Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis.

BACKGROUND: This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. RESULTS: Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I2 = 89%; P < .001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P < .001; I2 = 89%; P < .001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I2 = 95% P < .001); abduction, with a MD = 38° (95% CI 20°, 56°; I2 = 85%; P < .01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I2 = 87%; P = .005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I2 = 0%). CONCLUSIONS: Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears.

Comparing the effectiveness of CBT and low-frequency rTMS in reducing symptom severity and depression and improving working memory in adults with OCD: a clinical trial.

OBJECTIVE: This study aims to compare the effectiveness of cognitive-behavioral therapy (CBT) and low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) in reducing symptom severity and depression and improving working memory in adults with obsessive-compulsive disorder (OCD). METHODS: This is a randomized clinical trial conducted on 24 adults with OCD, randomly assigned into two groups of CBT (n = 12, received CBT with exposure and response prevention (ERP) individually at 20 sessions) and rTMS (n = 12, received LF (1-Hz) rTMS over the right dorsolateral prefrontal cortex (DLPFC) at 10 sessions). They completed the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, and two N-Back tasks before, immediately, and 1 month after interventions. RESULTS: Results showed a significant difference between the two methods in reducing the severity of OCD symptoms (p < 0.05) and depression (p = 0.002) immediately after interventions where the CBT with ERP was more effective, but no significant difference was found in terms of working memory (p > 0.05). No significant difference was found between groups in any study variables 1 month after interventions. CONCLUSION: Individual CBT with ERP is superior to LF rTMS for reducing the severity of symptoms and depression in OCD patients. However, there is no difference between them in improving working memory.

Impact of Severe Acute Respiratory Syndrome Coronavirus 2-Induced COVID-19 on Fixed Operating Room Times in Urologic Operations.

Objective: To evaluate the impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, on operating room (OR) efficiency for urologic procedures using the concept of fixed OR times. Patients and Methods: Over a 24-month period, urology OR data were prospectively collected. Operations were divided into fixed and variable time points. The fixed OR times were in-roomw to anesthesia-release time, anesthesia-release to cut time, in-room to cut time, and close to wheels-out time. Data from January 1, 2019, to December 31, 2019, were pre-COVID-19 data, and data from April 1, 2020, to December 31, 2020, were post-COVID-19 data. Operations were grouped into endoscopic, implant, major open, and robotic-assisted cases. In the post-COVID-19 era, all patients had a negative polymerase chain reaction test result within 48 hours of operation. The Wilcoxon rank sum test was used to compare the fixed OR times between the pre- and post-COVID-19 eras. Results: A total of 3189 procedures were evaluated: 2058 endoscopic operations (1124 in the pre-COVID-19 era and 934 in the post-COVID-19 era), 343 implant procedures (192 in the pre-COVID-19 era and 151 in the post-COVID-19 era), 222 major open procedures (119 in the pre-COVID-19 era and 103 in the post-COVID-19 era), and 566 robotic-assisted procedures (338 in the pre-COVID-19 era and 228 in the post-COVID-19 era). There were no fixed OR times in any of the examined groups that were negatively impacted by COVID-19. The percentage of the total OR time occupied by fixed OR variables in the pre-COVID-19 era was 40.6% for endoscopic operations, 41.1% for implant procedures, 29.8% for major open procedures, and 21.8% for robotic-assisted procedures. Conclusion: A substantial portion of the total OR time includes fixed time points. Furthermore, COVID-19 did not have a negative impact on fixed OR times in a negative testing environment. Urologic OR efficiency should be maintained in the post-COVID-19 era.

Effectiveness of a smartphone-based educational intervention to improve breastfeeding.

BACKGROUND: Exclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers' breastfeeding for infants younger than six months of age in Urmia, Iran. METHODS: A randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers. RESULTS: Forty mothers were assessed for primary outcomes in each group. At three months, the mothers' knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers' breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001). CONCLUSION: The smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.

Evaluating the efficacy of outpatient use of isosorbide mononitrate on cervical ripening in pregnant women with unfavourable cervix.

The aim of the present study was to evaluate the efficacy of outpatient administration of nitric oxide donor isosorbide mononitrate for cervical ripening. A randomised clinical trial was performed on term pregnant women with Bishop Score < 6. In the case group, Isosorbide-5-mononitrate capsule and in the control group, placebo was inserted in the posterior vaginal fornix for two consecutive days. The main outcomes were increases in Bishop Score after 48 hours of intervention, number of vaginal deliveries and interval from intervention to delivery.There was a significant increase of the mean Bishop score in the isosorbide group [3.57 ± 1.12 VS 1.54 ± 1.42 respectively (p = .001)]. The other outcome variables did not show a significant difference between the two groups except for headache which was significantly more in the case group. No cases of tachysystole were observed in the two groups. Additionally, haemoglobin levels after delivery did not show a significant difference between the two groups.Impact statement:What is already known on this subject? Cervical ripening in women with an unfavourable cervix and having an indication for induction of labour is an important issue in modern obstetrics. Different methods have been used for cervical ripening and induction of labour including mechanical (i.e. laminaria tents, Dilapan-S, foley catheter), medical (i.e. PGs) and supportive methods. There is no consensus on the best option for cervical ripeningWhat will the results of this study add to the current knowledge of this subject? Outpatient administration of nitric oxide could affect cervical ripening without a significant improvement in the duration of different stages of labour, intervention to delivery interval and number of vaginal deliveries.What are the implications of these findings for clinical practice and/or further research? Due to the contradictory results of various studies, more studies should be performed with greater sample size to evaluate nitric oxide donor isosorbide mononitrate effect on labour duration and reducing caesarean deliveries. Additional data is needed to assess the real impact of NO donors on different stages of labour and its implications.

Scientometric measures of prospectively registered clinical trials over time: A comparison of IRCT and ClinicalTrials.gov.

Background: Iranian Registry of Clinical Trials (IRCT) started as a primary registry in 2008. We examined the characteristics and scientometric measures of prospectively registered clinical trials in IRCT over time and compared them with that of ClinicalTrials.gov. Methods: We selected eligible trial records between 2008 and 2016 from the IRCT database. We assessed their characteristics and the journal metrics of ensuing outputs over the study period and compared our findings with the corresponding information from ClinicalTrials.gov reported by Magdalena Zwierzyna et al. and a random sample of trials registered with this registry. We used the chi-square test for comparison of proportions and Mann-Whitney U test for comparison of medians. P-value <0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics V.22. Results: 1751 prospectively registered clinical trials were eligible for analysis, of which 1526 (87%) had parallel-group design, 1541 (88%) reported to be randomized, 753 (43%) used double-blinding design, 485 (%27.7) had sample size more than 100, 1313 (75%) completed within a year, 1539 (87.9%) were single centered and 1529 (87.3%) exclusively used public money. Comparison with ClinicalTrials.gov showed that they are less likely to have multiple centers, funded by private sectors, continue beyond one year; and more likely to be randomized, double-blind and get published as a paper. The sample sizes were similar. Journal scientometric measures remained constant over the study period for both databases but were higher in ClinicalTrials.gov (median SJR=1.67, IQR=1.1-3.23) compared with IRCT (median SJR=0.58, IQR=0.34-0.91). Conclusion: Our findings suggest that clinical trials registered in IRCT are predominantly investigator-initiated studies with acceptable methodological features and high publication rate albeit in journals with substantially lower scientometric measures compared with that of ClinicalTrials.gov. Journal metric indices remained constant despite an increase in the number of registrations in IRCT.

Predictors of Hookah Smoking among Women in Bandar Abbas, Southern Iran: A Cross-Sectional Study Based on the Intervention Mapping Protocol.

Background: The purpose of this study was to determine the predictors of hookah smoking (HS) among professional HS women in Bandar Abbas, southern Iran using intervention mapping protocol. Methods: The present cross-sectional study is part of a larger study, which was conducted on 332 HS women using a multistage (clustered and randomized) process. Data were collected from October 2018 to August 2019 using a researcher-made questionnaire. Results: Mean age of the participants was 36.1 ± 13.3 years. Ordinal regression model, after the control of confounding variables, showed that attitudes, self-efficacy, habits, and intention were the most important predictors of HS behavior in women (OR = 1.14). The prevalence of HS was 1.76 times higher in women who did not want to quit hookah. Knowledge and Social norms were not associated with the HS behavior. Conclusions: According to the present findings, changing or eliminating women's positive attitude toward HS is deemed possible through reducing the social acceptance of HS in enculturating the negative attitude in society, enhancing women's self-efficacy via purposeful and specific education on resisting hookah temptation, unraveling all factors involved in habit formation and adjusting these factors through long-term interventions and timely interventions to affect intention to consumption before the actual occurrence of behavior (HS).

Comparing the effects of relaxation technique and inhalation aromatherapy on fatigue in patients undergoing hemodialysis.

This study aimed to compare the effects of relaxation techniques on fatigue in hemodialysis patients. This clinical trial study was conducted on 105 hemodialysis patients. The subjects were categorized into three groups as: relaxation, aromatherapy and control. In the relaxation group, Benson muscle relaxation techniques were employed; in the aromatherapy group, the inhalation of two drops of 5% lavender essential oil used and the control group only received regular healthcare actions. Data collected by using brief fatigue inventory, before and after the intervention. Results of the current study indicated significant differences in the mean of changes in fatigue scores before and after the intervention between the relaxation and aromatherapy groups, but the difference was insignificant in the control group. Aromatherapy with lavender essential oil can decrease the level of fatigue in the patients undergoing hemodialysis compared to Benson relaxation techniques.

The effect of adding whole body vibration training to strengthening training in the treatment of knee osteoarthritis: A randomized clinical trial.

Strengthening training (ST) and whole body vibration training (WBV) alone may improve symptoms of osteoarthritis of the knee. In this study, we investigated the effect of adding WBV training to quadriceps and hamstring muscles strengthening training on functional activity, pain, quality of life and muscle strength in patients with knee osteoarthritis. 28 volunteers were randomly allocated to two groups; 1) quadriceps and hamstring muscles strengthening training (ST group, 13 patients) and 2) quadriceps and hamstring muscles strengthening training along with WBV training (ST + WBV group, 15 patients). The treatment protocol for both groups involved 3 sessions per week for 8 weeks. All measurements were performed before and after intervention. The measurements included: pain by means of a visual analogue scale (VAS), quality of life by means of the WOMAC scale, functional activity by the 2 min walking test (2MWT), time up & go test (TUGT) and 50-foot walking test (50FWT) and the muscle peak torque (MPT), total work (TW) and muscle power (MP) as muscle performance of quadriceps and hamstring muscles by an Isokinetic Biodex machine. After intervention, the comparison of mean changes between two groups showed improvement in the WBV + ST group in terms of 2MWT, MPT, TW and MP variables (P < 0.05). However, no significant difference was found between the experimental groups in term of pain, quality of life, TUGT and 50FWT. These results suggest that adding whole body vibration training to strengthening training may provide better treatment effects for patients with knee osteoarthritis.

[Cost of dialysis in France]. / Coût de la dialyse.

According to latest data published by the French health authority (HAS), nearly 74,000 French patients in end-stage chronic renal disease are following a replacement therapy. They were 61,000 in 2007, amounting to a cost of 4 billions euros for public health insurance. The cost varies depending on the age and comorbidities. Continuous ambulatory peritoneal dialysis is the cheapest mode of treatment, while the heavy haemodialysis centres costs are close to twice as expensive. But these two different treatments are - a priori - not applied for the same patients in terms of level of severity of disease. Moreover, associated costs, medical treatment, transportation, etc. are to be taken into account, as well as losses of income for patients facing major job difficulties. As recommended by HAS experts, it will be important to regularly conduct surveys allowing a regular economic assessment of the various modes of financial healthcare for end-stage chronic renal disease.

Insuficiencia renal crónica terminal y hemodiálisis: Alteraciones endoscópicas e histológicas del tracto gastrointestinal

Objetivos: Determinar la frecuencia de alteraciones endoscópicas e histológicas del tracto digestivo en pacientes con IRC-T en hemodiálisis. Determinar la relación entre la presencia de síntomas y los hallazgos endoscópicos. Métodos: Estudiamos 55 pacientes con IRC-T en hemodiálisis en protocolo pretrasplante renal y 55 pacientes de la consulta de gastroenterología. Se realizó EDS y colonoscopia, con toma de biopsia independientemente de la presencia o no de lesiones. Se utilizó el X2 para las variables cualitativas con un valor de p<0.05, se realizó el cálculo del 95% intervalo de confianza. Resultados: De los 110 pacientes 70% presentó alteraciones en la EDS, de éstos 44.5% eran pacientes con IRC-T y 25.5% eran controles. La diferencia fue estadísticamente significativa (p<0.0001). El hallazgo histológico más frecuente fue gastritis crónica activa. Predominaron los cambios inflamatorios de la mucosa sobre la enfermedad ulcerosa. No hubo diferencia significativa en la EDI. Los pólipos de colon y adenomas tubulares fueron más frecuentes en los pacientes con IRC-T. Conclusiones: Las lesiones gastrointestinales son más frecuentes en pacientes con IRC-T. Es necesaria la realización de estudios endoscópicos pre-transplante renal.

Objectives: To determine the frequency of endoscopic and histological changes in the digestive tract in patients with CRF-T in hemodialysis treatment and, to determine the relationship between the presence of symptoms and endoscopic findings. Methods: 55 patients in hemodialysis were studied with T-IRC on pre - kidney transplant protocol and, 55 patients from the gastroenterology unit. Upper endoscopy (UE) and colonoscopy with biopsy samples were performed, regardless of the presence of injuries. X2 was used for qualitative variables with a p-value <0.05, with 95% confidence interval. Results: Of 110 patients 70% had UE abnormalities, of which 44.5% were IRC - T patients and 25.5% were controls. The difference was statistically significant (p <0.0001). The most common histological finding was active chronic gastritis. Inflammatory changes of the mucosa predominated over ulcerative disease. There were no significant differences regarding colonoscopy. Colon polyps and tubular adenomas were more common in patients with CRF-T. Conclusions: Gastrointestinal lesions are more common in patients with CRF-T. Endoscopic evaluation in Pre - renal transplant patients are necessary.