Although botulinum toxin (BoNT) has been suggested as a treatment to counter neuropathic pain, no previous systematic reviews investigated the multidimensional effects of BoNT on pain relief and ...Health-Related Quality of Life (HR-QoL). The aim of this systematic review is to summarize the current evidence on the effectiveness of BoNT treatment for neuropathic pain, and to characterize its multidimensional effectiveness in order to guide physicians in clinical practice. Five databases were systematically searched up to 4 April 2022, to identify randomized controlled trials satisfying the following criteria: adults suffering from neuropathic pain, BoNT administration, any comparator, multidimensional assessment of pain as primary outcome, HR-QoL, physical function, anxiety and depression, and sleep quality as secondary outcomes. Twelve studies were included. The multidimensional pain scales used were short-form McGill Pain Questionnaire, Neuropathic pain scale, Neuropathic Pain Symptom Inventory, International SCI Pain Basic Data Set, West Haven-Yale Multidimensional Pain Inventory, Brief Pain Inventory, and Douleur Neuropathique 4. These scales highlighted the positive effects of BoNT administration. According to the Jadad scale, all the RCTs included were high-quality studies. BoNT administration might be effectively introduced in the comprehensive management of neuropathic pain. Further research should focus on optimal and cost-effective therapeutic protocols.
Radiographic methods to assess skeletal maturity (SM) have a key role in adolescent idiopathic scoliosis (AIS) management, allowing to predict risk of spinal curve progression. Cervical vertebral ...maturation (CVM) has been recently introduced as an alternative tool to assess skeletal maturity; however, its clinical role is still debated.
This systematic review aimed to investigate the reliability of CVM in the SM assessment of growing subjects, comparing it to hand wrist maturation (HVM).
PubMed, Scopus, and Web of Science databases were systematically searched from inception until 31st December 2020 to identify observational studies presenting: growing subjects as participants; CVM methods as intervention; HVM methods as comparator; reliability for SM assessment as outcome. A 10-item quality tool has been used to assess study quality.
Out of 205 papers, 12 papers were included in the data synthesis. We classified 10 studies (83.3%) as medium-quality studies and 2 studies (16.7%) as high-quality studies. Eight studies reported a significant correlation between CVM Baccetti and different HWM methods.
Taken together, these findings suggested that CVM might be considered as reliable SM assessment method compared to HWM in growing subjects. However, further studies are warranted to confirm these findings.
Breast cancer-related lymphedema (BCRL) could be one consequence of breast cancer (BC). Although several risk factors have been identified, a predictive algorithm still needs to be made available to ...determine the patient's risk from an ensemble of clinical variables. Therefore, this study aimed to characterize the risk of BCRL by investigating the characteristics of autogenerated clusters of patients.
The dataset under analysis was a multi-centric data collection of twenty-three clinical features from patients undergoing axillary dissection for BC and presenting BCRL or not. The patients' variables were initially analyzed separately in two low-dimensional embeddings. Afterward, the two models were merged in a bi-dimensional prognostic map, with patients categorized into three clusters using a Gaussian mixture model.
The prognostic map represented the medical records of 294 women (mean age: 59.823±12.879 years) grouped into three clusters with a different proportion of subjects affected by BCRL (probability that a patient with BCRL belonged to Cluster A: 5.71%; Cluster B: 71.42%; Cluster C: 22.86%). The investigation evaluated intra- and inter-cluster factors and identified a subset of clinical variables meaningful in determining cluster membership and significantly associated with BCRL biological hazard.
The results of this study provide potential insight for precise risk assessment of patients affected by BCRL, with implications in prevention strategies, for instance, focusing the resources on identifying patients at higher risk.
There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients. This systematic review aimed ...to assess the role of occlusal splints on spinal posture of TMD patients. PubMed, Web of Science, and Scopus were systematically searched from inception until 5 January 2022 to identify observational studies with a longitudinal study design presenting: patients with diagnosis of TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); occlusal splint therapy as intervention; postural assessment as outcome. Out of 133 records identified, 104 were suitable for data screening, and only 7 articles were included satisfying the eligibility criteria. We found that occlusal splints might have a positive effect on posture in TMD patients, albeit there is little evidence of appropriate investigation for postural assessment. This systematic review suggested that the occlusal splint might be considered a non-invasive therapeutic approach for patients with TMD. However, the low number of studies with high-quality methodology in these patients showed an urgent need for further research using combined force platform stabilometry and kinematic evaluation of the spine to investigate the impact of occlusal splints on posture.
Lymphedema is a chronic disabling condition affecting a growing number of patients worldwide. Although lymphedema is not life-threatening, several reports underlined detrimental consequences in terms ...of distress, pain, functional impairment, and infections with a relevant decrease in quality of life. Currently, there is no cure, and the therapeutic management of this condition aims at slowing down the disease progression and preventing secondary complications. Early diagnosis is paramount to enhance the effects of rehabilitation or surgical treatments. On the other hand, a multidisciplinary treatment should be truly integrated, the combination of microsurgical and reductive procedures should be considered a valid strategy to manage extremity lymphedema, and rehabilitation should be considered the cornerstone of the multidisciplinary treatment not only for patients not suitable for surgical interventions but also before and after surgical procedures. Therefore, a specialized management of Plastic Reconstructive Surgeons and Physical and Rehabilitative Medicine physicians should be mandatory to address patients’ needs and optimize the treatment of this disabling and detrimental condition. Therefore, the aim of this review was to characterize the comprehensive management of lymphedema, providing a broad overview of the potential therapy available in the current literature to optimize the comprehensive management of lymphedema and minimize complications.
Introduction
The role of vitamin D supplementation on muscle function and physical performance is still debated. Calcifediol is an available treatment for hypovitaminosis D, particularly for ...extra-skeletal effects. Aim of this prospective cohort study was to evaluate the effectiveness of calcifediol on serum levels of 25(OH)D
3
, appendicular muscle strength, physical performance, and prevention of falls in post-menopausal women.
Methods
We recruited post-menopausal women aged ≥50 years, referring to an outpatient service for the management of osteoporosis over a 18-month period. We included women with a diagnosis of osteoporosis and/or vitamin D deficiency serum levels of 25(OH)D
3
<30 ng/ml. All the participants received calcifediol (20 μg, 4 oral drops/day) for a 6-month period. We evaluated at the baseline and after 6 months the following outcomes: serum levels of 25(OH)D
3
, appendicular muscle strength, using the Isometric Hand Grip Strength Test and the Knee Isometric Extension Strength Test, physical performance, using the Short Physical Performance Battery (SPPB) and the 4-m gait speed (4MGS), and the risk of falls (percentage of fallers and recurrent fallers and mean number of falls). A sub-analysis was performed in patients with vitamin D deficiency.
Results
We enrolled 113 post-menopausal women, mean aged 68.01 ± 9.13 years. After 6 months of treatment, there was a significant increase in serum levels of 25(OH)D
3
(
p
< 0.001), appendicular muscle strength (
p
< 0.001), and physical performance (
p
= 0.002 at SPPB and
p
= 0.010 at 4MGS, respectively). At 6 months, the percentage of fallers was lower, although not significantly (
p
= 0.078), whereas there was a significant reduction both in percentage of recurrent fallers and in the mean number of falls (
p
< 0.001 and
p
= 0.020, respectively).
Conclusion
Calcifediol was significantly effective in improving serum levels of 25(OH)D
3
and muscle function and in reducing the percentage of recurrent fallers and the mean number of falls in a cohort of post-menopausal women.
Rehabilitation might improve bone health in breast cancer (BC) patients, but the effects on bone biomarkers are still debated. Thus, this meta-analysis of randomized controlled trials (RCTs) aims at ...characterizing the impact of rehabilitation on bone health biomarkers in BC survivors. On 2 May 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for RCTs assessing bone biomarker modifications induced by physical exercise in BC survivors. The quality assessment was performed with the Jadad scale and the Cochrane risk-of-bias tool for randomized trials (RoBv.2). Trial registration number: CRD42022329766. Ten studies were included for a total of 873 patients. The meta-analysis showed overall significant mean difference percentage decrease in collagen type 1 cross-linked N-telopeptide (NTX) serum level ES: -11.65 (-21.13, -2.17),
= 0.02) and an increase in bone-specific alkaline phosphatase (BSAP) levels ES: +6.09 (1.56, 10.62). According to the Jadad scale, eight RCTs were considered high-quality studies. Four studies showed a low overall risk of bias, according to RoBv.2. The significant effects of rehabilitation on bone biomarkers suggested a possible implication for a precision medicine approach targeting bone remodeling. Future research might clarify the role of bone biomarkers monitoring in rehabilitation management of cancer treatment induced bone-loss.
Cancer pain is one of the most disabling symptoms complained by cancer patients, with a crucial impact on physical and psychological well-being. Botulinum neurotoxins (BoNTs) type A and B have ...emerged as potential interventions for chronic pain; however, their role in these patients is still debated. Thus, this systematic review of randomized controlled trials aimed at assessing the effects of BoNT treatment for cancer pain to guide physicians in an evidence-based approach integrating BoNT in cancer care. Out of 5824 records, 10 RCTs satisfied our eligibility criteria and were included in the present work for a total of 413 subjects with several cancer types (breast, head and neck, esophageal, and thoracic/gastric cancers). While some studies demonstrated significant pain reduction and improved quality of life post-BoNT-A injections, outcomes across different cancer types were inconclusive. Additionally, several effects were observed in functioning, dysphagia, salivary outcomes, esophageal strictures, gastric emptying, and expansions. This review emphasizes the need for further standardized research to conclusively establish the efficacy of BoNT in comprehensive cancer pain management.
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