Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis

The purpose of this meta-analysis was to identify if patient-specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI-assisted HTO, the weight bearing line ratio (WBL%), hip-knee-ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = −36.41; 95% CI: −42.30 to −30.53; p < 0.00001), HKA (MD = −9.95; 95% CI: –11.65 to –8.25; p < 0.00001), and mMPTA (MD = –8.40; 95% CI:−10.27 to −6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: −0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: −0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI −0.34 to 0.55; p = 0.64). The data show that 3D-based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.     

Association between folic acid,homocysteine, vitamin B12 and erectile dysfunction—A cross-sectional study

To evaluate the relationship between serum levels of folic acid (FA), homocysteine (HCY), vitamin B12 (B12) and erectile dysfunction (ED) and to explore their internal relationships. The study included 134 ED patients and 50 healthy controls. ED was assessed using IIEF-5 scores. ED group had lower median FA (6.08 versus 10.21; p < .001) and B12 (256.0 versus 337.5; p < .001) levels, and higher median HCY (11.4 versus 7.95; p < .001) levels, and these differences seemed to be more pronounced in the younger participants (age < 35 yr). FA decreased with the severity of ED (7.52 versus 6.15 versus 5.49 versus 3.97; p < .001), while HCY increased (10.35 versus 11.8 versus 12.9 versus 15; p < .001). Smoking and shift work were associated with lower FA levels. Multivariate analysis showed that serum FA and HCY revealed significant relation with ED. ROC analysis showed that FA ≤ 8.84 and HCY ≥ 10.35 were the best cut-off values for ED diagnosis. Both FA (r = −0.703, p < .001) and B12 (r = −0.576, p < .001) were negatively correlated with HCY. In conclusion, low FA levels and high HCY levels might be independent risk factors for ED. Low serum FA and B12 levels might co-cause high HCY levels and lead to ED.     

An independent indicator of erectile dysfunction is C-reactive protein/albumin ratio

Research has found that, instead of passive lipid-accumulated vascular damage, atherosclerosis which is the primary cause of erectile dysfunction (ED) can be seen as an active inflammatory cycle and that inflammation has a central role in the entire atherosclerotic process. As an inflammatory marker, serum C-reactive protein (CRP)/albumin ratio (CAR) may link to ED and ED severity. The CAR, demographic features and other criteria of 198 patients with ED who visited our outpatient clinic during March 2019–April 2020 were prospectively evaluated. The research also included healthy control subjects without systemic or infectious diseases. The mean difference of CAR between ED and no ED was statistically significant (0.55 ± 0.27 and 0.79 ± 0.49, p = .002 respectively). On the basis of the ROC analysis, CAR has a good ED diagnostic value with an area under the curve (AUC) of 0.63 (95% CI:0.541–0.714) and better diagnostic performance to distinguish ED severity (AUC:0.73, 95% CI:0.620–0.842). Additionally, mean CAR gradually increased with increasing severity of ED (for all p < .001). The CAR has been described as an independent ED indicator in the multivariate analysis (p = .001OR = 8.934; 95% CI:2.449–32.583). Increased CAR is associated with ED severity and increased ED risk. For CAR predicting ED and ED severity, a considerable cut-off point was identified.     

Novel predictive risk factor for Erectile Dysfunction: Serum folic acid

The purpose of this study was to compare the serum Folic Acid (FA) levels in patients with Erectile Dysfunction (ED) and healthy controls and whether levels vary with its severity. The study was carried out on 77 sexually active individuals, out of which 41 complained of ED and 36 were apparently normal. Patients were excluded if they had any diseases known to cause ED. The severity was further categorised based on IIEF-5 scores. Blood serum levels of testosterone, lipid profile, random blood sugar, liver function test, renal function test and FA levels were obtained in each patient. Independent-samples t test of significance was used when comparing between two means. Pearson's correlation coefficient (r) test was used for correlating data. All clinical and biochemical parameters except FA were comparable in both the groups. FA levels were significantly decreased in ED group (5.29 vs. 10.8; p value = .004). Smoking habits were comparable between the groups, and FA levels did not vary among smokers and nonsmokers (p value = .46). Serum FA levels significantly declined with increasing severity of ED (8.28 vs. 5.56 vs. 4.37 vs. 3.5; p value < .001). Thus, decreased FA might possibly be one of the novel risk factors for ED.     

Augmented Microfracture Technique Versus Microfracture in Talar Cartilage Restoration: A Systematic Review and Meta-Analysis

The aim of this meta-analysis was to compare the efficacy and safety between the microfracture (MFx) and augmented microfracture (MFx+) techniques for articular cartilage defects of the talus (OLTs). PubMed and EMBASE were searched from January 1950 to October 2020. Only randomized controlled trials, quasi-randomized controlled trials, and observational studies (retrospective and prospective) applying MFx and MFx+ techniques to treat talar cartilage defects were selected. Ten trials with 492 patients were included. There was significant difference in final American Orthopaedic Foot & Ankle Society score (AOFAS) (mean difference [MD] = 7.07; 95% confidence interval [CI], 3.70-10.44; p < .01), AOFAS change (MD = 7.97; 95% CI, 4.27-11.66; p < .01), visual analog scale (VAS) change score (MD = 0.44; 95% CI, 0.29-0.59; p < .01), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (MD = 12.51; 95% CI, 7.16-17.86; p < .01), complication (RR = 0.33; 95% CI, 0.16-0.69; p < .01), and revision (Relative risk = 0.34; 95% CI, 0.15-0.77; p < .05), between the MFx and MFx+ groups. No significant difference was observed for final VAS pain score (MD = -0.53; 95% CI, -1.2 to 1.05; p = .13) and Tegner scale (MD = 0.31; 95% CI, -1.05 to 1.66; p = .66) in either group. Our results suggest that augmented microfracture is superior to microfracture alone in the treatment of talar OLTs based on the AOFAS, MOCART, VAS score, complication rate, and revision ratio. Therefore, microfracture with augmentation should be considered as a treatment for OLTs of talus. However, more randomized trials are still required to determine the long-term superiority of MFx+.     

Hypertension might be a risk factor for erectile dysfunction: a meta‐analysis

The study aimed to evaluate whether hypertension was a risk factor for erectile dysfunction (ED). Databases including PubMed and Embase were retrieved to identify studies related to hypertension in ED patients. Odds ratio (OR) and 95% confidence interval (CI) were used as the effect size. Subgroup analyses stratified by total number of enrolled subjects and research regions were performed. Sensitivity analysis was performed by removing a single study at one time. Egger's test was used to evaluate the publication bias. Totally, 40 studies including 121,641 subjects were included in the meta‐analysis. As a result, hypertension was closely related to ED (OR = 1.74, 95% CI, 0.63–0.80, p < .01). Subgroup analysis indicated hypertension was the risk factor for ED whatever the participants numbers. When stratified by different regions, hypertension was a risk factor for ED in Africa (OR = 3.35, 95% CI, 1.45–7.77, p < .01), Americas (OR = 1.97, 95% CI, 1.68–2.31, p < 0.01), Asia (OR = 1.46, 95% CI, 1.16–1.84, p < .01) and Europe (OR = 1.83, 95% CI, 1.34–2.49, p < .01), but not in Australia. Hypertension may be a potential risk factor for ED.     

Serum vitamin D levels and erectile dysfunction: A systematic review and meta‐analysis

Suboptimal levels of serum vitamin D levels have been implied to be associated with cardiovascular diseases and endothelial dysfunction, conditions closely associated with erectile dysfunction (ED). The present systematic review and meta‐analysis was performed to evaluate the vitamin D levels in subjects with ED compared to controls and the 5‐item version of the international index of erectile function (IIEF‐5) score in subjects with vitamin D deficiency compared to those without vitamin D deficiency in order to elucidate the role of vitamin D in the pathogenesis of ED. Studies evaluating the possible association between vitamin D levels and ED were initially screened and thus included following electronic literature search of database Cochrane Library, PUBMED, EMBASE and MEDLINE. Essential article information including outcome measures was extracted from the qualified studies by two independent authors, and STATA 12.0 software was used conducted the meta‐analysis. Subgroup analyses were conducted by vitamin D detection methods and sample size. The standard mean difference (SMD) as well as the 95% confidence intervals (95% CIs) was applied to estimate the outcome measures. A total of seven articles were included in our meta‐analysis with a total of 4,132 subjects. Pooled estimate was in favour of increased vitamin D levels in subjects without ED with a SMD of 3.027 ng/ml, 95%CI 2.290–3.314, p = 0.000. However, subgroup analysis showed an opposite trend, after one study with a sample size over 1,000 that could possibly influence the weight balance was excluded, with a SMD of 0.267, 95%CI ?0.052 to 0.585, p = 0.101. We also identified about 0.320 higher in IIEF‐5 score (95%CI = 0.146–0.494, p = 0.000) in subjects without vitamin D deficiency versus with vitamin D deficiency. Nevertheless, subgroup analysis based on vitamin D detection methods obtained differential results (radioimmunoassay subgroup, SMD(95%CI) = 0.573 (0.275–0.870), p = 0.000; immunoassay subgroup, SMD(95%CI) = 0.189 (?0.025 to 0.404), p = 0.084). In conclusion, results from the present meta‐analysis did not provide a strong relationship between vitamin D and the risk of ED. However, the results should be interpreted with caution and more high quality studies are warranted.     

The effect of using tadalafil 5 mg/day on neutrophil–lymphocyte and platelet–lymphocyte ratios in mild‐medium and severe erectile dysfunction patients; and comparison of clinical response

To examine the relation between NLR (neutrophil–lymphocyte ratio) and PLR (platelet–lymphocyte ratio) rates and the severity of ED (erectile dysfunction) and the effect of tadalafil 5 mg/day on these, a total of 143 patients were retrospectively evaluated. Sixty‐three patients with ED who came for follow‐up examinations in the 1st month of the treatment were included as the study group, and 80 men who were not diagnosed with ED were as the control group. The age and Charlson Comorbidity Indexes (CCI) of the study and control groups were compared with the IIEF 5, NLR and PLR values before and after the treatment. The mean age and median CCI were higher in the severe ED group (p < 0.05). The mean NLR and PLR values were lower in the control group (p < 0.001). In the study group, the NLR and PLR values decreased with the increase in the IIEF 5 scores (p < 0.001). The ROC curve was significant for the NLR and PLR scores (AUC = 0.779, [95% CI: 0.698–0.860]; AUC = 0.754, [95% CI: 0.670–0.838] p < 0.001). Although more prospective and randomized studies are needed, the systemic inflammation decreases and the clinical symptoms improve in patients who use tadalafil 5 mg/day.     

Predictors of preoperative deep vein thrombosis in hip fractures: A systematic review and meta-analysis

BackgroundThe predictors of preoperative deep vein thrombosis (DVT) in patients with hip fractures remain unclear. Therefore, this study describes the results of a systematic review and meta-analysis of relevant peer-reviewed literature on this topic.MethodsWe searched PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE for articles published in English on the predictors of preoperative DVT in hip fractures. We calculated pooled odds ratios (OR) or mean differences (MD) for the DVT groups as compared with the non-DVT groups for each variable, including gender, age, body mass index, injury side, current smoking status, time from injury to admission, time from injury to surgery, fracture type, hypertension, arrhythmia, coronary artery disease, diabetes, stroke, kidney disease, liver disease, lung disease, malignancy, rheumatoid arthritis, D-dimer, fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, hemoglobin, albumin, total cholesterol, and triglycerides.ResultsWe included 9 studies involving 3,123 Asian patients with hip fractures (DVT, n = 570; non-DVT, n = 2,553). Being female (OR = 1.27; 95% confidence interval [CI] 1.04–1.56; p = 0.02), being of advanced age (MD = 1.63; 95% CI 0.80–2.47; p = 0.0001), having a longer time from injury to admission (MD = 0.80; 95% CI 0.48–1.12; p < 0.00001), having a longer time from injury to surgery (MD = 2.20; 95% CI 1.53–2.88; p < 0.00001), and the presence of kidney disease (OR = 1.76; 95% CI 1.04–2.96; p = 0.03) were correlated with a high risk of DVT. However, we found no significant differences between the two groups in the other predictors.ConclusionsEvidence indicates that being female, being of advanced age, having a longer time from injury to admission, having a longer time from injury to surgery, and having kidney disease are significantly correlated with a high risk of preoperative DVT in Asian patients with hip fracture. Further investigations with patients of other ethnicities are required.     

Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A systematic review and meta-analysis

BackgroundTotal hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes.MethodsWe performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome.ResultsThis meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002).ConclusionWe conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes.Level of evidenceLevel Ⅱ     

Meta-analysis of infrahepatic inferior vena cava clamping combined with the pringle maneuver during hepatectomy

This meta-analysis was conducted to evaluate the effectiveness and safety of infrahepatic inferior vena cava clamping combined with the Pringle maneuver during. hepatectomies. Clinical studies were retrieved from the PubMed, Embase, Cochrane Library, Medline and Web of Science databases. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled value using a fixed-effects or random-effects model.Nine studies with 1008 patients in total were included. The infrahepatic inferior vena cava clamping combined with Pringle maneuver group experienced less total operative blood loss (mean difference [MD] = -327.11; 95% CI: -386.50–267.72; P < 0.00001), less blood loss during transection (MD = -270.19; 95% CI: -344.99–195.38; P < 0.00001), fewer blood transfusions (odds ratio [OR] = 0.36; 95% CI: 0.25–0.53;P < 0.00001) and fewer postoperative complications (OR = 0.70; 95% CI: 0.52–0.95; P = 0.02) than did the control group. Operative time (MD = 8.54; 95% CI: 4.68–12.40; P < 0.0001) was similar in both groups. liver transection time,hospital stay, postoperative liver function and renal function did not differ between groups.Applying infrahepatic inferior vena cava clamping combined with the Pringle maneuver can effectively reduce intraoperative bleeding, blood transfusion rates, and postoperative complications, while adding minimal time to the operation.     

Effects of weight reduction on the breast cancer-related lymphedema: A systematic review and meta-analysis

BackgroundObesity has long been considered a risk factor for breast cancer–related lymphedema (BCRL), but the benefits of weight reduction in managing BCRL have not been clearly established.ObjectiveTo evaluate the beneficial effects of weight loss interventions (WLIs) on the reduction and prevention of BCRL.MethodsWe conducted a systematic review and meta-analysis by searching the PubMed, Scopus, and Embase databases from their earliest record to October 1st, 2019. We included randomized and non-randomized controlled trials involving adult patients with a history of breast cancer, that compared WLI groups with no-WLI groups, and provided quantitative measurements of lymphedema.ResultsInitial literature search yielded 461 nonduplicate records. After exclusion based on title, abstract, and full-text review, four randomized controlled trials involving 460 participants were included for quantitative analysis. Our meta-analysis revealed a significant between-group mean difference (MD) regarding the volume of affected arm (MD = 244.7 mL, 95% confidence interval [CI]: 145.3–344.0) and volume of unaffected arm (MD = 234.5 mL, 95% CI: 146.9–322.1). However, a nonsignificant between-group MD of −0.07% (95% CI: 1.22–1.08) was observed regarding the interlimb volume difference at the end of the WLIs.ConclusionsIn patients with BCRL, WLIs are associated with decreased volume of the affected and unaffected arms but not with decreased severity of BCRL measured by interlimb difference in arm volume.     

Platelet indices and erectile dysfunction: A systematic review and meta‐analysis

Elevated platelet levels have been postulated to be associated with cardiovascular diseases, conditions closely linked to erectile dysfunction (ED). The current systematic review and meta‐analysis was performed to assess the platelet indices, which including platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with ED compared to controls in an attempt to clarify the possible role of platelet indices in the pathogenesis of ED. We initially screened the candidate studies observing the possible association between platelet indices and ED following literature search of database Cochrane Library, PubMed, EMBASE and MEDLINE and therefore included the studies based on the pre‐defined inclusion and exclusion criteria. Two independent investigators extracted the related information on article data and outcome measures from the qualified studies, and a meta‐analysis was therefore performed using Stata 12.0 software. Subgroup analyses were conducted by the different ED aetiology obtained from the eligible studies. The standard mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were applied to estimate the outcome measures. A total of 14 articles were qualified in our meta‐analysis with a total of 1595 cases and 987 controls included. Pooled estimate was in favour of increased MPV levels in subjects with ED with a SMD of 0.651 fl, 95% CI 0.567–0.735, p = 0.000. Subgroup analysis showed that vasculogenic ED had a higher MPV levels than controls as well (SMD [95% CI] = 1.026 [0.823–1.228], p = 0.000). However, pooled analysis based on PLT and PDW levels has produced inconsistent results and not strong evidence on platelet level and ED correlation. In conclusion, vasculogenic ED patients had a higher MPV level in our study. However, the results need further interpretation with caution and more high‐quality studies are warranted.     

Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials

BackgroundThe superiority of negative pressure wound therapy (NPWT) to standard gauze dressings for managing open fractures of the lower limbs remains controversial. This study aimed to comprehensively compare their clinical efficacy through a meta-analysis using randomized controlled trials (RCTs) alone. We hypothesized that NPWT would be more superior against infections.MethodsA literature search was implemented in various databases, including PubMed, Web of Science, Medline, Clinicaltrial.gov, and Cochrane Library, etc, to screen eligible RCTs. All included RCTs were evaluated for risk of bias using the Cochrane Collaboration tool. In accordance with the heterogeneity assessment, a fixed-effect or random-effect model was chosen for the data analysis.ResultsTen RCTs, including 2780 patients, were eligible for the meta-analysis. We found that patients in the NPWT group showed a lower overall infection rate (MD=0.70, 95% CI: 0.54–0.90, P = 0.005), acute wound infection rate (MD = 0.35, 95% CI: 0.16–0.77, P = 0.009), and shorter hospital stay (MD = 24.00, 95% CI: 6.82–84.46, P < 0.00001) compared with the control group. The NPWT group showed a higher proportion of patients with wound coverage than the control group. No significant difference was found between the two groups in terms of function score and other complications, including deep infection rate, amputation, and bone nonunion.ConclusionsFrom the pooled results, we suggest that NPWT may be superior than traditional gauze dressings for managing open fractures of the lower limbs.     

Clinical and Patient-Reported Outcomes of Medial Stabilized Versus Non–Medial Stabilized Prostheses in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundThe aim of this systematic review and meta-analysis was to compare the clinical and patient-reported outcome measures (PROMs) of medial stabilized total knee arthroplasty (TKA) with non–medial stabilized TKAs.MethodsA systematic search of multiple databases was conducted in October 2019. A meta-analysis was conducted for the Knee Society Score (KSS), Knee Society Functional Score (KFS), range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS).ResultsA total of 857 articles yielded 21 studies eligible for inclusion with 13 studies used for quantitative analysis. The meta-analysis revealed that the medial stabilized group had a mean FJS that was 13.8 points higher than that of the non–medial stabilized TKA (mean difference [MD]: 13.83, P ≤ .0001, 95% confidence interval [CI]: 8.90-18.76, I² = 0%) which was less than the minimal clinically important difference of 14. The medial stabilized group also demonstrated a statistically significant difference in the postoperative ROM (MD = 2.52, P = .05, 95% CI: ?0.03 to 5.07, I² = 85%) and OKS when compared with the non–medial stabilized group (MD = 1.25, P = .02, 95% CI: 0.17-2.33, I² = 27%), but these were not clinically significant. There was no statistically or clinically significant difference in the KSS, KFS, and WOMAC scores.ConclusionMedial stabilized knee prostheses demonstrated no clinically significant differences for the ROM, OKS, WOMAC, KSS, and KFS. The FJS demonstrated the greatest MD and warrants further investigation. Future research is required using patient-reported outcome measures with a lower ceiling effect such as the FJS.     

Comparison of erectile function in patients with end-stage renal disease receiving haemodialysis and kidney transplantation

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18–65 were compared in terms of ED. IEFF-15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty-seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02–0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta-blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy.     

Comparison of dynamic versus static fixation of intramedullary nailing in tibial diaphyseal fractures: A systematic review and meta-analysis

IntroductionTibial fractures are common long bone injuries, often surgically fixed with intramedullary nails. Modern intramedullary tibial nails allow for two different fixation modes, namely static and dynamic modes. While studies have demonstrated benefits of using either fixation modes, there has been no consensus as to which fixation mode would produce better outcomes and less complications. This systematic review and meta-analysis aims to compare the efficacy and safety of dynamic versus static fixation of intramedullary nails in the operative fixation of tibial diaphyseal fractures.MethodsA meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on April 15, 2021. Data from all published literature meeting inclusion criteria were extracted and analysed with fixed- and random-effects models.Findings/results: A total of 478 statically fixed and 234 dynamically fixed patients were included in this meta-analysis. Dynamically fixed patients had a significantly shorter mean time to union (mean difference, MD = 5.18 weeks, 95%CI: 1.95–8.41 weeks, p = 0.002) and reoperation rates (OR = 0.21, 95%CI: 0.10–0.47, p < 0.001) than statically fixed patients. No significant difference was found between both groups in terms of malrotation (OR = 0.57, 95% CI: 0.07–4.41, p = 0.59), non-union (OR = 1.10, 95% CI: 0.24–5.05, p = 0.91), delayed union (OR = 1.15, 95%CI: 0.19–7.17, p = 0.88) and malunion (OR = 2.73, 95% CI: 0.29–25.26, p = 0.38).ConclusionWhile acknowledging that there is widespread surgeon preference to dyanamise or statically fix intramedullary nails in certain tibial fracture configurations, primary dynamic fixation of intramedullary tibial nails demonstrated significantly shorter times to bony union and less complications than static nailing in our meta-analysis. Further research on identifying patient factors and fracture patterns that would best benefit from dynamic fixation is required.     

Effectiveness and safety of endoscopy-assisted versus conventional open lateral neck dissection: A meta-analysis

The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional open lateral neck dissection (COLND) for the treatment of thyroid cancer with positive lymph node metastases. Medical literature databases including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang and VIP were systematically searched for articles that compared EALND and COLND for the treatment of thyroid carcinoma with lymph node metastasis, up to June 2019. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information and evaluated the methodological quality of included studies according to inclusion and exclusion criteria, resulting in the selection of seven studies with a total of 372 patients from six non-RCTs and an RCT. The results of meta-analysis showed that EALND was associated with a longer operative time (MD = 24.86, 951CI：21.76 to 27.96, P＜0.05), with a shorter postoperative stay (MD = ?1.45, 95％CI：-2.70 to ?0.21，P = 0.02), reduced length of scar (MD = ?8.14，95％CI：-8.41 to ?7.88, P＜0.00001) and a lower incidence of neck discomfort (OR = 0.19, 95％CI：0.07 to 0.58, P = 0.003) compared with COLND. The incidences in both groups of transient hypocalcemia (OR = 0.66，95％CI：0.28 to 1.55，P = 0.343), transient hoarseness (OR = 0.58，95％CI：0.17 to 1.93，P = 0.38)，chylous fistula (OR = 0.69，95％CI：0.26 to 1.83，P = 0.45), choking on water (OR = 0.24，95％CI：0.04 to 1.31，P = 0.10) and the number of lymph nodes retrieved from the lateral cervical region (MD = 0.14，95％CI：-0.36 to 0.65，P = 0.59) were not statistically significant. It was concluded that EALND was safe and feasible compared with COLND, despite the longer operation time. The incision was more aesthetically pleasing and the postoperative recovery was quicker, which makes EALND a clinical procedure worthy of use in such cases.     

Comparing outcomes of third and fourth kidney transplantation in older and younger patients

Performing third or fourth kidney transplantation (3KT and 4KT) in older patients is rare due to surgical and immunologic challenges. We aimed to analyze and compare the outcomes of younger (18–64 years) and older (≥65 years) recipients of 3KT and 4KT. Between 1990 and 2016, we identified 5816 recipients of 3KTs (153 were older) and 886 recipients of 4KTs (18 were older). The incidences of delayed graft function (24.3% vs. 24.8%, p = .89), primary non-function (3.2% vs. 1.3%, p = .21), 1-year acute rejection (18.6% vs. 14.8%, p = .24), and 5-year death censored graft failure (DCGF) (24.8% vs. 17.9%, p = .06) were not different between younger and older recipients of 3KT. However, 5-year mortality was higher in older recipients (14.0% vs. 33.8%, p < .001) which remained significant after adjustment (aHR = 3.21, 95% CI: 2.59–3.99). Similar patterns were noted in the 4KT cohort. When compared with waitlisted patients, 3KT and 4KT are associated with a lower risk of mortality; aHR = 0.37, 95% CI: 0.33–0.41 and aHR = 0.31, 95% CI: 0.24–0.41, respectively. This survival benefit did not differ by recipient age (younger vs. older, p for interaction = 3KT: .49 and 4KT: .58). In the largest cohort described to date, we report that there is a survival benefit of 3KT and 4KT even among older patients. Although a highly selected cohort, our results support improving access to 3KT and 4KT.