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Journal of Robotic Surgery May 2024Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have...
Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24 h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89 years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Ambulatory Surgical Procedures; Colectomy; Colorectal Neoplasms; Laparoscopy; Length of Stay; Postoperative Complications; Robotic Surgical Procedures
PubMed: 38713324
DOI: 10.1007/s11701-024-01961-3 -
JSES International May 2024Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle,... (Review)
Review
BACKGROUND
Various plate types are used in the surgical treatment of displaced midshaft clavicle fractures. These plates can be positioned in different locations on the clavicle, although no studies to date have elucidated optimal plate type and location of fixation. This systematic review compares the functional outcomes and complications in the management of displaced midshaft clavicle fractures using plate fixation by stratifying by both plate type and location.
METHODS
A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all papers reporting functional outcomes, union rates, and/or complications using plates for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until March 2022. A meta-analysis was conducted for functional outcomes and type of complication, stratified by plate type (locking, compression, or reconstruction) and location (superior or anteroinferior). Pooled estimates of functional outcome scores and incidence of complications were calculated using a random effects model. Risk of bias and quality were assessed using the risk of bias version 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. The confidence in estimates were rated and described according to the recommendations of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) working group.
RESULTS
Forty-five studies were included in the systematic review and 43 were included in the meta-analysis. Depending on plate type and location, pooled Constant-Murley Scores ranged from 89.23 to 93.48 at 12 months. Nonunion rates were 3% (95% confidence interval [CI] 1-6) for superior locking plates (GRADE Low). Rates of any complication (nonunion, hardware failure, hardware irritation, wound dehiscence, keloid, superficial infection, deep infection, delayed union, malunion, and/or persistent pain) by plate type and location ranged from 3% to 17% (GRADE Very Low to Moderate). Superior compression plates had the highest incidence of any complications (17% [95% CI 5-44], GRADE Very Low), while anterior inferior compression plates had the lowest incidence of any complication (3% [95% CI 0-15], GRADE Very Low). Hardware irritation was the most reported individual complication for superior locking plates and superior compression plates, 11% (95% CI 7-17, GRADE Low) and 11% (95% CI 3-33, GRADE Very Low), respectively.
CONCLUSION
Although most studies were of low quality, studies reporting functional outcomes generally showed good functional results and similar incidence of any complication regardless of plate type and location. There is no evidence of a plate and location combination to optimize patient functional outcomes or complications. We were unable to reliably evaluate union rates or individual complications for most plate types stratified by location.
PubMed: 38707570
DOI: 10.1016/j.jseint.2024.01.007 -
Arthroscopy, Sports Medicine, and... Apr 2024To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years. (Review)
Review
PURPOSE
To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years.
METHODS
This was a secondary analysis from a prior systematic review of the MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases on studies evaluating clinical outcomes in ACLR patients ≥40 years. Studies were included based on the following criteria: English-language studies reporting on postoperative complications and/or ACLR failure rates in patients ≥40 years. Case reports, technical notes, studies with duplicate reporting of patient cohorts, or studies using publicly available registry data were excluded. ACLR failure definitions, failure rates, graft rupture rates, revision ACLR and non-ACLR revision rates, and complication rates were recorded.
RESULTS
Twenty-one studies were included following full-text review. Autografts were used in 89.0% of cases. Definitions for ACLR failure varied, ranging from (1) revision ACLR, (2) graft rupture, (3) clinical examination of increased knee laxity, and (4) postoperative arthrofibrosis requiring an additional surgery. The median ACLR failure rate was 5.0% (range, 0%-12.1%) among the 9 studies reporting this outcome, with only 4 of the studies providing explicit definitions of failure. The median ACLR revision surgery, graft rupture, and non-ACLR revision surgery rates were 0% (range, 0%-7.7%), 2.7% (range, 0%-9.1%), and 7.2% (range 0%-34.4%), respectively. Commonly reported complications included pain (range, 0%-14.0%), stiffness (range, 0%-12.7%), hematoma (range, 2.5%-8.8%), neurovascular (range, 0%-41.7%), and undefined (range, 0%-13.8%).
CONCLUSIONS
ACLR in patients over 40 years old shows low failure rates.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II-IV studies.
PubMed: 38706974
DOI: 10.1016/j.asmr.2024.100899 -
BMC Cardiovascular Disorders May 2024Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about...
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event.
METHODS
We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis.
RESULTS
In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138).
CONCLUSION
While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
Topics: Adult; Female; Humans; Male; Middle Aged; Case Reports as Topic; Comorbidity; Coronary Vessel Anomalies; Prevalence; Prognosis; Risk Assessment; Risk Factors; Sex Factors; Stress, Psychological; Vascular Diseases
PubMed: 38702627
DOI: 10.1186/s12872-024-03902-2 -
PeerJ 2024Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate... (Meta-Analysis)
Meta-Analysis
Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.
BACKGROUND
Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR.
METHODS
This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model.
RESULTS
A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; = 0.001).
CONCLUSIONS
This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Return to Sport; Anterior Cruciate Ligament Injuries; Reinjuries; Risk Factors
PubMed: 38699196
DOI: 10.7717/peerj.17279 -
Sports Medicine - Open Apr 2024Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament...
Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis.
BACKGROUND
Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament reconstruction (ACLR). To improve our understanding of the extent of deficits in psychological readiness, a systematic review is necessary.
OBJECTIVE
To investigate psychological readiness (measured via the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI)) over time after ACL tear and understand if time between injury and surgery, age, and sex are associated with ACL-RSI scores.
METHODS
Seven databases were searched from the earliest date available to March 22, 2022. Articles reporting ACL-RSI scores after ACL tear were included. Risk of bias was assessed using the ROBINS-I, RoB-2, and RoBANS tools based on the study design. Evidence certainty was assessed for each analysis. Random-effects meta-analyses pooled ACL-RSI scores, stratified by time post-injury and based on treatment approach (i.e., early ACLR, delayed ACLR, and unclear approach).
RESULTS
A total of 83 studies were included in this review (78% high risk of bias). Evidence certainty was 'weak' or 'limited' for all analyses. Overall, ACL-RSI scores were higher at 3 to 6 months post-ACLR (mean = 61.5 [95% confidence interval (CI) 58.6, 64.4], I = 94%) compared to pre-ACLR (mean = 44.4 [95% CI 38.2, 50.7], I = 98%), remained relatively stable, until they reached the highest point 2 to 5 years after ACLR (mean = 70.7 [95% CI 63.0, 78.5], I = 98%). Meta-regression suggests shorter time from injury to surgery, male sex, and older age were associated with higher ACL-RSI scores only 3 to 6 months post-ACLR (heterogeneity explained R = 47.6%), and this reduced 1-2 years after ACLR (heterogeneity explained R = 27.0%).
CONCLUSION
Psychological readiness to return to sport appears to improve early after ACL injury, with little subsequent improvement until ≥ 2-years after ACLR. Longer time from injury to surgery, female sex and older age might be negatively related to ACL-RSI scores 12-24 months after ACLR. Due to the weak evidence quality rating and the considerable importance of psychological readiness for long-term outcomes after ACL injury, there is an urgent need for well-designed studies that maximize internal validity and identify additional prognostic factors for psychological readiness at times critical for return to sport decisions.
REGISTRATION
Open Science Framework (OSF), https://osf.io/2tezs/ .
PubMed: 38689130
DOI: 10.1186/s40798-024-00712-w -
Heliyon Apr 2024To investigate the effects of accommodation on the geometrical parameters of human lens.
PURPOSE
To investigate the effects of accommodation on the geometrical parameters of human lens.
METHODS
Eight databases from inception to November 2023 were used for the literature search: CNKI, CBM, VIP, Wan-Fang, PubMed, Web of Science, EMBASE, and the Cochrane Library. The Methodological Index for Non-randomized Studies was used to assess the risk of bias. The PRISMA were followed and the following outcomes were taken into consideration: lens diameter (LD), lens thickness (LT), anterior curvature radius (ACR), posterior curvature radius (PCR), lens center position (LCP), and total cross-sectional area (TCSA). This systematic review was registered on an international platform for registered systematic reviews and meta-analysis (INPLASY202260085).
RESULTS
A total of 19 studies were included. LT increased by 0.04 mm/D (18 studies; 95% confidence interval [CI], 0.03-0.06; = 96.6%; < 0.001). At the same time, LD, ACR, and PCR decreased by 0.06 mm/D (6 studies; 95%CI, -0.07-0.05; = 50.1%; < 0.001), 0.53 mm/D (8 studies; 95%CI, -0.64-0.41; = 96.5%; < 0.001), and 0.14 mm/D (9 studies; 95%CI, -0.19-0.09; = 94.7%; < 0.001) during accommodation, respectively. Moreover, LCP shifted forward by 0.01 mm/D (3 studies; 95%CI, -0.02-0.00; = 0.0%; < 0.001), and TCSA by 0.58 mm/D (2 studies; 95%CI, 0.41-1.57; = 97.0%; = 0.457) during accommodation.
CONCLUSIONS
Changes in LT, LD, ACR, PCR and LCP supported Helmholtz's theory. Different apparatuses or measurement methods influenced the measurement of lens geometrical parameters.
PubMed: 38681553
DOI: 10.1016/j.heliyon.2024.e29298 -
Orthopaedic Journal of Sports Medicine Apr 2024Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury....
BACKGROUND
Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury. Because conventional radiography is relatively easy, affordable, and available worldwide, the diagnostic efficacy of ACL standing, lateral decubitus, and supine stress radiography should be evaluated.
PURPOSE
To examine the existing literature regarding the application of stress radiography in evaluating the integrity of the ACL.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
Using the PubMed and MEDLINE databases for relevant articles published between 1980 and the present, a systematic review was conducted to identify evidence related to the radiographic diagnosis or assessment of ACL tears. The literature search was conducted in September 2022.
RESULTS
Of 495 studies, 16 (1823 patients) were included. Four studies examined standing stress radiography, and 12 investigated lateral decubitus or supine stress radiography. Significant heterogeneity in imaging technique and recorded anterior tibial translation was identified. Anterior tibial translation for ACL-injured knees ranged from 1.2 to 10.6 mm for standing stress radiographs and 2.7 to 11.2 mm for supine stress radiographs, with high sensitivities and specificities for both.
CONCLUSION
Stress radiography was a dependable diagnostic method for identifying ACL rupture. Further research is necessary to determine the ideal anatomic landmarks, optimal patient positioning, and appropriate applied stresses to establish a standardized protocol for both assessing ACL tears and evaluating the postoperative integrity of ACL reconstruction using stress radiography.
PubMed: 38680218
DOI: 10.1177/23259671241246197 -
Bioengineering (Basel, Switzerland) Apr 2024(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the... (Review)
Review
(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.
PubMed: 38671817
DOI: 10.3390/bioengineering11040396 -
The subcortical default mode network and Alzheimer's disease: a systematic review and meta-analysis.Brain Communications 2024The default mode network is a central cortical brain network suggested to play a major role in several disorders and to be particularly vulnerable to the...
The default mode network is a central cortical brain network suggested to play a major role in several disorders and to be particularly vulnerable to the neuropathological hallmarks of Alzheimer's disease. Subcortical involvement in the default mode network and its alteration in Alzheimer's disease remains largely unknown. We performed a systematic review, meta-analysis and empirical validation of the subcortical default mode network in healthy adults, combined with a systematic review, meta-analysis and network analysis of the involvement of subcortical default mode areas in Alzheimer's disease. Our results show that, besides the well-known cortical default mode network brain regions, the default mode network consistently includes subcortical regions, namely the thalamus, lobule and vermis IX and right Crus I/II of the cerebellum and the amygdala. Network analysis also suggests the involvement of the caudate nucleus. In Alzheimer's disease, we observed a left-lateralized cluster of decrease in functional connectivity which covered the medial temporal lobe and amygdala and showed overlap with the default mode network in a portion covering parts of the left anterior hippocampus and left amygdala. We also found an increase in functional connectivity in the right anterior insula. These results confirm the consistency of subcortical contributions to the default mode network in healthy adults and highlight the relevance of the subcortical default mode network alteration in Alzheimer's disease.
PubMed: 38665961
DOI: 10.1093/braincomms/fcae128