Single vs Bilateral Lung Transplant in the Management of Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Lung transplantation is recommended for select patients with end-stage chronic obstructive pulmonary disease (COPD). However, a consensus has not been reached regarding the optimal choice of lung transplantation: single lung transplants (SLTs) vs bilateral lung transplants (BLTs). This meta-analysis aimed to evaluate the safety and efficacy of SLT compared with BLT in managing end-stage COPD. METHODS: Cochrane, Embase, PubMed, and Scopus were searched for articles by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. The review was registered prospectively with PROSPERO (CRD42022343408). RESULTS: Seven studies of 311 screened met the eligibility criteria, with a total of 10,652 patients with end-stage COPD, SLT (n = 6233), or BLT (n = 4419). Overall survival rates of BLT group were more favorable than SLT group at 1 (odds ratio [OR] = 1.29, 95% CI: 1.16, 1.43, I2 = 0%), 5 (OR = 1.46, 95% CI: 1.35, 1.58, I2 = 23%), and 10 years (OR = 1.71, 95% CI: 1.57, 1.87, I2 = 12%) as well as the hazard ratio (HR = 0.73, 95% CI: 0.70, 0.76, I2 = 40%). Subgroup analysis on survival rates of alpha-1 antitrypsin deficiency also displayed a trend favoring BLT compared with SLT at 1 (OR = 1.60, 95% CI: 1.24, 2.08, I2 = 28%), 5 (OR = 1.84, 95% CI: 1.50, 2.26, I2 = 42%), and 10 years (OR = 1.98, 95% CI: 1.59, 2.48, I2 = 47%) as well as the HR (HR = 0.67, 95% CI: 0.35, 1.28, I2 = 82%). CONCLUSION: Compared with SLT, BLT seems to demonstrate more favorable trends in survival rates for the management of end-stage COPD. Despite the promising results, the groups have significant heterogeneity in baseline characteristics. Further prospective studies with extended follow-up periods are needed to ascertain the efficacy of treatment.

Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis.

INTRODUCTION: Rapid weight loss following Roux-en-Y gastric bypass surgery (RYGB) translates to an increased need for endoscopic retrograde cholangiopancreatography (ERCP) intervention. Laparoscopically Assisted Transgastric ERCP (LA-ERCP) has emerged to address the issue of accessing the excluded stomach. This study aims to evaluate the safety and efficacy of LA-ERCP procedure following RYGB. METHODS: The Cochrane, EMBASE, SCOPUS, MEDLINE, Daily and Epub databases were searched from inception to May 2022 using the PRISMA guidelines. Eligible studies reported participants older than 18 years who underwent the LA-ERCP procedure, following RYGB, and outcomes of patients. RESULTS: 27 unique studies met the inclusion criteria with 1283 patients undergoing 1303 LA-ERCP procedures. 81.9% of the patients were female and the mean age was 52.18 ± 13.38 years. The rate of concurrent cholecystectomy was 33.6%. 90.9% of procedures were undertaken for a biliary indication. The mean time between RYGB and LA-ERCP was 89.19 months. The most common intervention performed during the LA-ERCP was a sphincterotomy (94.3%). Mean total operative time was 130.48 min. Mean hospital length of stay was 2.697 days. Technical success was 95.3%, while clinical success was 93.8%. 294 complications were recorded with a 20.6% complication rate. The most frequent complications encountered were pancreatitis (6.8%), infection (6.1%), bleeding (3.4%), and perforation (2.5%). Rate of conversion to open laparotomy was 7%. CONCLUSION: This meta-analysis presents preliminary evidence to suggest the safety and efficacy of LA-ERCP procedure following RYGB. Further investigations are warranted to evaluate the long-term efficacy of this procedure using studies with long-term patient follow-up.

Comparison of a Wearable Accelerometer/Gyroscopic, Portable Gait Analysis System (LEGSYS+TM) to the Laboratory Standard of Static Motion Capture Camera Analysis.

Examination of gait patterns has been used to determine severity, intervention triage and prognostic measures for many health conditions. Methods that generate detailed gait data for clinical use are typically logistically constrained to a formal gait laboratory setting. This has led to an interest in portable analysis systems for near clinical or community-based assessments. The following study assessed with the wearable accelerometer/gyroscopic, gait analysis system (LEGSYS+TM) and the standard of static motion capture camera (MOCAP) analysis during a treadmill walk at three different walking speeds in healthy participants (n = 15). To compare each speed, 20 strides were selected from the MOCAP data and compared with the LEGSYS+ strides at the same time point. Both scatter and bland-Altman plots with accompanying linear regression analysis for each of the parameters. Each stride parameter showed minimal or a consistent difference between the LEGSYS+ and MOCAP, with the phase parameters showing inconsistencies between the systems. Overall, LEGSYS+ stride parameters can be used in the clinical setting, with the utility of phase parameters needing to be taken with caution.

Dexamethasone versus prednisone/prednisolone in the management of pediatric patients with acute asthmatic exacerbations: a systematic review and meta-analysis.

OBJECTIVE: Acute asthmatic exacerbation is a common condition for pediatric emergency visits. Recently, dexamethasone has increasingly been used as an alternative to prednisone. This study aimed to evaluate the safety and efficacy of dexamethasone (DEX) against prednisone/prednisolone (PRED) in managing pediatric patients with acute asthmatic exacerbation. DATA SOURCES: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to August 2022 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022353462). STUDY SELECTIONS: From 316 studies screened, seventeen studies met the eligibility criteria, with 5967 pediatric patients experiencing an asthma exacerbation requiring treatment with either DEX (n = 2865) or PRED (n = 3102). Baseline patient characteristics (age, sex, PRAM (pediatric respiratory assessment measure), previous corticosteroid and beta-agonist inhaler) were comparable between groups. RESULTS: After treatment administration, the DEX group had fewer vomiting incidents (OR = 0.24, 95% CI: 0.11, 0.51, I2 = 58%) and reduced noncompliance events (OR = 0.12, 95% CI: 0.04, 0.34, I2 = 0%) when compared to the PRED group. Regarding emergency-department (ED)-related outcomes, there were no differences in hospital admission rates (OR = 0.83, 95% CI: 0.58, 1.19, I2 = 15%), time spent in the ED (MD= -0.11 h, 95% CI: -0.52; 0.30, I2 = 82%) or relapse occurrences (OR = 0.67, 95% CI: 0.30, 1.49, I2 = 52%) between both groups. CONCLUSION: Although there were no differences between the DEX and PRED groups in terms of hospital admission rates, time spent in the ED or relapse events, pediatric patients receiving DEX experienced lower noncompliance and vomiting rates.

Clinical Characteristics of Patients with Myocarditis following COVID-19 mRNA Vaccination: A Systematic Review and Meta-Analysis.

COVID-19 mRNA vaccinations have recently been implicated in causing myocarditis. Therefore, the primary aim of this systematic review and meta-analysis was to investigate the clinical characteristics of patients with myocarditis following mRNA vaccination. The secondary aims were to report common imaging and laboratory findings, as well as treatment regimes, in these patients. A literature search was performed from December 2019 to June 2022. Eligible studies reported patients older than 18 years vaccinated with mRNA, a diagnosis of myocarditis, and subsequent outcomes. Pooled mean or proportion were analyzed using a random-effects model. Seventy-five unique studies (patient n = 188, 89.4% male, mean age 18-67 years) were included. Eighty-six patients had Moderna vaccines while one hundred and two patients had Pfizer-BioNTech vaccines. The most common presenting symptoms were chest pain (34.5%), fever (17.1%), myalgia (12.4%), and chills (12.1%). The most common radiologic findings were ST-related changes on an electrocardiogram (58.7%) and hypokinesia on cardiac magnetic resonance imaging or echocardiography (50.7%). Laboratory findings included elevated Troponin I levels (81.7%) and elevated C-reactive protein (71.5%). Seven patients were admitted to the intensive care unit. The most common treatment modality was non-steroid anti-inflammatory drugs (36.6%) followed by colchicine (28.5%). This meta-analysis presents novel evidence to suggest possible myocarditis post mRNA vaccination in certain individuals, especially young male patients. Clinical practice must therefore take appropriate pre-cautionary measures when administrating COVID-19 mRNA vaccinations.

Exercise-induced muscle damage on the contractile properties of the lumbar paraspinal muscles: a laser displacement mechanomyographic approach.

PURPOSE: This study investigated whether laser displacement mechanomyography (MMG) could detect acute injury of low back muscles following strenuous eccentric exercise. METHODS: Sixteen healthy adults (10 females, 6 males, mean ± standard deviation, age 21 ± 2.90 years, BMI 21.63 ± 1.99 kg/m2), without low back pain or low back resistance training, were recruited. Strength [maximum voluntary isometric contraction force (MVC)], pain intensity [visual analogue scale (VAS)], biological markers of muscle injury (serum myoglobin and creatine kinase levels), and MMG-derived muscle contractile properties were measured at seven different time points. Pre-exercise 'control' measures were taken prior to a strenuous eccentric exercise task, followed by an immediate post-exercise measurement and further four consecutive daily measurements. A final post-exercise measurement was completed on day 12 post-exercise. RESULTS: Compared to pre-exercise control, MVC was lower immediately post-exercise (day 1) and on days 2-3. VAS scores were higher post-exercise (day 1) and from days 2-5. Myoglobin was significantly higher on day 4, whilst creatine kinase was significantly higher on days 4-5. MMG-derived maximum muscle displacement (Dmax) was significantly diminished post-exercise (day 1) at all vertebral segments (L1-MT), while contraction velocity (Vc) was significantly slower at all segments except sacral multifidus. Vc recovered rapidly (by day 2), while mid-lumbar Dmax resolved on day 12. Dmax had moderate correlations with MVC (R = 0.61) and VAS (R = - 0.50), and low correlations with myoglobin (R = - 0.36). CONCLUSION: MMG appears capable of detecting changes in muscle contractile properties associated with an acute bout of low back pain.

Test-retest reliability of laser displacement mechanomyography in paraspinal muscles while in lumbar extension or flexion.

This study investigated test-retest reliability of mechanomyography (MMG) on lumbar paraspinal muscles. Healthy male and female subjects (mean ±â€¯standard deviation, 25 ±â€¯9.4 years, BMI 21.8 ±â€¯2.99, n = 34) were recruited. Two test sessions (one week apart) consisted of MMG (laser displacement sensor (LDS)) muscle evaluations over the 10 lumbar facet joints, and 2 bilateral sacral sites, in anatomical extension and flexion. Two-way repeated measures ANOVA with Tukey's post hoc showed no significant differences between testing sessions for the same position (p > 0.05). The intra-class correlation coefficients (ICCs) in extension were classified as 'very good' (0.8-0.9) for maximal muscle displacement (Dmax), contraction time (Tc) and velocity of contraction (Vr). Half relaxation time (½Tr) and half relaxation velocity (½Vr) were 'poor' (0.4-0.5) and 'good' (0.7-0.8). In flexion, Dmax, Tc and Vr were 'excellent' (≥0.9) whilst ½Tr and ½Vr were 'fair' (0.6-0.7) and 'very good'. Comparing extension against flexion, significant (p < 0.05) differences in Dmax and ½Vr were found (L1/L2-L5/S1). Tc was significant (p < 0.05) for all sites whilst Vc was for L1/L2 on both sides (p < 0.05). ½Tr showed no significance (p > 0.05). Most MMG-derived parameters thus appear as reliable measures of muscle contractile properties in lumbar extension and flexion, with flexion providing more reliable results (ICCs).

Test-Retest Reliability and Reproducibility of Laser- versus Contact-Displacement Sensors in Mechanomyography: Implications for Musculoskeletal Research.

Whole muscle mechanomyography (MMG) has gained considerable interest in recent years for its ability to noninvasively determine muscle contractile properties (ie, contraction time [Tc], half-relaxation time [1/2Tr], and maximal displacement [Dmax)]). The aim of this study was to evaluate the test-retest reliability of two fairly novel MMG transducers: a laser-displacement sensor (LDS) and contact-displacement sensor (CDS). MMG was conducted on the rectus femoris muscle of 30 healthy individuals on 4 separate occasions. Test-retest reliability was quantified using intraclass correlation coefficients (ICCs). Both sensors were reliable for time-derived parameters Tc (ICCs, 0.85-0.88) and 1/2Tr (0.77-0.89), with Dmax identified as the most reproducible parameter (0.89-0.94). The 2 sensors produced similar Tc and Dmax measures, although significant (P < .05) systematic bias was identified with the CDS recording higher mean values, on average. However, these differences may not be considered clinically significant. The wide limits of agreement identified between 1/2Tr measures (-19.0 ms and 25.2 ms) are considered unreliable from a clinical perspective. Overall, MMG demonstrated good-to-excellent reliability for the assessment of muscle contractile properties with no significant differences identified between sessions, thus further validating its applicability as a noninvasive measure of muscle contractile properties.

The effect of exercise hypertrophy and disuse atrophy on muscle contractile properties: a mechanomyographic analysis.

PURPOSE: To determine whether mechanomyographic (MMG) determined contractile properties of the biceps brachii change during exercise-induced hypertrophy and subsequent disuse atrophy. METHODS: Healthy subjects (mean ± SD, 23.7 ± 2.6 years, BMI 21.8 ± 2.4, n = 19) performed unilateral biceps curls (9 sets × 12 repetitions, 5 sessions per week) for 8 weeks (hypertrophic phase) before ceasing exercise (atrophic phase) for the following 8 weeks (non-dominant limb; treatment, dominant limb; control). MMG measures of muscle contractile properties (contraction time; T c, maximum displacement; D max, contraction velocity; V c), electromyographic (EMG) measures of muscle fatigue (median power frequency; MPF), strength measures (maximum voluntary contraction; MVC) and measures of muscle thickness (ultrasound) were obtained. RESULTS: Two-way repeated measures ANOVA showed significant differences (P < 0.05) between treatment and control limbs. During the hypertrophic phase treatment MVC initially declined (weeks 1-3), due to fatigue (decline in MPF), followed by improvement against control during weeks 6-8. Between weeks 5 and 8 treatment, muscle thickness was greater than control, reflecting gross hypertrophy. MMG variables Dmax (weeks 2, 7) and Vc (weeks 7, 8) declined. During the atrophic phase, MVC (weeks 9-12) and muscle thickness (weeks 9, 10) initially remained high before declining to control levels, reflecting gross atrophy. MMG variables D max (weeks 9, 14) and V c (weeks 9, 14, 15) also declined during the atrophic phase. No change in T c was found throughout the hypertrophic or atrophic phases. CONCLUSIONS: MMG detects changes in contractile properties during stages of exercise-induced hypertrophy and disuse atrophy suggesting its applicability as a clinical tool in musculoskeletal rehabilitation.

Determining minimal stimulus intensity for mechanomyographic analysis.

INTRODUCTION: Mechanomyography (MMG) has recently shown promise in monitoring recovery of injured muscles. However, delivering a maximal percutaneous neuromuscular stimulus (PNS) could potentially be painful on severely damaged muscles. The aim of this paper was to determine whether delivering a sub-maximal PNS could still obtain accurate MMG recordings of muscle contraction time (Tc). The effect of muscle architecture on determining the minimal level of current was also investigated. METHODS: Six muscles were investigated; 5 lower limb and the 1st dorsal interosseous. A 'current ramp' procedure was performed to determine minimal stimulus intensity required for accurate Tc recordings. A current ramp entails beginning at a low current (30mA) and increasing in increments of 10mA until a maximal muscle contraction is observed. RESULTS: For lower limb muscles, 130mA was the largest current required to obtain accurate Tc recordings in at least 95% of the population. This was up to a 50% reduction in the amount of current delivered for some muscles. Fibre type distribution showed the greatest relationship with mean minimum current. DISCUSSION: Future studies investigating injured or uninjured muscles via MMG, could use these submaximal currents to obtain accurate MMG recordings, whilst improving patient comfort and reducing experiment duration.

The architecture and contraction time of intrinsic foot muscles.

Although critical for effective human locomotion and posture, little data exists regarding the segmentation, architecture and contraction time of the human intrinsic foot muscles. To address this issue, the Abductor Hallucis (AH), Abductor Digiti Minimi (ADM), Flexor Digitorum Brevis (FDB) and Extensor Digitorum Brevis (EDB) were investigated utilizing a cadaveric dissection and a non-invasive whole muscle mechanomyographic (wMMG) technique. The segmental structure and architecture of formaldehyde-fixed foot specimens were determined in nine cadavers aged 60-80 years. The wMMG technique was used to determine the contraction time (Tc) of individual muscle segments, within each intrinsic foot muscle, in 12 volunteers of both genders aged between 19 and 24 years. While the pattern of segmentation and segmental -architecture (e.g. fibre length) and -Tc of individual muscle segments within the same muscle were similar, they varied between muscles. Also, the average whole muscle Tc of FDB was significantly (p < 0.05) shorter (faster) (Tc = 58 ms) than in all other foot muscles investigated (ADM Tc = 72 ms, EDB Tc = 72 ms and ABH Tc = 69 ms). The results suggest that the architecture and contraction time of the FDB reflect its unique direct contribution, through toe flexion, to postural stability and the rapid development of ground reaction forces during forceful activities such as running and jumping.