Association between serum TSH concentration and bone mineral density: an umbrella review.

INTRODUCTION: The aim of this study was to summarize the results of previous studies, standardize the data, and present new statistical results in order to provide physicians with clinically significant outcomes regarding the association between serum TSH concentration and bone mineral density (BMD). METHODS: To perform this umbrella review, a systematic search was conducted in which major online medical databases, such as PubMed, Web of Science, Embase, Scopus, Cochrane Library, and Google Scholar, were searched for meta-analyses and systematic reviews regarding the effect of TSH on BMD. Furthermore, all primary studies were screened for statistical analysis. RESULTS: The statistical outcomes of the present study were based on the data of 75,898 patients. The pooled risk ratio of any kind of fracture in patients with subclinical hyperthyroidism was estimated to be 1.36 (95% CI: 1.18-1.56; p < 0.001). The SMD for BMD in the distal radius in male patients receiving L-thyroxine suppression therapy was estimated to be -0.61 (95% CI: -1.10-(-0.11); p = 0.02). Furthermore, the pooled risk ratio of any fracture in patients receiving L-thyroxine suppression therapy was estimated to be 1.98 (95% CI: 0.98 - 3.98; p = 0.06). In these patients, the BMD may significantly differ from that in non-treated patients. However, the difference depends on the type of bone. CONCLUSIONS: Our data confirmed that subclinical hyperthyroidism has a detrimental effect on bones, causing decreased BMD. Based on the obtained results, the authors suggest that a reduced TSH serum level itself may be an individual factor associated with decreased BMD and, thus, with a greater risk of bone fracture. Nevertheless, it should be noted that the effects of TSH suppression therapy differ between areas of interest for assessing BMD. Furthermore, the results have shown that this issue may, in specific areas, concern not only postmenopausal women but also male patients. These conclusions should contribute to a careful consideration of the application of TSH suppressive therapy in all patients. Particular attention should be given to patients after DTC, while all the advantages and disadvantages of implementing L-thyroxine therapy should be individually considered.

The anatomy of the internal iliac artery: a meta-analysis.

BACKGROUND: The internal iliac artery (IIA) originates from the common iliac artery at the level of the sacroiliac joint and bifurcates between the L5 and S1 vertebrae. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the IIA, including their variations, length, and diameter. MATERIALS AND METHODS: Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched in order to find all studies considering the anatomy of the IIA. Eligibility assessment and data extraction stages were performed. RESULTS: In the general population the pooled prevalence of Type I (The superior gluteal artery arises independently with the inferior gluteal and internal pudendal arteries arising from a common trunk which dividing inside (Type IA) or outside (Type IB) pelvic cavity) was found to be 56.57% (95% CI: 53.00-60.10%). The pooled mean length of the IIA was set to be 39.95 mm (SE = 1.79) in the overall population. The pooled mean diameter of the IIA was found to be 6.86 mm (SE = 0.27). CONCLUSIONS: The IIA is responsible for supplying the majority of the structures located in the pelvis. Hence, it is crucial to be aware of the possible variants of the said vessel. The results presented in our study may be highly significant in various surgical procedures performed in that region.

Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis.

BACKGROUND: The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum. METHODS: The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP. RESULTS: A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%). CONCLUSION: The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.

Renal agenesis: A meta-analysis of its prevalence and clinical characteristics based on 15 641 184 patients.

Our objective was to analyse the newest relevant data on worldwide prevalence and associated symptoms of renal agenesis (RA). This meta-analysis builds on previous systematic reviews to include bilateral RA, its symptoms and data on gender, unilateral RA and anomaly location prevalence. Review of available data included records in English and other languages from PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect Korean Journal Database and Russian Citation Index and Google. A total of 15 641 184 patients were analysed in relation to the prevalence of RA. The pooled prevalence of RA was 0.03% (95% CI: 0.03%-0.04%). Based on 500 subjects, a pooled prevalence of 47.96% (95% CI: 31.55%-64.58%) for unilateral and 52.04% (95% CI: 35.42%-68.45%) for bilateral RA has been set. Our study presents the newest generalized findings on bilateral RA. There appears to be universal disease and symptom prevalence with minor differences between world regions, although quality of future observational research should include genomic data. This will provide even further insight into the prognosis of various renal anomalies and their etiologies.

The Morphology of the Pituitary Gland: A Meta-Analysis with Implications for Diagnostic Imaging.

The objective of this meta-analysis was to present transparent data on the morphology of the pituitary gland (PG) using the available data in the literature. The main online medical databases, such as PubMed, Embase, Scopus, and Web of Science, were searched to gather all relevant studies regarding PG morphology. The mean overall volume of the PG was found to be 597.23 mm3 (SE = 28.81). The mean overall height of the PG was established to be 5.64 mm (SE = 0.11). The mean overall length of the PG was found to be 9.98 mm (SE = 0.26). In the present study, the PG's overall morphology and morphometric features were analyzed. Our results showed that, on average, females from Asia have the highest volume of PG (706.69 mm3), and males from Europe have the lowest (456.42 mm3). These values are crucial to be aware of because they represent the normal average properties of the PG, which may be used as reference points when trying to diagnose potential pathologies of this gland. Furthermore, the present study's results prove how the PG's size decreases with age. The results of the present study may be helpful for physicians, especially surgeons, performing procedures on the PG.

The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy.

BACKGROUND: The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC. PURPOSE: To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies. STUDY DESIGN: Meta-analysis. MATERIALS AND METHODS: Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines. RESULTS: Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm2 (95% CI, 14.2-22.0 cm2 ), and 126.9 cm3 (95% CI, 87.2-166.5 cm3 ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%). CONCLUSIONS: The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.

A complete analysis of the surgical treatment for cubital tunnel syndrome: an umbrella review.

BACKGROUND: Numerous original studies have been presented regarding various surgical treatments for cubital tunnel syndrome (CubTS). The results of these analyses regarding the different surgical treatments for CubTS frequently differ and, in some cases, contradict each other, creating confusion. Therefore, our umbrella review aimed to summarize the evidence from meta-analyses and systematic reviews regarding the surgical treatments of CubTS, and along with the new, more detailed outcomes, provide an evidence-based tool for surgeons performing these procedures. MATERIALS AND METHODS: To perform this umbrella review, a systematic search was conducted for meta-analyses investigating CubTS in PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO medical databases. RESULTS: Detailed comparison of surgical outcomes, such as clinical improvement, complications, or reoperation rates, of different treatment methods for CubTS was performed. New risk ratios in all categories were established based on all of the primary studies available in the literature. DISCUSSION: The goal of the present umbrella review was to gather and summarize all data about the surgical treatments for CubTS in the available literature and provide new outcomes and an evidence-based tool for surgeons performing these procedures. Each comparison of the surgical techniques has been discussed, and the present study's results were compared with the outcomes of the previous studies.

The occipital artery: a meta-analysis of its anatomy with clinical correlations.

The occipital artery arises as one of the main branches of the external carotid artery. The goal of the present meta-analysis was to provide a detailed analysis of the complete anatomy of the occipital artery using the available data in the literature. The main online medical databases such as PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were used to gather all studies on anatomical variations, course, branches, and the close anatomical area of the occipital artery. A total of 65 studies were indicated, evaluated, and included in this meta-analysis. The occipital artery was found to run in the groove with a prevalence of 83.93% (95% confidence intervals: 50.53-100.00%). The occipital artery forming a common trunk with another artery had a prevalence of 13.91% (95% confidence intervals: 9.15-19.47%). The mean maximal diameter of the occipital artery was set to 2.26 mm (standard error = 0.15). The mean maximal diameter of the occipital segment of the occipital artery was found to be 1.24 mm (standard error = 0.15). The mean occipital artery length was set to 131.93 mm (standard error = 3.02). In conclusion, the authors of the present study believe that this is the most accurate and up-to-date meta-analysis regarding the anatomy of the occipital artery. Knowledge about this structure can be of great use when performing revascularization procedures, such as the occipital artery-posterior inferior cerebellar artery bypass, or reconstructive procedures, such as the occipital artery fascial flap.

Treatment options for oropharyngeal carcinoma - An umbrella review.

INTRODUCTION: Our umbrella review aimed to summarize and revisit the evidence from all of the meta-analyses and systematic reviews regarding the treatments of oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS: Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages. RESULTS: Finally, a total of 28 studies met the inclusion criteria and were included in this study. Out of those 28 meta-analyses, a total of 315 primary studies were screened in order to extract the data and perform the statistical analysis. In total, data from 22,619 patients was analyzed. CONCLUSION: The main objective of the present umbrella review was to summarize and analyze all of the evidence-based data provided by numerous meta-analyses and systematic reviews regarding the treatment of OPSCC. Our study delivers the most up-to-date and evidence-based results regarding the different therapeutic modalities of this malignancy in one concise review, making it the ultimate tool for physicians treating OPSCC.

Treatment Options for Tennis Elbow - An Umbrella Review.

INTRODUCTION: The main goal of the present umbrella review was to provide the most up-to- date and evidence-based results regarding the various treatment options for tennis elbow (TE), which hopefully will significantly decrease the confusions existing in the literature. Furthermore, our study differs from past analytical studies because, as to the best of the authors' knowledge, is the first to provide independent (not in comparison to other treatment) statistical results regarding the effectiveness of each TE treatment. MATERIALS AND METHODS: Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages. RESULTS: A total of 40 studies met the inclusion criteria and were included in this study. Out of those 40 meta-analyses, a total of 160 primary studies were screened in order to extract the data and perform a statistical analysis. CONCLUSION: The present umbrella review underlines the efficiency of injection therapies, especially autologous blood, and platelet-rich plasma, while simultaneously proving the ineffectiveness of acupuncture and shock wave therapy as treatments for TE. Furthermore, the value of other known conservative treatment modalities, such as physical therapy, has been demonstrated.

Penetration of the posterior interosseous nerve fibers into the dorsal capsule of the wrist - a new perspective on wrist innervation.

The dorsal capsule of the wrist and the DCSS may play a significant role in the conduction of nerve signals transmitted from proprioceptors present in SL to PIN, which is located above the dorsal capsule. Hence, this study aimed to determine if nerve fibers of PIN penetrate inside the dorsal capsule. The dorsal capsules of the wrist were dissected from both sides from 15 cadavers. Eventually, 30 dorsal capsules were dissected. It can be concluded that the PIN nerve fibers penetrate the dorsal capsule of the wrist, as the penetration was noticeable in every part evaluated. The present study proves that afferent fibers from the mechanoreceptors of the SLIL potentially pass through the DCSS and subsequently through the dorsal capsule of the wrist to the PIN. This knowledge can surely be of great use for hand surgeons that perform procedures on the dorsal wrist.