Aims
The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of ...phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.
Methods
The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.
Results
Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).
Conclusion
Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
Cite this article:
Bone Jt Open
2023;4(11):817–824.
•Prosthetics are the mainstay in surgery after resection of extremity bone tumors.•For these patients gait parameters deteriorated compared to healthy individuals.•Further refinement of surgical ...techniques is required.•New rehabilitation strategies and follow-up programming are needed.
Prosthetic reconstructive procedures have become the mainstay in contemporary surgical treatment following resection of extremity bone neoplasms. Given that these patients are of young age most of the time, achievement of robust functional outcomes is of paramount importance. The aim of this study is to assess the impact of this procedure on the gait parameters of cancer patients compared to healthy individuals. The Medline, Scopus and Cochrane databases were systematically searched until January 2022 for eligible studies. Gait parameters measured by gait analysis after prosthetic reconstruction were the outcomes of interest. Eight cohort studies were included in our analysis. From these, seven studied prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one exclusively studied prostetic reconstructions of the proximal femur. Compared to healthy individuals a significant decrease was evident in gait velocity (-0.16 m/sec, 95 %CI: −0.23 to −0.09, p-value < 0.001), in stride length (-6.07 %height, 95 %CI: −9,36 to −2.78, p-value < 0.001), in cadence (-3.96 stride/min, 95 %CI: −5.41 to −2.51, p-value < 0.001) and significant increase in cycle time (0.10 s, 95 %CI: 0.03 to 0.17, p-value = 0.005). Prosthetic reconstruction following lower limb tumor resection significantly affects the gait of patients. This knowledge can be utilized for further refinement of surgical techniques, rehabilitation strategies and follow-up programming.
Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission ...tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade.
The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented.
Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18F-FDG, one study used 18F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%–91%) and the pooled specificity was 89% (95% CI: 83%–93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22–80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54–11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11–0.61).
PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.
AimsThe standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of ...phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.MethodsThe MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.ResultsThree studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).ConclusionRotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
Given that patients who suffer from extremity malignancies are primarily young, the validation and refinement of the management techniques for these type of tumors appear essential. Prosthetic ...reconstruction has already been established as a reliable surgical procedure for patients with lower limb bone neoplasms. Reconstruction with allograft has also been considered a viable treatment alternative for these patients, but evidence regarding the comparison of the efficacy between these techniques is scarce. The aim of this study is to evaluate and compare the impact of these two procedures on the gait parameters of patients that underwent lower limb tumor resection. The Medline, Scopus, and Cochrane databases were systematically scrutinized in January 2022. The outcomes of interest were gait parameters. Four studies were included in our analysis, from which three included allograft versus prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one that evaluated the proximal femur. Compared to prosthetic reconstruction, allografts non-significantly increased gait velocity (0.04 m/s; 95% CI: − 0.03, 0.10;
I
2
= 0%) and stride length (0.43% height; 95% CI: − 3.50%, 4.36%;
I
2
= 27.7%), significantly increased cadence (4.12 stride/min; 95% CI: 1.40, 6.84;
I
2
= 0%), and non-significantly reduced stance time (− 0.57% cycle time; 95% CI: − 1.16%, 0.02%;
I
2
= 0%). Our results highlight the potential of allograft reconstruction and suggest that it should not be neglected as a valid treatment option with substantial functional outcomes, comparable to prosthetic reconstructive procedures. Larger studies are required to validate these conclusions.
Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) promised to transform the management of peritoneal carcinomatosis (PC). Forty years since the introduction ...of the technique, published data from randomized controlled trials (RCTs) remain scarce. We assessed the cumulative comprehensive available evidence on the use of HIPEC in gastrointestinal (GI) and biliary tract malignancies and established the current benchmark for GI HIPEC research in both the prevention and treatment of peritoneal metastases.
RCTs were identified through a systematic search of Medline, Cochrane and Embase databases. Overall survival and progression-free survival were the outcomes of interest.
The search resulted in 13 RCTs for gastric cancer (10 on prophylactic and 3 on therapeutic HIPEC), 4 for colorectal cancer (2 on prophylactic and 2 on therapeutic HIPEC), and 1 for pancreatic cancer. No RCTs were identified that included other types of GI or biliary tract cancers. Current randomized evidence does not support any overall survival benefit from the use of HIPEC in the adjuvant setting for gastric cancer or for colorectal cancer in any setting. Despite the survival benefit noticed in the treatment of PC from gastric cancer (risk ratio 0.85, 95% confidence interval 0.77-0.93; P<0.001), the results were derived from only 190 patients.
The current evidence from RCTs does not support the use of HIPEC in the treatment/prevention of PC in GI and biliary tract malignancies. HIPEC should continue to be considered experimental until level 1 evidence from properly designed international multicenter studies becomes available.
AIM:To investigate melatonin’s preventive action in oxidative stress in a rat model with high fat diet-induced non-alcoholic fatty liver disease(NAFLD).METHODS:NAFLD was induced by high fat ...diet(HFD)in adult,male,Wistar rats,weighing 180-230 g.After acclimatization for one week,they were randomly assigned to 6 experimental groups that comprised animals on regular diet plus 5 or 10 mg/kg melatonin,for 4 or 8 wk;animals on HFD,with or without 5 or 10 mg/kg melatonin,for 4 or 8 wk;and animals on HFD for 8 or 12 wk,with melatonin 10 mg/kg for the last 4 wk.Liver damage was assessed biochemically by the serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),and histologically.Lipid peroxidation and oxidative stress were assessed by malondialdehyde and glutathione levels in liver tissue.Lipidemic indices and portal vein pressure were also measured.RESULTS:Compared to rats not receiving melatonin,rats on 5 or 10 mg/kg of melatonin had lower mean liver weight(-5.0 g and-4.9 g)(P < 0.001)and lower liver weight to body weight ratio(-1.0%)(P < 0.001),for the two doses,respectively.All rats fed HFD without melatonin developed severe,grade Ⅲ,steatosis.Rats on HFD with concurrent use of melatonin showed significantly less steatosis,with grade Ⅲ steatosis observed in 1 of 29(3.4%)rats on 10 mg/kg melatonin and in 3 of 27(11.1%)rats on 5 mg/kg melatonin.Melatonin was ineffective in reversing established steatosis.Melatonin also had no effect on any of the common lipidemic serum markers,the levels of which did not differ significantly among the rats on HFD,irrespective of the use or not of melatonin.Liver cell necrosis was significantly less in rats on HFD receiving melatonin than in those not on melatonin,with the AST levels declining by a mean of 170 U/L(P = 0.01)and 224 U/L(P = 0.001),and the ALT levels declining by a mean of 62.9 U/L(P = 0.01)and 93.4 U/L(P < 0.001),for the 5 and 10 mg/kg melatonin dose,respectively.Melatonin mitigated liver damage due to peroxidation and oxidative stress in liver tissue as indicated by a significant decline in MDA production by 12.7(P < 0.001)and 12.2(P < 0.001)μmol/L/mg protein/mg tissue,and a significant increase in glutathione by 20.1(P = 0.004)and 29.2(P < 0.001)μmol/L/mg protein/mg tissue,for the 5 and 10 mg/kg melatonin dose,respectively.CONCLUSION:Melatonin can attenuate oxidative stress,lessen liver damage,and improve liver histology in rats with high fat diet-induced NAFLD,when given concurrently with the diet.
Cysts of the liver ligaments are extremely rare and cysts of the ligamentum teres of the liver have been sporadically reported in the literature during the last century. The present report describes ...a case of a symptomatic patient with a cyst of the ligamentum teres of the liver. The patient presented with right upper quadrant pain and indigestion during the last 2 years. Ultrasound and computed tomography scans revealed a water-density mass attached to the anterior abdominal wall, but definite diagnosis could not be reached. The cyst was completely excised during laparotomy. Cysts of the ligamentum teres of the liver, although infrequent, may produce clinical symptoms and require excision. Ultrasound and computed tomography scan preoperatively cannot rule out malignancy, thus exploratory laparotomy and total resection of these lesions are necessary.
In this study we examine the dynamic interrelationship in the output–energy–environment nexus by applying panel vector autoregression (PVAR) and impulse response function analyses to data on energy ...consumption (and its subcomponents), carbon dioxide emissions and real GDP in 106 countries classified by different income groups over the period 1971–2011. Our results reveal that the effects of the various types of energy consumption on economic growth and emissions are heterogeneous on the various groups of countries. Moreover, causality between total economic growth and energy consumption is bidirectional, thus making a case for the feedback hypothesis. However, we cannot report any statistically significant evidence that renewable energy consumption, in particular, is conducive to economic growth, a fact that weakens the argument that renewable energy consumption is able to promote growth in a more efficient and environmentally sustainable way. Finally, in analysing the case for an inverted U-shaped EKC, we find that the continued process of growth aggravates the greenhouse gas emissions phenomenon. In this regard, we cannot provide any evidence that developed countries may actually grow-out of environmental pollution. In the light of these findings, the efficacy of recent government policies in various countries to promote renewable energy consumption as a means for sustainable growth is questioned. Put differently, there seems to be an ethical dilemma, between high economic growth rates and unsustainable environment and low or zero economic growth and environmental sustainability.
We examine time-varying correlations among stock market returns, implied volatility and policy uncertainty. Our findings suggest that correlations are indeed time-varying and sensitive to oil demand ...shocks and US recessions.
•We examine dynamic correlations of stock market returns, implied volatility and policy uncertainty.•Dynamic correlations reveal heterogeneous patterns during US recessions.•Aggregate demand oil price shocks and US recessions affect dynamic correlations.•A rise in the volatility of policy uncertainty dampens stock market returns and increases uncertainty.•Increases in stock market volatility reduce stock market returns and increase uncertainty.
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