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 evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS:A prospective,double-blind,randomized, placebo-controlled study was conducted.One hundred and twenty-fo...AIM:To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS:A prospective,double-blind,randomized, placebo-controlled study was conducted.One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation.Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation.Total colonoscopic time,side effects of the medication,endoscopist and patient satisfaction were also compared. RESULTS:Sodium phosphate plus simethicone,compared to sodium phosphate plus placebo,improved visibility by diminishing air bubbles(100.00%vs 42.37%, P<0.0001)but simethicone failed to demonstrate improvement in adequacy of colon preparation(90.16% vs 81.36%,P=0.17).Endoscopist and patient satisfaction were increased significantly in the simethicone group.However,there was no difference in the total duration of colonoscopy and side effects of the medication. CONCLUSION:The addition of simethicone is of ben-efit for colonoscopic bowel preparation by diminishing air bubbles,which results in enhanced visibility.Endoscopist and patient satisfaction is also increased.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.
基金Supported by The Gastroenterological Association of Thailand
文摘AIM:To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS:A prospective,double-blind,randomized, placebo-controlled study was conducted.One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation.Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation.Total colonoscopic time,side effects of the medication,endoscopist and patient satisfaction were also compared. RESULTS:Sodium phosphate plus simethicone,compared to sodium phosphate plus placebo,improved visibility by diminishing air bubbles(100.00%vs 42.37%, P<0.0001)but simethicone failed to demonstrate improvement in adequacy of colon preparation(90.16% vs 81.36%,P=0.17).Endoscopist and patient satisfaction were increased significantly in the simethicone group.However,there was no difference in the total duration of colonoscopy and side effects of the medication. CONCLUSION:The addition of simethicone is of ben-efit for colonoscopic bowel preparation by diminishing air bubbles,which results in enhanced visibility.Endoscopist and patient satisfaction is also increased.
