Which physical therapy intervention is most effective in reducing secondary lymphoedema associated with breast cancer? Protocol for a systematic review and network meta-analysis.

INTRODUCTION: Lymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain. METHODS AND ANALYSIS: MEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results. ETHICS AND DISSEMINATION: This protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CDR42022323541.

Effects of laser photobiomodulation on tgf-ß and vegf expression in burn wound: systematic review and meta-analysis in the animal model / Influencia de la fotobiomodulación por láser en la expresión de tgf-ß y vegf en heridas por quemadura: revisión sistemática y meta-análisis en modelo animal

SUMMARY: Laser photobiomodulation (laser PBM) is known to be able to accelerate burn wound healing in the animal model; however little evidence exists on the action of laser PBM on the expression of important proteins in wound healing in the animal model, such as VEGF and TGF-ß1. The aim of this study was to carry out a systematic review in order to analyse the effect of laser PBM on VEGF and TGF-ß expression during burn wound repair in the animal model. A systematic review was carried out of the EMBASE, PubMed/ MEDLINE and LILACS databases. The studies included were preclinical studies that analysed the action of laser PBM on the expression of VEGF and TGF-ß (1, 2, 3) during burn wound repair in the animal model. The SYRCLE risk of bias tool was used. Random effect models were used to estimate the combined effect. Increased VEGF expression was observed with the use of laser PBM at 4.93 J/cm2 per point in the first two weeks after induction of the burn wound, with greater size of effect in the second week (SDM = 5.72; 95% CI: 3.14 to 8.31, I2 = 0 %; very low certainty of evidence). We also observed that the effect of laser PBM on TGF-ß1 expression was greater than in the control in the first week (SDM = -0.45; 95% CI: -1.91 to 1.02, I2 = 51 %; very low certainty of evidence), but diminished in the third week after induction of the lesion (SDM = -2.50; 95% CI: 3.98 to -1.01, I2 = 0 %; very low certainty of evidence). Laser PBM has an effect on TGF-ß1 and VEGF expression, promoting burn wound repair in the animal model.

RESUMEN: Es sabido que la fotobiomodulación por láser (FBM láser) puede acelerar el proceso de curación de heridas por quemadura en modelo animal, sin embargo aún se carece de mayor evidencia sobre la acción de la FBM láser en la expresión de proteínas importantes en el proceso de curación de heridas en modelo animal, como VEGF y TGF-ß1. Así, el objetivo de este estudio fue realizar una revisión sistemática a fin de analizar el efecto de la FBM láser sobre la expresión de VEGF, TGF-ß durante el proceso de reparación de heridas por quemadura en modelo animal. Se realizó una búsqueda sistemática en las bases de datos EMBASE, PubMed/MEDLINE y LILACS. Se incluyeron estudios preclínicos que analizaron la acción de la FBM láser en la expresión de VEGF, TGF-ß (1, 2, 3) durante el proceso de reparación de heridas por quemadura en modelo animal. Se utilizó la herramienta de riesgo de sesgo SYRCLE. Se utilizaron modelos de efectos aleatorios para estimar el efecto combinado. Observamos aumento de la expresión de VEGF con el uso de FBM láser 4.93 J/cm2 por punto, en las dos primeras semanas tras inducción de la herida por quemadura, con mayor tamaño de efecto en la segunda semana (SDM = 5,72; IC del 95%: 3,14 a 8,31, I2 = 0 %; certeza de la evidencia muy baja). También se observó el efecto de la FBM láser en la expresión del TGF- ß1 que fue mayor que el control en la primera semana (SDM = - 0,45; IC del 95%: -1,91 a 1,02, I2 = 51 %; certeza de la evidencia muy baja), disminuyendo en la tercera semana tras inducción de la lesión (SDM = -2,50; IC del 95%: -3,98 a -1,01; I2 = 0 %; certeza de la evidencia baja). La TFB por láser ejerce influencia en la expresión de TGF-ß1 y VEGF favoreciendo el proceso de reparación de heridas por quemadura en modelo animal.

Photobiomodulation Therapy in Burn Wound Healing: Systematic Review and Meta-Analysis of Preclinical Studies.

Background and objective: To determine the effectiveness of photobiomodulation therapy (PBMT) in the burn wound healing compared with the control or with the use of antibiotics, in animal models. Materials and methods: A systematic search was conducted in EMBASE, MEDLINE, and LILACS databases. Preclinical studies were included that analyzed the effectiveness of PBMT in the burn wound healing, which assessed wound contraction, angiogenesis, proliferation of fibroblasts, and collagen deposition. SYRCLE risk of bias tool was used. Random effects models were used to estimate the pooled effect. Results: Thirty-eight studies were included. PBMT favored wound contraction (mean difference = -11.47, 95% confidence interval -19.87 to -3.08, I2 = 0%; moderate certainty of evidence). PBMT also favored angiogenesis at doses between 11 and 20 J/cm2, and increased the collagenization rate. Conclusions: In animal models, PBMT favored wound contraction, angiogenesis, and collagen deposition in second- and third-degree burn wounds.

Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial.

OBJECTIVES: Early childhood caries (ECC) constitutes a serious public health issue, especially in communities without water fluoridation. We assessed the effectiveness of biannual fluoride varnish applications to prevent ECC in children from nonfluoridated rural areas. METHODS: A triple-blind randomized control trial with two parallel arms was conducted with 275 two- to three-year-old children without cavitated carious lesions from 28 rural public preschools in Chile. The preschools were located in areas of low socioeconomic status without access to fluoridated water. An oral health education component was administered to children, parents and educators. A new toothbrush and toothpaste for each child was delivered to the parents at baseline and at four follow-up visits. The participants were randomly allocated to receive fluoride varnish or placebo applications every six months. Trained, calibrated dentists blind to the treatment arm performed visual dental assessments at 6, 12, 18 and 24 months. The primary endpoint was the development of cavitated carious lesions in children during the 24-month follow-up period using WHO criteria, and the secondary outcomes were an increase in caries measured as a change in the index of decayed, missing or filled teeth (dmft) since the beginning of the study and the development of adverse effects. An intention-to-treat (ITT) approach was used for the primary analysis. RESULTS: We included 131 participants in the intervention group and 144 participants in the placebo group; of these children, 89 (67.9%) in the intervention group and 100 (69.4%) in the control group completed the protocol. The comparative ITT analysis of caries incidence after 24 months of follow-up showed a between-group prevention fraction of 18.9% (-2.9%-36.2%). Caries incidence was 45.0% for the experiment group and 55.6% for the control group (P = .081), with a mean dmft of 1.6 (SD = 2.4) and 2.1 (SD = 2.5), respectively. No adverse effects were reported. CONCLUSIONS: In conclusion, biannual fluoride varnish application is not effective in preschool children from rural nonfluoridated communities at a high risk of caries.

Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis.

OBJECTIVES: To assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontic pain after the application of orthodontic force (OF). METHODS: A systematic search was conducted in the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, and EBSCOhost databases. The study included randomized clinical trials (RCT) which analysed the effectiveness of LLLT in reducing orthodontic pain assessed at 24 and 72 hrs after the application of OF. The risk of bias of the eligible trials was assessed using the Cochrane Collaboration's risk of bias tool. Standard mean difference was calculated and pooled by meta-analysis using random effect models. RESULTS: Of 467 identified articles, 20 RCT were finally included. In the risk of bias assessments, 13 studies presented a high risk, 5 an unclear risk, and 2 a low risk. The meta-analysis showed that in patients treated with laser versus placebo there was a difference in favour of LLLT in spontaneous pain 24 and 72 hrs after the installation of light archwires and spontaneous pain and chewing pain 24 and 72 hrs after the installation of elastomeric separators. CONCLUSIONS: LLLT proved to be effective in promoting a reduction in spontaneous and chewing pain after the application of OF; however, the poor quality of the evidence requires these results to be treated with caution.

Autologous platelet-rich plasma for treating chronic wounds.

BACKGROUND: Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors with the potential to improve the healing of chronic wounds. This is the first update of a review first published in 2012. OBJECTIVES: To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS: In June 2015, for this first update, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library): Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We also searched for ongoing and unpublished clinical trials in the WHO International Clinical Trials Registry Platform (ICTRP) (searched January 2015). We did not impose any restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. We did not apply any date or language restrictions. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology, including two reviewers independently selecting studies for inclusion, extracting data, and assessing risk of bias. MAIN RESULTS: The search identified one new RCT, making a total of 10 included RCTs (442 participants, 42% women). The median number of participants per RCT was 29 (range 10 to 117). Four RCTs recruited people with a range of chronic wounds; three RCTs recruited people with venous leg ulcers, and three RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range 8 to 40 weeks).It is unclear whether autologous PRP improves the healing of chronic wounds generally compared with standard treatment (with or without placebo) (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.95 to 1.50; I(2) = 27%, low quality evidence, 8 RCTs, 391 participants). Autologous PRP may increase the healing of foot ulcers in people with diabetes compared with standard care (with or without placebo) (RR 1.22, 95% CI 1.01 to 1.49; I(2) = 0%, low quality evidence, 2 RCTs, 189 participants). It is unclear if autologous PRP affects the healing of venous leg ulcers (RR 1.02, 95% CI 0.81 to 1.27; I(2) = 0% ). It is unclear if there is a difference in the risk of adverse events in people treated with PRP or standard care (RR 1.05, 95% CI 0.29 to 3.88; I(2) = 0%, low quality evidence from 3 trials, 102 participants). AUTHORS' CONCLUSIONS: PRP may improve the healing of foot ulcers associated with diabetes, but this conclusion is based on low quality evidence from two small RCTs. It is unclear whether PRP influences the healing of other chronic wounds. The overall quality of evidence of autologous PRP for treating chronic wounds is low. There are very few RCTs evaluating PRP, they are underpowered to detect treatment effects, if they exist, and are generally at high or unclear risk of bias. Well designed and adequately powered clinical trials are needed.

Prótesis fija con sistema tubo-barra en odontopediatría: reporte de un caso clínico de 12 meses de seguimiento / Fixed prosthesis with tube-bar system in pediatric dentistry: a case report over 12 months of follow-up

Introducción: La pérdida prematura de incisivos primarios puede producir alteraciones estéticas, funcionales y psicológicas. La rehabilitación protésica permite reemplazar los dientes faltantes y evitar las secuelas que ello puede acarrear. Objetivo Describir la técnica y evolución clínica de una prótesis fija anterior tipo Denari durante 12 meses de seguimiento. Descripción del caso Paciente de sexo femenino de 3 años de edad que acude en busca de atención profesional posterior a la avulsión de los incisivos centrales superiores. Con la finalidad de devolver la estética del sector anterosuperior, recuperar la función oral e interferir con el hábito de interposición lingual se decidió realizar una terapia basada en prótesis parcial fija tipo Denari. Durante el año de seguimiento la prótesis fue muy bien tolerada por la paciente y sin alteración de los tejidos blandos adyacentes, destacando un aumento en el espacio interincisal, lo que demuestra el crecimiento transversal. Conclusión La prótesis dental en niños es una tarea exigente, marcada por la necesidad de adaptación a los cambios continuos que conllevan los procesos de crecimiento y maduración de complejo maxilofacial. En este contexto es que la prótesis tipo Denari con sistema tubo-barra es una excelente y estética alternativa en pacientes de corta edad en donde la prótesis va a permanecer en la boca por un largo período de tiempo, sin interferir en el crecimiento, desarrollo y función del sistema estomatognático.

Introduction: Premature loss of primary incisors may result in aesthetic, functional and psychologic problems. Prosthetic restoration allows replacing missing teeth, avoiding the unwanted consequences that their absence may carry. Objective The aim of this clinical case is to describe the technique and clinical evolution of a Denari fixed anterior prosthesis over 12 months of follow-up. Case description 3 year-old female patient sought professional attention after the avulsion of the upper central incisors. In order to restore the natural appearance of the anterior superior area, recover oral function and intervene in the habit of tongue interposition, the treatment decided upon was a partially fixed Denari prosthesis. During the follow-up year the prosthesis was very well tolerated by the patient and without altering any adjacent soft tissues. We highlight an increase in the interincisal space, which demonstrates transversal growth. Conclusion A dental prosthesis in a child is a demanding task marked by the need to adapt to the continuous changes brought about by maxillofacial growth and maturation. It is in this context that the Denari prosthesis with its tube-bar system is an excellent and esthetic alternative in young patients where the prosthesis is going to remain in place for a prolonged period without interfering in the growth, development and function of the stomatognatic system.