ABSTRACT
BACKGROUND: Given the paucity of literature on the management of infected metalwork and nonunion in neuropathic diabetic patients, a meta-analysis was designed to investigate the two major complications following Charcot reconstruction performed by means of internal fixation methods. METHODS: We searched PubMed, Scopus and CENTRAL until the 17th of May 2022 for completed studies investigating outcomes following midfoot and/or hindfoot and/or ankle diabetic Charcot reconstruction. For a paper to qualify for inclusion, an internal fixation element should have been considered. Random effects meta-analysis of proportion was performed to calculate the rate of post-operative deep-seated infections with the associated amputation rate and nonunions by using Open Meta-analyst software. Sub-analysis linked to anatomical location of reconstruction was performed and the quality of the included studies was appraised using the Moga tool. RESULTS: Thirty studies with 492 eligible reconstructions were considered. Of those, deep-seated infections were diagnosed in 46 cases (Estimated proportion was 6.7%, 95% CI [4.2%-9.2%]). Debridement and antibiotic administration with or without metalwork removal were considered in the majority of the participants with successful clinical outcomes. Amputation was performed in 15 patients due to unmanageable post-operative infection and nonunion was reported in 17 studies (Estimated rates were 36.6%, 95% CI [18.4%-56.3%]; and 11.9%, 95%CI [6.6%-18.1%]; respectively). CONCLUSIONS: Meta-analysis showed that although the overall risk of infection development is less than 10%, just below one third of the infected cases undergo late amputation. Moreover, internal fixation reconstructions carry a nonunion risk of just above 10%.
ABSTRACT
The environmental challenges the world faces nowadays have never been greater or more complex. Global areas covered by forests and urban woodlands are threatened by natural disasters that have increased dramatically during the last decades, in terms of both frequency and magnitude. Large-scale forest fires are one of the most harmful natural hazards affecting climate change and life around the world. Thus, to minimize their impacts on people and nature, the adoption of well-planned and closely coordinated effective prevention, early warning, and response approaches are necessary. This paper presents an overview of the optical remote sensing technologies used in early fire warning systems and provides an extensive survey on both flame and smoke detection algorithms employed by each technology. Three types of systems are identified, namely terrestrial, airborne, and spaceborne-based systems, while various models aiming to detect fire occurrences with high accuracy in challenging environments are studied. Finally, the strengths and weaknesses of fire detection systems based on optical remote sensing are discussed aiming to contribute to future research projects for the development of early warning fire systems.
ABSTRACT
PURPOSE: The conventional surgical treatment of moderate to severe hallux valgus (HV) deformity includes proximal metatarsal osteotomies (PMOs). Recent evidence suggests that the extension of indications for distal metatarsal osteotomies (DMOs) may result in comparable outcomes. The purpose of this study was to compare the efficacy of proximal with that of distal metatarsal osteotomies for moderate to severe HV deformity. METHODS: We searched PubMed, Scopus, and CENTRAL up to 25 July 2017. We included studies comparing the results of proximal and distal metatarsal osteotomies for moderate to severe HV deformity. The primary outcomes included the assessment of the first intermetatarsal angle (IMA) and American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. For the secondary outcomes, we considered the hallux valgus angle, sesamoid position, and participants' satisfaction. We also reported and analyzed complications. We evaluated all outcomes in the short-term (≤ 1 year) and medium-term (> 1 and < 10 years). The quality assessment was performed using the Cochrane risk of bias and ROBINS-I tools for randomized and non-randomized studies, respectively. RESULTS: Data from 696 cases were considered in this review. For the assessment of the first IMA, there was a slight advantage in favour of the PMO group in the medium term (SMD was - 0.38, 95% CIs - 0.65 to - 0.12, p < 0.05, I2 = 21%). For the rest outcomes, we did not detect any significant differences between the intervention groups. CONCLUSIONS: For clinical and radiological outcomes, the quantitative synthesis demonstrated that there were no significant differences between PMO and DMO groups in the medium term. These findings were supported by data from non-randomized studies. For the reported complications, we did not detect any significant differences between the intervention groups.