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European Journal of Orthodontics Aug 2024The use of clear aligners is becoming more common for aesthetic orthodontic treatment, but there are still concerns about how they affect mastication biomechanics in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of clear aligners is becoming more common for aesthetic orthodontic treatment, but there are still concerns about how they affect mastication biomechanics in the short and long term. The clear aligners treatment (CAT) mechanism changes the position of the mandible and maxilla, especially impacting the masseter muscle. Surface electromyography (sEMG) proves to be a useful method to evaluate masticatory muscle activity (MMA).
OBJECTIVES
To analyze the effect of clear aligners treatment on alterations in masticatory muscles (masseter, temporalis) using surface electromyography.
SEARCH METHODS
Five databases (PubMed, Web of Science, SCOPUS, Cochrane Library, and Google Scholar) were searched up to March 2024.
SELECTION CRITERIA
Studies in which MMA was evaluated after the installation of orthodontic clear aligners.
DATA COLLECTION AND ANALYSIS
Screening, data extraction, and quality assessments were performed by four investigators independently. The data, which evaluated temporalis and masseter muscle characteristics during CAT using surface electromyography, was extracted, and the quality of the studies was evaluated. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).
RESULTS
Six studies (two prospective cohort studies, three observational longitudinal studies, and one observational longitudinal case-control study) with low and moderate risk of bias were included in the qualitative synthesis. Six of these were also included in the meta-analysis. Our study investigated the dynamics of masseter and temporalis muscle activity during CAT. The results show that during maximal voluntary clenching, the masseter muscle demonstrated a significant initial increase (P < .05) followed by a subsequent non-significant decrease. It also showed that submaximal voluntary clenching consistently exhibited a significant reduction in muscle activity throughout the study period (P < .01). Assessment of muscle activity at the mandibular resting position revealed a variety of responses, with some participants showing a significant increase while others exhibited non-significant changes (P < .05, P > .05, respectively). However, the meta-analysis showed a non-significant difference in measuring masseter and temporalis muscles activity during CAT.
CONCLUSIONS
Based on existing evidence, it is reasonable to conclude that CAT affected MMA. During maximal voluntary clenching, masseter muscle activity initially increased but later decreased, while temporalis muscle activity showed mixed results. Submaximal voluntary clenching revealed a consistent decrease in muscle activity over time. Mandibular resting position assessments showed both increases and no significant changes in muscle activity. However, the existing literature is insufficient to draw concrete conclusions; therefore, well-conducted further research is needed to confirm this statement.
REGISTRATION
This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42024522231).
Topics: Humans; Electromyography; Masseter Muscle; Temporal Muscle; Adult; Masticatory Muscles; Mastication; Orthodontic Appliances, Removable
PubMed: 38943433
DOI: 10.1093/ejo/cjae030 -
NeuroRehabilitation 2024Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural... (Review)
Review
BACKGROUND
Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural instability. Many studies document the effects of exercise-based interventions, but the benefit of different exercise types remains unclear.
OBJECTIVE
To provide a commentary on the Cochrane Review by Ernst et al. on the effectiveness of different types of physical exercise regarding motor signs, Quality of Life (QoL), and the occurrence of adverse events.
METHODS
A systematic search was performed in CENTRAL, MEDLINE, Embase, and other databases. The search was performed also in trial registries, conference proceedings, and reference list of identified studies.
RESULTS
The review included 154 RCTs (with 7837 participants). The network meta-analyses (NMAs) on the severity of motor signs and QoL included data from 60 (2721 participants) and 48 (3029 participants) trials, respectively. The evidence from the NMA suggests that dance, gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs, and multi-domain training probably has a small beneficial effect on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. In addition, aqua-based training probably has a large beneficial effect on QoL, and mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL.
CONCLUSIONS
Current evidence supports the promotion of physical exercise among people with PD, identifying only small differences between exercises in influencing the severity of motor signs and QoL.
Topics: Humans; Parkinson Disease; Quality of Life; Exercise Therapy
PubMed: 38943407
DOI: 10.3233/NRE-246004 -
NeuroRehabilitation 2024It has been suggested that transcutaneous spinal cord stimulation (SCS) is effective in the rehabilitation of patients with spinal cord injury (SCI). However, the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been suggested that transcutaneous spinal cord stimulation (SCS) is effective in the rehabilitation of patients with spinal cord injury (SCI). However, the evidence is mainly based on case reports.
OBJECTIVE
To summarize the influence of transcutaneous SCS on extremity motor function of patients with SCI in a meta-analysis.
METHODS
A systematic literature search was performed in electronic databases including PubMed, Cochrane library, Embase, Web of Science, Wanfang, and CNKI to obtain relevant randomized controlled trials (RCTs). A random-effects model was used to pool the results by incorporating the impact of the potential heterogeneity. The most recent database search was conducted on December 31, 2023.
RESULTS
Six small-scale open-label or single-blind RCTs were included. Transcutaneous SCS on the basis of conventional rehabilitation could significantly improve limb strength (mean difference: 4.82, p = 0.004; I2 = 0%) and attenuate spasticity (MD: -0.40, p = 0.02; I2 = 0%). The upper-extremity motor function was not significantly affected (p = 0.75). However, transcutaneous SCS significantly improved mobility as indicated by walking speed (MD: 0.13 m/s, p = 0.009; I2 = 0%) and walking distance (standardized MD: 0.62, I2 = 0%).
CONCLUSION
Transcutaneous SCS is effective in improving limb strength, spasticity and mobility of patients with SCI.
Topics: Spinal Cord Injuries; Humans; Spinal Cord Stimulation; Transcutaneous Electric Nerve Stimulation; Randomized Controlled Trials as Topic; Outcome Assessment, Health Care
PubMed: 38943403
DOI: 10.3233/NRE-240057 -
Journal of Orthopaedic Surgery and... Jun 2024To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration... (Meta-Analysis)
Meta-Analysis Comparative Study
Comparative effectiveness of cortical bone trajectory screws and pedicle screws in the treatment of adjacent segment degeneration after lumbar fusion surgery: a systematic review and meta-analysis.
PURPOSE
To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion.
METHODS
This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library.
RESULTS
A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005].
CONCLUSION
Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period.
Topics: Humans; Spinal Fusion; Pedicle Screws; Cortical Bone; Lumbar Vertebrae; Treatment Outcome; Intervertebral Disc Degeneration; Bone Screws; Operative Time; Male; Female; Blood Loss, Surgical
PubMed: 38943143
DOI: 10.1186/s13018-024-04865-y -
Critical Care (London, England) Jun 2024Gut colonization with multidrug-resistant organisms (MDRO) frequently precedes infection among patients in the intensive care unit (ICU), although the dynamics of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gut colonization with multidrug-resistant organisms (MDRO) frequently precedes infection among patients in the intensive care unit (ICU), although the dynamics of colonization are not completely understood. We performed a systematic review and meta-analysis of ICU studies which described the cumulative incidence and rates of MDRO gut acquisition.
METHODS
We systematically searched PubMed, Embase, and Web of Science for studies published from 2010 to 2023 reporting on gut acquisition of MDRO in the ICU. MDRO were defined as multidrug resistant non-Pseudomonas Gram-negative bacteria (NP-GN), Pseudomonas spp., and vancomycin-resistant Enterococcus (VRE). We included observational studies which obtained perianal or rectal swabs at ICU admission (within 48 h) and at one or more subsequent timepoints. Our primary outcome was the incidence rate of gut acquisition of MDRO, defined as any MDRO newly detected after ICU admission (i.e., not present at baseline) for all patient-time at risk. The study was registered with PROSPERO, CRD42023481569.
RESULTS
Of 482 studies initially identified, 14 studies with 37,305 patients met criteria for inclusion. The pooled incidence of gut acquisition of MDRO during ICU hospitalization was 5% (range: 1-43%) with a pooled incidence rate of 12.2 (95% CI 8.1-18.6) per 1000 patient-days. Median time to acquisition ranged from 4 to 26 days after ICU admission. Results were similar for NP-GN and Pseudomonas spp., with insufficient data to assess VRE. Among six studies which provided sufficient data to perform curve fitting, there was a quasi-linear increase in gut MDRO colonization of 1.41% per day which was stable through 30 days of ICU hospitalization (R = 0.50, p < 0.01).
CONCLUSIONS
Acquisition of gut MDRO was common in the ICU and increases with days spent in ICU through 30 days of follow-up. These data may guide future interventions seeking to prevent gut acquisition of MDRO in the ICU.
Topics: Humans; Intensive Care Units; Drug Resistance, Multiple, Bacterial; Vancomycin-Resistant Enterococci; Incidence
PubMed: 38943133
DOI: 10.1186/s13054-024-04999-9 -
BMC Oral Health Jun 2024There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control.
MATERIALS AND METHODS
PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control.
RESULTS
33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively.
CONCLUSIONS
Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.
Topics: Humans; Diabetes Mellitus, Type 1; Child; Oral Health; Glycemic Control; Adolescent; DMF Index
PubMed: 38943074
DOI: 10.1186/s12903-024-04516-y -
Clinical Radiology Jun 2024A number of studies have reported that contrast-enhanced ultrasound (CEUS) imaging might be used for the early diagnosis of adnexal masses. A meta-analysis was performed...
Diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification for adnexal masses: a systematic review and meta-analysis.
AIM
A number of studies have reported that contrast-enhanced ultrasound (CEUS) imaging might be used for the early diagnosis of adnexal masses. A meta-analysis was performed to evaluate the diagnostic accuracy of CEUS combined with Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification for adnexal masses.
MATERIALS AND METHODS
Related articles were retrieved from PubMed, Web of Science, Embase, and the Cochrane Library in strict accordance with established standards, and data (including true positive, false positive, false negative, and true negative values) was extracted from the original articles. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the quality of articles and the possibility of bias. STATA 12.0 software was used to perform statistical analysis.
RESULTS
Five articles that included 598 patients were analyzed in this meta-analysis. The pooled sensitivity and specificity of CEUS combined with O-RADS for the diagnosis of adnexal masses were 0.95 (95% confidence interval [CI]: 0.91-0.98) and 0.86 (95% CI: 0.79-0.91). Moreover, the positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and area under the curve (AUC) were 6.81 (95% CI: 4.61-10.08), 0.05 (95% CI: 0.03-0.11), 111.30 (95% CI: 65.32-189.65), and 0.97 (95% CI: 0.95-0.98), respectively. The pooled AUC and DOR for the detection of CEUS combined with O-RADS were superior to O-RADS US.
CONCLUSION
Our findings revealed that O-RADS combined with CEUS can improve the diagnostic accuracy of ovarian adnexal masses.
PubMed: 38942707
DOI: 10.1016/j.crad.2024.05.021 -
Asian Journal of Surgery Jun 2024Distal gastrectomy (DG) with lymph node dissection for gastric cancer is routinely performed. In this meta-analysis, we present an updated overview of the perioperative... (Review)
Review
Distal gastrectomy (DG) with lymph node dissection for gastric cancer is routinely performed. In this meta-analysis, we present an updated overview of the perioperative and oncological outcomes of laparoscopic DG (LDG) and robotic DG (RDG) to compare their safety and overall outcomes in patients undergoing DG. An extensive search was conducted using the MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials from the establishment of the database to June 2023 for randomized clinical trials comparing RDG and LDG. The primary outcome was operative results, postoperative recovery, complications, adequacy of resection, and long-term survival. We identified twenty studies, evaluating 5,447 patients (1,968 and 3,479 patients treated with RDG and LDG, respectively). We observed no significant differences between the two groups in terms of the proximal resection margin, number of dissected lymph nodes, major complications, anastomosis site leakage, time to first flatus, and length of hospital stay. The RDG group had a longer operative time (P < 0.00001), lesser bleeding (P = 0.0001), longer distal resection margin (P = 0.02), earlier time to oral intake (P = 0.02), fewer overall complications (P = 0.004), and higher costs (P < 0.0001) than the LDG group. RDG is a promising approach for improving LDG owing to acceptable complications and the possibility of radical resection. Longer operative times and higher costs should not prevent researchers from exploring new applications of robotic surgery.
PubMed: 38942631
DOI: 10.1016/j.asjsur.2024.06.051 -
Journal of Shoulder and Elbow Surgery Jun 2024Rotator cuff tears (RCTs) are a prevalent cause of shoulder pain and dysfunction. For those who fail initial conservative treatment, operative intervention can be... (Review)
Review
INTRODUCTION
Rotator cuff tears (RCTs) are a prevalent cause of shoulder pain and dysfunction. For those who fail initial conservative treatment, operative intervention can be pursued. A significant and common complication after rotator cuff repair (RCR) is retearing or non-healing. Numerous augmentations to traditional suture RCR have been studied. Of these, the Smith+Nephew Regeneten bioinductive collagen patch has had promising initial results; however, analytic data for its use is lacking, and there is no meta-analysis comparing the available data to historical RCR outcomes.
METHODS
A PRISMA-guided literature search was conducted using Ovid MEDLINE, PubMED, Cochrane, and ClinicalTrials.gov. 13 studies met inclusion and exclusion criteria. Only clinical trials on full and partial-thickness tears were included. American Shoulder and Elbow Surgeon score (ASES), Constant-Murley score (CMS), the visual analog scale for pain (VAS), the minimal clinically important difference (MCID), tendon thickness, and complication rates were primary outcomes of interest. A meta-analysis was performed to determine the overall complication and retear rate from the included studies.
RESULTS
ASES, CMS, and VAS improved significantly in all studies that reported them, and most patients achieved MCID. Patient-reported outcome measure (PROM) improvements were similar to historical improvements in standard RCR, and a similar proportion of patients achieved MCID after standard repair. Tendon thickness improved significantly and to a similar degree as standard RCR. Overall retear rate after full thickness RCR augmented with the bioinductive patch was 8.3%. For partial thickness RCR, total retear rate of 1.1% across all patients. The overall complication rate with the bioinductive patch was 15.5% across all full-thickness RCR studies and 16.2% in partial thickness RCR. We found overall retear rate to be lower after augmentation with the bioinductive patch compared to traditional repair; however, the overall complication rate was similar for full-thickness tears and higher for partial-thickness tears. Lastly, adverse reactions to the bioinductive patch were noted at 0.2%.
CONCLUSIONS
The bioinductive collagen patch appears to be a safe augmentation for rotator cuff repair. Patients are likely to experience significant subjective improvement in PROMs and significant increases in tendon thickness. Retear rate has been a concern after RCR for decades, and the bioinductive patch may help mitigate this risk. There is a lack of case-control studies comparing the bioinductive patch to traditional suture RCR. Such data is needed to better determine the role of the bioinductive patch in the treatment of full and partial-thickness rotator cuff repairs.
PubMed: 38942225
DOI: 10.1016/j.jse.2024.05.002 -
Ageing Research Reviews Jun 2024Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized... (Review)
Review
Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.
PubMed: 38942197
DOI: 10.1016/j.arr.2024.102350