scholarly journals The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

2020 ◽  
Author(s):  
Jason Derry Onggo ◽  
James Randolph Onggo ◽  
Mithun Nambiar ◽  
Andrew Duong ◽  
Olufemi R Ayeni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Protective Factor ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Suture Repair ◽  
Significant Heterogeneity ◽  
Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

231 Breast Lymphedema After Breast Conservative Surgery; An Up-To-Date Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Abouelazayem ◽  
M Elkorety ◽  
S Monib
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Breast Surgery ◽  
Treatment Options ◽  
Conservative Surgery ◽  
Breast Size ◽  
Search Term ◽  
Common Complication ◽  
Breast Conservative Surgery ◽  
Conservative Breast Surgery

Abstract Background While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, Aim: We aimed to provide a systematic review to help avoiding or management of breast lymphoedema Method The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits Results A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean BMI was 28.4, most of the studies included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping. Conclusions Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

Management of carcinoid syndrome (CS): A systematic review of systemic treatment options.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 516-516
Author(s):  
Edward M. Wolin ◽  
Al Bowen Benson
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Symptom Relief ◽  
Safety Data ◽  
Significant Heterogeneity ◽  
Carcinoid Heart Disease ◽  
Systemic Treatments ◽  
Symptom Response

516 Background: CS is a major cause of symptom burden (diarrhea/flushing) in patients (pts) with neuroendocrine tumors and is associated with shortened survival and severe complications such as carcinoid heart disease. We performed a systematic review of clinical evidence for CS systemic treatments. Methods: PubMed, Embase, and Cochrane databases were searched. Large ( > 60 pt) prospective clinical trials investigating the efficacy/safety of systemic treatment options for pts with CS were eligible for inclusion. Data extracted included study design, pt population, interventions, prior treatments, permitted concomitant medications, study endpoints/statistical analyses, and efficacy/safety outcomes. Results: Six large prospective clinical trials (total 953 pts) were identified from 144 search results. Significant heterogeneity existed in pt populations, control groups (placebo vs active comparator), duration of therapy, study endpoints, and efficacy/safety data reporting. Interventions assessed were long-acting and subcutaneous octreotide (OCT & OCT SC), lanreotide (LAN), telotristat ethyl (TE)+somatostatin analogues (SSA), pasireotide (PAS), and everolimus (EVE)+OCT. Symptom response was variably assessed by the frequency of diarrhea/flushing and/or receipt of rescue short-acting SSA in 5/6 studies; a significant improvement in at least one of these measures occurred in 4 studies (OCT and OCT SC; LAN; TE+SSA). Failure to meet symptom response criteria ranged from 29-82% in the studies. Reported reductions in CgA and/or 5-HIAA reached statistical significance in 3 studies (LAN; EVE+OCT; TE+SSA). Interventions were generally well tolerated. Two phase 3 trials focused specifically on management of CS symptoms refractory to SSA; strategies included switching to PAS or an increased dose of OCT (40 mg q28d) for refractory diarrhea/flushing, or receipt of TE with continued SSA for refractory diarrhea. Conclusions: SSA provide substantial symptom relief for pts with CS. For refractory symptoms, TE can be added, SSA dose increased, and metastasis debulking can be used (with surgery, hepatic artery embolization, ablation, and PRRT). The addition of biologic agents to SSA can further improve CS management.

scholarly journals Risk models and scores for metabolic syndrome: a systematic review

2020 ◽  
Author(s):  
Musa Saulawa Ibrahim ◽  
Dong Pang ◽  
Yannis Pappas ◽  
Gurch Randhawa
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Metabolic Syndrome ◽  
External Validation ◽  
Statistical Properties ◽  
Risk Scores ◽  
Significant Heterogeneity ◽  
Risk Models ◽  
Increased Risk ◽  
Poor Reporting

Abstract Background: Metabolic syndrome - ‘a clustering of risk factors which includes hypertension, central obesity, impaired glucose metabolism with insulin resistance, and dyslipidaemia’ is linked with increased risk of CVD, T2DM and all-cause mortality. Despite the high number of models and scores for assessing the risk of developing MetS, there is hardly any used in research or practical setting. Hence, we conducted a systematic review to determine the performance of risk models and scores for predicting MetS.Methods: Following the methods proposed by EPPI-Centre, we systematically searched MEDLINE, CINAHL, PUBMED and Web of Science to identify studies that either derive or validate risk models or scores for predicting the risk of MetS. Search was originally done in September 2018 and updated in September 2020. Data concerning models’ statistical properties as well as details of internal or external validations were extracted. Tables were used to compare various components of models and statistical properties. Finally, PROBAST was used to assess the methodological quality (risk of bias) of included studies.Results: A total of 27 studies reporting about the development, validation or both of MetS risk models were included. There is significant heterogeneity between studies in terms of geography/demographics, data type and methodological approach. Majority of the models or risk scores were developed or validated using data from cross-sectional studies, or routine data. Various combinations of risk factors (predictors) were considered significant in the respective final model. Similarly, different criteria were used in the diagnosis of MetS, but, NCEP criteria including its modified versions were by far the most widely used (32.5%). There is generally poor reporting quality across the studies, especially concerning statistical data. Any form of internal validation is either not conducted, or not reported in nearly a fifth of the studies. Only two (2) risk models or scores were externally validatedConclusions: There is an abundance of MetS models in the literature. But, their usefulness is doubtful, due to limitations in methodology, poor reporting and lack of external validation and impact studies. Therefore, researchers in the future should focus more on externally validating/ applying such models in a different setting.Protocol:The protocol of this study can be found at https://bmjopen.bmj.com/content/9/9/e027326PROSPERO registration number CRD42019139326

scholarly journals Risk Factors for Mortality in Patients with Aortoesophageal Fistula Related to Aortic Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Shan Li ◽  
Feng Gao ◽  
Hai-ou Hu ◽  
Jin Shi ◽  
Jie Zhang
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Conservative Treatment ◽  
Hemorrhagic Shock ◽  
Multiorgan Failure ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Aortoesophageal Fistula ◽  
Aortic Graft ◽  
Graft Replacement

Objective. Aortoesophageal fistula (AEF) related to aortic aneurysm and dissection is an uncommon but life-threatening condition. We performed a systematic review of risk factors for mortality and factors associated with the prognosis of AEF. Methods. A systematic search of the PubMed, Embase, and Cochrane Library databases was performed. Clinical characteristics, diagnostic methods, and treatments were assessed in terms of their ability to predict mortality. Results. The systematic review identified 184 eligible articles including 219 patients with AEF. Multivariable Cox regression revealed positive correlations of hemorrhagic shock (hazard ratio (HR): 1.824, 95% CI: 1.217-2.735, P=0.004), sepsis (HR: 1.714, 95% CI: 1.112-2.641, P=0.015), multiorgan failure (HR: 3.060, 95% CI: 1.470-6.368, P=0.003), and conservative treatment (HR: 5.257, 95% CI: 3.405-8.116, P<0.001) with mortality and a negative correlation between combination therapy (aortic graft replacement and esophagectomy) and mortality (HR: 0.319, 95% CI: 0.125-0.813, P=0.017). Kaplan–Meier survival analysis showed that the 1-year cumulative survival rate was 42.5±3.8%. The overall fistula-related mortality rate was 47.0% (103/219). The most common causes of death were bleeding (54.9%) and infection (29.2%). Conclusions. We found that hemorrhagic shock, sepsis, and multiorgan failure were risk factors for death in patients with AEF. Additionally, conservative treatment was associated with a higher rate of mortality, while combined aortic graft replacement and esophagectomy improved the prognosis.

scholarly journals Do Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review

2019 ◽  
Vol 41 (08) ◽  
pp. 508-519 ◽  
Author(s):  
Júlia Ferreira Fante ◽  
Thais Daniel Silva ◽  
Elaine Cristine Lemes Mateus-Vasconcelos ◽  
Cristine Homsi Jorge Ferreira ◽  
Luiz Gustavo Oliveira Brito
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Data Extraction ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cross Sectional ◽  
Adequate Knowledge

Objective We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence – UI, fecal incontinence – FI, and pelvic organ prolapse – POP). Data sources A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018. Selection of studies A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data collection Two authors performed data extraction into a standardized spreadsheet. Data synthesis Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n = 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n = 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n = 3), low educational level (n = 4), low access to information (n = 5) and socioeconomic status (n = 3). Conclusion Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.

scholarly journals Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Zhou ◽  
Xueying Zhang ◽  
Lin Lyu ◽  
Xiaojun Ma ◽  
Guishen Miao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Protective Factor ◽  
Calcineurin Inhibitor ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Kidney Injury ◽  
Modifiable Risk Factors

Abstract Background Acute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost. We aimed to identify modifiable risk factors of AKI after LT. Methods A literature search of Pubmed, EMBASE and Cochrane Databases was performed to identify studies investigating risk factors of AKI after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect size and 95% confidence interval were pooled using a random-effect model with inverse-variance method. Results Sixty-seven articles with 28,844 patients were included in the meta-analysis. Seventeen modifiable risk factors were found, including overweight, preoperative use of diuretic, preoperative anemia, donation after cardiac death organ, donor BMI ≥ 30 kg/m2, ABO-incompatible LT, low graft to recipient body weight ratio, intraoperative hypotension, major bleeding, intraoperative use of vasopressor, large RBC transfusion, postreperfusion syndrome, postoperative use of vasopressors, overexposure to calcineurin inhibitor, calcineurin inhibitor without mycophenolate mofetil, graft dysfunction and infection. A total of 38 articles were included in the systematic review, in which 8 modifiable risk factors and 1 protective factor were additionally associated in single studies with the incidence of AKI after LT. Conclusions Effective interventions based on identified modifiable risk factors in the perioperative management and graft allocation and preservation may be promising to reduce the incidence of AKI after LT. Trial registration The protocol for this systematic review is registered with PROSPERO (No. CRD42020166918).

scholarly journals Left Ventricular Noncompaction—A Systematic Review of Risk Factors in the Pediatric Population

2021 ◽  
Vol 10 (6) ◽  
pp. 1232
Author(s):  
Katarzyna Łuczak-Woźniak ◽  
Bożena Werner
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Magnetic Resonance ◽  
Clinical Manifestations ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Left Ventricular Ejection ◽  
Left Ventricular Noncompaction ◽  
Ventricular Ejection Fraction ◽  
Ventricular Noncompaction

Left ventricular noncompaction (LVNC) is a heterogeneous, often hereditary group of diseases, which may have diverse clinical manifestations. This article reviews the risk factors for unfavorable outcomes of LVNC in children, as well as discuss the diagnostic methods and the differences between pediatric and adult LVNC. Through a systematic review of the literature, a total of 1983 articles were outlined; 23 of them met the inclusion criteria. In echocardiography the following have been associated with adverse outcomes in children: Left ventricular ejection fraction, end-diastolic dimension, left ventricular posterior wall compaction, and decreased strains. T-wave abnormalities and increased spatial peak QRS-T angle in ECG, as well as arrhythmia, were observed in children at greater risk. Cardiac magnetic resonance is a valuable tool to identify those with systolic dysfunction and late gadolinium enhancement. Genetic testing appears to help identify children at risk, because mutations in particular genes have been associated with worse outcomes. ECG and imaging tests, such as echocardiography and magnetic resonance, help outline risk factors for unfavorable outcomes of LVNC in children and in identifying outpatients who require more attention. Refining the current diagnostic criteria is crucial to avoid inadequate restrain from physical activity.

scholarly journals Prognosis and Risk Factors for Malignant Peripheral Nerve Sheath Tumor: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Zhenyu Cai ◽  
Xiaodong Tang ◽  
Haijie Liang ◽  
Rongli Yang ◽  
Taiqiang Yan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Potential Risk ◽  
Protective Factor ◽  
Meta Analysis ◽  
Nerve Sheath Tumor ◽  
Pooled Data ◽  
Large Size ◽  
Potential Risk Factors ◽  
Malignant Grade

Abstract Background: No available meta-analysis was printed to systematically introduce the MPNST clinic outcome and risk factors based on largely pooled data. This systematic review and meta-analysis aimed to investigate 5-year OS rate, 5-year EFS rate and LR rate for MPNST, and to assess potential risk factors for prognosis.Methods: Electronic articles published between January 1, 1966 and February 29, 2020, were searched and critically evaluated. The authors independently reviewed the abstracts and extracted data for 5-year OS rate, 5-year EFS rate, LR rate, and potential risk factors for prognosis.Results: Twenty-eight literatures were finally included for meta-analysis. The pooled 5-year OS rate, 5-year EFS rate, and LR rate were 49%, 37%, and 38%, respectively. The significant prognostic factors for survival were NF1 status, tumor size, depth, location, malignant grade, margin status, chemotherapy, and radiotherapy. Age and sex were not associated with survival.Conclusion: Survival and local recurrence of MPNST are poor. Worse prognosis is mainly associated with NF 1, large size, deep to fascia, high grade, metastases and location (trunk and head & neck). Complete resection with adequate surgical margins is the mainstay protective factor of MPNST patients, following necessary adjuvant therapies.

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