BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o...BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.展开更多
AIM: To examine whether visceral fat is associated with non-alcoholic steatohepatitis (NASH),to assess for parameters associated with visceral adiposity and to investigate for factors associated with fibrotic severity...AIM: To examine whether visceral fat is associated with non-alcoholic steatohepatitis (NASH),to assess for parameters associated with visceral adiposity and to investigate for factors associated with fibrotic severity in NASH. METHODS: Thirty NASH and 30 control subjects underwent biochemical tests,anthropometric assessment,bioelectrical impedance,dual energy X-ray absorptiometry and abdominal fat study by CT scan. Liver biopsies were graded according to the Brunt criteria. RESULTS: NASH subjects had elevated blood pressure,body mass index,waist circumference and waist-to-hip ratio. A greater number of diabetes mellitus,impaired glucose tolerance test and HOMA-IR > 3.5 were found in NASH patients. HOMA-IR > 2.8 (OR 20.98,95% CI 3.22-136.62; P < 0.001) and visceral fat area > 158 cm2 (OR 18.55,95% CI 1.60-214.67; P = 0.019) were independent predictors for NASH. Advanced stage of NASH was found in 15 (50%) patients. HOMA-IR > 3.5 (OR 23.12,95% CI 2.00-266.23; P = 0.012) and grading of portal inflammation (OR 7.15,95% CI 1.63-31.20; P = 0.009) were determined as independent risk factors for advanced stage of NASH. CONCLUSION: Obesity (especially central obesity) and metabolic syndrome are common in Thai NASH. Insulin resistance and elevated visceral fat are risk factors for the presence of NASH. The advanced stage of thedisease is related to insulin resistance.展开更多
文摘BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.
文摘AIM: To examine whether visceral fat is associated with non-alcoholic steatohepatitis (NASH),to assess for parameters associated with visceral adiposity and to investigate for factors associated with fibrotic severity in NASH. METHODS: Thirty NASH and 30 control subjects underwent biochemical tests,anthropometric assessment,bioelectrical impedance,dual energy X-ray absorptiometry and abdominal fat study by CT scan. Liver biopsies were graded according to the Brunt criteria. RESULTS: NASH subjects had elevated blood pressure,body mass index,waist circumference and waist-to-hip ratio. A greater number of diabetes mellitus,impaired glucose tolerance test and HOMA-IR > 3.5 were found in NASH patients. HOMA-IR > 2.8 (OR 20.98,95% CI 3.22-136.62; P < 0.001) and visceral fat area > 158 cm2 (OR 18.55,95% CI 1.60-214.67; P = 0.019) were independent predictors for NASH. Advanced stage of NASH was found in 15 (50%) patients. HOMA-IR > 3.5 (OR 23.12,95% CI 2.00-266.23; P = 0.012) and grading of portal inflammation (OR 7.15,95% CI 1.63-31.20; P = 0.009) were determined as independent risk factors for advanced stage of NASH. CONCLUSION: Obesity (especially central obesity) and metabolic syndrome are common in Thai NASH. Insulin resistance and elevated visceral fat are risk factors for the presence of NASH. The advanced stage of thedisease is related to insulin resistance.
