Purpose The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patient-reported outcome measures of medially stabilised (MS) TKA when compared to other TKA designs. Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses algorithm was used. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and EMCARE databases were searched to June 2020. Studies with a minimum of 12 months of follow-up comparing an MS TKA design to any other TKA design were included. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results The 22 studies meeting the inclusion criteria included 3011 patients and 4102 TKAs. Overall Oxford Knee Scores were significantly better (p = 0.0007) for MS TKA, but there was no difference in the Forgotten Joint Scores (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS)-Knee, KSS-Function, and range of motion between MS and non-MS TKA designs. Significant differences were noted for sub-group analyses; MS TKA showed significantly worse KSS-Knee (p = 0.02) and WOMAC (p = 0.03) scores when compared to Rotating Platform (RP) TKA while significantly better FJS (p = 0.002) and KSS-knee scores (p = 0.0001) when compared to cruciate-retaining (CR) TKA. Conclusion This review and meta-analysis show that MS TKA designs result in both patient and clinical outcomes that are comparable to non-MS implants. These results suggest implant design alone may not provide further improvement in patient outcome following TKA, surgeons must consider other factors, such as alignment to achieve superior outcomes. Level of evidence III.
Background Remission in ANCA-associated vasculitides (AAV) is achieved traditionally using glucocorticosteroids (GCS) and cyclophosphamide (CYC), followed by azathioprine (AZA) for maintenance therapy. Patients still experience a high relapse and remission failure rate whilst receiving these drugs. This regimen of treatment has also been linked to a substantial amount of cumulative toxicity giving rise to adverse effects. Recently there has been evidence that Rituximab (RTX) can be considered as an alternative drug for both remission induction and maintenance therapy. The evidence is scattered between the rheumatology and renal literature, where the use of RTX in routine clinical practice is emerging as the norm especially in the United States1. Objectives To conduct a systematic review of the evidence behind the use of RTX in induction of remission and maintenance in AAV. Methods The Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE were searched via OvidSP. The American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) were also searched online for relevant abstracts. Free text searches were accompanied with MeSH terms (AAV, rituximab, review, and efficacy) and results subjected to inclusion and exclusion criteria. Exclusions included non-English studies, animal studies, cryoglobulinaemia and secondary vasculitis. Remission was defined by the Birmingham Vasculitis Activity Score (BVAS) and the quality of each study was assessed via the Oxford Centre for Evidence Based Medicine (CEBM) levels of evidence tool. Results 22 studies met the criteria that studied a total of 729 patients; these included 4 randomised control trials (RCT)2–5, 3 open cohort studies6–8, and 16 case series. Results of the RCTs and open cohort studies are summarised in Table 1. In the case series, 88.2% of the 221 patients achieved either a partial or complete remission following RTX therapy; the mean assessment was carried out at 6.5 months from the start of treatment. Relapses occurred in 19.5% of these patients at an average of 13 months. In RTX maintenance therapy, 92.3% of the 39 patients responded with an averaged follow-up of 12 months. The overall response rate for remission induction included 382 RTX and 109 CYC patients. There was an 81.7% response with RTX vs. 56.9% CYC; mean assessment was carried out at 11 months RTX vs. 8 months CYC. Relapses occurred in 24.9% RTX at 16.5 months vs. 38.5% CYC at 21 months on average. The overall response in maintenance therapy included 170 RTX and 59 CYC patients. There was a 94.7% response with RTX at 21 months vs. 72.9% CYC at 28 months averaged follow-up; 91.6% RTX vs. 51.9% CYC at 34 months averaged follow-up. Conclusions RTX is non-inferior to CYC in remission induction of AAV patients. RTX is superior to AZA in maintaining remission in newly diagnosed and relapsing AAV patients. RTX treatment allows for a tapered reduction in GCS, as well as showing no differences in adverse events when compared to CYC and AZA. These results support...
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Background: Men aged 65Á79 are at the highest risk of having an abdominal aortic aneurysm (AAA) as well as a high incidence of rupture; this is treated as a surgical emergency, which has a total mortality of 75Á90%. 1Á5 The diameter of an AAA proves to be the most useful risk factor in predicting mortality rates. 6,7 Ultrasonography is widely accepted as an effective diagnostic imaging tool for detecting AAA. 8 Based on this, AAA elective repair is recommended to individuals with AAA of diameter ]55 mm. 6,7 The problem lies in detecting individuals with AAA as many are asymptomatic. 9 The aim of this article is to determine whether a population-based ultrasound screening programme can significantly reduce AAA mortality using the critical appraisal skills programme (CASP) tool. Method: Databases were searched for relevant literature. Studies were limited to randomised controlled trials (RCTs) that conducted a population-based screening programme using ultrasound. The results were further refined using inclusion and exclusion criteria. Four RCTs were selected for review. Results: The pooled results of 125,576 men showed a significant reduction in the incidence of ruptured AAAs and AAA-related mortality in the intervention group. There was an insignificant reduction in all-cause mortality, and a significant increase in surgical rates in the intervention group. One of the reviewed studies looked at the effects of screening on 9,342 women and reported an insignificant reduction in AAA-related mortalities, all-cause mortality, and ruptured incidence. Conclusion: There is evidence that a population-based screening has a significant effect in reducing AAA-related mortality in males aged 65Á74. Due to the paucity of evidence in current available literature, no definitive conclusions can be drawn regarding population-based screening for AAA in women; it is suggested that future studies should be carried out to assess the benefits and relative risks of screening for this population.
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