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Frontiers in Neurology 2018Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. To synthesiz findings of...
Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. To synthesiz findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in and healthy adults. risk-of-bias was assessed using the Down's and Black Tool. Synthesis : (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included . Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 and 429 healthy adults. found, in all areas of workspace, that : greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In ipsilateral and contralateral workspace, : larger errors in accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that , exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. .
PubMed: 29988530
DOI: 10.3389/fneur.2018.00472 -
The Journal of Prosthetic Dentistry Nov 2018Immediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional... (Meta-Analysis)
Meta-Analysis
STATEMENT OF PROBLEM
Immediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional outcome for patients. However, this approach remains controversial for a tooth with a periodontal or periapical lesion.
PURPOSE
The purpose of this systematic review was to analyze the treatment outcomes of immediate implant placement into extraction sockets with or without infection of periodontal or periapical origin in the esthetic zone and to provide treatment protocols based on current studies.
MATERIAL AND METHODS
An electronic search was performed in PubMed, ISI Web of Knowledge, and the Cochrane Library between January 2009 and October 2017. A subsequent manual search included all clinical studies published in the English language and excluded any reviews or animal studies. An article quality assessment scale, Newcastle-Ottawa Scale (NOS), was used to evaluate the quality of studies enrolled. The implant survival rate was expressed as risk ratio, whereas bone level changes and gingiva level changes were expressed as mean differences in millimeters with 95% confidence intervals. The meta-analysis was conducted by using commercial software.
RESULTS
The search initially found 1171 references. The manual search of the reference lists of identified articles yielded additional papers. Altogether, 9 studies were identified within the selection criteria, with NOS scores between 5 and 8. Compared with the healthy sites, immediate implant placement in infected sites in the esthetic zone showed similar survival rates (97.6% vs. 98.4%, respectively; risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97 to 1.00; P=.138). No statistically significant differences were found in bone level changes (mean difference [MD], 0.03; 95%CI, -0.09 to 0.14; P=.667) or in gingiva level changes (MD, -0.06; 95% CI, -0.13 to 0.01; P=.070) between the 2 groups.
CONCLUSIONS
Meta-analysis showed that immediate implant placement into infected sites and noninfected sites in esthetic zone had similar survival rates, bone level changes, and gingiva level changes.
Topics: Esthetics, Dental; Humans; Immediate Dental Implant Loading; Periapical Periodontitis; Tooth Socket
PubMed: 29961634
DOI: 10.1016/j.prosdent.2017.12.008 -
Deutsches Arzteblatt International May 2018Breast cancer is the most common cancer in women. The German S3 guideline of 2012 has now been updated to take account of advances in the early detection, diagnostic...
BACKGROUND
Breast cancer is the most common cancer in women. The German S3 guideline of 2012 has now been updated to take account of advances in the early detection, diagnostic evaluation, treatment, and follow-up care of this disease.
METHODS
The updating process was based on the adaptation of identified source guidelines and on reviews of the scientific evidence. A systematic search in multiple literature databases was carried out, and the full texts of the selected articles were evaluated. Suggested recommendations were then proposed by interdisciplinary working groups and modified and graded in a nominal consensus procedure.
RESULTS
The value of mammographic screening is confirmed in the updated guideline. As for the diagnostic evaluation of breast cancer, computed tomography is recommended for staging in patients with a high risk of recurrence, in addition to conventional methods. As for surgical treatment, the evidence supporting locoregional surgery for primary breast cancer now affords an opportunity for de-escalation: complete resection yields the best outcome, but a safety margin of several millimeters is not necessary. Axillary dissection is no longer recommended except in certain defined situations. Radiotherapeutic approaches consist of hypofractionated applications. Adjuvant systemic therapy is indicated for patients in certain high-risk situations defined by a constellation of factors including tumor grade, patient age, node status, Ki-67 antigen expression, hormone receptor status, and human epidermal growth factor receptor 2 (HER2) status. All patients with hormone receptor-positive breast cancer should receive endocrine therapy. The indication for chemotherapy and/or anti-HER2 therapy should be determined in consideration of the expected benefit and side effects.
CONCLUSION
Consistent implementation of the recommendations in the newly updated guideline can help lessen morbidity and mortality from breast cancer. The actual extent to which breast cancer guidelines are implemented should be a topic of future research.
Topics: Aftercare; Aged; Biopsy, Needle; Breast Neoplasms; Drug Therapy; Female; Germany; Guidelines as Topic; Humans; Mammography; Mass Screening; Middle Aged; Oncology Nursing; Radiography; Surgical Procedures, Operative; Tomography, X-Ray Computed
PubMed: 29807560
DOI: 10.3238/arztebl.2018.0316 -
Journal of the American Dental... Dec 2017The authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of... (Meta-Analysis)
Meta-Analysis
Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: A systematic review update and meta-analysis.
BACKGROUND
The authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of impacted mandibular third molars.
TYPES OF STUDIES REVIEWED
The authors searched for randomized clinical trials in which the investigators evaluated the efficacy of LLLT compared with that of placebo or no treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The authors used random effects model meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence.
RESULTS
The authors included 21 studies. There was low-certainty evidence that LLLT results in less pain at 2 days after surgery (mean difference [MD], -1.42 on a 10 point scale; 95% confidence interval [CI], -2.18 to -0.67) and moderate certainty that it results in negligibly less pain at 7 days (MD, -0.59; 95% CI, -0.96 to -0.22); moderate-certainty evidence that LLLT has a negligible benefit on reducing trismus at 2 days (MD, -3.42 millimeters; 95% CI, -5.34 to -1.50) and at 7 days after surgery (MD, -2.30 mm; 95% CI, -3.96 to -0.64); lastly, there was moderate-certainty evidence that LLLT results in less postoperative swelling at 2 days (standardized MD, -0.82; 95% CI, -1.28 to -0.35) and low-certainty evidence that LLLT results in negligibly less postoperative swelling at 7 days after surgery (standardized MD, -0.17; 95% CI, -0.4 to 0.07). Low-quality evidence suggests that LLLT will not cause adverse effects.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
LLLT probably has negligible benefits but may not result in adverse events. Evidence does not support the use of LLLT in clinical practice to reduce complications after impacted mandibular third-molar surgical extractions.
Topics: Humans; Low-Level Light Therapy; Mandible; Molar, Third; Postoperative Complications; Randomized Controlled Trials as Topic; Tooth, Impacted
PubMed: 28987483
DOI: 10.1016/j.adaj.2017.06.043 -
Journal of Oral and Maxillofacial... Oct 2017The aim of this study was to compare outcome measurements of skeletal and dental expansion with bone-borne (BB) versus tooth-borne (TB) appliances after surgically... (Comparative Study)
Comparative Study Review
PURPOSE
The aim of this study was to compare outcome measurements of skeletal and dental expansion with bone-borne (BB) versus tooth-borne (TB) appliances after surgically assisted rapid palatal expansion (SARPE). This study was performed to provide quantitative measurements that will help the oral surgeon and orthodontist in selecting the appliance with, on average, the greatest amount of skeletal expansion and the least amount of dental expansion.
MATERIALS AND METHODS
A computerized database search was performed using PubMed, EBSCO, Cochrane, Scopus, Web of Science, and Google Scholar on publications in reputable oral surgery and orthodontic journals. A systematic review and meta-analysis was completed with the predictor variable of expansion appliance (TB vs BB) and outcome measurement of expansion (in millimeters).
RESULTS
Of 487 articles retrieved from the 6 databases, 5 articles were included, 4 with cone-beam computed tomographic (CBCT) data and 1 with non-CBCT 3-dimensional cast data. There was a significant difference in skeletal expansion (standardized mean difference [SMD], 0.92; 95% confidence interval [CI], 0.54-1.30; P < .001) in favor of BB rather than TB appliances. However, there was no significant difference in dental expansion (SMD, 0.05; 95% CI, -0.24 to 0.34; P = .03).
CONCLUSION
According to the literature, to achieve more effective skeletal expansion and minimize dental expansion after SARPE, a BB appliance should be favored.
Topics: Humans; Oral Surgical Procedures; Palatal Expansion Technique; Time Factors
PubMed: 28531377
DOI: 10.1016/j.joms.2017.04.019 -
Journal of the American Dental... May 2017Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis.
TYPES OF STUDIES REVIEWED
The authors performed a systematic search by using PubMed (MEDLINE), Scopus, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials. The authors selected randomized controlled clinical trials in which the investigators evaluated the probing depth (PD) and clinical attachment level (CAL) in test groups by using CHX as an adjuvant and in control groups and subject to mechanical periodontal therapy (scaling and root planing [SRP] 4-6 visits or 24 hours).
RESULTS
The literature search resulted in 8 articles, which the authors then assessed for quality. After testing for heterogeneity, the authors performed a meta-analysis only in the SRP group with 4 to 6 visits. Results were positive for both PD and CAL with use of CHX. However, the summary measure was significant (P < .05) only for PD at 40 to 60 days (0.33 millimeters; 95% confidence interval, 0.08 to 0.58 mm) and 180 days (0.24 mm; 95% confidence interval, 0.02 to 0.47 mm) of follow-up, showing positive results for the use of CHX at those times. Although those differences were statistically significant, they could be interpreted as clinically slight.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Adjunctive use of CHX mouthrinse with mechanical SRP resulted in slightly greater PD reduction than did SRP alone. Clinicians must consider the small additional gain in PD reduction, negligible effect on CAL, and potential for tooth staining when using CHX as an adjunct to SRP in treating chronic periodontitis.
Topics: Chlorhexidine; Chronic Periodontitis; Combined Modality Therapy; Dental Scaling; Humans; Mouthwashes; Root Planing
PubMed: 28284417
DOI: 10.1016/j.adaj.2017.01.021 -
Circulation Feb 2017Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prenatal diagnosis of coarctation of the aorta (CoA) is still challenging and affected by high rates of false-positive diagnoses. The aim of this study was to ascertain the strength of association and to quantify the diagnostic accuracy of different ultrasound signs in predicting CoA prenatally.
METHODS
Medline, Embase, CINAHL, and Cochrane databases were searched. Random-effects and hierarchical summary receiver operating characteristic model meta-analyses were used to analyze the data.
RESULTS
Seven hundred ninety-four articles were identified, and 12 (922 fetuses at risk for CoA) articles were included. Mean mitral valve diameter score was lower (<0.001) and the mean tricuspid valve diameter score was higher in fetuses with CoA than in those without CoA (=0.01). Mean aortic valve diameter score was lower in fetuses with CoA than in healthy fetuses (≤0.001), but the ascending aorta diameter, expressed as score or millimeters, was similar between groups (=0.07 and 0.47, respectively). Mean aortic isthmus diameter scores measured either in sagittal (=0.02) or in 3-vessel trachea view (<0.001) were lower in fetuses with CoA. Conversely, the mean pulmonary artery diameter score, the right/left ventricular and pulmonary artery/ascending aorta diameter ratios were higher (<0.001, =0.02, and =0.02, respectively) in fetuses with CoA in comparison with controls, although aortic isthmus/arterial duct diameter ratio was lower in fetuses with CoA than in those without CoA (<0.001). The presence of coarctation shelf and aortic arch hypoplasia were more common in fetuses with CoA than in controls (odds ratio, 26.0; 95% confidence interval, 4.42-153; <0.001 and odds ratio, 38.2; 95% confidence interval, 3.01-486; =0.005), whereas persistent left superior vena cava (=0.85), ventricular septal defect (=0.12), and bicuspid aortic valve (=0.14) did not carry an increased risk for this anomaly. Multiparametric diagnostic models integrating different ultrasound signs for the detection of CoA were associated with an increased detection rate.
CONCLUSIONS
The detection rate of CoA may improve when a multiple-criteria prediction model is adopted. Further large multicenter studies sharing the same imaging protocols are needed to develop objective models for risk assessment in these fetuses.
Topics: Aorta; Aortic Coarctation; Databases, Factual; Female; Heart Ventricles; Humans; Pregnancy; Prenatal Diagnosis; Risk Factors; Ultrasonography, Prenatal
PubMed: 28034902
DOI: 10.1161/CIRCULATIONAHA.116.024068 -
PloS One 2016In nature, shooting mechanisms are used for a variety of purposes, including prey capture, defense, and reproduction. This review offers insight into the working... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In nature, shooting mechanisms are used for a variety of purposes, including prey capture, defense, and reproduction. This review offers insight into the working principles of shooting mechanisms in fungi, plants, and animals in the light of the specific functional demands that these mechanisms fulfill.
METHODS
We systematically searched the literature using Scopus and Web of Knowledge to retrieve articles about solid projectiles that either are produced in the body of the organism or belong to the body and undergo a ballistic phase. The shooting mechanisms were categorized based on the energy management prior to and during shooting.
RESULTS
Shooting mechanisms were identified with projectile masses ranging from 1·10-9 mg in spores of the fungal phyla Ascomycota and Zygomycota to approximately 10,300 mg for the ballistic tongue of the toad Bufo alvarius. The energy for shooting is generated through osmosis in fungi, plants, and animals or muscle contraction in animals. Osmosis can be induced by water condensation on the system (in fungi), or water absorption in the system (reaching critical pressures up to 15.4 atmospheres; observed in fungi, plants, and animals), or water evaporation from the system (reaching up to -197 atmospheres; observed in plants and fungi). The generated energy is stored as elastic (potential) energy in cell walls in fungi and plants and in elastic structures in animals, with two exceptions: (1) in the momentum catapult of Basidiomycota the energy is stored in a stalk (hilum) by compression of the spore and droplets and (2) in Sphagnum energy is mainly stored in compressed air. Finally, the stored energy is transformed into kinetic energy of the projectile using a catapult mechanism delivering up to 4,137 J/kg in the osmotic shooting mechanism in cnidarians and 1,269 J/kg in the muscle-powered appendage strike of the mantis shrimp Odontodactylus scyllarus. The launch accelerations range from 6.6g in the frog Rana pipiens to 5,413,000g in cnidarians, the launch velocities from 0.1 m/s in the fungal phylum Basidiomycota to 237 m/s in the mulberry Morus alba, and the launch distances from a few thousands of a millimeter in Basidiomycota to 60 m in the rainforest tree Tetraberlinia moreliana. The mass-specific power outputs range from 0.28 W/kg in the water evaporation mechanism in Basidiomycota to 1.97·109 W/kg in cnidarians using water absorption as energy source.
DISCUSSION AND CONCLUSIONS
The magnitude of accelerations involved in shooting is generally scale-dependent with the smaller the systems, discharging the microscale projectiles, generating the highest accelerations. The mass-specific power output is also scale dependent, with smaller mechanisms being able to release the energy for shooting faster than larger mechanisms, whereas the mass-specific work delivered by the shooting mechanism is mostly independent of the scale of the shooting mechanism. Higher mass-specific work-values are observed in osmosis-powered shooting mechanisms (≤ 4,137 J/kg) when compared to muscle-powered mechanisms (≤ 1,269 J/kg). The achieved launch parameters acceleration, velocity, and distance, as well as the associated delivered power output and work, thus depend on the working principle and scale of the shooting mechanism.
Topics: Animals; Biophysical Phenomena; Energy Metabolism; Fungi; Plant Physiological Phenomena; Predatory Behavior
PubMed: 27454125
DOI: 10.1371/journal.pone.0158277 -
European Urology Mar 2017Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery.
OBJECTIVE
To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP.
EVIDENCE ACQUISITION
A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion.
EVIDENCE SYNTHESIS
Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02-1.08, p<0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03-1.14, p=0.004), 6 mo (OR: 1.12, 95% CI: 1.09-1.15, p<0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03-1.22, p=0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05-1.15, p<0.001).
CONCLUSIONS
A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP.
PATIENT SUMMARY
We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.
Topics: Humans; Magnetic Resonance Imaging; Male; Organ Size; Postoperative Complications; Proportional Hazards Models; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Urethra; Urinary Incontinence
PubMed: 27394644
DOI: 10.1016/j.eururo.2016.06.023 -
Journal of the American Dental... Sep 2016Periodontal defect on the distal aspect of mandibular second molars is a common complication after mandibular third-molar extraction. Researchers have proposed different... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodontal defect on the distal aspect of mandibular second molars is a common complication after mandibular third-molar extraction. Researchers have proposed different procedures, but no evidence has shown that a single effective method can prevent or treat this complication.
METHODS
The authors conducted a systematic review and meta-analysis to answer this clinical question: what is the effect of regenerative periodontal therapy on the periodontal tissue healing of the distal site of the mandibular second molar after impacted mandibular third-molar extraction compared with extraction alone without using any biomaterials during a follow-up period of at least 6 months? The authors conducted an electronic search for randomized controlled trials using MEDLINE, Embase, and other databases, and they assessed the quality of selected articles.
RESULTS
Among the 1,083 eligible articles found in the initial search, 7 studies fit all of the selection criteria. All of these studies had a follow-up period lasting at least 6 months. The authors found that regenerative periodontal therapy was significantly more effective in gaining clinical attachment level or reducing probing depth at the distal site of the mandibular second molar than extraction without therapy (weighted mean difference of clinical attachment level gain, 1.94 millimeters [95% confidence interval {CI}, 1.56-2.31]; weighted mean difference of probing depth reduction, 1.67 mm [95% CI, 1.15-2.19]).
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The results of our systematic review and meta-analysis demonstrated that regenerative periodontal therapy effectively prevents the periodontal defect associated with impacted mandibular third-molar extraction. Clinicians should consider performing guided tissue regeneration when the defect is anticipated.
Topics: Guided Tissue Regeneration, Periodontal; Humans; Molar, Third; Periodontal Diseases; Tooth Extraction
PubMed: 27085787
DOI: 10.1016/j.adaj.2016.03.005