Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.

Introduction: Musculoskeletal disorders could be associated with metabolic disorders that are common after kidney transplantation, which could reduce the quality of life of patients. The aim of this study was to assess the prevalence of both musculoskeletal and metabolic disorders in kidney transplant patients. Methods: MEDLINE, CINAHL, Cochrane Library, EMBASE and Web of Science were searched from their inception up to June 2023. DerSimonian and Laird random-effects method was used to calculate pooled prevalence estimates and their 95% confidence intervals (CIs). Results: 21,879 kidney transplant recipients from 38 studies were analysed. The overall proportion of kidney transplant patients with musculoskeletal disorders was 27.2% (95% CI: 18.4-36.0), with low muscle strength (64.5%; 95% CI: 43.1-81.3) being the most common disorder. Otherwise, the overall proportion of kidney transplant patients with metabolic disorders was 37.6% (95% CI: 21.9-53.2), with hypovitaminosis D (81.8%; 95% CI: 67.2-90.8) being the most prevalent disorder. Conclusion: The most common musculoskeletal disorders were low muscle strength, femoral osteopenia, and low muscle mass. Hypovitaminosis D, hyperparathyroidism, and hyperuricemia were also the most common metabolic disorders. These disorders could be associated with poorer quality of life in kidney transplant recipients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier [CRD42023449171].

Body composition phenotypes and bone health in young adults: A cluster analysis.

BACKGROUND AND AIMS: Lean mass is considered the best predictor of bone mass, as it is an excellent marker of bone mechanical stimulation, and changes in lean mass are highly correlated with bone outcomes in young adults. The aim of this study was to use cluster analysis to examine phenotype categories of body composition assessed by lean and fat mass in young adults and to assess how these body composition categories are associated with bone health outcomes. METHODS: Cluster cross-sectional analyses of data from 719 young adults (526 women) aged 18-30 years from Cuenca and Toledo, Spain, were conducted. Lean mass index (lean mass (kg)/height (m)2), fat mass index (fat mass (kg)/height (m)2), bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed by dual-energy X-ray absorptiometry. RESULTS: A cluster analysis of lean mass and fat mass index z scores resulted in a classification of a five-category cluster solution that could be interpreted according to the body composition phenotypes of individuals as follows: high adiposity-high lean mass (n = 98), average adiposity-high lean mass (n = 113), high adiposity-average lean mass (n = 213), low adiposity-average lean mass (n = 142), and average adiposity-low lean mass (n = 153). ANCOVA models showed that individuals in clusters with a higher lean mass had significantly better bone health (z score: 0.764, se: 0.090) than their peers in other cluster categories (z score: -0.529, se: 0.074) after controlling for sex, age, and cardiorespiratory fitness (p < 0.05). Additionally, subjects belonging to the categories with a similar average lean mass index but with high or low-adiposity levels (z score: 0.289, se: 0.111; z score: 0.086, se: 0.076) showed better bone outcomes when the fat mass index was higher (p < 0.05). CONCLUSIONS: This study confirms the validity of a body composition model using a cluster analysis to classify young adults according to their lean mass and fat mass indices. In addition, this model reinforces the main role of lean mass on bone health in this population and that in phenotypes with high-average lean mass, factors associated with fat mass may also have a positive effect on bone status.

Osteosynthesis versus revision arthroplasty in Vancouver B2 periprosthetic hip fractures: a systematic review and meta-analysis.

PURPOSE: Several studies comparing osteosynthesis and stem revision in Vancouver B2 (VB2) periprosthetic hip fractures (PPHF) have been published. This work aims to be the first systematic review and meta-analysis to include only studies involving statistical comparison between the two techniques. METHODS: MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to October 2021 for studies involving a comparison between VB2 treated by osteosynthesis versus revision arthroplasty. The effect size (ES) was calculated using Cohen´s d index. RESULTS: From 17 published studies selected, a total of 856 patients were recruited (363 osteosynthesis / 493 revision arthroplasty). The pooled ES estimates for the Parker mobility score were 1.03 (95% CI, 0.22-1.84; I2 = 87.7%) for ORIF surgery, and 0.54 (95% CI, - 0.10-1.17; I2 = 83%) for revision surgery. The pooled ES estimates for the operative time, reintervention, complications, hospital stay and needing for blood transfusion were significant lower in ORIF than in revision surgery. There were no differences in first-year mortality between groups. There was a higher proportion of ASA > 3 patients in the ORIF group. CONCLUSION: Osteosynthesis versus revision arthroplasty has a shorter operative time, less need for blood transfusion, fewer complications and reoperation rate and shorter hospital stay. Nonetheless, similar results were found for functional tests and first-year mortality. These results support the use of osteosynthesis in selected patients (low functional demand, multiple comorbidities, and high anesthetic risk). LEVEL OF EVIDENCE: III.

Arthroscopic surgery versus open surgery for lateral epicondylitis in an active work population: a comparative study.

BACKGROUND: Lateral epicondylitis is common in workers who perform repetitive movements of the entire upper limb. Approximately 85%-90% of patients respond satisfactorily to conservative treatment, but in resistant patients, surgical treatment is considered. Classic open surgery is successful in between 70% and 97% of patients, similarly to more modern techniques such as arthroscopy. We sought to demonstrate the superiority of the Wolff technique in terms of clinical results. The goals of this study were to compare the functional and pain outcomes of arthroscopic surgery with open surgery using fasciotomy via the Wolff technique in the treatment of lateral epicondylitis. METHODS: This was a retrospective study of 47 working-age patients with resistant lateral epicondylitis: 27 underwent arthroscopic surgery and 20 underwent open surgery. Visual analog scale scores for pain and function, as well as the QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Mayo Elbow Performance Score, and Broberg and Morrey Rating System score, were collected preoperatively and postoperatively; return to patients' previous work and surgical time were also recorded. RESULTS: No statistically significant differences were observed between the groups in the reduction in the visual analog scale score (5.26 in arthroscopy group vs. 5.75 in fasciotomy group, P = .5), QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score (19 vs. 19.4, P = .9), Mayo Elbow Performance Score (82 vs. 81.5, P = .8), or Broberg and Morrey Rating System score (81.9 vs. 82.6, P = .9). The differences in terms of time off were also not statistically significant. The period of work leave corresponded, on average, to 83.78 days in the arthroscopy group and 89.95 days in the Wolff group. The mean surgical time was 44.2 minutes in the group undergoing arthroscopic intervention and 27.5 minutes in the fasciotomy group, showing a statistically significant difference (P < .001). CONCLUSIONS: Arthroscopic surgery and open surgery provide similar functional results and pain reduction in the treatment of lateral epicondylitis.

Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study.

BACKGROUND: Hallux valgus (HV) negatively impacts health-related quality of life (HRQoL). Patientreported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1-2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). METHODS: This was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). RESULTS: A total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre-post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre-post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). CONCLUSIONS: Our data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1-2 IMA, and DMAA.

The Role of Physical Fitness in the Relationship between Nut Consumption and Body Composition in Young Adults.

The main objective of this study was to estimate the association between nut consumption and body composition-related measures and to examine whether this relationship is mediated by cardiorespiratory fitness (CRF) and the muscle strength index (MSI) in young adults. A cross-sectional study involving college students (n = 354) aged 18-30 years from a Spanish public university was conducted. Body composition and fitness components were assessed using standard methods. Nut consumption was evaluated using a Food-Frequency Questionnaire. ANCOVA models were used to assess the mean differences in physical fitness and body composition by nut consumption categories. Hayes's PROCESS macro was applied for mediation and interaction analyses adjusted for the main confounders. Young adults with high nut consumption (≥5 portions of 30 g/week) showed significantly higher values of physical fitness components and fat-free mass and lower values of adiposity-related measures than their peers in the lowest categories of nut consumption (˂1 portion/week) (p < 0.05). No significant interaction between CRF and nut consumption on body composition was found. In the mediation analysis, CRF and MSI acted as full mediators of the relationship of nut consumption with fat-free mass and waist circumference/height index. Otherwise, CRF and MSI partially mediated the relationship between nut consumption and body mass index and percent of fat mass. Finally, nut consumption, per se, does not appear to have a significant impact on body composition indicators because these associations have been shown to be partially (for BMI and %BF) or entirely (for ratio WC/height and fat-free mass) explained by CRF and MSI.

Prevalence and trends of underweight in European children and adolescents: a systematic review and meta-analysis.

PURPOSE: This study aimed at providing prevalence trend estimates of underweight among children and adolescents in Europe from 2000 to 2017. METHODS: MEDLINE, Web of Science, Scopus and CINAHL were searched from their inception up to March 2020. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals. Underweight was defined according to the body mass index (BMI) cut-offs proposed by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) definition criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimates whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by sex, age range (2-13 and 14-18 years old), study year (2000-2006 and 2007-2017), country and European region were conducted. RESULTS: A total of 49 studies with data from 323,420 children and adolescents aged 2 to 18 years, from 26 countries were included. From 2000 to 2017, according to the IOTF criteria, the prevalence of underweight showed an increasing trend in Eastern, Northern and Southern Europe, where the underweight prevalence ranged from 9.1 to 12.0%, from 4.1 to 6.8%, and from 5.8 to 6.7%, respectively. In Western Europe, the prevalence of underweight tended to decrease, from 14.0 to 11.8%. No significant differences were found by sex or age range. CONCLUSION: The prevalence of underweight is considerable (overall, around 8-9%), particularly in Eastern Europe, and follows a slight upward trend during the past decade. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017056924.

The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis.

PURPOSE: To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). METHODS: MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. RESULTS: Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. CONCLUSION: Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.

Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis.

Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I2 = 87%) for body pain and 0.43 (CI 0.31-0.55, I2 = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I2 = 80%) and 0.42 (CI 0.21-0.63, I2 = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I2 = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.