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Global Spine Journal Mar 2021Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVE
Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation.
METHODS
A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate.
RESULTS
Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability.
CONCLUSIONS
This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
PubMed: 32875872
DOI: 10.1177/2192568220907574 -
PloS One 2020Double-lumen tube is commonly used in thoracic surgeries that need one-lung ventilation, but its big size and stiff structure make it harder to perform intubation than a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Double-lumen tube is commonly used in thoracic surgeries that need one-lung ventilation, but its big size and stiff structure make it harder to perform intubation than a conventional tracheal intubation tube.
OBJECTIVES
To investigate the effectiveness and safety of videoscopes for double-lumen tube insertion. The primary outcome was the success rate of first attempt intubation. Secondary outcomes were intubation time, malposition, oral mucosal damage, sore throat, and external manipulation.
DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
Databases (Pubmed, Embase, Cochrane, Kmbase, Web of science, Scopus) up to June 23, 2020 were searched.
ELIGIBILITY
Randomized controlled trials comparing different videoscopes for double-lumen tube intubation were included in this study.
METHODS
We classified and lumped the videoscope devices into the following groups: standard (non-channeled) videolaryngoscope, channeled videolaryngoscope, videostylet, and direct laryngoscope. After assessing the quality of evidence, we statistically analyzed and chose the best device based on the surface under the cumulative ranking curve (SUCRA) by using STATA software (version 16).
RESULTS
We included 23 studies (2012 patients). Based on the success rate of the first attempt, a rankogram suggested that the standard videolaryngoscope (76.4 of SUCRA) was the best choice, followed by videostylet (65.5), channeled videolaryngoscope (36.1), and direct laryngoscope (22.1), respectively. However, with regard to reducing the intubation time, the best choice was videostylet, followed by a direct laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope, respectively. Direct laryngoscope showed the lowest incidence of malposition but required external manipulation the most. Channeled videolaryngoscope showed the highest incidence of oral mucosal damage, but showed the lower incidence of sore throat than standard videolaryngoscope or direct laryngoscope.
CONCLUSION
Most videoscopes improved the success rate of double-lumen tube intubation; however, they were time-consuming (except videostylet) and had a higher malposition rate than the direct laryngoscope.
Topics: Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopy; One-Lung Ventilation; Pharyngitis; Randomized Controlled Trials as Topic; Thoracic Surgery; Video Recording
PubMed: 32857788
DOI: 10.1371/journal.pone.0238060 -
Asia-Pacific Journal of Ophthalmology... 2020The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral...
PURPOSE
The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty.
DESIGN
Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years.
METHODS
A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018).
RESULTS
After screening 1456 abstracts from search results, 1377 were eliminated due to irrelevant content. Full text of the remaining 79 articles and relevant cross-references were reviewed and summarized. Studies on cosmetic epicanthoplasty reported Z-plasty or modifications (n=8), advancement flap (n=4) or skin redraping procedures (n=1), removal or release of the orbicularis muscle (n = 14), with (n = 6) or without (n = 11) tightening medial canthal tendon. In lateral canthoplasty, approaches to preserve continuity of eyelid margin prevent lateral canthal deformity with inconspicuous incision via gray line (n = 2) or upper eyelid (n = 2) were described. Techniques of upper blepharoplasties described included open incision method (n = 9) with (n = 5) or without (n = 3) orbicularis resection, subbrow approach (n = 1), nonincisional suture blepharoplasty (n = 2), or partial incision blepharoplasty (n = 1). For lower blepharoplasties, techniques described included blepharoplasty with fat transposition (n = 7), transconjunctival blepharoplasty (n = 3), transcutaneous blepharoplasty and canthopexy (n = 1) or orbicularis flap (n = 2), minimally invasive or laser-assisted blepharoplasty (n = 2).
CONCLUSIONS
The recent trend of periocular surgical rejuvenation focuses on preserving soft tissue volume, avoiding skin or use hidden incision, taking the eyebrow and midface position into account, and measures to minimize iatrogenic eyelid malposition.
Topics: Blepharoplasty; Eyelids; Humans; Surgical Flaps
PubMed: 32804712
DOI: 10.1097/APO.0000000000000311 -
Journal of Orthopaedic Surgery and... Jul 2020Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
AIM
The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients.
METHODS
Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias.
RESULTS
From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05).
CONCLUSION
Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Pedicle Screws; Quality Assurance, Health Care; Safety; Spinal Fusion; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Young Adult
PubMed: 32690035
DOI: 10.1186/s13018-020-01798-0 -
PeerJ 2020The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels....
BACKGROUND
The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes.
METHODS
We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison.
RESULTS
In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4-10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8-6.8]; for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, for heterogeneity = 0.023) than was TAx TAVR.
CONCLUSIONS
DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
PubMed: 32435538
DOI: 10.7717/peerj.9102 -
The American Journal of Emergency... Jul 2020In this meta-analysis, we investigated the success rate of subclavian venous catheterization (SVC) as well as the incidence of related complications when performed via... (Meta-Analysis)
Meta-Analysis
Comparative evaluation of the clinical safety and efficiency of supraclavicular and infraclavicular approaches for subclavian venous catheterization in adults: A meta-analysis.
BACKGROUND
In this meta-analysis, we investigated the success rate of subclavian venous catheterization (SVC) as well as the incidence of related complications when performed via the supraclavicular (SC) or traditional infraclavicular (IC) approaches.
METHODS
Ignoring the original language, we identified and analyzed eight randomized controlled trials (RCTs) published on or before December 30, 2018, after searching the following five bibliographic databases: PubMed, Springer, Medline, EMBASE, and the Cochrane Library. All included studies compared the clinical safety and efficiency of the SC and IC approaches for SVC in adults. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Cannulation failure rates and the incidence of malposition were regarded as the primary outcome measures. Secondary outcome measures included cannulation access time and the incidence of pneumothorax and artery puncture.
RESULTS
Failure rates were significantly lower for SVC via the SC approach than via the IC approach [odds ratio, 0.66; 95% confidence interval (CI), 0.47 to 0.93]. The SC approach was also associated with a decreased incidence of catheter malposition, relative to that observed for the IC approach [odds ratio, 0.24; 95% CI, 0.13 to 0.46]. The SC approach did not reduce the time required for cannulation [mean difference, -74.74; 95% CI, -157.80 to 8.33], and there were no differences in the incidence of artery puncture [odds ratio, 0.60; 95% CI, 0.29 to 1.23] or pneumothorax [odds ratio, 0.89; 95% CI, 0.33 to 2.40].
CONCLUSION
Our findings suggest that SVC via the SC approach should be utilized in adults.
Topics: Arteries; Catheterization, Central Venous; Humans; Pneumothorax; Randomized Controlled Trials as Topic; Subclavian Vein; Time Factors
PubMed: 32334895
DOI: 10.1016/j.ajem.2020.04.015 -
Open Access Macedonian Journal of... Sep 2019Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following... (Review)
Review
BACKGROUND
Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition.
AIM
This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence.
METHOD
This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords ("Lower Eyelids Malposition" OR "Complications" OR "Ectropion" OR "Entropion") AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark).
RESULT
This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 - 0.69, p = 0.01).
CONCLUSION
There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.
PubMed: 31844463
DOI: 10.3889/oamjms.2019.726 -
Shoulder & Elbow Jul 2019Positioning of the glenoid component is one of the most challenging steps in shoulder arthroplasty, and prosthesis longevity as well as functional outcomes is considered... (Review)
Review
BACKGROUND
Positioning of the glenoid component is one of the most challenging steps in shoulder arthroplasty, and prosthesis longevity as well as functional outcomes is considered highly dependent on accurate positioning. This review considers the evidence supporting surgical navigation and patient-specific instruments for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty.
METHODS
A systematic literature search was performed for studies assessing glenoid implant positioning accuracy as measured by cross-sectional imaging on live subjects or cadaver models. Meta-analysis of controlled studies was performed to estimate the primary effects of navigation and patient-specific instruments on glenoid implant positioning error. Meta-analysis of absolute positioning outcomes was also performed for each group incorporating data from controlled and uncontrolled studies.
RESULTS
Nine studies, four controlled and five uncontrolled, with 258 total subjects were included in the analysis. Meta-analysis of controlled studies supported that both navigation and patient-specific instruments had a moderate statistically significant effect on improving glenoid implant positioning outcomes. Meta-analysis of absolute positioning outcomes demonstrates glenoid implant positioning with standard instrumentation results in a high rate of malposition.
DISCUSSION
Navigation and patient-specific instruments improve glenoid positioning outcomes. Whether the improvement in positioning outcomes achieved translate to better clinical outcomes is unknown.
PubMed: 31447941
DOI: 10.1177/1758573218806252 -
Current Reviews in Musculoskeletal... Jul 2019To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature. (Review)
Review
PURPOSE OF REVIEW
To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature.
RECENT FINDINGS
Current literature demonstrates that minimally invasive surgery (MIS) in spine has improved clinical outcomes and reduced complications when compared with open spinal procedures. Recent studies describing MI-TLIF primarily for degenerative disk disease, spondylolisthesis, and vertebral canal stenosis cite over 89 discrete complications, with the most common being radiculitis (ranging from 2.8 to 57.1%), screw malposition (0.3-12.7%), and incidental durotomy (0.3-8.6%). Minimally invasive spine surgery has a distinct set of complications in comparison with other spinal procedures. These complications vary based on the exact MIS procedure and indication. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy.
PubMed: 31302861
DOI: 10.1007/s12178-019-09574-2 -
International Journal of Surgery... Aug 2019chest tube insertions are commonly performed in various scenarios. Although frequent, these procedures result in a significant complication rate, especially in the acute...
BACKGROUND
chest tube insertions are commonly performed in various scenarios. Although frequent, these procedures result in a significant complication rate, especially in the acute care setting. Ultrasonography has been incorporated to interventional procedures aiming to reduce the incidence of complications. However, little is known about the applications of ultrasound in tube thoracostomies. The aim of this systematic review is to present the potential applications of ultrasonography as an adjunct to the procedure.
METHODS
we searched Medline/Pubmed, EMBASE and Scopus databases. Out of 3012 articles, we selected 19 for further analysis. Thirteen of those were excluded because they did not meet the inclusion criteria. Ultimately, 6 articles were thoroughly evaluated and included in the review.
RESULTS
The included articles show that ultrasound can be used to correctly identify a safe insertion site, to accurately find a vulnerable intercostal artery, and is reliable for timely diagnosis of drain malpositioning.
CONCLUSION
this systematic review highlights the potential benefits of incorporating ultrasonography in tube thoracostomies. No randomized clinical trials are available. However, it is reasonable to assume that proper use of ultrasound may reduce procedure-related complications.
Topics: Chest Tubes; Drainage; Humans; Thoracostomy; Ultrasonography, Interventional
PubMed: 31229699
DOI: 10.1016/j.ijsu.2019.06.012