Sensory organization for postural control in children with strabismus—A systematic review and meta-analysis

BackgroundPostural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits.Research questionDoes strabismus affect sensory organization for postural control in children?MethodsA systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review.ResultsEight of the 10 articles reviewed were included in the meta-analysis.Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI −0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, −0.94; 95 % CI, −1.74, −0.15). Overall, there was a high level of heterogeneity throughout the studies.SignificanceThis is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.     

Dose–effect response in image-guided adaptive brachytherapy for cervical cancer: A systematic review and meta-regression analysis

PurposeThis study aimed to integrate and update the dose–effect relationship between volumetric dose and local control for cervical cancer brachytherapy.Methods and MaterialsWe identified studies that reported high-risk clinical target volume (HR-CTV) D₉₀ and local control probability by searching PubMed, Web of Science, and the Cochrane Library databases through Oct 27, 2019. The regression analyses were performed using a probit model between HR-CTV D₉₀, D₁₀₀, intermediate-risk clinical target volume (IR-CTV) D₉₀, and dose to Point A vs. local control probability. Subgroup analyses were performed according to stratification: time of local control, income level of the country or region, stage of cancer, pathology, mean volume of HR-CTV, dose rate, image modality, concurrent chemoradiotherapy proportion, interstitial proportion, and mean overall treatment time.ResultsThirty-three studies encompassing 2893 patients were included. The probit model showed a significant relationship between the HR-CTV D₉₀ value and the local control probability, p < 0.0001. The D₉₀ corresponding to a probability of 90% local control was 83.7 Gy_EQD2,10 (80.6–87.8 Gy_EQD2,10). Of the 33 studies included in our analysis, eight studies, including 1172 patients, reported the IR-CTV D₉₀ value, ranging from 59.1 Gy_EQD2,10 to 72.3 Gy_EQD2,10. The probit model also showed a significant relationship between the IR-CTV D₉₀ value and the local control probability, p = 0.0464. The 60 Gy_EQD2,10 for IR-CTV D₉₀ corresponded to an 86.1% local control probability (82.0%–89.8%).ConclusionsA significant dependence of local control on HR-CTV D₉₀ and IR-CTV D₉₀ was found. A tumor control probability of >90% can be expected at doses >84 Gy_EQD2,10 and 69 Gy_EQD2,10, respectively, based on an updated meta-regression analysis.     

A meta-analysis of ¹⁸FDG-PET-CT, ¹⁸FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer

Background and purpose

Lung cancer is the most common cause of cancer related death among both men and women worldwide. The skeleton is the most common site of cancer metastasis. Early detection is crucial for prognosis. To evaluate and compare the capability for bone metastasis assessment of [¹⁸F] fluoro-2-d-glucose positron emission tomography with computed tomography (¹⁸FDG-PET–CT), [¹⁸F] fluoro-2-d-glucose positron emission tomography (¹⁸FDG-PET), magnetic resonance imaging (MRI) and bone scintigraphy (BS) in lung cancer patients, a meta-analysis is preformed.

Methods

We searched MEDLINE, OVID, EMBASE and the Cochrane Library for studies evaluating diagnosis validity of ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS between January 1990 and August 2010. Meta-analysis methods were used to pool sensitivity, specificity, diagnostic odd ratios (DORs) and to construct a summary receiver-operating characteristic curve (SROC).

Results

A total of 17 articles (9 ¹⁸FDG-PET–CT studies, 9 ¹⁸FDG-PET studies, 6 MRI studies and 16 BS studies) that included 2940 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for the detection of bone metastasis in lung cancer using ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS were 0.92 (95% CI, 0.88–0.95), 0.87 (95% CI, 0.81–0.92), 0.77 (95% CI, 0.65–0.87) and 0.86 (95% CI, 0.82–0.89), respectively. The pooled specificity for the detection of bone metastasis from lung cancer using ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS were 0.98 (95% CI, 0.97–0.98), 0.94 (95% CI, 0.92–0.96), 0.92 (95% CI, 0.88–0.95), 0.88 (95% CI, 0.86–0.89), respectively. The pooled DORs estimates for ¹⁸FDG-PET–CT 449.17 were significantly higher than for ¹⁸FDG-PET (118.25, P < 0.001), MRI (38.27, P < 0.001) and BS (63.37, P < 0.001). The pooled sensitivity of BS was not correlated with the prevalence of bone metastasis.

Conclusion

The results showed that both ¹⁸FDG-PET–CT and ¹⁸FDG-PET were better imaging methods for diagnosing bone metastasis from lung cancer than MRI and BS. ¹⁸FDG-PET–CT has higher diagnostic value (sensitivity, specificity and DORs) for diagnosing bone metastasis from lung cancer than any other imaging methods.     

Is there a critical period for bone response to weight-bearing exercise in children and adolescents? a systematic review

This systematic review examines and compares the bone mineral changes in children and adolescents, as measured by dual energy x ray absorptiometry, reported in exercise intervention studies. The effects of hormonal factors and growth on bone mineral change during puberty are examined, and the possibility of a critical period during which bone is especially adaptable to exercise is discussed.     

Reliability of aspartic acid racemization rate for chronological age estimation—a systematic review and meta-analysis

Objective

The biochemical approach of dental age using aspartic acid racemization has been widely reported. The aim of this systematic review was to determine the reliability and accuracy of dental age estimation using aspartic acid racemization rate analysis.

Design

Eight research databases (PubMed, Google Scholar, Embase, Cochrane, MEDLINE, TRIP, Web of Science, and Scopus) were utilised to gather and assess published literatures in compliance with the PRISMA 2020 guidelines and reported in PROSPERO (CRD42020208877). This systematic review and meta-analysis focused solely on cross-sectional studies. The quality evaluation was performed using the GRADE system. The standardized mean difference between estimated and chronological age was meta-analyzed using the random effects model.

Result

The literature review yielded 213 studies, of which 26 were considered acceptable for inclusion in this report. Out of 26 studies, 19 presented sufficient evidence for meta-analysis and the remaining 7 were used to construct a qualitative review. According to the meta-analysis, premolar-related studies had the least variability (Tau² = 0.23; I² = 72%) among other tooth groups.

Conclusion

A substantial degree of heterogeneity was found in every type of tooth. Only the premolar teeth had lower degree variability; thus, it is safe to believe that the premolar tooth is the best for this type of age estimation. It is recommended to develop population-specific mathematical equations to improve the accuracy of this age estimation approach.

     

The radiographic diversity of dental patterns for human identification — Systematic review and meta-analysis

This study aimed to revisit the scientific literature related to the diversity of dental patterns observed in radiographs. The rationale was to find evidence to support dental human identifications. A systematic review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Strategic search was accomplished in five electronic data sources (SciELO, Medline/Pubmed, Scopus, Open Grey and OATD) were searched. The study model of choice was observational analytical cross-sectional. The search resulted 4.337 entries. The sequential screening based on title, abstract and full-text reading led to 9 eligible studies (n = 5.700 panoramic radiographs) published between 2004 and 2021. Studies from Asian countries were predominant (e.g., South Korea, China, and India). All the studies showed low risk of bias (measured according to the Johanna Briggs Institute's critical appraisal tool for observational cross-sectional studies). Morphological, therapeutic, and pathological identifiers were charted from radiographs to create dental patterns across studies. Six studies (n = 2.553 individuals) had similar methodology and outcome metrics and were included in the quantitative analysis. A meta-analysis was performed and revealed a pooled diversity of the human dental pattern of 0.979 combining maxillary and mandibular teeth. The additional subgroup analysis with maxillary and mandibular teeth have a diversity rate of 0.897 and 0.924, respectively. The existing literature shows that human dental patterns are highly distinctive, especially if morphological, therapeutic and pathological dental features are combined. The diversity of dental identifiers found in the maxillary, mandibular and combined arches is hereby corroborated by this meta-analyzed systematic review. These outcomes support applications for evidence-based human identification.     

Sensitivity and specificity of post-mortem computed tomography in skull fracture detection—a systematic review and meta-analysis

International Journal of Legal Medicine - Post-mortem computed tomography (PMCT) has been increasingly used as routine examination in forensic pathology. No recent review of the growing number of...     

The diagnostic value of FDG and amyloid PET in Alzheimer’s disease—A systematic review

PurposeBy 2050 it is projected that 115 million people worldwide will have Alzheimer’s Disease (AD) [1]. Recent attempts have been made to redefine the diagnostic criteria of AD to include markers of neurodegeneration – measurable by FDG-PET – and markers of amyloid accumulation – measurable by amyloid-PET.Materials and methodsA systematic review of the literature was performed to examine the current diagnostic use of amyloid and FDG PET. MEDLINE and EMBASE databases and the Cochrane Database were searched for relevant papersResults and discussionThis search resulted in twenty-nine papers on amyloid imaging, twenty-three papers on FDG-PET and eight papers which utilized both techniques. Both modalities are considered in turn with regards to their diagnostic accuracy, their role in mild cognitive impairment (MCI) and prognostication, their use in the differential diagnosis of AD and their clinical application. As evidenced from the current literature, both amyloid and FDG-PET meet criteria for suitable biomarkers for the diagnosis of AD. They both indicate pathophysiological processes, albeit at different stages of the Alzheimer’s process, and are distinct from normal patterns of aging.ConclusionBoth techniques have been shown to detect AD with high sensitivity and specificity compared to other neurodegenerative processes and cognitively normal age-matched individuals. However, future studies with standardised, uniform thresholds and a lengthier longitudinal follow-up need to be conducted to allow us to make surer conclusions about the future role of PET in clinical practice. In addition, comparison with post-mortem diagnosis, rather than clinical diagnosis with its acknowledged flaws, would result in more powerful statistical outcomes – which is becoming increasingly important given that several disease-modifying AD drugs are now in phase 3 trials.     

Symptom response following acute bouts of exercise in concussed and non-concussed individuals – A systematic narrative review

BackgroundAthletes suspected of being concussed are frequently evaluated on the side-line for self-reported symptoms which guide subsequent management and return-to-play decisions. Concussion-like symptoms have been shown to be influenced by prior participation in physical activity; however, the potential contribution of acute exercise on symptoms is not well understood.ObjectiveThe purpose of this study was to systematically review the literature in order to further understand the acute effects of exercise on documented self-reported symptoms in both concussed and non-concussed individuals.DesignSystematic narrative review.MethodsNine electronic databases were systematically searched using keywords and MeSH terms that included; self-reported symptoms, sports-related concussion, brain concussion, exercise and athletic injuries. In addition, an extensive search of the grey literature was conducted.ResultsOf the 785 articles retrieved, only five met the inclusion criteria comprising a total of 295 concussed and non-concussed participants. In general, the mean symptom scores increased from pre-exercise to post-exercise levels immediately following acute bouts of exercise in both concussed and non-concussed individuals.ConclusionAlthough the symptom scores increased following exercise in both concussed and non-concussed participants, this increase was only maintained for a relatively short duration. Thus, the application to real world situation is still to be established.     

Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials

A systematic review to determine if exercise alone or as part of a comprehensive intervention can improve self esteem in children and young people is described. Twenty three randomised controlled trials were analysed. A synthesis of several small, low quality trials indicates that exercise may have short term beneficial effects on self esteem in children and adolescents. However, high quality research on defined populations with adequate follow up is needed.     

The French–Canadian data set of Demirjian for dental age estimation: A systematic review and meta-analysis

BackgroundEstimation of age of an individual can be performed by evaluating the pattern of dental development. A dataset for age estimation based on the dental maturity of a French–Canadian population was published over 35 years ago and has become the most widely accepted dataset. The applicability of this dataset has been tested on different population groups.AimTo estimate the observed differences between Chronological age (CA) and Dental age (DA) when the French Canadian dataset was used to estimate the age of different population groups.Materials and methodsA systematic search of literature for papers utilizing the French Canadian dataset for age estimation was performed. All language articles from PubMed, Embase and Cochrane databases were electronically searched for terms ‘Demirjian’ and ‘Dental age’ published between January 1973 and December 2011. A hand search of articles was also conducted.ResultsA total of 274 studies were identified from which 34 studies were included for qualitative analysis and 12 studies were included for quantitative assessment and meta-analysis. When synthesizing the estimation results from different population groups, on average, the Demirjian dataset overestimated the age of females by 0.65 years (?0.10 years to +2.82 years) and males by 0.60 years (?0.23 years to +3.04 years).ConclusionThe French Canadian dataset overestimates the age of the subjects by more than six months and hence this dataset should be used only with considerable caution when estimating age of group of subjects of any global population.     

The ultrasonographic “whirlpool sign” in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis

Purpose

A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The objective of this review was to assess the validity and accuracy of this sign by performing a comprehensive systematic literature review and meta-analysis.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (August, 2017), using the following databases: BMJ Best Practice, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Selected studies were further assessed for relevance and quality using the Oxford 2010 Critical Appraisal Skills Program (CASP).

Results

Of the studies assessed, a total of 723 participants were included, with a mean of 72.3 (SD 71.9) participants. Of the participants, 226 (31.3%) were diagnosed with testicular torsion (TT). Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of the WS of 0.73 (95% CI, 0.65–0.79) and 0.99 (95% CI, 0.92–0.99), respectively. Removal of all neonates increased the pooled sensitivity to 0.92 (95% CI, 0.70–0.98) while the pooled specificity remained almost unchanged at 0.99 (95% CI, 0.95–1.00). The estimated summary effect of all studies with sufficient data was 4.34 (95% CI, 1.01–7.67; n?=?394; p?=?0.001). A large degree of heterogeneity was suggested by an I² statistic of 88.27% (95% CI, 68.60–98.68%). Removal of neonatal subjects increased the estimated summary effect to 5.32 (95% CI, 1.59–9.05; n?=?375; p?=?0.001).

Conclusion

The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.

     

Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review

ObjectiveThe aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020).Eligibility criteriaTwo authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing.Results13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions.ConclusionThere was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.     

Is antimicrobial photodynamic therapy a useful therapeutic protocol for oral decontamination? A systematic review and meta-analysis

BackgroundThe aim of the present systematic review and meta-analysis was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) as a therapeutic protocol for oral decontamination.MethodsIn order to address the focused question: Is aPDT a useful therapeutic protocol for oral decontamination?, an electronic search without time or language restrictions was conducted up to July 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, photodynamic therapy, disinfection, mouth, saliva and oral. The exclusion criteria included reviews, case-reports, case-series, commentaries, letters to the editor, interviews, and updates. Four randomized control trials were included and processed for data extraction.ResultsAll studies reported that aPDT was effective in reducing the overall oral microbial load in saliva. Considering the effects of aPDT + photosensitizer (PS) compared with PS alone, there was no heterogeneity noticed for aPDT + PS (Q value = 0.15, P = 0.69, I² = 0%). The overall mean difference for bacterial count in CFU/ml between aPDT + PS and PS alone was also not significant (weighted mean difference = −0.41, 95% CI = −1.12 to 0.29, p = 0.24) at follow-up.ConclusionThe efficacy of aPDT for oral decontamination remains unclear. Further well-designed randomized clinical trials assessing the efficacy of aPDT reducing the oral microbial load are need.     

Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review

Purpose

Antibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA.

Methods

A detailed and systematic search of the Pubmed, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword “total knee arthroplasty” “total knee replacement” “total knee prosthesis” and “antibiotic-loaded bone cement” with no limit regarding the year of publication. We used modified Coleman scoring methodology (mCMS) to identify scientifically sound articles in a reproducible format. The review was limited to the English-language articles.

Results

Six articles met inclusion criteria. In total, 6318 arthroplasties were included in our study. 3217 of these arthroplasties received antibiotic-loaded bone cement and 3101 arthroplasties served as the control. There was no statistical difference between the two groups in terms of the incidence of deep or superficial surgical site infection. The average mCMS score was 67.6, indicating good methodological quality in the included studies.

Conclusions

Present review did not reveal any significant difference in terms of rate of deep or superficial surgical site infection in patients receiving antibiotic-loaded bone cement compared with the control (plain bone cement) during primary TKA. The clinical relevance of this study was that the use of antibiotic-loaded bone cement did not significantly reduce the risk of infection in primary TKA.

Level of evidence

III.