer a significant but incomplete clinical improvement, and the regeneration potential is still unsatisfactory. Building upon the overall positive results of these "old" technologies to address partial meniscal loss, further innovation is urgently needed in this field to provide patients better joint sparing treatment options.
PubMed: 33898878
DOI: 10.1016/j.bioactmat.2021.03.033