scholarly journals Surgical treatment of stable foci of the osteochondritis dissecans in children: a systematic review

2021 ◽  
Vol 25 (3) ◽  
pp. 179-185
Author(s):  
A. V. Semenov ◽  
D. M. Kukueva ◽  
Yu. G. Lipkin ◽  
I. N. Isaev ◽  
V. V. Koroteev ◽  
...  

Introduction. The osteochondritis dissecans (OCD) is a pathologic condition of osteochondral tissue predominantly in the femoral condyles, which is met most often in adolescents and which can lead to the formation of early arthrosis in the knee joint in the remote time. By modern concepts, stable OCD foci are the foci with intact articular cartilage without the risk of migration into the joint cavity. To date, there are very few studies in the world literature on the treatment of early stages of osteochondrosis dissecans.Material and methods. Two independent researchers have carried out a systematic review of literature sources (2000-2020 ) using Pubmed, Medline and GoogleScholar. 9 publications were selected for data analysis out of 5184 publications after the qualitative assessment by the Yang scale and the obtained consensus in disputable situations.Results. Statistical analysis of the obtained data with the Statistica program revealed that the average rate of OCD foci healing was seen in 86.7% (from 70.6 to 100%). The most effective outcomes were in the group of antegrade drilling (95.3% of healed foci), then in the group with biodegradable implants fixation (88.5%), then the group of antegrade drilling with the introduction of bone marrow aspirate concentrate (BMAC) - 76.9%, and then the retrograde drilling - 76.8%.Conclusion. The analysis performed have shown a significant heterogeneity in data reporting, different methods for diagnosing osteochondritis dissecans, different approaches to healing assessment as well as a small number of children in samples what determined the lack of statistical significance between different options of surgical treatment (p = 0.27). Carefully planned trials with a proper design, standardized techniques for healing assessment and time of their application as well as the assessment of comparison groups and of all other necessary factors affecting lesion healing are needed.

2012 ◽  
Vol 132 (9) ◽  
pp. 1241-1250 ◽  
Author(s):  
Jörn Zwingmann ◽  
Norbert P. Südkamp ◽  
Hagen Schmal ◽  
Philipp Niemeyer

2021 ◽  
Author(s):  
Wei Wang ◽  
Cong Chen ◽  
Siqi Chen

Abstract Background Surgical resection of olfactory groove meningiomas (OGMs) is challenging and lots of surgical approaches can be chosen. We conducted a systematic review and meta-analysis of the studies investigating surgical resection of OGMs to better understand the surgical treatment of OGMs.Methods PubMed, Embase and Cochrane Library were used to search the studies reporting treatment outcomes of surgery for patients with OGMs. The final eligible studies were assessed using the Oxford Center for Evidence Based Medicine for level of evidence. Relevant parameters were extracted to perform descriptive and/or quantitative analyses.Results A total of 42 studies including 1673 patients were included in this systematic review (8 level 3 studies and 34 level 4 studies). Surgeries through transcranial approaches (TCAs) and endoscopic endonasal approach (EEA) were done on 1596 and 77 patients, respectively. Based on a random effects model, rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak were determined to be 92.4% (CI: 88.6-95.5%) and 5.9% (95% CI: 3.4-9%), respectively. The mortality following surgery was 1.6% (95% CI: 0.9-2.5%) under a fixed effects model. Through subgroup analyses, TCAs were found to be more favorable in GTR and CSF leakage compared to EEA. Besides, anterolateral TCA was associated with better control of CSF leakage than anterior TCA. Conclusion Surgical treatment is capable of achieving GTR in the vast majority of patients with OGMs and postoperative mortality is under well control. Transcranial approach allows a better chance of GTR and better control of CSF leak in comparison to EEA. In comparison to anterior TCA, anterolateral TCA is associated less mortality. However, low evidence level and significant heterogeneity of the included studies prevent the formation of more solid conclusions.


2021 ◽  
Author(s):  
Huifang Bai ◽  
Yizhen Cao ◽  
Yunqiu Chen ◽  
Lingmin Zhang ◽  
Mei Cheng

Abstract Background: Angiostrogylus cantonensis (A.cantonensis) is a zoonotic parasitic nematode, with a worldwide distribution, causing eosinophilic meningitis or meningoencephalitis in humans. Although the biology of A.cantonensis is relatively well known, little is understood about the transmission level in different zoogeographical regions, especially in Asia. Here, to evaluate the prevalence of A.cantonensis in rodent hosts in China and several Asian countries, we conducted a systematic review registered with PROSPERO (CRD42020161665). Methods: Records were selected systematically from 7 databases (Medline via to Pubmed, Web of science, Scopus, Google Scholar, CNKI, Wangfang, CBM ). Forest plots and random-effects model were used to display pooled estimates. The Freeman-Tukey double arcsine transformation of R software was used to conduct meta-analysis and statistical significance was set at 0.05.Results: A total of 67 studies met the inclusion criteria and were included in the systematic review and meta-analysis. The pooled prevalence estimates of A.cantonensis infection in rodents was 0.1003 (95%CI: 0.0765, 0.1268). There was significant heterogeneity in reported outcomes (p<0.0001). So we considered that there was no publication bias in the included studies.Conclusion: The A.cantonensis infection rate among rodent hosts was still high in Asia, particularly in China, especially in Rattus norvegicus, and thus comprehensive measures should be taken for rodent hosts control to avoid an angiostrongyliasis outbreak. Due to the wide distribution and movement of rodent hosts, people in all regions of China, even in other Asia area live at risk of an infection. Hence, the development of more reliable diagnostic tests will be key for an effective identification of cases as well as improved patient care. Consequently, further studies are required to updated strategies for controlling A.cantonensis infection among human population.


2021 ◽  
pp. 036354652110007
Author(s):  
Junaid Sayani ◽  
Tobias Plotkin ◽  
Daniel Timothy Burchette ◽  
Joideep Phadnis

Background: The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject. Purpose: To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment). Results: No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions. Conclusion: Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.


2020 ◽  
Author(s):  
Kurt D Shulver ◽  
Nicholas A Badcock

We report the results of a systematic review and meta-analysis investigating the relationship between perceptual anchoring and dyslexia. Our goal was to assess the direction and degree of effect between perceptual anchoring and reading ability in typical and atypical (dyslexic) readers. We performed a literature search of experiments explicitly assessing perceptual anchoring and reading ability using PsycInfo (Ovid, 1860 to 2020), MEDLINE (Ovid, 1860 to 2019), EMBASE (Ovid, 1883 to 2019), and PubMed for all available years up to June (2020). Our eligibility criteria consisted of English-language articles and, at minimum, one experimental group identified as dyslexic - either by reading assessment at the time, or by previous diagnosis. We assessed for risk of bias using an adapted version of the Newcastle-Ottawa scale. Six studies were included in this review, but only five (n = 280 participants) were included in the meta-analysis (we were unable to access the necessary data for one study).The overall effect was negative, large and statistically significant; g = -0.87, 95% CI [-1.47, 0.27]: a negative effect size indicating less perceptual anchoring in dyslexic versus non-dyslexic groups. Visual assessment of funnel plot and Egger’s test suggest minimal bias but with significant heterogeneity; Q (4) = 9.70, PI (prediction interval) [-2.32, -0.58]. The primary limitation of the current review is the small number of included studies. We discuss methodological limitations, such as limited power, and how future research may redress these concerns. The variability of effect sizes appears consistent with the inherent variability within subtypes of dyslexia. This level of dispersion seems indicative of the how we define cut-off thresholds between typical reading and dyslexia populations, but also the methodological tools we use to investigate individual performance.


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