scholarly journals Outcome of surgical repair of adult digital nerve injury: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025443 ◽  
Author(s):  
Rebecca L E Dunlop ◽  
Justin Conrad Rosen Wormald ◽  
Abhilash Jain
Keyword(s):  
Systematic Review ◽  
Nerve Injury ◽  
Systematic Reviews ◽  
Outcome Measure ◽  
Surgical Repair ◽  
Nerve Repair ◽  
Case Series ◽  
Adverse Outcomes ◽  
Digital Nerve ◽  
Protective Sensation

ObjectivesA systematic review to assess the evidence supporting surgical repair of digital nerve injury versus no repair in adults in terms of clinical outcomes.DesignA Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review with methodology based on the Cochrane Handbook of Systematic Reviews of Interventions.Data sourcesDatabases included OvidMEDLINE, EMBASE, AMED, clinicaltrials.gov and the Cochrane Database of Systematic Reviews, searched from inception until 10 November 2018.Eligibility criteriaAdult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded.Data extraction and synthesisStudy data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work. The National Institute of Health quality assessment tool for case series was used to assess risk of bias.ResultsThirty studies were included. One compared surgical repair with non-repair. All studies were case series of between 15 and 110 nerve injuries, with heterogeneous patient, injury and treatment characteristics. Two studies detailed nerve repair without magnification. Static 2-point discrimination (s2PD) was the most commonly reported outcome measure. Return of protective sensation was achieved in most cases in the nerve repair and no nerve repair groups. Repair resulted in better s2PD than no repair, but <25% repaired nerves achieved normal levels. Adverse outcomes were similar between repair and no repair groups.ConclusionsOnly level IV evidence is available to support surgical repair of digital nerves in adults. Return of normal sensibility is uncommon and almost all unrepaired nerves regained protective sensation by 6 months and all patients declined further surgery. There was no difference in adverse outcomes. There is currently a lack of high-quality evidence to support surgical repair of digital nerve injuries in adults and further research is needed.PROSPERO registration numberCRD42017065092.

scholarly journals Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review

Hand ◽  
2019 ◽  
Vol 15 (2) ◽  
pp. 157-164
Author(s):  
Zachary J. Herman ◽  
Asif M. Ilyas
Keyword(s):  
Systematic Review ◽  
Nerve Injury ◽  
Surgical Management ◽  
Meta Analysis ◽  
Nerve Repair ◽  
Complication Rates ◽  
Digital Nerve ◽  
Exclusion Criteria ◽  
Conduit Repair ◽  
Repair Techniques

Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.

scholarly journals Efficacy and safety of instantaneous wave-free ratio in patients undergoing coronary revascularisation: protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017868
Author(s):  
Joey S.W. Kwong ◽  
Sheyu Li ◽  
Wan-Jie Gu ◽  
Hao Chen ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Coronary Revascularisation ◽  
Eligibility Criteria ◽  
Registration Number ◽  
Collection Form ◽  
Randomised Controlled ◽  
Meta Analyses

IntroductionEffective selection of coronary lesions for revascularisation is pivotal in the management of symptoms and adverse outcomes in patients with coronary artery disease. Recently, instantaneous ‘wave-free’ ratio (iFR) has been proposed as a new diagnostic index for assessing the severity of coronary stenoses without the need of pharmacological vasodilation. Evidence of the effectiveness of iFR-guided revascularisation is emerging and a systematic review is warranted.Methods and analysisThis is a protocol for a systematic review of randomised controlled trials and controlled observational studies. Electronic sources including MEDLINE via Ovid, Embase, Cochrane databases and ClinicalTrials.gov will be searched for potentially eligible studies investigating the effects of iFR-guided strategy in patients undergoing coronary revascularisation. Studies will be selected against transparent eligibility criteria and data will be extracted using a prestandardised data collection form by two independent authors. Risk of bias in included studies and overall quality of evidence will be assessed using validated methodological tools. Meta-analysis will be performed using the Review Manager software. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Ethics and disseminationEthics approval is not required. Results of the systematic review will be disseminated as conference proceedings and peer-reviewed journal publication.Trial registration numberThis protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017065460.

Outcomes of surgical repair of a single digital nerve in adults

2019 ◽  
Vol 44 (6) ◽  
pp. 560-565 ◽  
Author(s):  
Abhilash Jain ◽  
Rebecca Dunlop ◽  
Tim Hems ◽  
Jin Bo Tang
Keyword(s):  
Surgical Repair ◽  
Nerve Repair ◽  
Hand Dominance ◽  
Digital Nerve ◽  
Current Standard ◽  
Recent Systematic Review ◽  
Standard Management ◽  
Nerve Recovery ◽  
Sensory Recovery ◽  
Improved Function

Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.

scholarly journals A systematic review of the use of magnetic resonance imaging in non-conditional pacemakers and implantable defibrillators

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Murphy ◽  
R K Kerley ◽  
P K Kearney
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Magnetic Resonance ◽  
Case Reports ◽  
Case Series ◽  
Adverse Outcomes ◽  
Resonance Imaging ◽  
Cardiac Implantable Electronic Devices ◽  
Relative Safety ◽  
Mri Conditional

Abstract Background Cardiac implantable electronic devices (CIEDs) were long considered a contraindication for magnetic resonance imaging (MRI). Modern devices are now MRI conditional, but still the majority of CIEDs in the population are legacy devices and are classified as unsafe for MRI. There is growing consensus that MRI is also safe in these patients. Purpose The purpose of this study was to perform an up to date systematic review of the evidence evaluating the use of MRI in patients with non-conditional CIEDs. Methods Searches of the PubMed, CINAHL and Embase databases were performed. Studies that assessed the rate of adverse outcomes after MRI in patients with non-conditional CIEDs were included. Studies were excluded if they did not disclose the conditionality of patients CIEDs. Case reports or case series were not included. Results 36 cohort studies were identified. No patient in these studies died during or immediately after MRI. Symptom associated with either torque or heating occurred in &lt;1% of patients. Electrical resets occurred 1–2% of patients. There were no cases of non-conditional lead or generator failure. Inappropriate pacing occurred in &lt;1% of patients. No ICD shocks occurred during MRI. Changes in CIED parameters occurred in 1–4% of patients. Conclusions This systematic review highlights the relative safety of the use of MRI in patients with non-conditional CIEDs. Demonstrated be the fact that no deaths or device shocks have been suffered as a consequence of MRI in any of these studies, and the extremely low incidence of device or lead related complications. Still strict selection and monitoring protocol should be used when imaging these patients. FUNDunding Acknowledgement Type of funding sources: None.

Axillary Nerve Injury

2018 ◽  
Author(s):  
Russell A. Payne ◽  
Elias B. Rizk
Keyword(s):  
Nerve Injury ◽  
Surgical Repair ◽  
Sports Injuries ◽  
External Rotation ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Surgical Exploration ◽  
Direct Nerve

Axillary nerve injury has been associated with sports injuries, especially those involving anterior shoulder dislocation. The nerve injury leads to weakness of the deltoid and teres minor muscles, which impairs abduction and external rotation of the arm at the shoulder. Electrodiagnostic studies are helpful for determining extent of reinnervation and recovery after injury. In the absence of clinical or electrodiagnostic signs of recovery 3 to 6 months after injury, it is appropriate to offer surgical exploration. The options for surgical repair include direct nerve repair, nerve grafting, and nerve transfer. In appropriately selected individuals, outcomes are favorable.

Clinical impact of needle-free connector design: A systematic review of literature

2020 ◽  
Vol 21 (6) ◽  
pp. 847-853 ◽  
Author(s):  
Victor Daniel Rosenthal
Keyword(s):  
Systematic Review ◽  
Bloodstream Infection ◽  
Systematic Reviews ◽  
Microbial Contamination ◽  
Open Systems ◽  
Central Line ◽  
Adverse Outcomes ◽  
Infection Rates ◽  
Positive Displacement ◽  
Control And Prevention

The objective of this systematic review is to analyze types of needle-free connectors and open systems and their effects on central line–associated bloodstream infection rates and other adverse outcomes through a research protocol consistent with the Preferred Reporting Items for Systematic Reviews’ recommendations. MEDLINE and Cochrane databases of systematic reviews were searched for relevant comparative studies published from January 2000 to September 2017. Eighteen studies compared central line–associated bloodstream infection (according to the Centers for Disease Control and Prevention/National Healthcare Safety Network definition), internal microbial contamination, occlusions, phlebitis, and other outcomes associated with needle-free connectors with a positive displacement device, negative displacement device, neutral displacement device, or three-way stopcock. Ten studies reported central line–associated bloodstream infection rates, which were lower with positive displacement devices versus negative displacement devices/neutral displacement devices (one study) and with negative displacement devices versus three-way stopcocks (three studies), but varied with different positive displacement device and negative displacement device/neutral displacement device designs (four studies). Seven studies reported internal microbial contamination rates, which were higher with three-way stopcocks versus negative displacement devices (two studies) and positive displacement devices (two studies), lower when positive displacement devices were used versus neutral displacement devices (one study), and varied with different types of negative displacement device (one study). Central line–associated bloodstream infection rates and most other outcomes analyzed were statistically significantly higher with three-way stopcocks (open devices) versus positive displacement device, negative displacement devices, and neutral displacement devices, but varied among closed device designs.

scholarly journals Mesenchymal Stem Cell Treatment Perspectives in Peripheral Nerve Regeneration: Systematic Review

2021 ◽  
Vol 22 (2) ◽  
pp. 572
Author(s):  
Andrea Lavorato ◽  
Stefania Raimondo ◽  
Marina Boido ◽  
Luisa Muratori ◽  
Giorgia Durante ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stem Cells ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Nerve Injury ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
High Survival ◽  
Nerve Lesion ◽  
Differentiation Potential

Traumatic peripheral nerve lesions affect hundreds of thousands of patients every year; their consequences are life-altering and often devastating and cause alterations in movement and sensitivity. Spontaneous peripheral nerve recovery is often inadequate. In this context, nowadays, cell therapy represents one of the most innovative approaches in the field of nerve repair therapies. The purpose of this systematic review is to discuss the features of different types of mesenchymal stem cells (MSCs) relevant for peripheral nerve regeneration after nerve injury. The published literature was reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A combination of the keywords “nerve regeneration”, “stem cells”, “peripheral nerve injury”, “rat”, and “human” were used. Additionally, a “MeSH” research was performed in PubMed using the terms “stem cells” and “nerve regeneration”. The characteristics of the most widely used MSCs, their paracrine potential, targeted stimulation, and differentiation potentials into Schwann-like and neuronal-like cells are described in this paper. Considering their ability to support and stimulate axonal growth, their remarkable paracrine activity, their presumed differentiation potential, their extremely low immunogenicity, and their high survival rate after transplantation, ADSCs appear to be the most suitable and promising MSCs for the recovery of peripheral nerve lesion. Clinical considerations are finally reported.

Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma

2014 ◽  
Vol 121 (1) ◽  
pp. 176-183 ◽  
Author(s):  
Aswin Chari ◽  
Angelos G. Kolias ◽  
Thomas Santarius ◽  
Simon Bond ◽  
Peter J. Hutchinson
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Subdural Hematoma ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Invasive Technique ◽  
Twist Drill ◽  
Case Control Studies ◽  
New Techniques ◽  
Novel Technique

Object The incidence of chronic subdural hematoma (CSDH) is expected to increase substantially over the next 25 years. Continuing refinement of techniques for surgical evacuation is essential for optimizing patient outcomes. A novel technique involving a hollow screw, which is threaded through a twist-drill hole in the cranium and then connected to a closed drainage system, has been increasing in popularity. The aim of this systematic review is to collate and analyze the published experience with this novel technique and to evaluate its efficacy in comparison with the other surgical treatment methods. Methods This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42013003544). MEDLINE, Web of Knowledge, EMBASE, and the Cochrane Database of Systematic Reviews were searched for published series involving more than 10 patients treated with these new techniques. Results Nine eligible studies were found (6 case series and 3 case-control studies) comprising 796 patients treated with these new techniques. Pooled analysis showed a “success rate” of 77.6% (95% CI 74.6%–80.4%), recurrence rate of 22.4%, and in-hospital mortality of 1.4%. Conclusions This systematic review adds further evidence to the pool of data assessing the safety and efficacy of the use of this novel, minimally invasive technique for the treatment for CSDH. Overall, twist-drill craniostomy with hollow screws appears to be safe and effective. Class I evidence is necessary to optimize the surgical management of patients with CSDH.

scholarly journals Comparison of the cardiovascular presentations, complications and outcomes following different coronaviruses’ infection: A systematic review

2021 ◽  
Vol 13 (2) ◽  
pp. 92-101
Author(s):  
Mohammad Mostafa Ansari Ramandi ◽  
Hossein Yarmohammadi ◽  
Somayeh Beikmohammadi ◽  
Behzad Hassan Hosseiny Fahimi ◽  
Farbod Hatami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Studies ◽  
Systematic Reviews ◽  
Case Reports ◽  
Cardiac Injury ◽  
Laboratory Data ◽  
Case Series ◽  
Signs And Symptoms ◽  
Mesh Terms ◽  
Thrombotic Complications

Manifestations caused by coronavirus family have presented it in many ways during the previous years. The aim of this systematic review was to gather all possible cardiovascular manifestations of the coronavirus family in the literature. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Scopus, Web of Science, Cochrane and ProQuest which were updated on May 1, 2020 for the last time. Regarding to the novelty and speed of publications on COVID-19, we searched Google Scholar and also references of included studies and review articles in the systematic search results were searched manually. The searched keywords were the combination of the following MeSH terms: "COVID-19", "SARS", "MERS" and "cardiovascular presentation". The systematic review was registered with ID CRD42020180736 in International Prospective Register of Systematic Reviews (PROSPERO). After screening, 28 original articles and ten case studies (five case reports and five case series) were included. Most of the studies were focused on COVID-19 (20 original articles and four case studies) while the only studies about Middle East Respiratory Syndrome (MERS) were a case report and a case series. Almost all the cardiovascular presentations and complications including acute cardiac injury, arrhythmias and the thrombotic complications were more prevalent in COVID-19 than severe acute respiratory syndrome (SARS) and MERS. The cardiac injury was the most common cardiovascular presentation and complication in COVID-19 whereas thrombotic complications were commonly reported in SARS. The cardiac injury was the predictor of disease severity and mortality in both COVID-19 and SARS.Coronavirus 2019 may present with cardiovascular manifestations and complications in signs and symptoms, laboratory data and other paraclinical findings. Also, cardiovascular complications in the course of COVID-19 may result in worse outcomes.

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