Methodological Index For Non-Randomized Studies Research Articles

Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis.

To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened for clinical interventional studies addressing the impact of NSPT on pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) outcomes in PD patients. Furthermore, the research strategy was implemented using a hand search. Studies were selected, and data were extracted by two independent reviewers. Random effects models were applied to perform a meta-analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias. Fifteen articles were finally included for qualitative synthesis. Among them, eight single-arm cohort studies met the final inclusion criteria for meta-analysis. The Rob2 analysis evidenced that one randomized clinical trial (RCT) had a low risk, three RCTs raised some concerns, and three RCTs had a high risk of bias, while the MINORS scores ranged from 9 to 14. The meta-analysis showed that NSPT significantly impacted FMD (p<0.001) and CIMT (p=0.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (I2=78% for FMD and I2=62% for CIMT). Despite some beneficial effects on FMD and CIMT, due to study limitations, high heterogeneity, and risk of bias, it cannot be concluded that NSPT is effective in improving arterial stiffness. Therefore, further studies are necessary to achieve high-quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients. PROSPERO ID CRD42024501399. Periodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta-analysis indicates that nonsurgical periodontal treatment (NSPT) may reduce cardiovascular disease risk in patients with PD. The moderate evidence derived from the studies that were finally included showed that NSPT had beneficial effects on flow-mediated dilatation and carotid intima-media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta-analysis were characterized by high heterogeneity and risk of bias and were derived from uncontrolled clinical trials or randomized clinical trials with limitations. Therefore, more studies with standardized protocols and homogeneous arterial stiffness outcomes are needed to elevate the quality of the present evidence.

The Role of Cognitive Reserve in Post-Stroke Rehabilitation Outcomes: A Systematic Review

Background/Objectives: Stroke remains a major cause of disability and death, with survivors facing significant physical, cognitive, and emotional challenges. Rehabilitation is crucial for recovery, but outcomes can vary widely. Cognitive reserve (CR) has emerged as a factor influencing these outcomes. This systematic review evaluates the role of CR in post-stroke rehabilitation, examining whether higher CR is associated with better outcomes. Methods: A systematic search of PubMed, Google Scholar, Scopus, and Cochrane Library databases was conducted for studies published between 2004 and 2024. Studies examining social-behavior CR proxies (e.g., education, bilingualism) and their impact on post-stroke outcomes were included. Data were analyzed using descriptive statistics. The study quality was assessed using the Methodological Index for NOn-Randomized Studies (MINORS) scale. Results: Among 3851 articles screened, 27 met the inclusion criteria. Higher education levels, bilingualism, and engagement in cognitively stimulating activities were associated with better cognitive outcomes and functional recovery. Lower socioeconomic status (SES) correlated with poorer outcomes. Early rehabilitation and dynamic CR proxies showed stronger associations with cognitive recovery than static ones. Conclusions: CR may predict post-stroke rehabilitation outcomes, with education, bilingualism, and active engagement in cognitive activities showing potential benefits. Future research should explore CR’s role alongside factors like lesion location and severity in enhancing recovery.

Sexual dysfunction in lymphoma survivors: a scoping review.

Lymphoma and cancer-related treatment can cause many complications, including sexual dysfunction, a common symptom experienced by lymphoma survivors during the disease trajectory and survivorship. A scoping review was performed to determine the current state of knowledge about sexual dysfunction in lymphoma survivors and identify knowledge gaps and implications for future research. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched to identify all primary peer-reviewed research articles published in the English language that were pertinent to sexual dysfunction in lymphoma survivors. The framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist were used to assess and synthesize the available evidence on sexual dysfunction in lymphoma survivors. This review provided supportive evidence that sexual function in lymphoma survivors is a major ongoing area of concern. Thirty eligible articles published from 1979 to 2023 were appraised in this review. Most of the studies (73.33%) used a cross-sectional design. Using the Methodological Index for Non-Randomized Studies, more than half of the publications (53.33%) achieved a C quality ranking. The reviewed studies revealed that sexual dysfunction was a prevalent symptom experienced by lymphoma survivors, with predictors such as age, gender, sex hormones, stage of disease, and types of cancer treatment. Healthcare providers need to consistently perform routine assessment of sexual function and provide adequate treatment options. The reviewed studies document the problem of sexual dysfunction and offer potential areas of improvement for clinical practice. However, in the majority of the studies, longitudinal data were not obtained which could provide valuable insights on sexual functioning in lymphoma survivors. Despite many years of research on sexual function in lymphoma survivors, substantial gaps in knowledge regarding sexual issues in this population remain. Healthcare providers should routinely assess sexual function of survivors and provide treatment options. Psychosexual interventions should be tailored for the needs of cancer survivors. Sexual function education is essential for all oncologists and should be included in the care pathway from diagnosis until survivorship.

Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis.

Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects. An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale. Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0-160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome. This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient. Systematic review and meta-analysis. Level III.

Most Athletes who fail to Return to Sport After Latarjet Procedure Cite Psychological Factors: a Systematic Review.

The purpose of this study was to identify the return-to-sport (RTS) rate in athletes undergoing a Latarjet procedure, while outlining the specific reasons for failure to RTS. An electronic literature search was conducted (PubMed/MEDLINE, Scopus, Web of Science). Studies in peer-reviewed journals with Latarjet procedures performed on athletes that reported rates and reasons for failure to RTS were included. Excluded studies were those that reported solely on non-athletes, non-Latarjet surgery, and missing rates of and reasons for failure to RTS. Study heterogeneity was assessed using the I2 statistic and quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. After review of 3617 articles, a total of 18 studies with 1,066 patients met the inclusion criteria. The level of evidence for included studies ranged from LOE II to LOE IV. Rates of not returning to sports (NRTS) ranged from 3.4-35.3%. More studies cited shoulder-unrelated reasons than shoulder-related reasons for why athletes failed to RTS. Ten (55.5%) studies, making up 656 (61.5%) patients reported that shoulder-unrelated reasons were accountable for more than 50% of NRTS. Only 3 (16.7%) studies reported 100% NRTS due to shoulder-related reasons, which include fear of reinjury and psychological factors. Study heterogeneity was found to be moderate (I2 = 73.4%; 95% CI: 57.5-83.3; p < 0.001) and study quality was found to be satisfactory (Mean MINORS score 12.1 for non-comparative and 20.5 for comparative studies). According to this systematic review, the rate of NRTS after Latarjet ranged from 3.4-35.3% across 18 studies, with the majority of studies citing non-shoulder related reasons such as fear or reinjury or psychological factors as the major deterrent for returning to sports. IV Systematic Review of Case Series.

The impact of renin-angiotensin-aldosterone system inhibitors on the recurrence of chronic subdural hematoma: a systematic review and meta-analysis.

This meta-analysis seeks to investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on the recurrence of chronic subdural hematoma (cSDH). Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, this study conducted a comprehensive online search across various databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, without time restrictions. Two reviewers independently screened titles, abstracts, and full texts based on predetermined criteria, resolving any discrepancies through discussion or consultation with a third reviewer. The quality and risk of bias of the included studies were assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Cochrane's tool for evaluating risk of bias in randomized controlled trials. Six studies aligned with the study objectives were included after a systematic search across 6 databases. The RAAS inhibitors group comprised 404 participants, while the control or placebo group included 1828 participants. Analysis for publication bias using the Egger test indicated no bias in the studies (P = 0.151). The odds ratio for cSDH recurrence with RAAS inhibitor use compared to non-use was reported as OR = 1.06; confidence interval 0.6-1.893, p-value = 0.818, showing no significant association between RAAS inhibitor use and cSDH recurrence. The results suggest no significant link between RAAS inhibitor use and cSDH recurrence. However, due to the limited number and design of studies, as well as the lack of clinical trials, further research is needed to determine the effectiveness of this treatment.

Primary retroperitoneal lymph node dissection in stage II testicular seminoma: a systematic review.

To conduct a systematic review of the current literature to determine the current role of primary retroperitoneal lymph node dissection (RPLND) in stage II testicular seminoma and its associated oncological, functional and peri-operative outcomes. A comprehensive literature search was conducted in Medline, Embase, and Scopus for publications from inception until November 2023. The systematic review was registered on PROSPERO (ID CRD42023449781), was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilised the Methodological Index for Non-Randomised Studies (MINORS) tool. Six studies involving 385 patients were analysed, with 48.5% clinical stage IIA and 51.5% stage IIB seminomas. The patients' mean (range) age was 37 (20-64) years. The median operation time was 187 min, median estimated blood loss was 150 mL and median length of hospital stay was 4 days. In all, 6.1% of patients developed complications that were greater or equal to Clavien-Dindo grade 3. Only four studies reported on anejaculation rate (median: 4.9%). Only one study had long-term data, demonstrating a 92% 5-year overall survival for stage IIA/B disease treated with RPLND. The remaining five studies had a median follow-up of between 18.5 and 37 months and reported a mean recurrence rate of 15.6%. Most recurrences (78%) were not within the field of RPLND. Recurrence was associated with higher clinical and pathological lymph node stage, and metachronous or delayed development of retroperitoneal lymphadenopathy (initially stage I disease, as opposed to de novo stage IIA/B disease). Primary RPLND, performed by experienced surgeons, has good peri-operative outcomes. Recurrence is more common than with standard treatment, but long-term survival and functional data are limited, although promising.

Streptokinase or Alteplase for Acute Limb Ischemia? A Meta-Analysis

Background: Acute limb ischemia (ALI) is a vascular emergency that necessitates prompt and effective treatment to restore blood flow and prevent limb loss. Thrombolytic therapy, particularly with agents like streptokinase and alteplase, plays a pivotal role in ALI management. This meta-analysis and systematic review aimed to compare the efficacy and safety of streptokinase and alteplase in treating ALI. Methods: A comprehensive search of PubMed, Embase, Science Direct, and the Cochrane Library databases was conducted up to August 13, 2024, to identify relevant studies. The inclusion criteria encompassed clinical trials involving patients diagnosed with ALI who received either streptokinase or alteplase as the initial thrombolytic treatment. The quality of the included studies was rigorously assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Methodological Index for Non-Randomized Studies (MINOR) criteria. A meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate risk ratios (RRs) with their corresponding 95% confidence intervals (CIs). Results: The final analysis included 20 studies, encompassing both qualitative and quantitative assessments. A comparative analysis of streptokinase and alteplase for limb salvage at 30 days revealed a significant advantage in favor of alteplase, with a relative risk ratio (RR) of 0.78 (95% CI 0.69-0.88, I² = 0%). Furthermore, streptokinase was associated with a higher rate of primary amputation, with an RR of 2.54 (95% CI 1.50-4.32, I² = 0%) compared to alteplase. The use of streptokinase also correlated with a higher risk of complications, including major bleeding (RR 1.75, 95% CI 0.04-84.30, I² = 77%) and minor bleeding (RR 1.41, 95% CI 0.60-3.32, I² = 0%). Conclusion: The findings of this meta-analysis underscore the superior efficacy of alteplase in achieving limb salvage in ALI, coupled with a more favorable safety profile. The preferential use of alteplase in clinical practice is recommended, particularly in patients with severe ischemia. However, careful patient selection and close monitoring are crucial when streptokinase therapy is considered.

Effectiveness of surfing on psychological health in military members: a systematic review

IntroductionSurfing, a leisure activity known for its positive physical and mental health effects, has emerged as a potential therapeutic intervention. This study aims to systematically review the available evidence on...

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

A systematic review on the techniques, long-term outcomes, and complications of partial breast irradiation after breast-conserving surgery for early-stage breast cancer.

To evaluate the efficacy and safety of four techniques of partial breast irradiation (PBI) including interstitial brachytherapy (ISBT), balloon-based brachytherapy (BBT), Intraoperative radiotherapy (IORT) and three-dimensional conformal radiotherapy (3DCRT) in the treatment for early-stage breast cancer patients after breast-conserving surgery. A systematic search was performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, Embase, Cochrane Library and Web of Science databases. The inclusion criteria were clinical trials and observational studies that reported on outcome measures of principal PBI techniques. The methodological quality of the included research data was assessed using bias risk assessment tool with the Methodological Index for Non-Randomized Studies (MINORS), and the research information were analyzed using data analysis software. Clinical studies were collected from the earliest available date until September 2023. Fifty-one studies were included, with a total sample size of 7708. The results of network meta-analysis (NMA) showed that ISBT can lower the local recurrence (SUCRA: 73.8%). In terms of reducing distant metastasis, 3DCRT may be the best choice (SUCRA: 52.5%). And IORT has the highest 5-year overall survival (SUCRA: 90%). Furthermore, ISBT also has the advantages of lowest risk with fat necrosis (SUCRA: 72.5%), infection (SUCRA: 78.3%) and breast pain (SUCRA: 86.2%). BBT may be the optimal solution for fibrosis (SUCRA: 76.9%) and hyperpigmentation (SUCRA: 66.7%). 3DCRT has lower incidence of telangiectasia (SUCRA: 56.7%) and better cosmetic result (SUCRA: 85%). Postoperative PBI treatment using ISBT after breast-conserving surgery in patients with early-stage breast cancer may be a more valuable choice based on the treatment efficacy and is associated with fewer late side-effects. Large-scale, prospective, long-term studies are warranted to clarify the role of different PBI techniques in selected patients.

High mortality rate and restricted mobility in above knee amputation following periprosthetic joint infection after total knee arthroplasty: A systematic review.

To systematically review the literature on the outcomes of above knee amputation as a salvage procedure after periprosthetic joint infection in total knee arthroplasty. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Scopus, Web of Science, and Embase electronic databases were utilized to identify all studies evaluating clinical outcomes of patients with above knee amputation following PJI from inception to June 24, 2023. Studies were excluded for failure to report functional outcomes specifically related to AKA in PJI following TKA, utilizing surgical interventions other than amputation, AKA indicated for other reasons than PJI, technical studies, conference abstracts, case reports and non-English language. The quality of studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. Seven retrospective studies, categorized as Therapeutic Level III evidence, were analyzed, involving a total of 188 patients who underwent AKA following PJI after TKA. The findings consistently indicate that post-AKA, patients experienced a notable decline in their level of independence and reported worsening ambulatory status. Infection and wound complications were common post-AKA, leading to revision surgeries, while the mortality rate ranged from 9 to 50% in the included studies. Polymicrobial organisms were frequently found in pre-AKA PJI, with MRSA being a common causative organism. AKA due to PJI following TKA is associated with restricted mobility and high mortality rate. Polymicrobial infections and MRSA were identified as common infecting organisms, emphasizing the complexities and challenges associated with managing these infections. The reported functional outcomes, ambulatory status, complications, reoperations, and mortality rates highlight the importance of providing comprehensive, individualized care to these patients.

Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.

The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.

The Effectiveness of Exercise in Reducing Cardiovascular Risk Factors Among Adults: A Systematic Review and Meta-Analysis.

Cardiovascular disease (CVD) remains one of the major causes of sickness and death in the world. However, lifestyle modifications, such as exercise, can significantly reduce the risk of this disease. This study aimed to assess the effectiveness of various forms of physical activity in reducing CVD risk factors among adults. A comprehensive search of the databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Excerpta Medica Database (EMBASE) databases was conducted between January 1, 2014, and May 31, 2024, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs), cohort studies, and observational studies on the impact of aerobic, resistance, or combined training on cardiovascular risk factors in adults (≥18 years) were considered for inclusion. Data relating to primary outcomes, including stroke and myocardial infarction rates, BP, cholesterol levels, and BMIwere collected. The Cochrane risk-of-bias tool and the Methodological Index for Non-Randomized Studies (MINORS) checklist were used for quality and bias assessment. Meta-analyses were performed using the RevMan software, with heterogeneity evaluated by I² statistics; 17 studies, including 11 RCTs and six cohort studies, met the inclusion criteria. There was a significant reduction in the mean systolic BP (SBP) by 3.32 mmHg [95% confidence interval (CI): 0.85-5.78 mmHg; p<0.0001] and mean diastolic BP (DBP) by 2.99 mmHg (95% CI: 2.34-3.64 mmHg; p < 0.00001) after exercise interventions. Moreover, cholesterol levels and BMI values improved with exercise. Those who exercised had a lower risk of stroke or heart attack compared with the controls [odds ratio (OR): 0.57; 95% CI: 0.28-1.14; p >0.0001], although there was substantial heterogeneity in effect size across the studies (I² = 98%). Different types of physical activity (i.e., aerobic, resistance, or combined exercise) can effectively reduce key cardiovascular risk factors, including BP, cholesterol levels, and BMI values. Regular physical activity is still regarded as the most effective preventive measure against CVD, despite inconsistencies in research findings. Future studies should aim to identify optimal exercise programs and their long-term effects on diverse populations.

Comparative Evaluation of the Accuracy of Electronic Apex Locator and Digital Radiography for Working Length Determination in Primary Teeth: A Systematic Review.

It is challenging to perform a pulpectomy procedure in primary tooth because of its physiological root resorption and variation in root morphology. Working length measurement is considered to be one of the critical steps, as it determines the extent of obturation and apical seal. To compare the accuracy of electronic apex locator (EAL) and digital radiography (DR) for working length determination in primary teeth. In this systematic review, electronic databases and grey literature were searched from 1st January 2005 to 1st January 2023 for randomized control trial, non- randomized control trial, in vitro studies, ex vivo studies that compared accuracy of EAL and DR in primary teeth. Two reviewers independently identified studies, retrieved data, and assessed risk of bias using the revised and validated MINORS (methodological index for non-randomized studies) criteria. Ten studies were included in qualitative analysis. Seven out of ten studies showed low risk of bias whereas other three studies showed high risk of bias. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted. Available evidence suggests a moderate quality of evidence in this systematic review. Analyzing the ten studies included in this systematic review, the majority of studies showed statistically insignificant difference between EAL and DR. However, EAL was closer to actual WL as compared to DR. Based on the evidence that is currently available; EAL can be considered as an alternative for working length measurement in primary teeth.

Association Between Alpha-1 Adrenoreceptor Antagonist Use and Cognitive Impairment: A Systematic Review.

Alpha-1 adrenergic receptor (α1-AR) antagonists are commonly used for management of benign prostatic hyperplasia or hypertension. Some studies have shown a potential link between α1-AR antagonist use and cognitive impairment. Given the conflicting data surrounding α1-AR antagonists association with cognitive dysfunction, we aim to systematically review the association of cognitive dysfunction with α1-AR antagonist use to aid clinician decision both with medication initiation and continuation. A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched Ovid Cochrane, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science on March 7, 2023, with an update run on January 22, 2024. The primary outcome was cognitive dysfunction. We used Cochrane risk of bias for randomized controlled trials (RCTs) and MINORS (Methodological Index for Non-Randomized Studies) criteria for non-RCTs to evaluate study quality. This study was registered with PROSPERO (CRD42024505751). We identified 7 studies for our systematic review (3 RCTs, 4 non-RCTs). Tamsulosin was the most studied medication (6 of 7 studies). Tamsulosin was associated with no cognitive dysfunction in 2 RCTs, increased risk for dementia in 2 non-RCTs, no change in cognition in 1 non-RCT, and decreased risk for dementia in 1 non-RCT. Among 3 non-RCTs analyzing alfuzosin, it was associated with decreased risk of or no association with dementia in 2 studies and increased risk for dementia in 1 study. Doxazosin, prazosin, and terazosin were neutral or showed a negative risk for dementia. Our systematic review did not show a convincing causal association between α1-AR antagonists, including tamsulosin, and cognitive dysfunction. Considering the existing literature, it is appropriate to use α1-AR antagonists without concern for cognitive dysfunction. Future research, through robust study designs considering the multifactorial nature of cognitive dysfunction, is required to further evaluate this association.

Can a 1.5-Stage Revision be an Effective Alternative for Chronic Periprosthetic Hip and Knee Infections? A Systematic Review and Meta‐Analysis

BackgroundA 1.5-stage revision could be an alternative to a 2-stage revision for treating hip and knee chronic periprosthetic infections, guaranteeing the maintenance of joint function and infection control and preventing infection-free patients from undergoing further surgery. Our systematic review aimed to answer several questions about the indication, the infection eradication rate, and the long-term functional outcome of 1.5-stage revisions used to treat chronic periprosthetic infections of the hip and knee. MethodsA systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including studies dealing with the use of 1.5-stage and two-stage surgery for chronic periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) or total hip arthroplasty (THA). The Coleman Methodology Score and the Methodological Index for Non-randomized Studies (MINORS) score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the infection eradication rate using either the 1.5-stage revision or the two-stage technique. A total of 494 patients (111 hips and 385 knees) who underwent 1.5-stage with a mean age of 69 years (range, 61 to 82) were identified in the ten included studies. ResultsThe most common cause of reoperation was the conversion to the definitive prosthesis, followed by aseptic loosening. Infection control was reached in 84.6% of the 1.5-stage and 76.1% of the two-stage cohorts. The infection recurrence rate was higher in the two-stage cohort than the 1.5-stage group (21.8 versus 14.3%). ConclusionThe 1.5-stage technique represents a valid treatment option in selected patients who have chronic PJI who cannot undergo further surgeries, adding together the benefits of the one- and two-stage procedures. Furthermore, the 1.5-stage showed a better success rate in the infection resolution than the two-stage technique.

Choice of Acromioclavicular Dislocation Treatment Should Not Be Influenced by Risk of Development of Acromioclavicular Osteoarthritis: A Systematic Review With Meta-Analysis.

It is currently unknown to what degree surgical or nonoperative treatment of acromioclavicular (AC) dislocation influences the development of osteoarthritis (OA). The aim of this study was to evaluate AC OA after surgical and nonoperative treatment for AC dislocations, compare OA prevalence between treatment options, and compare OA prevalence between the injured and contralateral shoulder. Articles reporting on the prevalence of OA after surgical or nonoperative treatment of an AC dislocation with a minimal 2-year follow-up were included. AC OA presence was extracted for the injured and contralateral shoulder. Treatment categories were defined based on anatomical variation in the reattachment of ligaments: AC fixation, coracoclavicular (CC) fixation, AC and CC fixation, Bosworth screw synthetic graft, tendon graft, and conservative. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Ninety-four articles were included for qualitative analysis, and 7 articles were included for meta-analysis (n = 3,812; follow-up = 2.0-24.2 years; mean age 37.6 ± 10.4 years). A total of 3,483 patients underwent surgical treatment, and 329 patients underwent conservative treatment. OA prevalence ranged from 6.7%-29.3% between 7 pooled treatment categories. Most included studies had a follow-up <10 years (94%) and OA prevalence increased with time, regardless of treatment option. There was no difference in OA prevalence between the injured and contralateral shoulder (p = 0.120). MINORS scores were varied, ranging from poor to very good. The pooled AC OA prevalence of the 7 treatment categories ranged from 6.7% for the CC fixation surgical group to 29.3% for the conservative treatment group. However, the included studies were predominantly of low quality and had varying follow-up periods, with most having relatively short follow-up durations. No difference in AC OA prevalence was found between the injured and contralateral shoulder. Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC AO. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Opioid consumption following foot and ankle surgery: a systematic review

Objective: Systematically review studies characterizing postoperative opioid consumption in patients submitted to foot and anklesurgery to identify trends in opioid consumption among regions of procedures (forefoot, midfoot, hindfoot/ankle) and ultimatelycreate prescribing guidelines that treat patient’s pain adequately while limiting leftover pills. Methods: A systematic review was performed following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Retrospective and prospective observational cohort studies that reported mean opioid consumption following foot and ankle surgery were included, as well as data from our institution that fit the review’s parameters. Studies that did not report this data or reported patients receiving alternative surgical techniques were excluded. The risk of bias in non-randomized studies – of exposure (ROBINS-E) tool and the Methodological index for non-randomized studies (MINORS) criteria were used to assess bias and study quality, respectively. Results: Three hundred ninety-five articles were identified, and six studies, including our institution’s, met inclusion criteria. Reported data from 2,445 patients were synthesized to show opioid consumption overall, by region of surgery, and by invasiveness of procedure. Four of five studies found significantly higher opioid use postoperatively in patients submitted to hindfoot/ankle surgery, and two of five studies found significantly higher consumption among those submitted to bony foot and ankle surgery. Conclusion: Prescribing physicians must approach foot and ankle patients on a case-by-case basis to ensure adequate pain management while mitigating excess opioid risk. For prescriptions of 5 mg oxycodone pills, we recommend 15-, 20-, and 25-pill prescriptions for patients submitted to forefoot, midfoot, and hindfoot/ankle surgery. Level of Evidence I; Systematic review.

Lateral femoral wall thickness in trochanteric hip fractures: a systematic review.

Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS). A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test. Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm. A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.