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European Journal of Vascular and... Jan 2024Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to summarise the published results of manufactured F/B-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated with branched configurations.
DATA SOURCES
PubMed, Scopus and The Cochrane Library were searched for articles (2018 - 2021) about patients with elective, urgent, or emergency aortic requiring a proximal landing zone in the aortic arch (zone 0 - 1 - 2) and treated by F/B-TEVAR.
REVIEW METHODS
The systematic review and meta-analysis were performed according to the PRISMA guidelines. Open repair, supra-aortic trunk (SAT) debranching + standard TEVAR, and in situ physician modified and parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality rate. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up.
RESULTS
Of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). F-TEVAR, B-TEVAR, and F+B-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 - 0.97; I = 0%; p for heterogeneity (Het) = .77) and the 30 day mortality rate was 6.7% (95% CI 0.05 - 0.09; I = 0%; p Het = .66). No statistical differences were found comparing fenestrated with branched endografts, except for a higher rate of type I - III endoleaks in F-TEVAR (9.8% vs. 2.6%; p = .034). The overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 - 96.4% and 94 - 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively.
CONCLUSION
F/B-TEVAR for the treatment of the aortic arch, according to experience in dedicated centres, now enjoys a satisfactory level of technical success together with a progressively reduced early mortality rate. There are several limitations, and further studies are needed to reach clearer conclusions.
Topics: Humans; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Treatment Outcome; Risk Factors; Endovascular Procedures; Postoperative Complications; Prosthesis Design; Retrospective Studies
PubMed: 37536517
DOI: 10.1016/j.ejvs.2023.07.048 -
Biomedical Engineering Online Dec 2016This paper presents a review on design issues and solutions found in active lower limb prostheses. This review is based on a systematic literature search with a... (Review)
Review
This paper presents a review on design issues and solutions found in active lower limb prostheses. This review is based on a systematic literature search with a methodical search strategy. The search was carried out across four major technical databases and the retrieved records were screened for their relevance. A total of 21 different active prostheses, including 8 above-knee, 9 below-knee and 4 combined knee-ankle prostheses were identified. While an active prosthesis may help to restore the functional performance of an amputee, the requirements regarding the actuation unit as well as for the control system are high and the development becomes a challenging task. Regarding mechanical design and the actuation unit high force/torque delivery, high efficiency, low size and low weight are conflicting goals. The actuation principle and variable impedance actuators are discussed. The control system is paramount for a "natural functioning" of the prosthesis. The control system has to enable locomotion and should react to the amputee's intent. For this, multi-level control approaches are reviewed.
Topics: Amputees; Ankle; Artificial Limbs; Biomechanical Phenomena; Electromyography; Gait; Humans; Knee Joint; Knee Prosthesis; Lower Extremity; Prosthesis Design; Torque
PubMed: 28105948
DOI: 10.1186/s12938-016-0284-9 -
Clinical Orthopaedics and Related... Jul 2014Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent... (Review)
Review
BACKGROUND
Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies.
QUESTIONS/PURPOSES
We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis. Secondarily, we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries.
METHODS
We conducted a systematic review of English language studies published after 1996. Adverse events of interest included rates of early failure, time to revision, revision, reoperation, dislocation, infection/sepsis, femoral neck fracture, mortality, and postoperative component alignment. Revision rates were compared with those from four national joint replacement registries. Results were reported as adverse event rates per 1000 person-years stratified by device market status (in use and discontinued). Comparisons between event rates of metal-on-metal hip resurfacing and THA are made using a quasilikelihood generalized linear model. We identified 7421 abstracts, screened and reviewed 384 full-text articles, and included 236. The most common study designs were prospective cohort studies (46.6%; n = 110) and retrospective studies (36%; n = 85). Few randomized controlled trials were included (7.2%; n = 17).
RESULTS
The average time to revision was 3.0 years for metal-on-metal hip resurfacing (95% CI, 2.95-3.1) versus 7.8 for THA (95% CI, 7.2-8.3). For all devices, revisions and reoperations were more frequent with metal-on-metal hip resurfacing than THA based on point estimates and CIs: 10.7 (95% CI, 10.1-11.3) versus 7.1 (95% CI, 6.7-7.6; p = 0.068), and 7.9 (95% CI, 5.4-11.3) versus 1.8 (95% CI, 1.3-2.2; p = 0.084) per 1000 person-years, respectively. This difference was consistent with three of four national joint replacement registries, but overall national joint replacement registries revision rates were lower than those reported in the literature. Dislocations were more frequent with THA than metal-on-metal hip resurfacing: 4.4 (95% CI, 4.2-4.6) versus 0.9 (95% CI, 0.6-1.2; p = 0.008) per 1000 person-years, respectively. Adverse event rates change when discontinued devices were included.
CONCLUSIONS
Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing, except when discontinued devices are removed from the analyses. Results from the literature may be misleading without consistent definitions, standardized outcome metrics, and accounting for device market status. This is important when clinicians are assessing and communicating patient risk and when selecting which device is most appropriate for individual patients.
Topics: Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Chi-Square Distribution; Hip Joint; Hip Prosthesis; Humans; Likelihood Functions; Linear Models; Metal-on-Metal Joint Prostheses; Osteoarthritis, Hip; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Risk Factors; Surface Properties; Time Factors; Treatment Outcome
PubMed: 24700446
DOI: 10.1007/s11999-014-3556-3 -
Journal of Indian Prosthodontic Society 2022To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR). (Meta-Analysis)
Meta-Analysis
A comparison of marginal bone loss, survival rate, and prosthetic complications in implant-supported splinted and nonsplinted restorations: A systematic review and meta-analysis.
AIM
To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR).
SETTINGS AND DESIGN
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). The PROSPERO registry, which keeps track of prospective systematic reviews, also received this paper (CRD42021229477).
MATERIAL AND METHODS
An electronic search was done in PubMed, the Cochrane Central Trials Register, Scopus, Science Direct, and Google Scholar searches were carried out. The search was limited to articles published in English and covered the period from January 2010 to August 2020.
STATISTICAL ANALYSIS USED
To conduct the meta analysis, researchers employed methodologies such as continuous measurement and odds ratios.
RESULTS
For both qualitative and quantitative analysis, 19 scientific studies were chosen. 3682 implants were placed in 2099 patients with a mean age of 59 years (splinted, 2529; non-splinted, 1153); the mean age was not provided in 5 trials. For splinted restorations, there were statistically significant differences in MBL, indicating the former has less MBL than for NSR. Splinted restorations had much greater survival rates than NSR, according to a qualitative study. Rest prosthesis complications with or without splinting were essentially the same.
CONCLUSIONS
Splinted implant restorations lost less bone than non-splinted implant restorations, according to this meta analysis. This was particularly true for posterior restorations. Lower implant failure was associated with splinted restorations. Restorations with and without splinting had the same level of prosthetic problems.
Topics: Humans; Middle Aged; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Dental Implants; Alveolar Bone Loss; Prospective Studies; Survival Rate
PubMed: 36511022
DOI: 10.4103/jips.jips_365_21 -
Indian Journal of Dental Research :... 2018The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis.
OBJECTIVE
The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis.
MATERIALS AND METHODS
A systematic review protocol was registered at PROSPERO registry, University of York, UK (CRD42016041919). Following databases were explored: PubMed, CINAHL, Cochrane, and Web of knowledge. The PICO model included participants who received occlusal splint or complete denture or full arch fixed dental prosthesis at the centric relation position. The intervention was the use of facebow transfer. Comparators were prosthesis made without using a facebow. Outcomes were the patient satisfaction of the prosthesis and the need for laboratory adjustments. Only randomized clinical trials were included in the present review. A customized data extraction pro forma was used to extract the data and assess its quality.
RESULTS
A total of 505 articles were retrieved. On excluding duplicates, protocols, case reports, case series, narrative reviews, etc., only eight studies were selected for review. Six clinical trials on 249 complete dentures and two clinical trials on 65 occlusal splints were reviewed. No study on full arch crown and bridge work satisfied the inclusion criteria.
CONCLUSIONS
The use of facebow did not yield a superior fit or comfort of the complete dentures or occlusal splints. Therefore, there is no evidence of the utility facebow transfer for these prostheses. However, no inference could be drawn for its utility in full arch fixed dental prosthesis as there were no studies to draw an inference.
Topics: Centric Relation; Dental Articulators; Dental Prosthesis Design; Denture Design; Denture, Complete; Humans; Occlusal Splints
PubMed: 29900923
DOI: 10.4103/ijdr.IJDR_377_17 -
Journal of Neuroengineering and... May 2022The inability of users to directly and intuitively control their state-of-the-art commercial prosthesis contributes to a low device acceptance rate. Since... (Review)
Review
BACKGROUND
The inability of users to directly and intuitively control their state-of-the-art commercial prosthesis contributes to a low device acceptance rate. Since Electromyography (EMG)-based control has the potential to address those inabilities, research has flourished on investigating its incorporation in microprocessor-controlled lower limb prostheses (MLLPs). However, despite the proposed benefits of doing so, there is no clear explanation regarding the absence of a commercial product, in contrast to their upper limb counterparts.
OBJECTIVE AND METHODOLOGIES
This manuscript aims to provide a comparative overview of EMG-driven control methods for MLLPs, to identify their prospects and limitations, and to formulate suggestions on future research and development. This is done by systematically reviewing academical studies on EMG MLLPs. In particular, this review is structured by considering four major topics: (1) type of neuro-control, which discusses methods that allow the nervous system to control prosthetic devices through the muscles; (2) type of EMG-driven controllers, which defines the different classes of EMG controllers proposed in the literature; (3) type of neural input and processing, which describes how EMG-driven controllers are implemented; (4) type of performance assessment, which reports the performance of the current state of the art controllers.
RESULTS AND CONCLUSIONS
The obtained results show that the lack of quantitative and standardized measures hinders the possibility to analytically compare the performances of different EMG-driven controllers. In relation to this issue, the real efficacy of EMG-driven controllers for MLLPs have yet to be validated. Nevertheless, in anticipation of the development of a standardized approach for validating EMG MLLPs, the literature suggests that combining multiple neuro-controller types has the potential to develop a more seamless and reliable EMG-driven control. This solution has the promise to retain the high performance of the currently employed non-EMG-driven controllers for rhythmic activities such as walking, whilst improving the performance of volitional activities such as task switching or non-repetitive movements. Although EMG-driven controllers suffer from many drawbacks, such as high sensitivity to noise, recent progress in invasive neural interfaces for prosthetic control (bionics) will allow to build a more reliable connection between the user and the MLLPs. Therefore, advancements in powered MLLPs with integrated EMG-driven control have the potential to strongly reduce the effects of psychosomatic conditions and musculoskeletal degenerative pathologies that are currently affecting lower limb amputees.
Topics: Amputees; Artificial Limbs; Electromyography; Humans; Walking
PubMed: 35526003
DOI: 10.1186/s12984-022-01019-1 -
Advanced Drug Delivery Reviews 2020Microneedles (MNs) have been used to deliver drugs for over two decades. These platforms have been proven to increase transdermal drug delivery efficiency dramatically...
Microneedles (MNs) have been used to deliver drugs for over two decades. These platforms have been proven to increase transdermal drug delivery efficiency dramatically by penetrating restrictive tissue barriers in a minimally invasive manner. While much of the early development of MNs focused on transdermal drug delivery, this technology can be applied to a variety of other non-transdermal biomedical applications. Several variations, such as multi-layer or hollow MNs, have been developed to cater to the needs of specific applications. The heterogeneity in the design of MNs has demanded similar variety in their fabrication methods; the most common methods include micromolding and drawing lithography. Numerous materials have been explored for MN fabrication which range from biocompatible ceramics and metals to natural and synthetic biodegradable polymers. Recent advances in MN engineering have diversified MNs to include unique shapes, materials, and mechanical properties that can be tailored for organ-specific applications. In this review, we discuss the design and creation of modern MNs that aim to surpass the biological barriers of non-transdermal drug delivery in ocular, vascular, oral, and mucosal tissue.
Topics: Administration, Topical; Biological Transport; Drug Delivery Systems; Equipment Design; Humans; Microinjections; Microtechnology; Polymers; Prostheses and Implants
PubMed: 31837356
DOI: 10.1016/j.addr.2019.11.010 -
Journal of Indian Prosthodontic Society 2023Implant-supported prostheses have considerable biomechanical advantages in partially edentulous patients when compared to other prosthetic options. Given the steady drop... (Meta-Analysis)
Meta-Analysis
Implant-supported prostheses have considerable biomechanical advantages in partially edentulous patients when compared to other prosthetic options. Given the steady drop in the frequency of patients reporting with complete edentulism, it is not unusual to see situations where teeth and implants can be splinted to provide support for fixed prostheses. A tooth implant prosthesis differs majorly from an implant-supported prosthesis in terms of force dissipation and design. The aim of this systematic review was to compare the survival rates of tooth-implant-supported prostheses with fully implant-supported and fully tooth-supported prostheses. Using the appropriate search terms, PubMed, Google Scholar, and other indexed journals were used to search the English-language literature. According to the review protocols and the PICOS inclusion criteria, the pertinent studies were chosen. The screening of appropriate studies, evaluation of study quality, and data extraction were carried out independently by two reviewers. The pooling of survival data by prostheses failure, implant failure, and marginal bone loss was used in the meta-analysis. The cumulative data of all included studies indicated that tooth-implant-supported prostheses showed a 5-year survival rate of 77%-84% and a 10-year survival rate of 72%. The pooled risk ratio for prostheses failure and implant failure was 0.99 and 1.76, respectively. These results were not statistically significant (P > 0.05). The pooled standard mean difference for marginal bone loss was 0.59, and the results were statistically significant (P < 0.05). A tooth-implant-supported fixed partial denture (FPD) has a similar survival rate when compared to implant-supported FPD or T-FPD.
Topics: Humans; Dental Implants; Tooth; Dental Implantation; Dental Prosthesis, Implant-Supported
PubMed: 37861608
DOI: 10.4103/jips.jips_161_23 -
Biomedizinische Technik. Biomedical... Feb 2024To determine, through clinical studies, whether there is a correlation between the Periotest value (PTV) and the implant stability quotient (ISQ). (Review)
Review
OBJECTIVES
To determine, through clinical studies, whether there is a correlation between the Periotest value (PTV) and the implant stability quotient (ISQ).
CONTENT
Methods to evaluate the stability of dental implants.
SUMMARY
A search was performed in the PubMed, Scopus, and Web of Science databases for articles on the proposed subject up to January 29, 2023, using search terms that combined "resonance frequency analysis" and "Periotest" with "correlation" or "relationship"; and combinations of "implant stability quotient" and "Periotest" with "correlation" or "relationship." The inclusion criteria were clinical studies in English involving human subjects who received dental implants and evaluating the correlation between PTV and ISQ. A total of 46 articles were screened, of which 10 were selected for full-text analysis, and eight articles were included in this review. Based on three articles, 75 % of the results of this systematic review showed a negative correlation between PTV and ISQ, regardless of the type of stability assessed. Based on the remaining five articles, 100 % (regardless of the patient's gender) and 66.66 % of the results showed a negative correlation for primary and secondary stability, respectively. There is a negative correlation between PTV and ISQ for both primary and secondary dental implant stability.
OUTLOOK
This review can serve as a reference for the development of methodologies for future clinical studies on this topic.
Topics: Humans; Osseointegration; Dental Implants; Dental Implantation, Endosseous; Dental Prosthesis Retention
PubMed: 37489593
DOI: 10.1515/bmt-2023-0194 -
Journal of the American Heart... Apr 2024It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the... (Meta-Analysis)
Meta-Analysis
Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years.
BACKGROUND
It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions.
METHODS AND RESULTS
We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], <0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], <0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], <0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM.
CONCLUSIONS
The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
Topics: Humans; Female; Aortic Valve; Heart Valve Prosthesis Implantation; Aortic Valve Stenosis; Prosthesis Failure; Treatment Outcome; Heart Valve Prosthesis; Risk Factors; Prosthesis Design
PubMed: 38533939
DOI: 10.1161/JAHA.123.033176