Cyclic increase in the ADAMTS1-L1CAM-EGFR axis promotes the EMT and cervical lymph node metastasis of oral squamous cell carcinoma.

The matrix metalloprotease A disintegrin and metalloprotease with thrombospondin motifs 1 (ADAMTS1) was reported to be involved in tumor progression in several cancer types, but its contributions appear discrepant. At present, the role of ADAMTS1 in oral squamous cell carcinoma (SCC; OSCC) remains unclear. Herein, The Cancer Genome Atlas (TCGA) database showed that ADAMTS1 transcripts were downregulated in head and neck SCC (HNSCC) tissues compared to normal tissues, but ADAMTS1 levels were correlated with poorer prognoses of HNSCC patients. In vitro, we observed that ADAMTS1 expression levels were correlated with the invasive abilities of four OSCC cell lines, HSC-3, SCC9, HSC-3M, and SAS. Knockdown of ADAMTS1 in OSCC cells led to a decrease and its overexpression led to an increase in cell-invasive abilities in vitro as well as tumor growth and lymph node (LN) metastasis in OSCC xenografts. Mechanistic investigations showed that the cyclic increase in ADAMTS1-L1 cell adhesion molecule (L1CAM) axis-mediated epidermal growth factor receptor (EGFR) activation led to exacerbation of the invasive abilities of OSCC cells via inducing epithelial-mesenchymal transition (EMT) progression. Clinical analyses revealed that ADAMTS1, L1CAM, and EGFR levels were all correlated with worse prognoses of HNSCC patients, and patients with ADAMTS1high/L1CAMhigh or EGFRhigh tumors had the shortest overall and disease-specific survival times. As to therapeutic aspects, we discovered that an edible plant-derived flavonoid, apigenin (API), drastically inhibited expression of the ADAMTS1-L1CAM-EGFR axis and reduced the ADAMTS1-triggered invasion and LN metastasis of OSCC cells in vitro and in vivo. Most importantly, API treatment significantly prolonged survival rates of xenograft mice with OSCC. In summary, ADAMTS1 may be a useful biomarker for predicting OSCC progression, and API potentially retarded OSCC progression by targeting the ADAMTS1-L1CAM-EGFR signaling pathway.

Patient Decision Aids for Breast Cancer Reconstruction: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Breast cancer has surpassed lung cancer to become the most frequently diagnosed cancer in women. There has been a dramatic increase in the use of breast reconstruction after mastectomy. However, struggle in making decisions regarding breast reconstruction has existed. Thus, decision aid (DA) is necessary to be conducted, and further studies are needed to promote better decision aid. This review discussed how DAs can be used to help women make decisions about breast reconstruction after mastectomy. Additionally, the review was the first to compare different DA formats to determine which one is most effective. METHODS: We searched for relevant studies published before October 2022 in PubMed and Embase using the medical subject headings "breast reconstruction" and "decision aid." Demographic data as well as decision, outcomes and instruments used for assessment were also collected. Risk of bias was measured by the Cochrane Risk-of-Bias 2 (RoB 2) tool. RESULTS: A network meta-analysis of 14 RCTs with a total of 1401 patients wereincluded. 90.9% participants presented usable results for evaluation of decisional conflict, and web-based DA (-0.3, 95% CI -0.56 to -0.05) showed significant improvement. 50.3% participants provided results of decisional regret, and no subgroups showed significant reduction. 60.3% participants contributed to results for knowledge, and web-based DA (0.61, 95% CI 0.01 to 1.21) showed the most positive effect. 44.5% participants were included for evaluation of satisfaction, and web-based DA (0.44, 95% CI 0.15 to 0.72) revealed significant increase. CONCLUSION: The review concluded that web-based decision aids are the favorable format of decision aid.

Endovascular Occlusive or Sclerosing Agent Monotherapy for Varicose Veins: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

This systematic review and network meta-analysis investigated the clinical efficacy and safety of chemical agent injections in patients with varicose veins. PubMed, Embase, and Cochrane databases were searched for eligible studies where patients administered endovascular agents comprised an intervention group, and patients administered other interventions comprised the comparison group. The endovascular agents included foam and liquid form sclerotherapy or cyanoacrylate glue. The other interventions in this study included surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and placebo. A network meta-analysis for treatment effectiveness was performed. In addition, we illustrated the P-score lines of success rate and complication rate sorted by the P-score. Our results showed that at all postprocedural time intervals, cyanoacrylate glue therapy exhibited a significantly higher success rate compared with foam and liquid sclerotherapy. According to the plot of P-score lines, cyanoacrylate glue had an overall tendency of higher success rate and lower complication rate compared with foam and liquid sclerotherapy. Comparing with the other invasive treatments, cyanoacrylate glue may be non-inferior and could be considered as an option for treating varicose veins. However, the clinical benefits and safety of endovascular agents for the treatment of varicose veins require further corroboration through randomized control trials.

An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds.

Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.

Efficacy of Laser in Hair Removal: A Network Meta-analysis.

BACKGROUND: Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions. METHODS: The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot. RESULTS: A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars. CONCLUSION: Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

Comparing the efficacy of different steroids for rhinoplasty: A systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Rhinoplasty can cause tissue trauma and inflammatory responses. Edema and ecchymosis, especially on the face, accompanied by inflammation are common complications. The anti-inflammatory properties of steroids can reduce postoperative edema and ecchymosis. OBJECTIVE: This review aims to determine the most effective type of steroids for preventing complications related to rhinoplasty. METHODS: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The population of comprised patients who underwent rhinoplasty or septorhinoplasty. Different types of steroids administrated intravenously during the perioperative period were compared. The primary outcome of postoperative edema and other outcomes were evaluated on postoperative day 1, 3, and 7. Random-effects model was performed. The means and standard deviations were extracted. RESULTS: Eighteen randomized controlled trials were included. The network meta-analysis revealed that dexamethasone and methylprednisolone significantly reduced edema on postoperative day 1 compared with placebo. No significant differences between the effects of any of two types of steroids were noted. CONCLUSION: At least one dose of intravenous steroid intervention is recommended during the perioperative period of rhinoplasty. However, in terms of reducing edema and ecchymosis, no significant differences were noted among dexamethasone, methylprednisolone, and betamethasone.

Determinants of the success in flap reconstruction-Outcome analysis of 120 flaps in 484 procedures for pressure injury.

Pressure injury (PI) mainly occurs in bedridden older adults or those with physical limitations. Here, we aimed to determine the appropriate timing to conduct flap reconstruction in patients with PIs and identify factors affecting surgical outcomes. We retrospectively reviewed the data of all patients who received debridement or flap reconstruction surgery for PIs in our hospital from January 2016 to December 2021. The extracted data included patient demographics, surgical records, blood test results, vital signs, and flap outcomes. In total, 484 surgical procedures (364 debridements and 120 flaps) were performed on 216 patients. Serum albumin level of ≥2.5 g/dL remarkably increased the likelihood of complete wound healing (odds ratio [OR] = 4.12, P = .032) and reduced the risk of postoperative complications (OR = 0.26, P = .040). In contrast, advanced age (OR = 1.04, P = .045) and serum creatinine level ≥2 mg/dL (OR = 5.07, P = .016) increased the risk of postoperative complications. Thus, patients with a favourable nutrition status have a higher likelihood of achieving complete wound healing. By contrast, patients who are older and have serum creatinine ≥2 mg/dL and serum albumin <2.5 g/dL tend to develop more postoperative complications. Overall, thorough correction for patient inflammation, infection, anaemia, and malnutrition status can provide optimal flap surgery outcomes.

Effectiveness of Botulinum Toxin Injection on Bruxism: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: The present study compiled evidence on the efficacy of botulinum toxin A (BTX) for management of bruxism. METHODS: A literature review that included randomized control, cohort, as well as observational studies published between January 2000 and November 2022 was conducted. All studies related to BTX injections administered into the masseters of patients with bruxism were included. Primary outcomes were measured by performing a meta-analysis of changes in maximal biting forces and pain severity and meta-regression of the effects of the BTX dose. RESULTS: Ten studies were included for quantitative analysis. The analysis of the maximal biting force after BTX injections demonstrated a significant reduction at 1 month or less compared with both oral splints (P < 0.000001) and saline injections (P = 0.01). BTX continued to outperform oral splinting (P = 0.001) and saline placebos (P = 0.03) at 3 months. Between 3 and 6 months, a significantly higher maximal biting strength was observed in the BTX group than the oral splinting group (P < 0.00001). No significant differences in the maximal biting force were observed between the BTX and saline placebo groups (P = 0.50). A similar trend was observed in the analysis of pain reduction after botulinum treatment. Additionally, for every unit increase in the BTX dose, pain severity decreased by 0.0831 points (P = 0.0011). CONCLUSION: BTX is effective in reducing biting strength and pain severity. BTX effects are evident at less than 4 weeks, peak between 5 and 8 weeks, and last for up to 24 weeks. Higher BTX doses result in greater improvement in pain. Although BTX benefits manifest earlier, they gradually diminish, and oral splinting exerts a more enduring effect, especially after 9-12 weeks. BTX injections into masseters are recommended as management options for bruxers, especially for those having difficulties complying with wearing oral splints or those seeking earlier symptom relief. However, future studies should determine BTX effects beyond 24 weeks and after repetitive injections and how bruxers of different ages or genders respond to treatment. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tissue Sealants for Facial Rhytidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: The aging face can be surgically treated with a face-lift (rhytidectomy); however, bleeding and hematoma are complications that surgeons seek to prevent. Objective: To compare the drainage volume and rate of hematoma in studies of rhytidectomy among those having tissue sealants and those without. Methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42022325404). We included randomized controlled trials (RCTs) that the enrolled participants undergoing rhytidectomy and used tissue sealants as the intervention. We calculated the mean and standard deviation for the drainage volume; risk ratios (RRs) were used for hematoma incidents. Results: Seven RCTs were included. The drainage volume was significantly lower in the tissue sealant group than in the control group (mean difference [MD]: -11.01, confidence interval [95% CI]: -18.39 to -3.63, p < 0.00001). As for hematomas, the incidence was also lower in the tissue sealant group (RR: 0.29, 95% CI: 0.08-0.99, p = 0.05). Conclusion: This study suggests that tissue sealants can be effective in reducing drainage volume and hematoma in face-lift; however, autologous and homologous tissue sealants can be further compared in future RCTs.

The change of clinical features and surgical outcomes in patients with pressure injury during the COVID-19 pandemic.

This retrospective study aims to explore whether the COVID-19 pandemic altered patient conditions and surgery outcomes by studying 213 pressure injury (PI) patients who underwent surgery during 2016 to 2019 (pre-COVID) and 2020 to 2021 (COVID) in Taiwan. We extracted patient demographics, surgical and blood test records, preoperative vital signs, and flap surgery outcomes. In total, 464 surgeries were performed, including 308 pre-COVID and 156 COVID. During the COVID period, there were more patients presenting with dementia, and it had significantly more patients with >12 000 white blood cells/µL (24.03% vs 15.59%, P = 0.029), higher C-reactive protein levels (7.13 ± 6.36 vs 5.58 ± 5.09 mg/dL, P = 0.014), pulse rates (86.67 ± 14.76 vs 81.26 ± 13.66 beats/min, P < 0.001), and respiratory rates (17.87 ± 1.98 vs 17.31 ± 2.39 breaths/min, P = 0.009) but lower haemoglobin levels (9.75 ± 2.02 vs 10.43 ± 1.67 mg/dL, P < 0.001) preoperatively. There were no between-group differences in flap surgery outcomes but had fewer flap surgeries during COVID-19. Thus, PI patient condition was generally poor during the COVID-19 pandemic because of reduced access to medical treatment; this problem may be resolved through holistic care during a future pandemic or pandemic-like situation.

Effectiveness of Botulinum Toxin Type A Injection on Scars: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Scars can cause pain, long-term physical dysfunction, and psychological harm. Botulinum toxin type A (BoNT-A) is one treatment choice for scars, but further evidence is needed to confirm its efficacy. METHODS: This systematic review included randomized controlled trials that investigated the effectiveness of BoNT-A on scars. The mean and standard deviation for the Vancouver Scar Scale, Stony Brook Scar Evaluation Scale, visual analog scale for appearance evaluation, visual analog scale for scar pain evaluation, and scar width were extracted for subgroup analysis. RESULTS: Twenty-one randomized controlled trials were included. The BoNT-A group had a lower Vancouver Scar Scale score than the saline group (standardized mean difference, -0.73; 95 percent CI, -1.12 to -0.35; p = 0.0002) but a higher score than the steroid group (standardized mean difference, 0.85; 95 percent CI, 0.27 to 1.43; p = 0.004). The BoNT-A group exhibited a higher Stony Brook Scar Evaluation Scale grade than the saline group (standardized mean difference, 1.42; 95 percent CI, 0.83 to 2.00; p < 0.00001). The visual analog scale for appearance evaluation revealed higher scores in the BoNT-A group than in the saline group (standardized mean difference, 1.14; 95 percent CI, 0.69 to 1.60; p < 0.00001). As for pain evaluation, the BoNT-A group had a lower visual analog scale score than the steroid group (standardized mean difference, -2.57; 95 percent CI, -4.40 to -0.74; p = 0.006). Furthermore, scar width was significantly shorter in the BoNT-A group than in the control group (standardized mean difference, -1.11; 95 percent CI, -1.38 to -0.83; p < 0.00001). CONCLUSIONS: BoNT-A is more effective in treating scars than saline, although steroids may exhibit higher potency. Therefore, it can be considered an alternative in patients not amenable to steroid treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Patient Comfort with Various Local Infiltration Anesthetics for Minor Oculoplastic Surgery: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES: To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS: This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS: Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS: "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER: CRD42021260332 (PROSPERO).

Combined impacts of histamine receptor H1 gene polymorphisms and an environmental carcinogen on the susceptibility to and progression of oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the most frequently encountered type of oral cancer. Histamine receptor H1 (HRH1) was reported to play a crucial role in OSCC carcinogenesis, but impacts of genetic variants of HRH1 on OSCC remain unclear. Herein, we investigated the association between functional single-nucleotide polymorphisms (SNPs) of HRH1 and OSCC susceptibility or clinicopathologic variables by logistic regression models. HRH1 genotypes at four loci (rs346074, rs346076, rs901865, and rs2606731) were analyzed by a TaqMan allelic discrimination assay, and we found that patients harboring HRH1 rs901865 T and rs346074 T alleles had a significantly lower risk of developing larger tumor sizes (>T2) under a dominant model. Based on the environmental carcinogen exposure status, we observed that HRH1 rs901865 polymorphic variants were also associated with a lower risk of developing more-advanced clinical stages (III or IV) in patients with a betel-quid-chewing habit. Moreover, genotype screening of rs901865 and rs346074 in OSCC cell lines showed that cells respectively carrying the CT and TT genotypes expressed lower HRH1 levels compared to cells carrying the CC genotype of rs901865 and rs346074. Furthermore, analyses of TCGA and GEO databases revealed that HRH1 expression levels were upregulated in head and neck squamous cell carcinoma (HNSCC) and OSCC tissues compared to normal tissues and were correlated with larger tumor sizes and poorer prognoses. These results indicated the involvement of HRH1 SNPs rs901865 and rs346074 in OSCC development and support the interaction between HRH1 gene polymorphisms and an environmental carcinogen as a predisposing factor for OSCC progression.

Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Acne scarring, formed by the deposition of collagen following inflammatory acne, not only represents a cosmetic problem but also poses a psychological health risk to patients. As microneedling has become a common treatment for acne scarring, an increasing number of studies have compared the efficacy and safety of microneedling. In this study, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing microneedling with other treatments. METHOD: Three databases, namely Embase, PubMED, and Cochrane library, were searched until June 20, 2021, for RCTs only. Studies using microneedling in both treatments were excluded. RESULTS: Twelve studies, totaling 414 participants, were included in our meta-analysis. For objective scar improvement, the pooled estimate analysis of the first group, treated with microneedling without radiofrequency, yielded a mean difference of 0.42 (95% CI-0.12-0.73%) with a significant difference at the 5% significance level. The second group, treated with fractional radiofrequency microneedling, exhibited no significance at the 5% significance level. Regarding subjective satisfaction, most results exhibited no significant difference between microneedling and other treatments. Although no case of secondary scarring or infection was reported in our study, the pooled result of postinflammatory hyperpigmentation was significant at the 5% significance level and preferred microneedling treatment. CONCLUSION: Microneedling without radiofrequency achieved superior results in terms of scar improvement. No form of microneedling caused postinflammatory hyperpigmentation-an advantage in acne scar treatment. Thus, microneedling is a favorable choice for the treatment of acne scarring. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Efficacy of Local Anesthesia for Postoperative Pain Control in Breast Augmentation Surgery: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Breast augmentation can cause severe postoperative pain; therefore, some surgeons perform wound infiltration with a local anesthetic solution. This study investigated the postoperative pain relief of local analgesics in breast augmentation surgery. METHODS: We searched three databases for randomized controlled trials evaluating the outcomes of local wound irrigation with local analgesics during or after breast augmentation surgery. The solutions included ropivacaine, bupivacaine, bupivacaine plus ketorolac. The control groups may be saline alone or no irrigation. Network meta-analysis was further employed based on the frequentist approach. Outcomes were reported as weighted mean differences with 95% confidence intervals. RESULTS: Comparisons between the interventions of our included studies revealed that only bupivacaine plus ketorolac (versus placebo) significantly reduced pain at 1 h postoperatively, as indicated by the visual analog scale pain score reduction of 2.22 (- 3.98, - 0.47). Other comparisons showed no significant differences. Moreover, three of the included studies reported postoperative medication use. Two of them reported that postoperative narcotic use was reduced, but the others did not report any such reduction. CONCLUSIONS: Our results showed possibility that local irrigation with bupivacaine plus ketorolac might reduce pain 1 h after surgery. In addition, local anesthesia might reduce postoperative narcotic use. However, due to the small number of included studies, the clinical benefits of local anesthesia in breast augmentation surgery require further confirmation. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimal timing and effect of music therapy in patients with burn injuries: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Burn injuries may have both physiological and psychological consequences. Numerous studies have reported the use of music therapy during burn injury treatment, but the optimal timing for music therapy remains unclear. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials on patients with burn injuries to analyze the effects of music intervention on them at different timings: background (T0) and time before (T1), during (T2), and after (T3) change dressing (CD). METHOD: The PubMed and EMBASE databases were searched for articles published before Novenber 2020 based on predetermined criteria. Our search focused on two keywords: music and burn. Reviewers extracted data from all eligible studies independently. The I2 statistic was used to determine statistical heterogeneity. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Relevant Forest plots were also created. RESULT: This study finally included seven trials recruiting a total of 524 patients. The results indicated that compared with non-music intervention, music intervention significantly reduced anxiety at T0 (SMD = -1.32, 95% CI [-2.61, -0.02], T1 (SMD = -2.15, 95% CI [-4.30, -0.00]) and T2 (SMD = -0.39, 95% CI [-0.74, -0.04]). Moreover, they also significantly reduced the pain levels at T0 (SMD = -1.59, 95% CI [-2.00, -1.17]) and T2 (SMD = -0.47, 95% CI [-0.82, -0.12]), improved the mental condition, and reduced the amount of opioid analgesics used at T0. CONCLUSION: Music therapy seems to have some effects at T0 and T1 in patients with burn injuries. Music therapy was more effective in improving psychological outcomes than physiological outcomes. However, additional high-quality studies related to music therapy for patients with burn injuries are warranted.

Assisted therapy with platelet-rich plasma for burn patients: A meta-analysis and systematic review.

INTRODUCTION: Platelet-rich plasma (PRP) therapy has been used in different medical fields, but its effectiveness in burn wound healing remains debatable. In this study, we performed a systematic review and meta-analysis of the available evidence on burn patients treated with PRP to evaluate the safety and efficacy of the treatment. METHODS: Randomized controlled trials evaluating the efficacy of PRP in patients with burn injuries were selected. Eligible retrospective studies were abstracted and assessed for the risk of bias by two reviewers and results of mean time to complete epithelization and wound closure rate in the included studies were analyzed. Studies on the correlation between PRP and burn wound healing published in English or Chinese before March 2020 were retrieved from PubMed. RESULTS: Eight studies (including 449 patients) met our inclusion criteria. Qualitative analysis revealed that compared with the control group, the PRP group had significantly better wound closure rates at weeks 2 (mean difference (MD): 12.79 [95% confidence interval (CI): 7.08, 18.49]; I2: 0%; p < 0.0001) and 3 (MD: 12.66 [95% CI: 5.97, 19.34]; I2: 55%; p = 0.0002) and time to complete epithelialization (MD: -3.45 [95% CI: -4.87, -2.04] (days); I2: 0%; p < 0.00001). There was no significant difference in infection rate or graft take rate. CONCLUSIONS: PRP application can accelerate wound closure, however, it has no effect on the rates of wound infection and graft take rate.

Negative pressure wound therapy for burn patients: A meta-analysis and systematic review.

Negative pressure wound therapy (NPWT), which has been applied in various medical specialties to accelerate wound healing, has been the object of a few investigations. We explored the effectiveness of NPWT and the possibility of its inclusion in burn management guidelines. Randomised controlled trials comparing NPWT with non-NPWT treatments for burn wounds were extracted from PubMed. For the risk of bias analysis, all included studies were evaluated according to the Cochrane risk of bias tool and the approaches outlined in the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Handbook. Outcomes such as graft take rate in the first week, infection rate, and overall complication rate were analysed. Six studies that included a total of 701 patients met our inclusion criteria. Qualitative analysis revealed that the NPWT group had a significantly better overall graft rate in the first week (P = 0.001) and a significantly lower infection rate (P = 0.04). No significant difference in the overall complication rate was found. Our results indicate that NPWT is a safe method for stimulating healing and lowering the infection rate of burn wounds. NPWT can be part of general burn management, and its incorporation into burn treatment guidelines is recommended.