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Cell Transplantation 2024Transplantation of mesenchymal stem cells (MSCs) is one of the hopeful treatments for spinal cord injury (SCI). Most current studies are in animals, and less in humans,... (Meta-Analysis)
Meta-Analysis
Transplantation of mesenchymal stem cells (MSCs) is one of the hopeful treatments for spinal cord injury (SCI). Most current studies are in animals, and less in humans, and the optimal transplantation strategy for MSCs is still controversial. In this article, we explore the optimal transplantation strategy of MSCs through a network meta-analysis of the effects of MSCs on SCI in animal models. PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Service System (SinoMed) databases were searched by computer for randomized controlled studies on MSCs for SCI. Two investigators independently completed the literature screening and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 software was used to assess the quality of the included literature. Stata 16.0 software was used for standard meta-analysis and network meta-analysis. Standardized mean difference (SMD) was used for continuous variables to combine the statistics and calculate 95% confidence interval (95% CI). < 0.05 was considered a statistically significant difference. Cochrane's test and the value were used to indicate the magnitude of heterogeneity. A random-effects model was used if > 50% and < 0.10 indicated significant heterogeneity between studies, and conversely, a fixed-effects model was used. Evidence network diagrams were drawn based on direct comparisons between various interventions. The surface under the cumulative ranking curve area (SUCRA) was used to predict the ranking of the treatment effects of each intervention. A total of 32 animal studies were included in this article for analysis. The results of the standard meta-analysis showed that MSCs improved motor ability after SCI. The network meta-analysis showed that the best treatment effect was achieved for adipose tissue-derived mesenchymal stromal cells (ADMSCs) in terms of cell source and intrathecal (IT) in terms of transplantation modality. For transplantation timing, the best treatment effect was achieved when transplantation was performed in the subacute phase. The available literature suggests that IT transplantation using ADMSCs in the subacute phase may be the best transplantation strategy to improve functional impairment after SCI. Future high-quality studies are still needed to further validate the results of this study to ensure the reliability of the results.
Topics: Animals; Humans; Rats; Disease Models, Animal; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Network Meta-Analysis; Spinal Cord Injuries
PubMed: 38910431
DOI: 10.1177/09636897241262992 -
Journal of Hand Surgery Global Online Mar 2024Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior...
PURPOSE
Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior deltoid-to-triceps tendon transfer and transfer of the branch of the axillary nerve to the triceps motor branch of the radial nerve have been described for triceps reanimation. This systematic review aimed at reviewing current evidence in the two schools of surgery in terms of their outcome and complication profile.
METHODS
A systematic review was conducted using MEDLINE (1974-2023) and EMBASE (1946-2023) databases. The keyword terms "elbow extension," "triceps," "deltoid," "nerve transfer," "spinal cord injury," "tetraplegia," "quadriplegia," and "tetraplegic" were used in the initial search, which was supplemented with manual searches of the bibliographies of retrieved articles.
RESULTS
Twenty studies met our inclusion criteria, with 14 studies (229 limbs) on posterior deltoid-to-triceps tendon transfer, 5 studies (23 limbs) on axillary to radial nerve transfer, and 1 study (1 limb) on combined transfer. For the tendon transfer group, the majority of studies reported a median triceps power of grade 3, with a wide range of failure percentage to reach antigravity (0% to 87.5%). Common complications included gradual stretching of the musculotendinous unit, rupture of the tendon transferred, elbow contracture, and infection. For the nerve transfer group, the majority of studies also reported a median triceps power reaching grade 3. There were no reported complications or loss of power in donor action of shoulder abduction or external rotation.
CONCLUSIONS
Transfer of the axillary nerve branch to the triceps motor branch of the radial nerve in tetraplegia shows promising results, with comparable triceps muscle power compared to traditional tendon transfer and a low incidence of complication.
TYPE OF STUDY/LEVEL OF EVIDENCE
Systematic Review III.
PubMed: 38903844
DOI: 10.1016/j.jhsg.2023.11.012 -
Journal of Hand Surgery Global Online Mar 2024This review aimed to compare the postoperative outcomes of open reduction internal fixation (ORIF) versus excision in the surgical treatment of hook of hamate fractures.
PURPOSE
This review aimed to compare the postoperative outcomes of open reduction internal fixation (ORIF) versus excision in the surgical treatment of hook of hamate fractures.
METHODS
A systematic review of PubMed and EMBASE databases from 1954 to 2023 was performed using the search term "hook of hamate fracture" to identify all publications regarding the use of ORIF or excision in the treatment of hook of hamate fractures. Outcomes included a return to sport, pain, ulnar nerve dysfunction, flexor tendon dysfunction, union rate, wrist range of motion (ROM; % of contralateral hand), grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, and hand scores.
RESULTS
Twenty-seven of the 705 total screened articles were included. Excision of the hook of hamate ( = 779) resulted in a shorter return to sport time (6 vs 7.8 weeks), lower rates of postoperative pain (6.1% vs 33.3%), higher rates of ulnar nerve sensory dysfunction (4.2% vs 0%), and higher rates of ulnar nerve motor dysfunction (1.5% vs 0%) relative to ORIF ( = 51). Chronic fractures had a longer return to sport time (7.2 vs 5.7 weeks) relative to nonchronic injuries.
CONCLUSIONS
Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures. However, based on the sparsity of available data, we are unable to determine a consistent difference between hook of hamate excision and ORIF.
CLINICAL RELEVANCE
To our knowledge, no current consensus on the optimal surgical treatment for hook of hamate fractures exists. Our findings emphasize the need for a large prospective cohort study using standardized outcomes to provide strong evidence as to whether surgical excision or ORIF yields greater outcomes in the treatment of hook of hamate fractures.
PubMed: 38903831
DOI: 10.1016/j.jhsg.2023.11.011 -
Scientific Reports Jun 2024A network meta-analysis of randomized controlled trials was conducted to compare and rank the effectiveness of various noninvasive brain stimulation (NIBS) for... (Meta-Analysis)
Meta-Analysis
A network meta-analysis of randomized controlled trials was conducted to compare and rank the effectiveness of various noninvasive brain stimulation (NIBS) for Parkinson's disease (PD). We searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Chinese Biomedical Literature Service System (SinoMed) databases from the date of database inception to April 30th, 2024. Two researchers independently screened studies of NIBS treatment in patients with PD based on inclusion and exclusion criteria. Two researchers independently performed data extraction of the included studies using an Excel spreadsheet and assessed the quality of the literature according to the Cochrane Risk of Bias Assessment Tool (RoB2). Network meta-analysis was performed in StataMP 17.0. A total of 28 studies involving 1628 PD patients were included. The results showed that HF-rTMS over the SMA (SMD = - 2.01; 95% CI [- 2.87, - 1.15]), HF-rTMS over the M1 and DLPFC (SMD = - 1.80; 95% CI [- 2.90, - 0.70]), HF-rTMS over the M1 (SMD = - 1.10; 95% CI [- 1.55, - 0.65]), a-tDCS over the DLPFC (SMD = - 1.08; 95% CI [- 1.90, - 0.27]), HF-rTMS over the M1 and PFC (SMD = - 0.92; 95% CI [- 1.71, - 0.14]), LF-rTMS over the M1 (SMD = - 0.72; 95% CI [- 1.17, - 0.28]), and HF-rTMS over the DLPFC (SMD = - 0.70; 95% CI [- 1.21, - 0.19]) were significantly improved motor function compared with sham stimulation. The SUCRA three highest ranked were HF-rTMS over the SMA (95.1%), HF-rTMS over the M1 and DLPFC (89.6%), and HF-rTMS over the M1 (73.0%). In terms of enhanced cognitive function, HF-rTMS over the DLPFC (SMD = 0.80; 95% CI [0.03,1.56]) was significantly better than sham stimulation. The SUCRA three most highly ranked were a-tDCS over the M1 (69.8%), c-tDCS over the DLPFC (66.9%), and iTBS over the DLPFC (65.3%). HF-rTMS over the M1 (SMD = - 1.43; 95% CI [- 2.26, - 0.61]) and HF-rTMS over the DLPFC (SMD = - 0.79; 95% CI [- 1.45, - 0.12)]) significantly improved depression. The SUCRA three highest ranked were HF-rTMS over the M1 (94.1%), LF-rTMS over the M1 (71.8%), and HF-rTMS over the DLPFC (69.0%). HF-rTMS over the SMA may be the best option for improving motor symptoms in PD patients. a-tDCS and HF-rTMS over the M1 may be the NIBS with the most significant effects on cognition and depression, separately.Trial registration: International Prospective Register of Systematic Review, PROSPERO (CRD42023456088).
Topics: Parkinson Disease; Humans; Network Meta-Analysis; Transcranial Magnetic Stimulation; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38902308
DOI: 10.1038/s41598-024-64196-0 -
Sports Health Jun 2024Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries. (Review)
Review
CONTEXT
Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries.
OBJECTIVE
To determine risk factors (RFs) for shoulder injuries in female athletes who play overhead sports and evaluate strategies to reduce shoulder injuries in these athletes.
DATA SOURCES
A systematic electronic search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Databases included were PubMed, Tulane Matas Library Search Engine, and Google Scholar, with search terms: "Overhead injuries/Shoulder AND female athletes AND Risk Factors."
STUDY SELECTION
Of the initial 1574 studies identified, 314 were evaluated for eligibility by full-text review and 291 studies were excluded. Overall, 23 studies were included in this study. Studies were published from 2000 to 2021, subject age range was 15 to 35 years, with documented prevalence of shoulder injuries in female athletes playing overhead sports.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 2.
DATA EXTRACTION
Two independent researchers completed abstract and full-text review. Data extraction used the Covidence and Cochrane Consumer guide template.
RESULTS
Volleyball was the most common sport with shoulder injuries (6/23; 26%) followed by softball 5/23 (22%), swimming 5/23 (22%), gymnastics 4/23 (17%), tennis 3/23 (13%), water polo 2/23 (8%), and basketball 1/23 (4%). Six RFs (dominant shoulder, volume/overuse, time in sport, older age at time of injury, past injury, and multidirectional instability) were described. Of the 23 studies, 9 (39%) identified the dominant shoulder as a RF for sustaining injury (mean risk ratio [RR], 2.04), while 6 (26%) cited volume of repetition and overuse as a prominent RF (RR, 1.45).
CONCLUSION
This systematic review demonstrates important RFs for shoulder injuries in female athletes associated with playing overhead sports. Multiple prevention strategies are described. Prevention programs are helpful in reducing the risk of reinjury.
PubMed: 38898813
DOI: 10.1177/19417381241259987 -
Archives of Physical Medicine and... Jun 2024To systematically review the literature for efficacy Gleno-humeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes DATA SOURCES:... (Review)
Review
OBJECTIVE
To systematically review the literature for efficacy Gleno-humeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes DATA SOURCES: PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, and Google Scholar and Web of Science were searched for relevant studies published.
STUDY SELECTION
A review of randomized controlled trials and quasi-experiments conducted in English language that assessed the effectiveness of Gleno-humeral Internal Rotation Deficit (GIRD) and the risk of upper extremity injury in athletes who perform overhead movements. The review included seven randomized controlled trials and two quasi-experiments out of 5403, which involved a total of 360 participants.
DATA EXTRACTION
Two reviewers independently screened the articles, scored methodological quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials.
DATA SYNTHESIS
The efficacy of different types of techniques was evaluated. Joint mobilization, sleeper stretch, cross body stretch, myofacial release, kinesio and rigid taping showed improvement in pain score and range of motion. Furthermore, self-myo-facial release tends to improve internal rotation; sleeper stretch and crossbody stretch tend to improve internal rotation with 40 percent decline in pain. However kinesio-taping and rigid taping showed good result in improvement of internal rotation Acute results determined that the (Metabolic equivalent) MET group had significantly more horizontal adduction ROM post-treatment compared to the control group (p=0.04). No differences existed between MET and joint mobilizations or joint mobilizations and the control group for horizontal adduction (p>0.16). No significant between group differences existed acutely for internal rotation (p>.28). There were no significant between group differences for either horizontal adduction or internal rotation at the 15- minute posttests (p>0.70).
CONCLUSIONS
In conclusion, the study evaluated the efficacy of various techniques in improving pain score and range of motion in individuals with Gleno-humeral Internal Rotation Deficit (GIRD). Joint mobilization, sleeper stretch, cross body stretch, myofascial release, kinesio-taping, and rigid taping all showed improvements in pain score and Range of motion. However, there were no significant between-group differences for either horizontal adduction or internal rotation at the 15-minute post-tests. Overall, these findings suggest that a combination of these techniques may be effective in treating individuals with GIRD.
PubMed: 38897400
DOI: 10.1016/j.apmr.2024.05.027 -
Journal of Clinical Medicine Jun 2024: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and... (Review)
Review
Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.
: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. : Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. : Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. : The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
PubMed: 38893055
DOI: 10.3390/jcm13113344 -
Journal of Clinical Medicine May 2024: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of... (Review)
Review
: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of arthroscopic revision Bankart repair. : Following the PRISMA guidelines and registered on PROSPERO, this systematic review examined twenty-five articles written between 2000 and 2024. Two independent reviewers assessed eligibility across three databases, focusing on recurrent instability as the primary endpoint, while also noting functional measures, adverse events, revision operations, and return-to-sport rates when available. : The key surgical techniques for recurrent instability post-Bankart repair were identified, with revision arthroscopic Bankart being the most common (685/1032). A comparative analysis revealed a significantly lower recurrence for open coracoid transfer compared to arthroscopic revision Bankart repair (9.67% vs. 17.14%; < 0.001), while no significant difference was observed between remplissage plus Bankart repair and Bankart repair alone (23.75% vs. 17.14%; = 0.24). The majority of studies did not include supracritical glenoid bone loss or engaging Hill-Sachs lesions, and neither subcritical nor non-engaging lesions significantly influenced recurrence rates ( = 0.85 and = 0.80, respectively). : Revision arthroscopic Bankart repair remains a viable option in the absence of bipolar bone loss; however, open coracoid transfer appears to have lower recurrence rates than arthroscopic Bankart repair, consistent with prior evidence. Further studies should define cutoffs and investigate the roles of critical glenoid bone loss and off-track Hill-Sachs lesions. Preoperative measurements of GBL on three-dimensional computed tomography and characterizing lesions based on glenoid track will help surgeons to choose ideal candidates for arthroscopic revision Bankart repair.
PubMed: 38892778
DOI: 10.3390/jcm13113067 -
Journal of Clinical Medicine May 2024Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on... (Review)
Review
Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords "spinal cord injury," "pain," "exercise," "disability," "paraplegia," and "tetraplegia" across the DBpia, EMBASE, PubMed, and Science Direct databases. From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population.
PubMed: 38892777
DOI: 10.3390/jcm13113066 -
Acta Orthopaedica Jun 2024Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies.
PATIENTS AND METHODS
We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis.
RESULTS
We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA's benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4).
CONCLUSION
Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.
Topics: Humans; Carpometacarpal Joints; Osteoarthritis; Thumb; Randomized Controlled Trials as Topic; Arthroplasty, Replacement; Trapezium Bone
PubMed: 38887076
DOI: 10.2340/17453674.2024.40816