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Annals of Surgery Open : Perspectives... Jun 2024This study, examining literature up to December 2023, aims to comprehensively assess surgical care for incarcerated individuals, identifying crucial knowledge gaps for... (Review)
Review
OBJECTIVE
This study, examining literature up to December 2023, aims to comprehensively assess surgical care for incarcerated individuals, identifying crucial knowledge gaps for informing future health services research and interventions.
BACKGROUND
The US prison system detains around 2 million individuals, mainly young, indigent males from ethnic and racial minorities. The constitutional right to healthcare does not protect this population from unique health challenges and disparities. The scarcity of literature on surgical care necessitates a systematic review to stimulate research, improve care quality, and address health issues within this marginalized community.
METHODS
A systematic review, pre-registered with the International Prospective Register of Systematic Reviews (CRD42023454782), involved searches in PubMed, Embase, and Web of Science. Original research on surgical care for incarcerated individuals was included, excluding case reports/series (<10 patients), abstracts, and studies involving prisoners of war, plastic surgeries for recidivism reduction, transplants using organs from incarcerated individuals, and nonconsensual surgical sterilization.
RESULTS
Out of 8209 studies screened, 118 met inclusion criteria, with 17 studies from 16 distinct cohorts reporting on surgical care. Predominantly focusing on orthopedic surgeries, supplemented by studies in emergency general, burns, ophthalmology, and kidney transplantation, the review identified delayed hospital presentations, a high incidence of complex cases, and low postoperative follow-up rates. Notable complications, such as nonfusion and postarthroplasty infections, were more prevalent in incarcerated individuals compared with nonincarcerated individuals. Trauma-related mortality rates were similar, despite lower intraabdominal injuries following penetrating abdominal injuries in incarcerated patients.
CONCLUSION
While some evidence suggests inferior surgical care in incarcerated patients, the limited quality of available studies underscores the urgency of addressing knowledge gaps through future research. This is crucial for patients, clinicians, and policymakers aiming to enhance care quality for a population at risk of surgical complications during incarceration and postrelease.
PubMed: 38911628
DOI: 10.1097/AS9.0000000000000434 -
Plastic and Reconstructive Surgery.... Jun 2024In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from...
BACKGROUND
In this systematic review, we assessed the therapeutic efficacy and safety of collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from subtle to pronounced lesions.
METHODS
A systematic review was performed following PRISMA guidelines for CCH and TS treatment to the thigh and gluteal regions. A proportion meta-analysis was then conducted using Stata statistical software.
RESULTS
A total of 14 studies were incorporated into the final analysis. Nine focused on TS and five on CCH injection, collectively reporting outcomes for 1254 patients. Of these, 465 received CCH injection and 789 underwent subcision. For bruising, rates were 89% [95% confidence interval (CI), 71%-96%] with CCH injection and 99% (95% CI, 85%-99%) for subcision; pain requiring analgesic was reported at 74% (95% CI, 55%-87%) for CCH and 60% (95% CI, 43%-76%) for subcision; both showed induration at 7% (95% CI, 5%-11% for CCH, 95% CI, 2%-25% for subcision), whereas skin discoloration was higher post-CCH injection at 16% (95% CI, 10%-26%) compared with 7% (95% CI, 5%-10%) postsubcision.
CONCLUSIONS
Both CCH and TS seem effective treatments for cellulite. However, upon evaluating the adverse outcomes between the two modalities, subcision demonstrated a higher incidence of bruising, albeit similar rates of induration compared with CCH injection. Conversely, the CCH injection group manifested a higher propensity for pain requiring analgesia and notably exhibited increased instances of skin discoloration compared with their subcision patient group. Further standardized research is crucial for more informed cellulite treatment decisions and for comparing efficacy, safety, and cost-effectiveness between TS and CCH.
PubMed: 38911581
DOI: 10.1097/GOX.0000000000005857 -
Surgery Jun 2024Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative... (Review)
Review
BACKGROUND
Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative delirium renders the elucidation of its risk factors challenging. This research aims to delineate the prevalence and the specific risk factors of postoperative delirium in patients with cancer undergoing free flap reconstruction through a systematic review and meta-analysis to enlighten proactive prevention measures.
METHODS
The researchers systematically queried both the international and Chinese databases. Searches were performed for publications from inception until September 14, 2023, using the terms "free tissue flaps," "delirium," "neoplasms," and "risk factors." Data synthesis and statistical analysis were conducted using Stata SE (version 15.0) to calculate the combined effect size for identified risk factors. Reported outcomes included weighted mean differences or odds ratios with their respective 95% confidence intervals.
RESULTS
Twelve case-control studies were included (n = 3,256). Among them, 515 patients developed postoperative delirium after free flap surgery, compared with 2,741 patients who did not. The outcomes suggest that the risk factors include but are not limited to age, male, late neoplasm staging, use of hypnotic or antipsychotic, history of background diseases, psychiatric review, tracheotomy, and impaired wound healing. In contrast, early neoplasm staging and others are the protective factors with statistical significance. Multivariate analysis further identified significant correlations between preoperative albumin, perioperative blood transfusion, sleep disturbance, postoperative visual analog scale, postoperative albumin, smoking, and the appearance of postoperative delirium.
CONCLUSION
The determined risk factors were grouped into preoperative, intraoperative, and postoperative categories substantiated by current data to present instructions for postoperative delirium prevention.
PubMed: 38910046
DOI: 10.1016/j.surg.2024.05.009 -
Brain Research Jun 2024Non-invasive brain stimulation induces changes in spontaneous neural activity in the cerebral cortex through facilitatory or inhibitory mechanisms, relying on... (Review)
Review
BACKGROUND
Non-invasive brain stimulation induces changes in spontaneous neural activity in the cerebral cortex through facilitatory or inhibitory mechanisms, relying on neuromodulation of neural excitability to impact brain plasticity. This systematic review assesses the state-of-the art and existing evidence regarding the effectiveness of NIBS in cognitive recovery among patients with chronic stroke.
MATERIALS AND METHODS
We conducted a systematic search, following PRISMA guidelines, for articles published from January 2010 through September 2023. We searched the following databases: PubMed, Embase, Cochrane Database of Systematic Reviews, PEDro, Rehab Data, and Web of Science.
RESULTS
Our electronic searches identified 109 papers. We assessed and included 61 studies based on their pertinence and relevance to the topic. After reading the full text of the selected publications and applying predefined inclusion criteria, we excluded 32 articles, leaving 28 articles for our qualitative analysis. We categorized our results into two sections as follows: (1) Cognitive and emotional domains (11 studies), (2) language and speech functions (16 studies).
CONCLUSION
Our findings highlight the potential of NIBS, such as tDCS and rTMS, in the cognitive, linguistic, and emotional recovery of post-stroke patients. Although it seems that NIBS may work as a complementary tool to enhance cognitive and communication abilities in patients with stroke -also in the chronic phase- evidence on behavioural outcomes is still poor. Future studies should focus on this important issue to confirm the effectiveness of neuromodulation in chronic neurological diseases. PROSPERO Registration: CRD42023458370.
PubMed: 38909976
DOI: 10.1016/j.brainres.2024.149093 -
Journal of Plastic, Reconstructive &... Jun 2024Protocols surrounding opioid reduction have become commonplace in plastic surgery to improve peri-operative outcomes. Within such protocols, opioid requirement is a... (Review)
Review
INTRODUCTION
Protocols surrounding opioid reduction have become commonplace in plastic surgery to improve peri-operative outcomes. Within such protocols, opioid requirement is a frequently analyzed outcome. Though often examined, there is no literature standard conversion for morphine milligram equivalents (MME) at present, leading to questionable external validity. We hypothesized significant heterogeneity in MME reporting would exist within plastic surgery literature.
METHODS
Following the PRISMA guidelines, the authors conducted a systematic review of 16 journals. Clinical studies focused on opioid reduction within plastic surgery were identified. Primary outcomes included reporting of morphine equivalents (ME) delivery (IV/oral), operative ME, inpatient ME, outpatient ME, timeline, and method of calculation.
RESULTS
Among the 101 studies analyzed, 73% reported opioid requirements in the form of ME. Among those that used ME, 3% reported IV ME, 41% reported oral, 32% reported both, and 25% gave no indication of either. Operative ME were reported in 19% of studies. Furthermore, 54% of studies reported inpatient ME whereas 32% of studies reported outpatient ME. Only 19% reported the number of days opioids were consumed postoperatively. Moreover, 27% of the studies reported the actual method of ME conversion, with 17 unique methods described. Only 8 studies (8%) reported using the Center for Disease Control and Prevention guidelines for ME conversion.
CONCLUSION
There is significant variability among the reported ME conversion methodology within plastic surgery literature. Highlighting these discrepancies is an essential step in creating and implementing a single, standard method to mitigate opioid morbidity in plastic surgery and to optimize enhanced recovery protocols.
PubMed: 38909598
DOI: 10.1016/j.bjps.2024.06.001 -
Journal of Neurosurgery. Pediatrics Jun 2024Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can...
OBJECTIVE
Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can address these sequelae, the postoperative outcomes, complications, and mortality risk of reduction cranioplasty are not well understood given the rarity of hydrocephalic macrocephaly. Therefore, the primary objective of this systematic review was to evaluate the surgical outcomes of reduction cranioplasty for the treatment of hydrocephalic macrocephaly.
METHODS
A systematic review was performed using the PubMed, Scopus, and Web of Science databases while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened 350 studies; 27 studies reporting surgical outcomes on reduction cranioplasty for hydrocephalic macrocephaly met inclusion criteria. Data on study design, patient demographics, operative details, and surgical outcomes were collected.
RESULTS
There were 65 reduction cranioplasties among the 27 included studies. Eighteen (66.7%) studies presented level V evidence, 7 (25.9%) presented level IV evidence, and 2 (7.4%) presented level III evidence. Following reduction cranioplasty, there was improvement in postoperative head positioning in 23 (85.2%) studies, improvement in postoperative cosmesis in 22 (81.5%) studies, and improvement in global postoperative neurological functioning in 20 (74.1%) studies. The median estimated blood loss was 633 mL (range 20-2600 mL). Shunt revisions were the most common complication, reported in 9 (47.4%) of the 19 studies assessing complications. Of the 65 patients, there was a mortality rate of 6.2% (n = 4).
CONCLUSIONS
The majority of the included studies reported improvement in head size, head positioning, cranial cosmesis, and global neurological functioning following reduction cranioplasty for hydrocephalic macrocephaly. However, the prevalence of lower-level evidence, risk of blood loss, complications, and mortality indicates the need for a serious discussion of surgical indication, an experienced team, and thorough perioperative planning to perform these complex surgeries.
PubMed: 38905711
DOI: 10.3171/2024.4.PEDS23486 -
Lasers in Medical Science Jun 2024This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to... (Meta-Analysis)
Meta-Analysis Review
This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to determine the optimal timing for intervention. A systematic search was conducted across four databases using a predefined search strategy. Studies included were randomized controlled trials, non-randomized studies, and case series focusing on laser therapy for CL/P scars. Data extraction and analysis were performed using Revman Software. A total of two randomized controlled trials, four non-randomized studies, and three case series were included in the analysis. The fractional CO laser was the most commonly utilized type of laser. Following laser therapy, there was a significant decrease in Vancouver Scar Scale (VSS) scores by 4.05 (95% CI, 2.10-5.99). Meta-analysis revealed that laser treatment groups exhibited a significantly lower mean VSS score (1.3; 95% CI, 0.02-2.67) compared to control groups. Moreover, initiating laser therapy intervention at one month postoperatively resulted in a significantly lower VSS score compared to initiation at three months postoperatively (difference of 1.70; 95% CI, 1.33-2.08). No severe complications were reported. Laser therapy demonstrates effectiveness and safety in improving CL/P scars, with earlier intervention yielding greater benefits.
Topics: Humans; Cicatrix; Cleft Lip; Cleft Palate; Laser Therapy; Lasers, Gas; Low-Level Light Therapy; Treatment Outcome
PubMed: 38902432
DOI: 10.1007/s10103-024-04082-3 -
Aesthetic Plastic Surgery Jun 2024With the increasing global clinical application of regenerative injection materials, there is a growing recognition of the crucial role played by poly-L-lactic acid... (Review)
Review
OBJECTIVES
With the increasing global clinical application of regenerative injection materials, there is a growing recognition of the crucial role played by poly-L-lactic acid (PLLA). The aim of this study is to conduct a systematic review on the therapeutic efficacy and safety of PLLA in clinical applications for facial treatments.
METHODS
We conducted a search of the PubMed, EMBASE, Web of Science, and Wanfang databases, followed by screening of the retrieved articles based on predefined inclusion and exclusion criteria. We then performed an analysis on the final set of included articles that met our inclusion criteria. Within these included articles, quality assessment for randomized controlled trials (RCTs) was carried out using the Jadad scale, while non-randomized controlled trials (non-RCTs) were evaluated using the MINORS scale.
RESULTS
Our search of above database, using the relevant search terms, yielded a total of 1300 PLLA-related articles. After applying the inclusion and exclusion criteria, 1280 articles were excluded. Only 20 articles, 16 in English and 4 in Chinese, were included in our final analysis, among them 16 NRCTs and 4 RCTs. According to the different clinical evaluation standards, the treatment of PLLA has achieved good outcomes. Most PLLA injection-related adverse events are mild and self-limited, without any additional treatment requirement.
CONCLUSION
PLLA is a reasonably safe and effective facial injection material that can be applied in different facial injection areas and depth using various reconstitute and injection methods.
LEVEL OF EVIDENCE I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 38902341
DOI: 10.1007/s00266-024-04098-8 -
Aquatic Toxicology (Amsterdam,... Jun 2024The presence of microplastics in the aquatic environment has attracted widespread attention. A large number of studies have assessed the effects of microplastics on the... (Review)
Review
The presence of microplastics in the aquatic environment has attracted widespread attention. A large number of studies have assessed the effects of microplastics on the respiratory system of aquatic animals, but the results are not directly comparable across studies due to inconsistent evaluation criteria. Therefore, we adopted an integrated research approach that can integrate and parse complex data to improve reliability, conducted a systematic review and meta-analysis of 35 published studies, and elucidated the mechanisms of microplastic damage to cells. The results showed that PE had the greatest impact on aquatic animals, and fish were the most sensitive to the effects caused by microplastics, with oxidative stress induced by exposure concentrations exceeding 1000 µg/L or exposure times exceeding 28 days, leading to depletion of antioxidant defenses, cellular damage, inflammatory responses, and behavioral abnormalities. As this review is based on existing studies, there may be limitations in terms of literature quality, data availability and timeliness. In conclusion, we suggest to combat microplastic pollution by limiting plastic use, promoting plastic substitution and recycling, and enhancing microplastic capture degradation technologies.
PubMed: 38901219
DOI: 10.1016/j.aquatox.2024.107003 -
Aesthetic Plastic Surgery Jun 2024Our meta-analysis indicated favorable results in improving scar hyperpigmentation through fat grafting, but there remains a need for further investigation using...
Our meta-analysis indicated favorable results in improving scar hyperpigmentation through fat grafting, but there remains a need for further investigation using objective measures to validate these clinical findings and elucidate the underlying mechanisms. Current evidence from animal studies showed that fat grafting may exert its beneficial effects on scar hyperpigmentation through complex cellular and molecular pathways involving the regulation of melanin synthesis and skin remodeling. However, interpretation can be influenced by various factors, highlighting the importance of integrating multiple lines of evidence to draw robust conclusions.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 38898244
DOI: 10.1007/s00266-024-04165-0