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Bioactive Materials Nov 2021Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term... (Review)
Review
Acute or degenerative meniscus tears are the most common knee lesions. Meniscectomy provides symptomatic relief and functional recovery only in the short- to mid-term follow-up but significantly increases the risk of osteoarthritis. For this reason, preserving the meniscus is key, although it remains a challenge. Allograft transplants present many disadvantages, so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal scaffolds. The aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both and in clinical studies. Three databases were searched: 46 preclinical studies and 30 clinical ones were found. Sixteen natural, 15 synthetic, and 15 hybrid scaffolds were studied . Among them, only 2 were translated into clinic: the Collagen Meniscus Implant, used in 11 studies, and the polyurethane-based scaffold Actifit®, applied in 19 studies. Although positive outcomes were described in the short- to mid-term, the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical literature. Few studies also combined the use of cells or growth factors, but these augmentation strategies have not been applied in the clinical practice yet. Current solutions offer a significant but incomplete clinical improvement, and the regeneration potential is still unsatisfactory. Building upon the overall positive results of these "old" technologies to address partial meniscal loss, further innovation is urgently needed in this field to provide patients better joint sparing treatment options.
PubMed: 33898878
DOI: 10.1016/j.bioactmat.2021.03.033 -
European Journal of Vascular and... Feb 2021There is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid endarterectomy (CEA) mostly because under this term various... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
There is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid endarterectomy (CEA) mostly because under this term various "closure" techniques are included, from direct closure to a wide spectrum of patches with different materials.
DATA SOURCES
MEDLINE (via PubMed) and SCOPUS.
REVIEW METHODS
This was a systematic review of the Medline (via PubMed) and SCOPUS databases for randomised controlled trials (RCTs) comparing different CEA closure techniques. Network meta-analysis (NMA) was performed with a frequentist approach. The primary and the secondary outcome measures were the 30 day combined stroke and death rate and the late restenosis rate, respectively.
RESULTS
Twenty-three RCTs were finally included in the NMA with a total of 4440 patients randomised, representing seven different techniques (primary carotid closure, n = 753; EvE, n = 431; vein patch closure, n = 973; polytetrafluoroethylene [PTFE] patch, n = 948; Dacron patch, n = 828; bovine pericardium patch, n = 249; and polyurethane patch, n = 258). NMA showed that EvE had a decreased 30 day combined stroke and death rate vs. all other methods of arterial closure, with the exception of PTFE and bovine pericardium patching. Additionally, EvE was associated with the lowest restenosis rate vs. all other methods of arterial closure after CEA. EvE was significantly superior to Dacron patches with regard to late restenosis, with the prediction intervals (PIs) lying completely on the beneficial side (risk ratio 0.06; PI 0.01-0.58) and increasing confidence of this comparison. Rare catastrophic complications of vein patch blow out or synthetic patch infection were reported in 0.2% of the total (n = 9/4 400) and no comparisons were made.
CONCLUSION
EvE and patching with bovine pericardium or PTFE is associated with a lower incidence in both short term and late undesired outcomes following CEA and seems to represent the best choice compared with other carotid closure techniques. These results may support the vascular surgeon's choice of technique/patch material.
Topics: Biocompatible Materials; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carotid Arteries; Endarterectomy, Carotid; Humans; Outcome Assessment, Health Care; Postoperative Complications; Wound Closure Techniques
PubMed: 33257115
DOI: 10.1016/j.ejvs.2020.10.009 -
Revista Latino-americana de Enfermagem 2014to evaluate the effectiveness of hydrocolloids in the healing of pressure ulcers in adult and older adult patients. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
to evaluate the effectiveness of hydrocolloids in the healing of pressure ulcers in adult and older adult patients.
METHOD
systematic review with meta-analysis, based on the recommendations of the Cochrane Handbook. The search was undertaken in the databases: Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science and the Scientific Electronic Library Online.
RESULTS
646 primary studies were identified, 69 were evaluated and nine were selected, referring to the use of the hydrocolloid dressing in healing; of these, four studies allowed meta-analysis. There was no statistically significant difference between the hydrocolloid group and the foams group (p value=0.84; Odds Ratio 1.06, CI 95% 0.61-1.86). A slight superiority of the polyurethane dressings was observed in relation to the hydrocolloid dressings.
CONCLUSION
the evidence is not sufficient to affirm whether the efficacy of hydrocolloid dressings is superior to that of other dressings. It is suggested that clinical randomized trials be undertaken so as to ascertain the efficacy of this intervention in the healing of pressure ulcers, in relation to other treatments.
Topics: Adult; Aged; Bandages; Bandages, Hydrocolloid; Humans; Pressure Ulcer; Treatment Outcome; Wound Healing
PubMed: 25029065
DOI: 10.1590/0104-1169.3480.2445 -
Caries Research 2011The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries.
MATERIALS AND METHODS
The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables.
RESULTS
An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis.
CONCLUSION
Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as 'weak'.
Topics: Cariostatic Agents; Chlorhexidine; Controlled Clinical Trials as Topic; Drug Combinations; Ethanol; Gingival Recession; Humans; Incidence; Paint; Polyurethanes; Root Caries; Thymol
PubMed: 21525751
DOI: 10.1159/000327374 -
Polymers Jul 2022Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has... (Review)
Review
Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has been seen, the wound-healing process is complex, which includes four different stages. So far, the design and evaluation of polyurethane for wound dressing has focused on achieving good properties (mechanical, physicochemical, and biological), but each of them separates from the others or even directed at only one of the stages of skin wound-healing. Therefore, the aim of this systematic review is to explore the applications of polyurethanes in wound dressings and to determine whether could be designed to cover more than one stage of skin wound-healing. The PRISMA guidelines were followed. The current research in this field does not consider each stage separately, and the design of polyurethane dressings is focused on covering all the stages of wound healing with a single material but is necessary to replace polyurethanes in short periods of time. Additionally, little emphasis is placed on the hemostasis stage and further characterization of polyurethanes is still needed to correlate mechanical and physicochemical properties with biological properties at each stage of the wound-healing. Current research demonstrates an effort to characterize the materials physiochemically and mechanically, but in terms of their biological properties, most of the literature is based on the performance of histological tests of explants morphologically probing the compromised tissues, which give an indication of the potential use of polyurethanes in the generation of wound-healing dressings.
PubMed: 35893955
DOI: 10.3390/polym14152990 -
The Cochrane Database of Systematic... Jan 2006The male condom, which consists of a thin sheath placed over the glans and shaft of the penis, is designed to prevent pregnancy by providing a physical barrier against... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The male condom, which consists of a thin sheath placed over the glans and shaft of the penis, is designed to prevent pregnancy by providing a physical barrier against the deposition of semen into the vagina during intercourse. Beginning in the 1990s, nonlatex male condoms made of polyurethane film or synthetic elastomers were developed as alternative male barrier methods for individuals with allergies, sensitivities or preferences that prevented the consistent use of condoms made of latex.
OBJECTIVES
The review sought to evaluate nonlatex male condoms in comparison with latex condoms in terms of contraceptive efficacy, breakage and slippage, safety, and user preferences.
SEARCH STRATEGY
We searched computerized databases for randomized controlled trials of nonlatex condoms. We also wrote to the manufacturers of nonlatex condoms and known investigators in an attempt to locate any other trials not identified in our search.
SELECTION CRITERIA
The review included all randomized controlled trials identified in the literature search that evaluated a male nonlatex condom made of polyurethane film or synthetic elastomers in comparison with a latex condom.
DATA COLLECTION AND ANALYSIS
We evaluated all titles and abstracts located in the literature searches for inclusion. Two authors independently extracted data from the identified studies. We analyzed data with RevMan. The Peto odds ratio (Peto OR) with 95% confidence interval (CI) was calculated for each outcome of contraceptive efficacy, condom breakage and slippage, discontinuation of use, safety, and user preference. Contraceptive efficacy, early discontinuation, and safety outcomes were also measured with survival analysis techniques.
MAIN RESULTS
While the eZ.on condom did not protect against pregnancy as well as its latex comparison condom, no differences were found in the typical-use efficacy between the Avanti and the Standard Tactylon and their latex counterparts. The nonlatex condoms had significantly higher rates of clinical breakage than their latex comparison condoms: the Peto OR for clinical breakage ranged from 2.6 (95% CI 1.6 to 4.3) to 5.0 (95% CI 3.6 to 6.8). Few adverse events were reported. Substantial proportions of participants preferred the nonlatex condom or reported that they would recommend its use to others.
AUTHORS' CONCLUSIONS
Although the nonlatex condoms were associated with higher rates of clinical breakage than their latex comparison condoms, the new condoms still provide an acceptable alternative for those with allergies, sensitivities, or preferences that might prevent the consistent use of latex condoms. The contraceptive efficacy of the nonlatex condoms requires more research.
Topics: Condoms; Contraception; Humans; Latex; Male; Polystyrenes; Polyurethanes; Randomized Controlled Trials as Topic
PubMed: 16437459
DOI: 10.1002/14651858.CD003550.pub2 -
The Cochrane Database of Systematic... Jan 2015Eczema is an inflammatory skin disease that tends to involve skin creases, such as the folds of the elbows or knees; it is an intensely itchy skin condition, which can... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Eczema is an inflammatory skin disease that tends to involve skin creases, such as the folds of the elbows or knees; it is an intensely itchy skin condition, which can relapse and remit over time. As many as a third of people with eczema who have a positive test for allergy to house dust mite have reported worsening of eczema or respiratory symptoms when exposed to dust.
OBJECTIVES
To assess the effects of all house dust mite reduction and avoidance measures for the treatment of eczema.
SEARCH METHODS
We searched the following databases up to 14 August 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 8), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant studies. We handsearched abstracts from international eczema and allergy meetings.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of any of the house dust mite reduction and avoidance measures for the treatment of eczema, which included participants of any age diagnosed by a clinician with eczema as defined by the World Allergy Organization. We included all non-pharmacological and pharmacological interventions that sought to reduce or avoid exposure to house dust mite and their allergenic faeces. The comparators were any active treatment, no treatment, placebo, or standard care only.
DATA COLLECTION AND ANALYSIS
Two authors independently checked the titles and abstracts identified, and there were no disagreements. We contacted authors of included studies for additional information. We assessed the risk of bias using Cochrane methodology.
MAIN RESULTS
We included seven studies of 324 adults and children with eczema. Overall, the included studies had a high risk of bias. Four of the seven trials tested interventions with multiple components, and three tested a single intervention. Two of the seven trials included only children, four included children and adults, and one included only adults. Interventions to reduce or avoid exposure to house dust mite included covers for mattresses and bedding, increased or high-quality vacuuming of carpets and mattresses, and sprays that kill house dust mites.Four studies assessed our first primary outcome of 'Clinician-assessed eczema severity using a named scale'. Of these, one study (n = 20) did not show any significant short-term benefit from allergen impermeable polyurethane mattress encasings and acaricide spray versus allergen permeable cotton mattress encasings and placebo acaricide spray. One study (n = 60) found a modest statistically significant benefit in the Six Area, Six Sign Atopic Dermatitis (SASSAD) scale over six months (mean difference of 4.2 (95% confidence interval 1.7 to 6.7), P = 0.008) in favour of a mite impermeable bedding system combined with benzyltannate spray and high-filtration vacuuming versus mite permeable cotton encasings, water with a trace of alcohol spray, and a low-filtration vacuum cleaner. The third study (n = 41) did not compare the change in severity of eczema between the two treatment groups. The fourth study (n = 86) reported no evidence of a difference between the treatment groups.With regard to the secondary outcomes 'Participant- or caregiver-assessed global eczema severity score' and the 'Amount and frequency of topical treatment required', one study (n = 20) assessed these outcomes with similar results being reported for these outcomes in both groups. Four studies (n = 159) assessed 'Sensitivity to house dust mite allergen using a marker'; there was no clear evidence of a difference in sensitivity levels reported between treatments in any of the four trials.None of the seven included studies assessed our second primary outcome 'Participant- or caregiver-assessed eczema-related quality of life using a named instrument' or the secondary outcome of 'Adverse effects'.We were unable to combine any of our results because of variability in the interventions and paucity of data.
AUTHORS' CONCLUSIONS
We were unable to determine clear implications to inform clinical practice from the very low-quality evidence currently available. The modest treatment responses reported were in people with atopic eczema, specifically with sensitivity to one or more aeroallergens. Thus, their use in the eczema population as a whole is unknown. High-quality long-term trials of single, easy-to-administer house dust mite reduction or avoidance measures are worth pursuing.
Topics: Acaricides; Adolescent; Adult; Animals; Bedding and Linens; Child; Child, Preschool; Dust; Eczema; Elbow; Environmental Exposure; Household Work; Humans; Knee; Middle Aged; Pyroglyphidae; Randomized Controlled Trials as Topic; Respiratory Hypersensitivity; Young Adult
PubMed: 25598014
DOI: 10.1002/14651858.CD008426.pub2 -
Medicine Mar 2021The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the effect of a polyurethane (PU) tracheal tube cuff on the prevention of... (Meta-Analysis)
Meta-Analysis
Comparison of polyurethane tracheal tube cuffs and conventional polyvinyl chloride tube cuff for prevention of ventilator-associated pneumonia: A systematic review with meta-analysis.
BACKGROUND
The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the effect of a polyurethane (PU) tracheal tube cuff on the prevention of ventilator-associated pneumonia (VAP).
METHODS
We performed a systematic search using the MEDLINE database through PubMed, Cochrane Central Register of Controlled Trial, SCOPUS, and Web of Science.Randomized controlled trials comparing the incidence of VAP and clinically relevant outcomes between PU cuff tubes and polyvinyl chloride (PVC) cuff tubes in adult patients. Two authors independently extracted study details, patient characteristics, and clinical outcomes such as incidence of VAP, bacterial colonization of tracheal aspirate, duration of mechanical ventilation, ICU stay, and ICU mortality.
RESULTS
From 309 studies identified as potentially eligible, six studies with 1226 patients were included in this meta-analysis. All studies compared the incidence of VAP between PU cuffs and PVC cuffs. Use of a PU cuff was not associated with a reduction in VAP incidence (RR = 0.68; 95% CI, 0.45-1.03) with significant statistical heterogeneity (I2 = 65%). The quality of evidence was "very low." According to the TSA, the actual sample size was only 15.8% of the target sample size, and the cumulative Z score did not cross the trial sequential monitoring boundary for benefit. No positive impact was reported for the other relevant outcomes for PU cuffs.
CONCLUSIONS
The use of a PU cuff for mechanical ventilation did not prevent VAP. Further trials with a low risk of bias need to be performed.
Topics: Equipment Design; Humans; Intensive Care Units; Intubation, Intratracheal; Pneumonia, Ventilator-Associated; Polyurethanes; Polyvinyl Chloride; Respiration, Artificial
PubMed: 33655952
DOI: 10.1097/MD.0000000000024906 -
World Journal of Gastroenterology Sep 2016To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions. (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.
METHODS
A systematic review and meta-analysis was performed following the PRISMA process. PubMed (Medline), EMBASE (Excerpta Medical Database), AMED (Allied and Complementary medicine Database), Scopus and online content, were searched for studies reporting on the NiTi-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.
RESULTS
Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2% (95%CI: 94.8%-98.9%; I (2) = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I (2) = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I (2) = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined. Pooled stent migration rate was 4.7% (95%CI: 2.5%-7.7%; I (2) = 0%). Finally, tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2% (95%CI: 3.7%-22.1%; I (2) = 82.2%). No funnel plot asymmetry to suggest publication bias (bias = 0.39, P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.
CONCLUSION
The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth.
Topics: Adult; Aged; Aged, 80 and over; Alloys; Deglutition Disorders; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Statistics as Topic; Stents; Treatment Outcome
PubMed: 27678367
DOI: 10.3748/wjg.v22.i34.7841 -
Annals of Work Exposures and Health Jul 2020Diisocyanates are a group of chemicals that are widely used in occupational settings. They are known to induce various health effects, including skin- and respiratory...
Diisocyanates are a group of chemicals that are widely used in occupational settings. They are known to induce various health effects, including skin- and respiratory tract sensitization resulting in allergic dermatitis and asthma. Exposure to diisocyanates has been studied in the past decades by using different types of biomonitoring markers and matrices. The aim of this review as part of the HBM4EU project was to assess: (i) which biomarkers and matrices have been used for biomonitoring diisocyanates and what are their strengths and limitations; (ii) what are (current) biomonitoring levels of the major diisocyanates (and metabolites) in workers; and (iii) to characterize potential research gaps. For this purpose we conducted a systematic literature search for the time period 2000-end 2018, thereby focussing on three types of diisocyanates which account for the vast majority of the total isocyanate market volume: hexamethylene diisocyanate (HDI), toluene diisocyanate (TDI), and 4,4'-methylenediphenyl diisocyanate (MDI). A total of 28 publications were identified which fulfilled the review inclusion criteria. The majority of these studies (93%) investigated the corresponding diamines in either urine or plasma, but adducts have also been investigated by several research groups. Studies on HDI were mostly in the motor vehicle repair industry [with urinary hexamethylene diamine result ranging from 0.03 to 146.5 µmol mol-1 creatinine]. For TDI, there is mostly data on foam production [results for urinary toluene diamine ranging from ~0.01 to 97 µmol mol-1 creatinine] whereas the available MDI data are mainly from the polyurethane industry (results for methylenediphenyl diamine range from 0.01 to 32.7 µmol mol-1 creatinine). About half of the studies published were prior to 2010 hence might not reflect current workplace exposure. There is large variability within and between studies and across sectors which could be potentially explained by several factors including worker or workplace variability, short half-lives of biomarkers, and differences in sampling strategies and analytical techniques. We identified several research gaps which could further be taken into account when studying diisocyanates biomonitoring levels: (i) the development of specific biomarkers is promising (e.g. to study oligomers of HDI which have been largely neglected to date) but needs more research before they can be widely applied, (ii) since analytical methods differ between studies a more uniform approach would make comparisons between studies easier, and (iii) dermal absorption seems a possible exposure route and needs to be further investigated. The use of MDI, TDI, and HDI has been recently proposed to be restricted in the European Union unless specific conditions for workers' training and risk management measures apply. This review has highlighted the need for a harmonized approach to establishing a baseline against which the success of the restriction can be evaluated.
Topics: Biological Monitoring; Humans; Occupational Exposure; Polyurethanes; Toluene 2,4-Diisocyanate; Workplace
PubMed: 32313948
DOI: 10.1093/annweh/wxaa038