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Κυριακή 16 Ιανουαρίου 2022

Profile of Injured Singers: Expectations and Insights

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Objectives

To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training.

Study Design

Retrospective.

Methods

Retrospective review of 438 singers with phonotraumatic lesions over a 9-year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed.

Results

Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training.

Conclusions

Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps.

Level of Evidence

4 Laryngoscope, 2022

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FOCUS THEME ISSUE: CONCISE COMMUNICATION Dysbiosis of nail microbiome in patients with psoriasis

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ABSTRACT

Shifts in skin microbiome are considered to be involved in the pathogenesis of psoriasis. However, data on the microbial dysbiosis of nail psoriasis is scarce. In this study, we aim to investigate and characterize the nail bacterial and fungal microbiome in patients with psoriasis. Nail samples were collected prospectively from 36 subjects with nail psoriasis, 24 psoriatic subjects without nail involvement, and 32 healthy controls. Amplicon sequencing was performed to evaluate the bacterial and fungal community compositions. Significant alterations in the bacterial microbiome were found in the nail samples of psoriatic patients. The unaffected nails in psoriatic patients were associated with higher bacterial diversity, and a higher relative abundance of Enhydrobacter, whereas nail psoriasis was correlated with a decreased relative abundance of Anaerococcus. Shifts in fungal community composition was reflected by a higher proportion of Malassezia in the unaffec ted nails of psoriatic patients and an increased proportion of Candida in psoriatic nails. Shifts in the nail microbiome in psoriasis suggest a potential role of microbes in the development of nail psoriasis. Future researches focusing on these microorganisms may help to explain the pathogenesis of psoriasis.

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Clinicopathologic analysis of malignant or premalignant cutaneous neoplasms in Japanese kidney transplant recipients

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Int J Clin Exp Pathol. 2021 Dec 15;14(12):1138-1147. eCollection 2021.

ABSTRACT

It is well known that recipients of kidney transplants are at an increased risk of developing malignant or premalignant cutaneous neoplasms (MPCNs) after transplantation. However, the pathogenesis of MPCNs after kidney transplant has not been well-studied in Asian populations. This study aimed to describe the clinicopathologiccharacteristics of MPCNs in an Asian population. We retrospectively reviewed the medical records of 1956 patients who received kidney transplants at two hospitals in Japan, between 2003 and 2019. Among these patients, 24 developed 50 MPCN lesions, including 14 squamous cell carcinoma (SCC, 28%), 23 Bowen's disease (BD, 46%), 11 actinic keratosis (AK, 22%), and two basal cell carcinoma (BCC, 4%). No patient had malignant melanoma. The duration from transplantation to the diagnosis was significantly longer for SCC than for BD or AK (P=0. 021, 0.036, respectively). Seven patients had multiple MPCNs in sun-exposed areas of skin. Among the 50 MPCNs, 40 (80%) were located in sun-exposed areas, and 10 (20%) were located in sun-protected areas. MPCNs in sun-exposed skin were frequently accompanied by dermal solar elastosis (90%, 36/40). We found high-risk human papillomavirus (HR-HPV) infections in two anogenital lesions (100%, 2/2). In contrast, HR-HPV infections were not detected in any extragenital lesions (0%, 0/30). Our results suggested that, among Japanese recipients of kidney transplant, MPCNs in sun-exposed skin areas may be associated with immunosuppression and ultraviolet exposure.

PMID:35027994 | PMC:PMC8748015

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Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries

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Crit Care Med. 2022 Jan 6. doi: 10.1097/CCM.0000000000005433. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the feasibility of monitoring tissue oxygen tension from the injury site (psctO2) in patients with acute, severe traumatic spinal cord injuries.

DESIGN: We inserted at the injury site a pressure probe, a microdialysis catheter, and an oxygen electrode to monitor for up to a week intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue glucose, lactate/pyruvate ratio (LPR), and psctO2. We analyzed 2,213 hours of such data. Follow-up was 6-28 months postinjury.

SETTING: Single-center neurosurgical and neurocritical care units.

SUBJECTS: Twenty-six patients with traumatic spinal cord injuries, American spinal injury association Impairment Scale A-C. Probes were inserted within 72 hours of injury.

INTERVENTIONS: Insertion of subarachnoid oxygen electrode (Licox; Integra LifeSciences, Sophi a-Antipolis, France), pressure probe, and microdialysis catheter.

MEASUREMENTS AND MAIN RESULTS: psctO2 was significantly influenced by ISP (psctO2 26.7 +/- 0.3 mm Hg at ISP > 10 mmHg vs psctO2 22.7 +/- 0.8 mm Hg at ISP <= 10 mm Hg), SCPP (psctO2 26.8 +/- 0.3 mm Hg at SCPP < 90 mm Hg vs psctO2 32.1 +/- 0.7 mm Hg at SCPP >= 90 mm Hg), tissue glucose (psctO2 26.8 +/- 0.4 mm Hg at glucose < 6 mM vs 32.9 +/- 0.5 mm Hg at glucose >= 6 mM), tissue LPR (psctO2 25.3 +/- 0.4 mm Hg at LPR > 30 vs psctO2 31.3 +/- 0.3 mm Hg at LPR <= 30), and fever (psctO2 28.8 +/- 0.5 mm Hg at cord temperature 37-38[degrees]C vs psctO2 28.7 +/- 0.8 mm Hg at cord temperature >= 39[degrees]C). Tissue hypoxia also occurred independent of these factors. Increasing the FIO2 by 0.48 increases psctO2 by 71.8% above baseline within 8.4 minutes. In patients with motor-incomplete injuries, fluctuations in psctO2 correlated with fluctuations in limb motor score. The injured cord spent 11% (39%) hours at psctO2 less than 5 mm Hg (< 20 mm Hg) in patients with motor-complete outcomes, compared with 1% (30%) hours at psctO2 less than 5 mm Hg (< 20 mm Hg) in patients with motor-incomplete outcomes. Complications were cerebrospinal fluid leak (5/26) and wound infection (1/26).

CONCLUSIONS: This study lays the foundation for measuring and altering spinal cord oxygen at the injury site. Future studies are required to investigate whether this is an effective new therapy.

PMID:35029868 | DOI:10.1097/CCM.0000000000005433

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A systematic review: metabolomics‐based identification of altered metabolites and pathways in the skin caused by internal and external factors

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Abstract

The skin's ability to function optimally is affected by many diverse factors. Metabolomics has a great potential to improve our understanding of the underlying metabolic changes and the affected pathways. Therefore, the objective of this study was to review the current state of the literature and to perform further metabolic pathway analysis on the obtained data. The aim was to gain an overview of the metabolic changes under altered conditions and to identify common and different patterns as a function of the investigated factors.

A cross-study comparison of the extracted studies from different databases identified 364 metabolites, whose concentrations were considerably altered by the following factor groups: irradiation, xenobiotics, aging, and skin diseases (mainly psoriasis). Using metabolic databases and pathway analysis tools the individual metabolites were assigned to the corresponding metabolic pathways and the most strongly affected signaling pathways were identified.

All factors induced oxidative stress. Thus, antioxidant defense systems, especially coenzyme Q10 (aging) and the glutathione system (irradiation, aging, xenobiotics) were impacted. Lipid metabolism was also impacted by all factors studied. The carnitine shuttle as part of β-oxidation was activated by all factor groups except aging. Glycolysis, Krebs (TCA) cycle and purine metabolism were mainly affected by irradiation and xenobiotics. The pentose phosphate pathway was activated and Krebs cycle was downregulated in response to oxidative stress. In summary, it can be ascertained that mainly energy metabolism, lipid metabolism, antioxidative defense and DNA repair systems were impacted by the factors studied.

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The effect of COVID-19 pandemic on laryngeal cancer in a tertiary referral center

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Eur Arch Otorhinolaryngol. 2022 Jan 15. doi: 10.1007/s00405-022-07268-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate whether there was a significant change in the laryngeal cancer stage before and after the COVID-19 pandemic.

METHODS: This retrospective cohort study was conducted to evaluate the data of patients who operated due to laryngeal cancer in a tertiary referral hospital's ear, nose, and throat (ENT) department between June 2018 and 2021. The patients were included at the same period of the years to rule out any seasonal changes. The basic characteristic, tumor localization, and TNM stage of the patients were compared.

RESULTS: 97 patients were operated due to laryngeal cancer during the time period reviewed. 57 (58.8%) patients were operated before and 40 (41.2%) after the COVID-19 pandemic. When comparing the patients before and after the COVID-19 pandemic period, the mean age significan tly differed between the study groups that older age was observed in patients who admitted before the COVID-19 pandemic (62.8 ± 6.5 vs. 57.3 ± 6.8, p < 0.001). Regarding the TNM classification, the patients in the after COVID-19 pandemic group had higher rates of T4 stage laryngeal cancer compared to before COVID-19 pandemic group (12 (30%) vs. 4 (7%), p: 0.003).

CONCLUSION: Younger patients have operated after the COVID-19 pandemic, and the patients were presented with larger tumor sizes. The pandemic may increase the time between diagnosis and surgery in laryngeal cancer patients.

PMID:35031859 | DOI:10. 1007/s00405-022-07268-z

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Recommendations to protect patients with cancer against the Omicron variant

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Préconisations pour protéger les patients de la filière oncologique face au variant OmicronRecommendations to protect patients with cancer against the Omicron variant
Author links open overlay panelJérômeBarrière1GérardZalcman2LaurentFignon3NathanPeiffer-Smadja4ClarisseAudigier-Valette5MichelCarles6
https://doi.org/10.1016/j.bulcan.2021.12.007Get rights and content
La protection contre le SARS-CoV-2 des patients suivis pour cancer sous traitement antinéoplasique est un enjeu prioritaire de la communauté oncologique depuis le début de la pandémie. Cet objectif s'est concrétisé en France par des actions fortes et rapides : la sanctuarisation « COVID-free » dès mars 2020 des services de chimiothérapie, l'accès prioritaire dès janvier 2021 [[1], [2]] à la vaccination et l'autorisation dès avril 2021 d'une troisième dose vaccinale précoce (DGS urgent avril 21) en cas de facteurs de risque d'immunodépression.

Nous avons récemment proposé un arbre décisionnel en fonction du taux d'anticorps (Ac) anti-Spike (S) après la deuxième dose, dans le but d'identifier les patients pouvant bénéficier d'une troisième dose précoce, en priorisant ceux ayant un taux < 260 BAU/mL [3]. Il s'agissait là de permettre un schéma vaccinal complet accéléré pour répondre au variant Delta [4].

L'émergence en Europe [5] et dans le monde, fin 2021, du variant Omicron à forte contagiosité impose une réponse rapide. Ce variant est caractérisé par un échappement immunitaire partiel à important, à la fois contre l'immunité post-infectieuse, post-vaccinale et contre les anticorps monoclonaux anti-SARS-CoV-2, qui est lié à de nombreuses mutations de la protéine S [[6], [7]].

Plusieurs raisons justifient cette urgence. D'une part, l'émergence d'Omicron s'est partout traduite à ce jour par la disparition rapide des autres variants en circulation. C'est donc la souche qui menace aujourd'hui les patients y compris oncologiques. D'autre part, l'efficacité de la réponse immunitaire liée soit à une infection préalable par d'autres souches, soit à la vaccination, semble fragilisée par Omicron [[7], [8]]. Enfin, la neutralisation du SARS-Cov2 obtenue par les combinaisons d'anticorps monoclonaux anti-SARS-CoV-2 disponibles (casirivimab/imdevimab et tixagevimab/cilgavimab) apparaît sur les données préliminaires de tests de neutralisation in vitro nulle pour les premiers et très incertaine pour les derniers [9]. Or, ces anticorps, lorsqu'ils étaient administrés en prophylaxie permettaient de diminuer significativement le risque d'infection à SARS-CoV-2 (étude PROVENT, [10]) et, lorsqu'ils étaient administrés en traitement précoce, le risque de COVID-19 sévère [11].

Nous alertons la communauté oncologique sur le risque supplémentaire de COVID-19 grave lié à l'émergence du variant Omicron, pour les patients suivis pour cancer. Prenant en compte les données disponibles en population générale, ce risque est majeur dans la population oncologique, comme pour d'autres populations immunodéprimées (thérapies ciblées anti-CD20 par exemple). Néanmoins, la quantification précise de ce risque en termes d'hospitalisation et de décès n'est pas connue à ce jour.

Afin d'anticiper cette nouvelle menace, à la fois du point de vue du risque de contagiosité que de l'échappement à la réponse immune, nos six propositions sont les suivantes :

Proposition 1 : recommander une troisième dose vaccinale pour tous avec contrôle du taux résiduel d'Ac anti-S à trois mois. Face au variant Omicron, les données déjà disponibles objectivent une diminution de l'efficacité vaccinale plus rapide que par rapport au variant Delta, avec manifestement une protection accrue du booster (dose 3) [12]. Le niveau d'Ac anti-S obtenu après une dose 3 a été rapporté environ neuf fois supérieur qu'après une dose 2 dans la population générale [13]. En oncologie les données sont encore trop peu nombreuses mais certains patients semblent tirer nettement bénéfice du boosteravec des taux d'Ac anti-S sous chimiothérapie qui dépassent les taux atteints après deux doses [14], qui rappelons-le demeurent significativement inférieurs à la population générale à quatre semaines de la dose 2 [15]. Recommander la dose 3 précocement (à trois ou quatre mois de la dose 2) pour tous les patients oncologiques désormais (certains n'ont à ce jour encore uniquement reçu deux doses), et administrer une dose 4 pour ceux ayant déjà fait leur dose 3 depuis trois à quatre mois en fonction du taux d'Ac anti-S résiduel, apparaît opportun pour tenter de protéger au mieux ces patients face au variant Omicron qui nécessite un taux d'anticorps protecteurs plus élevés que face aux précédents variants. Ayant montré que les traitements par anticorps anti-CD20 constituent un facteur de risque majeur d'absence de réponse humorale à la vaccination chez les patients atteints de leucémie lymphoïde chronique ou lymphome, même avec une troisième dose vaccinale précoce [16], la dose 4 a cependant très peu de chances d'être efficace dans ce sous-groupe de patients.

Proposition 2 : retenir le seuil de 1000 BAU/mL comme taux d'Ac anti-S pour une dose vaccinale additionnelle (dose 4). Si le taux d'anti-S mesuré est < 1000 BAU/mL, une dose additionnelle est proposée. Ce seuil correspond en effet à celui obtenu environ trois à quatre mois après dose 2 dans une population sans comorbidité [17] et à qui désormais une dose 3 est proposée de manière anticipée pour conférer rapidement une protection sérologique optimale face à Omicron. Ce seuil pourrait donc être la valeur retenue pour la surveillance des patients immunodéprimés, en particulier les patients oncologiques, afin de proposer une dose vaccinale additionnelle, c'est-à-dire une dose 4.

Proposition 3 : prescription en prophylaxie primaire pré-exposition de l'association d'anticorps monoclonaux tixagevimab/cilgavimab (EVUSHELD®, AstraZeneca), pour les patients sans séroconversion après dose 3–4. Cette association d'anticorps à demi-vie longue demeure efficace in vitro sur le variant Delta. Lorsque Omicron sera le variant majoritaire, le risque de perte de sensibilité décrit in vitro devrait alors faire prioriser l'anticorps sotrovimab (XEVUDY®, GSK) [18] semblant moins affecté in vitro par les mutations d'Omicron [9] même si les données d'efficacité clinique de l'association tixagevimab/cilgavimab face à Omicron pourraient s'avérer suffisantes, avec possiblement la nécessité d'une deuxième administration précoce pour maintenir un taux élévé des anticorps dans le sang ou d'une augmentation de la dose.

Actuellement seuls les patients atteints d'hémopathies lymphoïdes ou ayant reçu une greffe de cellules souches hématopoïétiques sont éligibles en oncologie à la procédure d'accès précoce. Il nous semble opportun d'élargir à l'ensemble de la population oncologique sous traitement actif les indications, face au risque omicron, en l'absence de séroconversion après un schéma vaccinal à quatre doses. Le seuil de 264 BAU/mL actuellement seuil de prescription reste à préciser face au variant Omicron et pourrait nécessiter un relèvement à 1000 BAU/mL.

Proposition 4 : vaccination complète (trois doses) pour les proches des patients sous chimiothérapie. Nous recommandons également la vaccination des enfants de cinq à onze ans en contact de parents immunodéprimés, en accord avec la plupart des sociétés savantes pédiatriques mondiales et les autorités américaines (FDA) et européennes (EMA) du médicament.

Proposition 5 : port d'un masque de protection de type Filtering Face Piece type 2 (FFP2/N95) pour les patients en cours de traitement actif, dont certains (avec cancer pulmonaire, hémopathie lymphoïde…) ont un risque de décès de 30 % ou plus en cas de contamination, dans les lieux avec du public. De récentes données comparatives en conditions expérimentales évaluent une protection individuelle supérieure par rapport au port de masques chirurgicaux [19]. Le gain peut apparaître cependant limité si le port des masques chirurgicaux était bien respecté par tous, mais cette condition apparaît peu réaliste dans les lieux avec public (cinéma, transports en commun etc.) ou encore lors des transports en VSL/ambulance, voire lors des séances de chimiothérapie en salle commune. La protection d'un masque de type FFP2 nous apparaît ainsi être une recommandation basée sur le principe de précaution (accord d'experts) en période de forte circulation virale d'un agen t pathogène très contagieux pour protéger une population immunodéprimée.

Ces masques représentent un surcoût non négligeable par rapport aux masques dits chirurgicaux simples, eux remboursés. Nous recommandons donc de manière rapide leurs remboursements sur prescription médicale.

Proposition 6 : favoriser si disponibilité l'inclusion des patients suivis pour une néoplasie dans les essais thérapeutiques innovants que ce soit en prophylaxie primaire ou post-exposition, en cas de PCR positive en ciblant les anticorps monoclonaux ou thérapies antivirales à venir telles que l'association PF-07321332 et ritonavir (PAXLOVID®, Pfizer) dont les données d'efficacité contre le variant Omicron, ou dans une population immunodéprimée ne sont pas encore connues.

En conclusion, la mise en œuvre de ces six propositions est de nature à protéger au mieux les patients suivis pour cancer, en particulier ceux en soins actifs, avec des données suffisantes pour formuler des recommandations complètes associant plusieurs mesures de protection qui prennent en compte le risque d'inefficacité vaccinale. Dans un contexte de reprise épidémique avec un nouveau variant hautement contagieux et échappant au moins partiellement à l'immunité acquise, nous n'avons pas le temps d'attendre des études à plus large échelle. Pour les patients immunodéprimés, c'est une menace immédiate dès janvier 2022 à laquelle nous devons apporter une réponse rapide, qui s'adaptera aux futures informations dès qu'elles seront disponibles.

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© 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

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Bull Cancer. 2022 Jan 11:S0007-4551(21)00685-8. doi: 10.1016/j.bulcan.2021.12.007. Online ahead of print.

NO ABSTRACT

PMID:35031126 | DOI:10.1016/j.bulcan.2021.12.007

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Magnesium alginate versus proton pump inhibitors for the treatment of laryngopharyngeal reflux: a non-inferiority randomized controlled trial

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Eur Arch Otorhinolaryngol. 2022 Jan 15. doi: 10.1007/s00405-021-07219-0. Online ahead of print.

ABSTRACT

PURPOSE: Proton pump inhibitors (PPIs) are commonly prescribed for laryngopharyngeal reflux (LPR), but their efficacy remains debated. Alginates is an option for the treatment of LPR with few adverse effects. The study aimed to investigate the non-inferiority of an alginate suspension (Gastrotuss®) compared to PPIs (Omeprazole) in reducing LPR symptoms and signs.

METHODS: A non-inferiority randomized controlled trial was conducted. Fifty patients with laryngopharyngeal symptoms (Reflux Symptom Index -RSI- ≥ 13) and signs (Reflux Finding Score -RFS- ≥ 7) were randomized in two treatment groups: (A) Gastrotuss® (20 ml, three daily doses) and, (B) Omeprazole (20 mg, once daily). The RSI and the RFS were assessed at baseline and after 2 months of treatment.

RESULTS: Groups had similar RSI and RFS scores at baseline. From pre- to 2-month posttreatment, the mean RSI significantly decreased (p = 0.001) in alginate and PPI group (p = 0.003). The difference between groups in the RSI change was not significant (95%CI: - 4.2-6.7, p = 0.639). The mean RFS significantly decreased in alginate (p = 0.006) and PPI groups (p = 0.006). The difference between groups in the mean change RFS was not significant (95%CI: - 0.8; 1.4, p = 0.608).

CONCLUSION: After 2 months of treatment, LPR symptoms and signs are significantly reduced irrespective of the treatment. Alginate was non-inferior to PPIs and may represent an alternative treatment to PPIs for the treatment of LPR.

PMID:35032204 | DOI:10.1007/s00405-021-07219-0

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Anterior Cervical Discectomy and Fusion Using Zero-P System for Treatment of Cervical Spondylosis: A Meta-Analysis

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Pain Res Manag. 2021 Dec 16;2021:3960553. doi: 10.1155/2021/3960553. eCollection 2021.

ABSTRACT

OBJECTIVE: The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis.

METHODS: Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 softwa re was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups.

RESULTS: A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P = 0.0009] of the Zero-P group were significant ly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = -0.23, CI (-1.38, 95% 0.92), P = 0.69], postoperative cervical curvature [WMD = -0.38, CI (-1.77, 95% 1.01), P = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P = 0.38], preoperative DHI [WMD = -0.04, CI (-0.14, 95% 0.22), P = 0.65], and postoperative DHI [WMD = 0.06, CI (-0.22, 95% 0.34), P = 0.675] were not significantly different between the two groups.

CONCLUSION: It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.

PMID:34956433 | PMC:PMC8702348 | DOI:10.1155/2021/3960553

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