Randomized controlled trials in cervical myelopathy: a systematic scoping review

Εισαγωγή: Σύμφωνα με τα αποτελέσματα των τελευταίων ερευνών τα τελευταία χρόνια έχουν αυξηθεί σε σημαντικό βαθμό οι νοσηλείες ασθενών με αυχενική μυελοπάθεια. Συχνότερα αίτια αυχενικής μυελοπάθειας αποτελούν η αυχενική μυελοπάθεια εκφυλιστικής αιτιολογίας, το τραύμα, οι όγκοι και οι λοιμώξεις Σκοπός: Σκοπός του παρόντος scoping review είναι να καταγράψει το εύρος των τυχαιοποιημένων κλινικών μελετών πάνω στην αυχενική μυελοπάθεια, το πόσο καλά οι γεωγραφικές περιοχές και οι υποπληθυσμοί αντιπροσωπεύονται, ποιες μέθοδοι χρησιμοποιήθηκαν περισσότερο και ποιο ήταν το επίκεντρο των μελετών. Παράλληλα, κατέστη δυνατό να σημειωθούν τα όποια κενά παρουσιάζει η βιβλιογραφία πάνω σε αυτό το θέμα. Υλικά και μέθοδοι: Το παρόν scoping review συμπεριέλαβε όλες τις τυχαιοποιημένες κλινικές μελέτες πάνω στην αυχενική μυελοπάθεια που είναι καταχωρημένες στο PubMed.com, στο Scopus.com και στο ClinicalTrials.gov από το 1990 έως το 2022. Οι λέξεις- κλειδιά “αυχενική μυελοπάθεια” και “τυχαιοποιημένες κλινικές μελέτες” χρησιμοποιήθηκαν. Για τη διεξαγωγή του review χρησιμοποιήθηκαν οι κατευθυντήριες οδηγίες PRSIMA-ScR. Αποτελέσματα: Η πλειοψηφία των κλινικών μελετών πραγματοποιήθηκε από ένα φορέα έρευνας (65,2 %), ενώ το 71,5 % των μελετών επικεντρώθηκε σε μελέτη θεραπειών, κυρίως μέσω χειρουργικών προσεγγίσεων. Όσο αναφορά την γεωγραφική εκπροσώπηση, οι περισσότερες μελέτες προέρχονται από τη Βόρεια Αμερική και κυρίως από τις ΗΠΑ. Οι κλίμακες JOA και mJOA ήταν οι μετρικές πρωτευόντων αποτελεσμάτων που μελετήθηκαν περισσότερο. Η αυχενική μυελοπάθεια εκφυλιστικής αιτιολογίας ήταν το αίτιο αυχενικής μυελοπάθειας που διερευνήθηκε περισσότερο (57,6 %). Συμπεράσματα: Παρά την πληθώρα ερευνών που επικεντρώνονται στη διερεύνηση διάφορων τρόπων θεραπείας, κυρίως μέσω χειρουργικών προσεγγίσεων, παρατηρείται ένας μικρός αριθμός ερευνών που επικεντρώνεται στον τομέα της διάγνωσης. Ένα ακόμη ζήτημα το οποίο προκύπτει είναι η ανάγκη να συμπεριλαμβάνονται στις κλινικές δοκιμές, ειδικά αυτές που επικεντρώνονται στην χειρουργική, οι 4 συγκεκριμένες κλίμακες που προτείνει η AO Spine έτσι ώστε να μελετώνται και να συγκρίνονται οι διάφορες μέθοδοι πιο αποτελεσματικά.Background: Recent research has documented a significant increase in hospitalization of patients with cervical myelopathy. Among the risk factors of the above condition include degenerative causes most commonly in the elderly and trauma. Objective: The present study undertakes a scoping review of randomized controlled trials in cervical myelopathy to determine how well subpopulations and geographic areas are represented, the methodologies used and what the focal points of those trials were. Furthermore, it was made possible to identify areas where more research is needed. Design: This scoping review included all randomized controlled trials on cervical myelopathy registered in the PubMed.com, Scopus.com and ClinicalTrials.gov from 1990 to 2022. The keywords “cervical myelopathy” and “randomized controlled trial” were used. PRISMA-ScR guidelines were used to conduct this review. Results: Single-center institutions (65.2 %) conducted most of the clinical trials, while 71.5 % of all the included trials focused on treatment strategies, most often through surgical approaches. In terms of geographical representation, most of the studies originated from North America, particularly from the US. The Japanese Orthopedic Association Score (JOA) and modified Japanese Orthopedic Association Score (mJOA) is the outcome measure studied the most. Degenerative Cervical Myelopathy was the cause of cervical myelopathy investigated the most (57.6 %). Conclusions: While there has been noted a plethora of studies focusing on various ways of treatment, mainly through surgical procedures, the field of diagnosis remains relatively unexplored. Another issue that should be addressed is the need to always include and study the specific outcome measures that AO Spine suggests, particularly in surgical trials, to compare various methods and approaches more efficiently

Drug Eluding Stents for Malignant Airway Obstruction: A Critical Review of the Literature

Lung cancer being the most prevalent malignancy in men and the 3rd most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement

Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis

ObjectiveEndometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness.MethodsMedline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET.ResultsThe initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30–1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30–2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52–1.22), p = 0.30]ConclusionOur meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients.Systematic Review RegistrationPROSPERO (CRD42023414117

Coexistence of squamous cell tracheal papilloma and carcinoma treated with chemotherapy and radiotherapy: a case report

BACKGROUND: Papillomatosis presents, most frequently, as multiple lesions of the respiratory tract, which are usually considered benign. Malignant degeneration into squamous cell carcinoma is quite common, although curative approaches vary a lot in modern literature. CASE REPORT: We report a case of a 66-year-old male patient with the coexistence of multiple squamous cell papilloma and carcinoma in the upper trachea with severe airway obstruction that was diagnosed through bronchoscopy and treated by performing an urgent tracheostomy, followed by concurrent chemotherapy and radiotherapy. There was no evidence of recurrence after a 12-month follow-up period. CONCLUSION: This study underlines the diagnostic and therapeutic value of bronchoscopy as well as multimodality palliative treatment in such cases. To the best of our knowledge, this is the first study to describe an immediate treatment protocol with tracheostomy and concurrent chemotherapy/radiotherapy in a patient with squamous cell tracheal papilloma and carcinoma

A rare case of anastomosis between the external and internal jugular veins

Jugular veins bring deoxygenated blood from the head back to the heart. There are two sets of external and internal veins. The external jugular vein receives the greater part of the blood from the cranium and the deep parts of the face. It commences from the substance of the parotid gland and runs down the neck at the posterior border of sternocleidomastoideus and ends in the subclavian vein in front of the scalenus anterior. The external jugular vein is covered by the platysma and its upper half runs parallel with the great auricular nerve. There is also another minor jugular vein, the anterior, draining the submaxillary region. In our patient, we recognized a shunt between the external and internal jugular veins. It appeared in the middle of the veins, between the pair of valves, which are placed ~2.5 cm above the termination of the vessel. The anastomosis was fully functional, and there was no problem in the blood pressure of the patient. Moreover, the shunt was not associated with any systemic disease

Single sternal metastasis due to malignant melanoma with unexpected long-term survival: a case report

Metastases from melanoma have a very poor prognosis for the patient. Single metastatic lesions in the sternum due to melanoma are extremely rare. A rare case of a presternal mass in a 56-year-old patient who had undergone excision for malignant melanoma is presented. Review of the patient’s history and surgical resection of a single metastatic soft tissue lesion offer the best chance of long-term survival

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries