British medical bulletin最新文献

Introduction: Surgical treatment of pelvic girdle pain (PGP) involves arthrodesis of sacroiliac (SI) and pubic symphysis joints. Fusion of pubic symphysis involves the implantation of an autologous iliac crest tricortical graft harvested from the iliac crest. The objective was to assess the safety of a novel synthetic graft substitute (b.Bone) for iliac crest reconstruction and to evaluate the results of PGP surgical treatment.

Sources of data: Consecutive participants undergoing pelvic fusion and requiring iliac crest reconstruction were enrolled and followed-up for 12 months in a prospective first-in-human clinical investigation. Adverse events were documented, and health-related quality of life was evaluated using EuroQol-5D-5L questionnaire. Iliac crest defect healing was evaluated by the Modified Lane and Sandhu radiological scoring system. In addition, relevant published peer-reviewed scientific articles identified from PubMed.

Areas of agreement: The EQ-5D-5L scores improved steadily reaching the highest point at 365 days. By 365 days complete healing of the bone defect was observed.

Areas of controversy: The management of PGP remains challenging with mixed results reported in the literature.

Growing points: While there is lack of consensus on how to manage PGP, the present study shows improved outcomes at one year following surgery. The synthetic b.Bone scaffold is a safe option with good healing outcomes for iliac crest defect reconstruction.

Areas timely for developing research: Although b.Bone synthetic scaffold found to be safe, further studies reporting on surgical treatment of PGP are required to confirm the findings in comparative trials.

Background: Utilizing Artificial Intelligence (AI) in clinical settings may offer significant benefits. A roadblock to the responsible implementation of medical AI is the remaining uncertainty regarding requirements for AI users at the bedside. An overview of the academic literature on human requirements for the adequate use of AI in clinical settings is therefore of significant value.

Sources of data: A systematic review of the potential implications of medical AI for the required competencies of physicians as mentioned in the academic literature.

Areas of agreement: Our findings emphasize the importance of physicians' critical human skills, alongside the growing demand for technical and digital competencies.

Areas of controversy: Concrete guidance on physicians' required competencies in AI-assisted clinical settings remains ambiguous and requires further clarification and specification. Dissensus remains over whether physicians are adequately equipped to use and monitor AI in clinical settings in terms of competencies, skills and expertise, issues of ownership regarding normative guidance, and training of physicians' skills.

Growing points: Our review offers a basis for subsequent further research and normative analysis on the responsible use of AI in clinical settings.

Areas timely for developing research: Future research should clearly outline (i) how physicians must be(come) competent in working with AI in clinical settings, (ii) who or what should take ownership of embedding these competencies in a normative and regulatory framework, (iii) investigate conditions for achieving a reasonable amount of trust in AI, and (iv) assess the connection between trust and efficiency in patient care.

Background: Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.

Sources of data: A systematic search of different databases to July 2024 was performed to define the role of circRNA in OP therapy. Seventeen suitable studies were identified.

Areas of agreement: CircRNAs may be useful in studying metabolic processes in OP and identify possible therapeutic targets and new drug therapies.

Areas of controversy: The metabolic processes involved in OP are regulated by many genes and cytokines that can be targeted by CircRNAs. However, it is not easy to predict whether the in vitro responses of the studied CircRNAs and their interaction with drugs are also applicable in vivo.

Growing points: Metabolic processes can be affected by gene dysregulation of CircRNAs on various growth factors. Areas timely for developing research: Despite the predictability of CircRNA pharmacological response in vitro, such pharmacological response cannot be expected to be replicated in vivo.

Data availability: The data that support the findings of this study are available from the corresponding author.

Introduction: Achilles tendinopathy (AT) is common, particularly in runners. High-volume injections (HVIs) may be beneficial in the management of AT compared to other conservative management options, including exercise regimens, platelet-rich plasma (PRP) injections, and extracorporeal shockwave therapy. The published research on the effectiveness of HVI in the treatment of AT was evaluated in this systematic review.

Sources of data: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed when conducting this systematic review. The electronic databases PubMed, Embase, Cochrane, Web of Science, CINAHL, and OVID were thoroughly searched, from inception to 13 September 2023, for articles assessing HVI for AT.

Areas of agreement: A total of 10 studies with 460 participants met the inclusion criteria. HVI typically consisted of saline, local anaesthetic, and corticosteroids. HVI combined with corticosteroids demonstrated immediate and long-term improvements in ankle function. Compared to HVI without corticosteroids, HVI with corticosteroids exhibited greater, early improvements in pain and function, with no significant differences at later follow-up points. Significant reductions in tendon thickness and neovascularity were also found with HVI treatment over time.

Areas of controversy: No adverse events were reported with HVI, despite the use of corticosteroids.

Growing points: HVI is an effective and safe modality, particularly in the short term, to significantly reduce pain and discomfort in the Achilles tendon, especially when supplemented with corticosteroids.

Areas timely for developing research: More robust randomized controlled trials, with longer-term follow-ups and homogeneity, are needed to fully establish its efficacy for AT.

Introduction: Historically, anterior cruciate ligament (ACL) ruptures in the paediatric age group were managed conservatively with bracing, casting, activity modification, and physical therapy. However, most of these patients had to reduce their sports activities, and secondary damages to the affected knee were prevalent.

Source of data: Published scientific literature in Embase, Web of Science, PubMed, and Google Scholar databases.

Areas of agreement: ACL reconstruction in children with open physes patients is debated. Any damage to the physes around the knee could lead to growth abnormalities and axial deviation of the knee.

Areas of controversy: Different grafts are available and suitable for ACL reconstruction in skeletally immature patients; however, which graft performs better remains unclear.

Growing points: This systematic review compared bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts for ACL reconstruction in skeletally immature patients. The joint laxity, Patient-reported outcome measures (PROMs), return to sport, and complications were compared.

Areas timely for developing research: In skeletally immature patients, HT, BPTB, and QT autografts for ACL reconstruction yielded good outcomes. Comparative studies are strongly required to establish the most suitable autograft.

Introduction: Motor neuron disease (MND) is a devastating neurodegenerative disease characterized by progressive muscle weakness.

Sources of data: PubMed, MEDLINE, and Cochrane databases were searched for articles to March 2024. Searches involved the terms 'motor neuron disease' or 'amyotrophic lateral sclerosis' and 'epidemiology', 'diagnosis', 'clinical', 'genetic', 'management', 'treatment', or 'trial'.

Areas of agreement: Evidence-based management involves riluzole, multidisciplinary care, provision of noninvasive ventilation and gastrostomy, and symptomatic treatments. Tofersen should be offered to treat SOD1-MND.

Areas of controversy: Edaravone and Relyvrio are approved treatments in the USA, but insufficient evidence was found to support approval in the UK and Europe.

Growing points: The discovery of neurofilaments as MND biomarkers, growth of platform trials and development of novel therapies provide optimism for more powerful neuroprotective therapies.

Areas timely for developing research: Further work should focus on the elucidation of environmental causes of MND, gene-environment interactions, and advanced cellular models of disease.

Introduction: Fractures of the distal radius are common in pediatric population, with considerable variation in the management of pediatric wrist fractures across different countries. It is crucial to consider the different approaches to conservative management and surgical intervention. The decision on the appropriate treatment method often depends on the type and severity of the fracture, as well as the available healthcare resources and expertise in each country. This article tries to identify these variations, so the various healthcare systems can work toward implementing best practices in the management of pediatric wrist fractures on a global scale.

Source of data: Published peer-reviewed articles identified in electronic databases, including PubMed Scopus and Google Scholar.

Areas of agreement: The management of pediatric wrist fractures can differ significantly among countries given the high variability in healthcare resources and cultural practices.

Areas of controversy: The management of pediatric wrist fractures can be challenging in certain countries, especially in developing regions with limited resources.

Growing points: Challenges such as long therapeutic delays, lack of appropriate anesthesia, and the absence of fluoroscopy can complicate the treatment process. Randomized controlled clinical trials (RCTs) are vital in providing high-quality evidence to guide clinical decision-making, especially in the field of pediatric wrist fractures.

Areas timely for developing research: Efforts to support and prioritize the conduct and dissemination of RCTs in pediatric wrist fracture management can ultimately lead to more consistent, effective, and evidence-based care for children with wrist fractures worldwide.

Introduction: The complex phenomenon of the athlete's heart (AH) describes the chronic physiological structural and functional adaptation secondary to repeated exposure of an acute exercise stimulus.

Sources of data: This narrative review is based on published evidence.

Areas of agreement: Highly trained athletic individuals frequently display cardiac parameters which are suggestive of an AH and can exceed the traditional 'normal' limits.

Area of controversy: The physiological processes underpinning the extent of cardiac adaption and how this is closely linked to exercise type, but also sex, ethnicity, and body size.

Growing points: Since its seminal description by Morganroth and colleagues in 1975, our understanding of the AH has evolved in tandem with improvements in cardiac imaging techniques alongside the exploration of more diverse athletic populations. This narrative review aims to provide a balanced discussion of the multi-factorial nature of structure and function of the AH with specific reference to the unique physiological exercise stimuli.

Areas timely for developing research: Despite great interest in cardiac adaptations across a broad spectrum of athletic populations, future research designs should consider the use of new and novel imaging techniques to enhance our understanding of the acute cardiovascular responses which ultimately mediates such adaptations, especially in athletic populations underrepresented in the literature.