Case Series Studies Research Articles

Decoding mpox: a systematic review and meta-analysis of the transmission and severity parameters of the 2022–2023 global outbreak

IntroductionThe 2022–2023 mpox outbreak has been the largest in history. We aim to synthesise the key epidemiological parameters related to the dynamics, transmission, and severity of mpox (incubation period, serial...

Clinical and Pathological Staging Discrepancies in Laryngeal Cancer: A Systematic Review

Background/Objectives: Laryngeal squamous cell carcinoma (LSCC) is one of the most prevalent and challenging malignancies of the head and neck. Clinical staging (cTNM) plays a pivotal role in therapeutic decision-making. However, current imaging modalities often fall short, resulting in discrepancies between cTNM and pathological staging (pTNM). This systematic review aimed to critically evaluate the existing literature on the concordance between clinical and pathological staging of LSCC, quantifying staging inaccuracies and highlighting the prevalence of both under- and overstaging at diagnosis. Methods: A comprehensive search of the English-language literature was conducted across multiple databases, including PubMed, Embase, Scopus, the Cochrane Library, and Web of Science. Eligibility was limited to retrospective case series and observational studies reporting sufficient data to directly correlate individual patients’ cTNM and pTNM classifications. Results: Thirty-one studies comprising 7939 patients met the inclusion criteria. The overall concordance rate between cT and pT was approximately 86.43%. The concordance rates between cT and pT were 82.41%, 82.03%, 78.14%, and 89.64% for cT1, cT2, cT3, and cT4, respectively. Most discordant cases in cT2 and cT3 involved understaging at clinical diagnosis. Conclusions: The limited accuracy of clinical staging in reflecting the true extent of disease remains a critical challenge in the management of LSCC. The inability of current imaging techniques to reliably detect the subtle invasion of key anatomical structures contributes to both under- and overstaging, with significant clinical implications. For patients undergoing non-surgical organ-preservation strategies, these inaccuracies may adversely affect oncologic outcomes.

The Use of Antibiotics Impregnated Bone Cement in Reducing Surgical Site Infections in Spine Surgery: A Systematic Review.

Spine surgeries are one of the most widely accepted method of surgery in orthopaedics. However, one of the most common complications of spine surgeries is surgical site infection (SSI), that associated with various post operative morbidities. The use of antibiotics impregnated bone cement (AIBC) is common in orthopaedics surgeries. Therefore, we aim to provide comprehensive review of AIBC use in spine surgeries. Data was gathered from PubMed, Europe PMC, and ScienceDirect using keywords associated with AIBC and spine surgeries. We included all publications associated with AIBC and spine surgeries. Studies without full paper, non-English publications, review articles, and animal or cadaveric studies are excluded. The quality of each included studies assessed using Newcastle Ottawa Scale (NOS) and Joana Briggs Institute (JBI) Critical Appraisal for case reports, case series, and quasi experimental studies. 15 studies with total of 322 patients using AIBC in spine surgery were included. 10 of 15 studies reported 100% infection-free event with AIBC administration with or without given systemic antibiotics. Two studies did not report 100% infection free event due to MRSA infections and technical causes. 3 studies reported the use of AIBC without disclosing outcomes. Various types of bacteria ranging from MSSA to MRSA have been discovered, with PMMA and vancomycin being the most frequently used AIBC. Antibiotics impregnated bone cement can be used to prevent post-operative infections due to its high effectiveness, easy administration, and no side effects have ever been reported. Further studies are needed to determine the most appropriate antibiotics, dose, and type of cement.

Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis

AimGender dysphoria (GD) refers to the psychological distress associated with the incongruence between one’s sex and one’s gender identity. To manage GD, individuals may delay the development of primary and...

Integrating Forensic Autopsies with Proteomic Profiling for Suicide Risk Assessment: A Comprehensive Review of Literature.

Suicide is a major global public health concern that affects people of all ages, with over 700000 individuals intentionally ending their lives every year. Suicide is a multifactorial event related to multiple risk factors interlocking with each other, among which neurobiological factors are considered to be an objective measure of the incidence of this phenomenon and can be used as a measurable tool for evaluating suicidal tendencies. The aim of this study is to thoroughly examine available data and assess candidate proteins as prospective biomarkers for predicting suicides and ascertaining the manner of death in forensic cases. An electronic search was conducted on PubMed, Science Direct Scopus, and the Excerpta Medica Database. The systematic review adhered to PRISMA guidelines and encompassed case series, prospective and retrospective studies, and short communications published in English. The focus was on proteomics and suicide, specifically, those studies where researchers conducted human proteomic analyses on specimens obtained from individuals who completed or attempted suicide. A total of 14 studies met the inclusion criteria, resulting in a dataset of numerous candidate protein biomarkers. These include tenascin-C, potassium voltage-gated channel subfamily Q member 3, vimentin-immunoreactive astrocytes, glutathione S-transferase theta 1, iron transport proteins, Acrystallin chain B, manganese superoxide dismutase, glial fibrillary acidic protein, various glycolytic pathway proteins, 14-3-3 eta and 14-3-3 theta proteins, specific cytoskeleton proteins, C-reactive protein, serum amyloid A protein 1, extrinsic coagulation pathway proteins, the vacuolar-type proton pump ATPase subunit, plasma apolipoprotein A-IV, and ER stress proteins. These proteins are proposed as a panel of biomarkers to be evaluated in conjunction with other clinical predictors of suicide. This review aims to provide a comprehensive summary of all proteomic studies conducted on cases of attempted or completed suicide. By doing so, it seeks to bridge existing gaps in knowledge and pave the way for future investigations. The ultimate goal is to potentially identify a suicide biomarker.

Outcomes of Total Joint Arthroplasty in Patients Who Have Ehlers-Danlos Syndrome: A Systematic Review and Meta-Analysis.

Patients who have Ehlers-Danlos Syndrome (EDS), a group of connective tissue disorders characterized by aberrant collagen synthesis and processing, have an increased likelihood of requiring a total joint arthroplasty (TJA), including total hip or knee arthroplasty (THA or TKA). This study aimed to synthesize outcomes following TJA in patients who have EDS. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that described outcomes of TJA in EDS patients were searched from PubMed, Medline, The Cochrane Library, and Embase. Case series and cohort studies were included if they identified patients who had EDS who underwent either primary THA or TKA. Rates of reoperation and/or revision, instability or frank dislocation, aseptic loosening, periprosthetic fractures, periprosthetic joint infection (PJI), medical complications, wound complications, and readmissions were collected and compared to patients who do not have EDS undergoing TJA for osteoarthritis when available. Individual pooled comparative meta-analysis was performed for each variable. Patient-reported outcome measures (PROMs) were collected and qualitatively described. The search yielded eight publications with 1,769 EDS patients (1,011 THA and 758 TKA) describing outcomes after TJA, seven of which were included in the meta-analysis. Following THA, EDS patients were at increased risk of all-cause revision (OR [odds ratio] = 2.40, P < 0.001), instability/dislocation (OR = 3.22, P < 0.001), and aseptic loosening (OR = 3.76, P < 0.001). Following TKA, EDS patients were at increased risk of all-cause revision (OR = 1.54, P = 0.006), instability (OR = 2.96, P < 0.001), periprosthetic fracture (OR = 2.91, P = 0.009), and wound complications/hematoma (OR = 2.91, P < 0.001). There were no differences in medical complications, PJI, or readmission. The PROMs were similar between the cohorts and significantly improved compared to the baselines. Patients who have Ehlers-Danlos have an increased risk of implant-related complications following TJA. The EDS patients undergoing arthroplasty may benefit from careful planning with surgical techniques and constrained designs that minimize instability.

Posterior Urethral Valves and Fertility: Insight on Paternity Rates and Seminal Parameters.

Posterior urethral valves (PUVs) represent the most common cause of male congenital lower urinary tract obstruction, often responsible for renal dysplasia and chronic renal failure. Despite recent improvements in patients' outcomes thanks to prenatal ultrasound early diagnosis, PUVs can still impact sexual function and fertility. This study aims to review the available evidence on fertility in PUV patients, examining paternity rates and semen parameters. A review was conducted of the PubMed, Cochrane, Scopus, and Embase databases. Studies focusing on fertility and paternity outcomes in PUV patients were selected, including case reports, case series, and retrospective and prospective studies. A total of 15 studies met the inclusion criteria. The review revealed that PUV patients often exhibit compromised semen parameters, including low sperm count, reduced motility, and abnormal morphology, as well as alterations in seminal plasma. PUV diagnoses are common in adults exhibiting infertility and ejaculation disorders, suggesting PUVs cannot be considered only a pediatric disease. Paternity rates among PUV patients were rarely reported in extenso, hampering the correct assessment of the overall medium paternity rate and its comparison with that of healthy individuals. Lastly, seminal parameters were assessed in a minimal cohort of patients, therefore, they could not be considered representative. Fertility and seminal parameters in PUV patients represent an under-investigated area. PUVs can variably and non-univocally affect fatherhood, and they may be associated with compromised semen quality. Early intervention and long-term follow-up are essential to address potential fertility issues. Future research should focus on developing targeted strategies to preserve and enhance fertility in this patient population.

Toscana virus: A comprehensive review of 1381 cases showing an emerging threat in the Mediterranean regions.

Toscana virus (TOSV) is a sand fly-borne phlebovirus causing central nervous system (CNS) infection in Mediterranean countries, during summer season. However, clinical aspects of the disease caused by this virus are poorly known by clinicians, so that its prevalence is probably underestimated due to a lack of diagnosis. The data was gathered from all available case series and retrospective studies identifying TOSV as the causative viral agent. The informations of age, sex, clinical characteristics, laboratory findings, imaging results and clinical outcomes of TOSV infection were recorded and analyzed. A total of 95 articles including TOSV infections resulting in a total of 1381 cases, were analyzed. Our findings indicatethat TOSV affects individuals across various age groups, with a median age of 44.45 years. A notable disparity in infection rates between genders, with men being significantly more likely to present symptoms due to TOSV than women, with a sex ratio of 2.0. The clinical presentation of TOSV infection encompasses a range of symptoms, including fever, headache, retro-orbital pain, neurological and muscular manifestations with less common reports of cutaneous and gastrointestinal symptoms. To date, six fatalities have been attributed to TOSV infections, with a median age of 76 years. Diagnostic evaluation of TOSV infections often involves the analysis of cerebrospinal fluid, where findings may include an elevated white blood cell count. These findings underscore the diverse clinical manifestations of TOSV infections including flu like symtomps. TOSV is an emerging infectious threat that warrants inclusion in the diagnostic protocols for patients presenting with CNS, particularly within the Mediterranean basin or for those with recent travel history to endemic regions during warmer months when sand flies are actively circulating.

Venous Thromboembolism in Patients with Neuroendocrine Neoplasms: A Systematic Review of Incidence, Types, and Clinical Outcomes.

Background: Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with unique biological characteristics and complications, including thromboembolism. This systematic review evaluates the incidence, types, and clinical outcomes of venous thromboembolic events (VTEs) in NEN patients. Methods: A systematic search of PubMed, Scopus, and Embase was conducted to identify studies on TEs in NENs. Eligible studies included case reports, case series, and retrospective cohort studies reporting VTEs, including deep vein thrombosis (DVT), pulmonary embolism (PE), and visceral vein thrombosis (VVT). Data were extracted on tumor site, functionality, differentiation grade, and VTE type. Results: In total, 33 studies were included, comprising 26 case reports, 2 case series, and 5 retrospective cohort studies. VTE prevalence ranged from 7.5% to 33% across studies. The most common VTEs were DVT, PE, and portal vein thrombosis (PVT). A meta-analysis revealed a pooled VTE prevalence of 11.1% (95% CI: 9.07-13.53%). Pancreatic NENs exhibited the highest thrombotic burden, particularly in poorly differentiated and advanced-stage tumors. Functioning tumors, including glucagonomas and ACTH-secreting NENs, were strongly associated with VTEs, potentially related to their systemic effects on coagulation and inflammation. Conclusions: Venous thromboembolism is a significant complication in NEN patients, especially in advanced or poorly differentiated tumors. Early detection and targeted management are critical for improving outcomes. Further investigations are required to clarify the mechanisms underlying thromboembolism in NENs and to develop optimized prophylactic and therapeutic strategies tailored to this patient population.

Challenges in the Management of Pediatric Pancreatic Hydatid Disease: A Systematic Review of the Literature and Our Clinical Experience

ABSTRACT Pancreatic hydatid disease (PHD) in children is rare compared to liver and lung involvement. The rarity and overlap with other cystic lesions often lead to challenges in the preoperative diagnosis and intraoperative surprises. Clear guidelines on the appropriate management of PHD are lacking. This review is intended to address these gaps in the literature. A systematic literature search was performed in PubMed, Scopus, Cochrane Central Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric PHD. Observational studies such as case reports, case series, and retrospective studies were included. Letters, editorials, conference abstracts, comments, animal studies, and non-English literature studies were excluded. After sorting out 794 articles, 11 articles describing 16 patients (including our cases) were included in qualitative synthesis. The author’s two cases were described separately. Preoperative diagnosis was made in only 35.71% of the patients. Both the conservative surgical (92.86%) and radical approaches (7.14%) have been described with favorable results (85.71%). One patient managed with the conservative surgical approach developed a pancreatic leak. No recurrence was reported. PHD in children is rare. Accurate preoperative diagnosis is uncommon and requires a high index of suspicion. A normal pancreas, nondilated pancreatic duct, and normal enzymes in a patient from an endemic zone should prompt consideration of PHD. Surgical management must be individualized due to the limited data. Both conservative and radical approaches can be effective, but caution is needed for potential pancreatic leaks after the conservative approach due to ductal communication.

Superabsorbent wound dressings for the management of highly exuding wounds: a literature review.

Exudate management is essential for creating a moist wound environment that promotes optimal healing, especially in highly exuding wounds, where choosing an appropriate wound dressing to handle high volumes of exudate is a key part of the wound management strategy. Superabsorbent wound dressings (SWDs) have been designed to absorb and retain large amounts of exudate. Thus, they are advocated for management of wounds with moderate-to-high levels of exudate to reduce the risk of leakage and damage to the periwound skin. The SWD category contains numerous brands with different structural and compositional designs. Those differences affect absorption capacity of the products, but also affect structural integrity, risk of leakage, adherence to the wound bed upon dressing removal etc. Herein, we aim to provide a brief overview of the clinical evidence and technical performance characteristics of the SWD category, and identify technical improvement areas. Clinical evidence within the SWD category was primarily limited to product evaluations, case series and case studies. With limited comparative clinical evidence available within this product category, we provide an overview of in vitro comparisons of technical performance characteristics related to absorption capacity, fluid retention, structural integrity, waterproofness, and ability to sequester host-derived enzymes and microorganisms. Substantial differences in in vitro performance characteristics in this product category were identified, which may have implications for their clinical performance. With the currently available in vitro evidence, there is no SWD showing superior performance across all functionalities, indicating a continued need for product development within this product category.

Enhancing Infection Control in ICUS Through AI: A Literature Review.

Infection control in intensive care units (ICUs) is crucial due to the high risk of healthcare-associated infections (HAIs), which can increase patient morbidity, mortality, and costs. Effective measures such as hand hygiene, use of personal protective equipment (PPE), patient isolation, and environmental cleaning are vital to minimize these risks. The integration of artificial intelligence (AI) offers new opportunities to enhance infection control, from predicting outbreaks to optimizing antimicrobial use, ultimately improving patient safety and care in ICUs. The primary objectives are to explore AI's impact on predicting HAIs, real-time monitoring, automated sterilization, resource optimization, and personalized infection control plans. A comprehensive search of PubMed and Scopus was conducted for relevant articles up to January 2024, including case series, reports, and cohort studies. Animal studies and irrelevant articles were excluded, with a focus on those considered to have significant clinical relevance. The review highlights AI's prowess in predicting HAIs, surpassing conventional methods. Existing evidence demonstrates AI's efficacy in accurately predicting and mitigating HAIs. Real-time patient monitoring and alert systems powered by AI are shown to enhance infection detection and patient outcomes. The paper also addresses AI's role in automating sterilization and disinfection, with studies affirming its effectiveness in reducing infections. AI's resource optimization capabilities are exemplified in ICU settings, showcasing its potential to improve resource allocation efficiency. Furthermore, the review emphasizes AI's personalized approach to infection control post-procedures, elucidating its ability to analyze patient data and create tailored control plans.

Application of Reverse Sural Flaps in Pediatric Patients: A Systematic Review.

The reverse sural flap (RSF) is a random-type, pedicled flap based on sural artery perforators indicated for traumatic lower-extremity wounds. The RSF has demonstrated comparable results to free flap placement in the adult population for reconstruction of distal third defects, but few reports describe its application and outcomes in the pediatric population. We investigated RSF application in pediatric patients (<18 years of age) through systematic review and meta-analysis. PubMed, Scopus, CINAHL, and ProQuest databases were utilized. Inclusion criteria included case series and chart studies reporting on pediatric RSF patients. Primary outcomes included overall flap survival rate, venous congestion, and necrosis. Screening of 244 initial articles yielded 16 studies for further review and statistical analysis. There were 207 patients treated with a mean age of 9.51 ± 2.27 years and follow-up of 20.07 months. The majority of studies focus on the distal third as the primary site for RSF reconstruction, with fasciocutaneous being the most commonly used flap type. Trauma was the predominant etiology of soft-tissue defect (91.0%). Analysis of outcomes shows a 91.0% survival rate for reverse sural flaps. Approximately 13.0% of patients experienced venous congestion. Flap necrosis rate was 15.0%, although most cases were subtotal (93.1%) and successfully managed through additional skin grafting. With comparable efficacy to free flaps for distal third defects in the pediatric population as well as similar success rates to adult RSF patients, the RSF should be considered a first-line therapy for lower-extremity soft-tissue reconstruction in pediatric patients.

Subcutaneous injections of dextrose in musculoskeletal pain, a potential therapeutic intervention: scoping review.

The aims of this review were to identify and to analyze the clinical studies that used subcutaneous injections of dextrose for treating musculoskeletal pain, in order to establish an overview. A systematic search was carried out in scientific databases including Web of Science, Cochrane Central Register of Controlled Trials, PUBMED and other sources, up until March 2024. We included clinical studies that used subcutaneous injections of dextrose in the treatment of individuals with musculoskeletal pain associated with tendinopathies, enthesopathy, osteoarthritis, ligament sprains, muscle strains or bursitis of various locations. Twenty studies that met the criteria were included in this review; of those, 13 were randomized clinical trials, one non-randomized comparative study and six were case series studies, comprising a total of 1226 patients. In all included studies, efficacy in pain reduction was reported in the groups treated with dextrose when comparing evaluations at baseline, short term and medium term. Subcutaneous injections of dextrose could be a beneficial treatment for reducing musculoskeletal pain; however, factors such as the high heterogeneity in the treatment schemes, uncertainty in the mechanisms of action and the level of evidence found, indicate that this technique is still under development.

Lymph node ratio (LNR) and lymph node yield (LNY) in head and neck cancer: A systematic review and meta-analysis.

A growing amount of evidence points at lymph node yield (LNY) and lymph node ratio (LNR) as useful indicators in the prognostic evaluation of patients affected by head and neck squamous cell carcinoma (HNSCC) who require neck dissection. The aim of this study was to assess the importance of LNY and LNR in the prognostic evaluation of head and neck cancer patients. Included studies were those examining LNY and/or LNR in head and neck cancer patients. We excluded case reports or case series, thyroid cancer or salivary gland cancer studies, a sample size less than 20, and studies with incomplete or missing survival estimate. Of the 2435 studies identified through a database search, 95 were reviewed for full text and 63 were finally included for the final analysis. Electronic databases, including PubMed (MEDLINE), Embase, and Scopus were screened up to January 1, 2024. The systematic review was conducted according to the MOOSE checklist. A set of sub-group meta-analyses were performed for oral cavity, oropharynx, hypopharynx, larynx, and mixed subsites using a random-effects model. Overall survival (OS), Disease Specific Survival (DSS), and Disease-Free Survival (DFS) Hazard Ratios (HR) related to a prespecified LNR and LNY exact value were chosen as summary statistics. Cumulative Hazard Ratios with 95% Confidence Interval (CI) were presented, calculated through the inverse variance method. Heterogeneity was evaluated with I2 statistics. Results of the meta-analysis showed increased OS for a higher LNY (HR 1.33 95% CI 1.23-1.45). Regarding the LNR, a lower LNR value has an impact on survival, with an OS HR of 1.96 (95% CI 1.72-2.24). The same was true for DFS (HR 2.43 95% CI 1.82-3.23), and DSS (HR 2.07 95% CI 1.83-2.33). Our analysis confirms the importance of LNY and LNR as prognostic indicators. Future studies are needed to establish the optimal cut-off values for both factors. LNY and LNR have the potential to be routinely evaluated in patients who undergo neck dissection for HNSCC.

A Review of the Multilayering Technique of Injecting Dermal Fillers

The multilayer injection technique for dermal fillers has emerged as a promising strategy in facial rejuvenation, aiming to restore volume, enhance contours, and achieve a more natural and youthful appearance by strategically placing fillers of varying rheology in multiple facial planes. This contrasts with more traditional, single-layer injection techniques. This scoping review aims to critically evaluate evidence around the feasibility, procedural approaches, outcomes, and complications associated with the multilayer approach. A review of the literature was conducted across multiple databases, including Medline, Web of Science, and Embase, for studies published between January 1, 2010, and June 4, 2024. The search included keywords related to dermal fillers, facial rejuvenation, and multilayer injection techniques. Experimental studies, including randomized control trials (RCTs), observational studies, retrospective studies, case series, and cadaver studies were considered eligible for review. The search yielded 6 studies that met the inclusion criteria: 2 cadaver studies with associated prospective studies and 4 retrospective reviews. The studies collectively involved 464 patients and 15 human cadavers. The cadaver studies focused on establishing the anatomical justification for the multilayer technique, while the clinical studies reported high patient and physician satisfaction with few complications. The multilayer injection technique is a promising approach to facial rejuvenation, offering natural-looking results with a sound anatomical basis and low risk of complications. However, the existing literature is limited by methodological shortcomings, including variations in study designs, lack of control groups, and reliance on subjective assessments. Further rigorous research is needed to validate the efficacy and safety of this technique in live patient settings.

Does Position of Pedicle Screws Correlate With Adjacent Segment Degeneration? An Average 6-Year Follow-Up Retrospective Study.

Retrospective case serie. Assess the correlation between pedicle screw (PS) position of the first instrumented vertebra (FIV) with proximal adjacent segment degeneration (ASD) development or progression. Patients ≥55years who have undergone lumbar fusion with a minimum 2-year follow-up were included. Radiographic PS position was assessed by the angle between the first PS and the upper vertebral endplate (VE) and by the PS tip-VE distance. Radiographic parameters of ASD included: disc height, disc angle, and vertebral listhesis. ASD magnetic resonance imaging (MRI) parameters included: disc degeneration and lumbar stenosis. ROC curve analysis was performed to identify the best cut-off points in correlation with lumbar stenosis. Forty-eight patients were included with an average follow-up of 6years. All 48 included patients developed some degree of ASD whether on radiographic or MRI parameters. PS tip-VE distance and PS-VE angle were both positively correlated with: (1) Delta (Δ) lumbar stenosis; (2) Δ Disc degeneration; and (3) Δ Disc height. ROC curve analysis correlating PS tip-VE distance and PS-VE angle with an increase in the canal stenosis severity ≥2° resulted in a cut-off point of 36% and 9.5°, respectively. The cranial orientation (PS-VE angle) of the pedicle screw in the first instrumented vertebra, along with a shorter pedicle screw tip-vertebral endplate distance (PS tip-VE), positively correlated with ASD progression at an average 6-year follow-up. Protective values against lumbar stenosis were identified as a PS tip-VE distance ≥36% of the first instrumented vertebra height and a PS-VE angle ≤9.5° relative to the upper vertebral endplate.

Evaluation of Effect of Laser in Root Canal Disinfection in Pulp Regenerative Therapy: A Systematic Review.

Background: The evaluation of the effect of laser in disinfection of root canal in pulp regenerative therapy, if found effective laser can be used for root canal disinfection in cases of regenerative endodontic therapy. Objective: This study includes a systematic review addressing the question of whether laser is effective in root canal treatment in regenerative endodontic therapy. Methods: Randomized controlled trials (RCTs), case series, and animal studies evaluating the effect of laser-assisted endodontic irrigation in pulp regenerative therapy were included. Review articles, case reports, and in vitro studies were excluded. The data search covers all publications without limitation by year. The last search was conducted on December 31, 2023. An electronic search was performed using the following databases: PubMed, Cochrane Library, and Google Scholar. The result of this review was in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Assessment of risk of bias was done using the modified Cochrane Risk of Bias Tool. Results: The initial search resulted in 749 articles. Eleven duplicate articles were removed. Following the titles and abstracts screening, 11 articles were identified to form the basis of this systematic review. Three articles were excluded as full text was unavailable. Overall, eight studies evaluated the laser effect in root canal disinfection in pulp regenerative therapy, which were included in this systematic review. Of the included studies, a low risk of bias was shown by 7/8 studies, and a moderate risk of bias was shown by 1/8 studies. Conclusion: Laser can be used for root canal disinfection in cases of regenerative endodontic therapy. There is a need for further RCTs about individual laser groups and their disinfection effect on regenerative endodontic therapy for obtaining a higher level of evidence.

Repair Fails More Frequently Than Reconstruction in Acute Posterolateral Corner Knee Injuries: A Systematic Review of Outcomes Following Surgical Management.

To synthesize the current literature on PLC reconstruction and repair, focusing on a comparison of surgical techniques and outcomes based on injury chronicity in the setting of sports-related ligament tears. A systematic review of the literature including queries of the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in March of 2024. Studies were included if they were of level IV evidence or greater, reported PLC reconstruction or repair outcomes, and had a minimum 2-year follow-up. Patient demographics, injury type, time from injury to surgery, surgical technique, subjective patient outcomes, objective physical exam findings, and complications were obtained. Postoperative physical exam findings of varus and posterolateral rotatory stability and reoperation for instability were used to determine surgical success or failure. Means and ranges were recorded for continuous variables. Forest plots were generated for failure rates by subgroup and an I-squared statistic was used as a measure of heterogeneity. Except for 3 studies, injuries were considered acute when treated within 3 weeks of injury. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) for cohort studies and the National Institute of Health (NIH) Quality Assessment Tool for case series studies. Twenty-nine of the sixty-three reviewed studies (791 patients) met inclusion criteria. Two of the studies were level II, eleven level III, and sixteen level IV evidence. Mean patient age ranged from 19 to 69.1 years. Mean time from injury to surgery ranged from 8.1 to 19 days (acute) and 7.2 weeks to 70.2 months (chronic). Mean postoperative Lysholm scores ranged from 80.8 to 97.0 (acute) and 76.5 to 94.5 (chronic). Mean postoperative IKDC scores ranged from 59.8 to 87.3 (acute) and 64 to 91.9 (chronic). Within the acute PLC group, 114 (59.3%) patients were treated with isolated repair and the remaining 78 (40.7%) were treated with reconstruction. Within this group, failure rates, defined by varus stress examination or reoperation, ranged from 0 to 40%. More specifically , reconstruction failure rates ranged from 0 to 15%, whereas repair failure rates ranged from 0 to 40%. All 602 chronic PLC patients were treated with reconstruction and the failure rate ranged from 0 to 27%, with a single outlier study of two patients reporting a 50% failure rate. The findings of this review suggest that repair of PLC injuries in the acute setting may fail at higher rates than reconstruction. Additionally, chronic PLC injuries are predominantly treated with reconstruction and experience greater variability in their rates of success compared to acute injuries. High-quality, well-controlled studies are needed to determine optimal management of both acute and chronic PLC injuries.

Risk Factors Associated With the Development of Calciphylaxis in Patients With Chronic Kidney Disease: A Systematic Review.

Calciphylaxis is a rare but potentially life-threatening disease that is not yet completely understood. It occurs mainly in patients with chronic kidney disease termed calcific uremic arteriolopathy (CUA) but also affects patients with normal renal function. Although this disease's pathogenesis is unclear, it is associated with the dysregulation of calcium and phosphate and subsequent calcification of peripheral arterioles. Calciphylaxis has up to 80% mortality, even with multidisciplinary and multimodal treatment modalities. The available literatureidentified some relevant risk factors associated with the development of calciphylaxis, but the authors differ significantly in risk profiling. Moreover, most papers on calciphylaxis are observational studies, namely case series, case reports, cohort, and cross-sectional studies. Although recently available articles mentioned some risk factors, the studies mainly focused on diagnosis, treatment, and prognosis with limited emphasis on structured risk profiling. In addition, experimental and systemic review studies on risk factors associated with calciphylaxis are lacking. Thus, this systematic review'sprimary focusisto determine risk factors associated with developing calciphylaxis in patients with chronic kidney disease. We searched electronic databases from 2018 to 2024 for articles that containedrelevant risk factors linked with the development of calciphylaxisusing the keywords calciphylaxis, chronic kidney disease, and risk factors. We identified 486 articles, removed duplicate papers from selected articles, applied inclusion and exclusion criteria, and conducted a quality assessment test. Two independent authors performed data extraction manually, and we compared the results for consistency and accuracy. Twenty-two articles met the eligibility criteria, butonly 16 articles passed the quality assessment appraisal and were included in the systematic review. We identified 1,739 patients: 664 (38.2%) and 1075 (61.81%) were males and females, respectively. A total of 1373 (78.95%) were on dialysis, and 926 (53.25%) were diabetics. Caucasians and patients with obesity were 695 (37.90%) and 613 (35.25%), respectively.At the time of diagnosis, 599 (34.45%), 311 (17.90%), and 278 (15.99%) were on vitamin K antagonists (VKA), vitamin D, and calcium phosphate binders. The number of patients with elevated parathyroid hormone was 196 (11.27%). Our study found no experimental or systematic reviews that primarily focused on risk factors associated with the development of calciphylaxis. Our research indicated that dialysis is the most frequent risk factor linked to the development of calciphylaxis. Other risk factors include being caucasian, female gender, obese, diabetic mellitus (DM), having elevated parathyroid hormone, and use of VKA (warfarin), vitamin D, and calcium phosphate binders. These findings are consistent with the evidence seen in most of the articles we reviewed. However, the papers we studied are mainly observational mono-centered research articles, with the majority having a small sample size. Thus, we recommend a multicenter, large-scale experimental study to assessrisk factors and profiling for the development of calciphylaxis in patients with chronic kidney disease.