British medical bulletin最新文献

Introduction: Lisfranc injuries, not as rare as previously reported, range from ligamentous to complex fracture-dislocations. Anatomical studies have identified a complex of discrete structures, and defined the anatomical characteristics of the Lisfranc joint.

Sources of data: A narrative evidence-based review encompassed and analyzed published systematic reviews. Outcomes included clinical and surgical decision-making, including clinical-presentation, diagnosis, pathological-assessment, surgical-management techniques and indications, post-surgical care and comparative outcomes.

Areas of agreement: Better understanding of the Lisfranc complex anatomy aids surgical treatment and tactics. Prognosis is related to injury severity, estimated by the number of foot columns affected. Surgical outcome is determined by anatomical reduction for most fixation and fusion techniques. Appropriate treatment allows return to sport, improving outcome scores.

Areas of controversy: Identification of Lisfranc injuries may be improved by imaging modalities such as weight-bearing computer tomography. Recent evidence supports dorsal plate fixation as a result of better quality of reduction. In complex injuries, the use of combined techniques such as trans-articular screw and plate fixation has been associated with poorer outcomes, and fusion may instead offer greater benefits.

Growing points: Open reduction is mandatory if closed reduction fails, highlighting the importance of understanding surgical anatomy. If anatomical reduction is achieved, acute arthrodesis is a safe alternative to open reduction internal fixation in selected patients, as demonstrated by comparable outcomes in subgroup analysis.

Areas for developing research: The current controversies in surgical treatment remain around techniques and outcomes, as randomized controlled trials are infrequent.

Background: Workplace exposure to solar ultraviolet (UV) causes malignant melanoma and non-melanoma skin cancer. The evidence for beneficial effects of solar UV exposure in reducing the risks for other cancers is increasing. The intensity of UV radiation at the Earth's surface is dependent on latitude, but even in northern European countries exposure can be high enough for outdoor work to cause skin cancer.

Growing points: Awareness of the health risks and benefits of occupational solar UV exposure is poor. Actions to reduce the risk of skin cancer have been identified and employers should recognize their responsibility to actively manage these risks. There is evidence for reduced risks for breast, ovarian and colorectal cancer and possibly other cancers linked to solar UV exposure.

Sources of data: This narrative review draws on published scientific articles and material designed to assist identifying strategies to protect workers from solar UV exposure.

Areas of agreement: Solar UV exposure can be harmful. Wavelengths in the UVB range are more effective in causing erythema and DNA damage. Solar UV is the main source of vitamin D for most people. Primary and secondary prevention for skin cancer can potentially eliminate these risks but the evidence for effectiveness is limited.

Areas of controversy: Potential health benefits of UV exposure, particularly for reduced cancer risk. Determining and communicating optimal exposure to maximize health benefits. The risk of non-melanoma skin cancers may be more than doubled for some workers in temperate latitudes.

Areas timely for developing research: Exposure-response epidemiological studies; studies of the health benefits of occupational UV exposure; studies of the effectiveness of intervention strategies to prevent skin cancer. Use of low-cost UV sensors in workplaces.

Background: Multiple vaccine platforms against COVID-19 have been developed and found safe and efficacious at a record speed. Although most are effective, they vary in their ease of production and distribution, their potential speed of modification against new variants, and their durability of protection and safety in certain target groups.

Sources of data: Our discussion is based on published reports of clinical trials and analyses from national and global health agencies.

Areas of agreement: The production of neutralizing antibodies against the viral spike protein is protective, and all vaccines for which published data exist have been found to be effective against severe disease caused by the viral strain they target.

Areas of controversy: The degree to which vaccines protect against emerging variants, moderate disease and asymptomatic infection remains somewhat unclear.

Growing points: Knowledge of the duration of protection and its decay is increasing, and discussions of booster frequency and target strains are ongoing.

Areas timely for developing research: The global effort to combat transmission and disease continues to rely upon intense epidemiological surveillance, whilst real-world data and clinical trials shape vaccination schedules and formulae.

Introduction: Rotator cuff tears (RCT) are a common cause of shoulder pain and disability, with massive RCT accounting for 10-40% of all rotator cuff tears.

Sources of data: A systematic search of PubMed and Scopus electronic databases was performed up to August 2022, and a total of 17 scientific articles were included in the present PRISMA compliant systematic review.

Areas of agreement: Understanding the geometric patterns in RCT is essential to achieve appropriate repositioning of the injured tendons in their anatomic location. The long head of the biceps tendon (LHBT) is usually exposed when defects of the anterolateral corner are present and can be easily used to augment rotator cuff repairs.

Areas of controversy: There are no definite guideline regarding the management of massive rotator cuff tears.

Growing points: The use of LHBT graft is safe and effective, but technically demanding. All studies were level IV articles of medium to high quality.

Areas timely for developing research: Prospective long term follow-up studies and randomized controlled trials are needed, adding imaging evaluation and appropriate clinical outcome measures at follow-up.

Background: There is evidence for a bi-directional relationship between COVID-19 and the cardiovascular (CV) system.

Source of data: Published literature.

Areas of agreement: Pre-existing heart failure (HF) increases the risk of mortality with COVID-19. CV complications are recognized, including increased rates of acute coronary syndromes, HF, arrhythmia and myocarditis. Drugs targeting the angiotensin system are safe and may provide prognostic benefit.

Areas of controversy: Vaccination as a cause of myocarditis remains a key area of contention.

Growing points: As the pandemic progresses, we are gaining more data about the long-term effects of COVID-19 on the CV system: long COVID, and medium-to-long-term increases in CV risk.

Areas timely for developing research: Large-scale longitudinal studies will shed light on long-term CV outcomes with COVID-19. Furthermore, the differential effects of COVID-19 variants on the CV system must be investigated.