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resection is more suitable.

Inguinal hernia has a lifetime incidence of 27% in men and 3% in women. Surgery is the recommended treatment, but there is no consensus on the best method. Open repair is most popular, but there are concerns about the risk of chronic groin pain. Laparoscopic repair is increasingly accepted due to the lower risk of chronic pain, although its recurrence rate is still unclear. The aim of this overview is to compare the risk of recurrence and chronic groin pain in laparoscopic versus open repair for inguinal hernia.

We searched Ovid MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses. Only reviews of randomised controlled trials (RCTs) in adults published in English were included. Conference proceedings and editorials were excluded. The quality of the systematic reviews was assessed using the AMSTAR 2 checklist. Two outcomes were considered hernia recurrence and chronic pain.

Twenty-one systematic reviews and meta-analyses were included. Laparoscopic repaepairs.

The diagnosis and treatment of small bowel diseases (SBDs) has always been a challenge. The purpose of this study was to evaluate the value of double-balloon enteroscopy (DBE) in the diagnosis and treatment of small bowel diseases.

The clinical data of 466 patients who underwent double-balloon enteroscopy (DBE) in the Endoscope Center of Gastroenterology Department of the First People's Hospital of Yunnan Province from Jan. 2015 to Dec. 2020 were analysed retrospectively. The factors included age, sex, indications, endoscopic treatment results, pathological results, discharge diagnosis and so on.

A total of 370 patients underwent 466 double-balloon enteroscopies, among whom 274 underwent one examination and 96 received two-way examinations (oral and transanal approaches). Abnormalities were detected in 299 cases, with a detection rate of 80.81% (299/370). The common indications were occult gastrointestinal bleeding (OGIB) (30.8%, 114/370) and abdominal pain (28.3%, 105/370). The diagnosis rates were 64.9% and 77.1%, respectively. The common positive findings included nonspecific inflammation/erosion (60 cases), ulcers (34 cases), diverticulum (32 cases), polyps (26 cases) and Crohn's disease (CD) (24 cases). The common tumours were lymphoma(12 cases), adenocarcinoma(11 cases) and stromal tumour(8 cases). Lymphoma was mostly located in the ileum, while stromal tumours and adenocarcinoma were mostly located in the duodenum and jejunum. The main endoscopic intervention measures were haemostasis and polypectomy, including haemostatic clip, argon plasma coagulation (APC), endoscopic mucosal resection (EMR), endoscopic trap resection, endoscopic foreign body extraction and other operations, without serious complications.

DBE has a high success rate in the diagnosis and treatment of some SBDs, and it is a safe and effective management method.

DBE has a high success rate in the diagnosis and treatment of some SBDs, and it is a safe and effective management method.

Mixed modalities are frequently utilized in total shoulder arthroplasty (TSA) to control pain, improve patient satisfaction, reduce narcotics use and facilitate earlier discharge. We investigate the relationship between early postoperative pain control and long-term functional outcomes after shoulder arthroplasty.

A retrospective review identified 294 patients (314 shoulders) who underwent anatomic or reverse TSA and received a continuous cervical paravertebral nerve block perioperatively. Opioid and non-opioid analgesics were also available to the patients in an "as needed" capacity to augment perioperative pain control. In addition to demographic and surgical characteristics, the impact on functional outcomes of relative pain (i.e., a patient's subjective pain relative to the entire cohort), pain gradient (i.e., the slope of a patient's subjective pain), and opioid consumption during the first 24h postoperatively were assessed. Shoulder function was assessed using validated outcome measures collected atulder function with the Constant score at 2 years postoperatively in both univariate and multivariate analysis. Larger-scale investigation may be warranted to see if this is true for other functional outcome measures.

III, treatment study.

III, treatment study.Post-mortem computed tomography (PMCT) has been increasingly used as routine examination in forensic pathology. No recent review of the growing number of papers on the ability of PMCT to detect skull fracture exists, and original papers report sensitivities from 0.85 to 1.00. This systematic review (PROSPERO CRD42021233264) aims to provide a meta-analysis of sensitivity and specificity of PMCT in skull fracture detection. We searched PubMed, MEDLINE and Embase for papers published between January 2000 and August 2021 reporting raw numbers, sensitivity and specificity or Abbreviated Injury Score for PMCT compared to autopsy. Papers without both PMCT and autopsy, no separate reporting of the neuro-cranium, exclusively on children, sharp trauma, gunshot or natural death as well as case reports and reviews were excluded. Two authors independently performed inclusion, bias assessment and data extraction. QUADAS-2 was used for bias assessment and a random effects models used for meta-analysis. From 4.284 hits, 18 studies were eligible and 13 included in the meta-analysis for a total of 1538 cases. All deceased were scanned on multi-slice scanners with comparable parameters. Images were evaluated by radiologists or pathologists. Intra- and inter-observer analyses were rarely reported. In summary, sensitivity of PMCT for detection of fractures in the skull base was 0.87 [0.80; 0.92] with specificity 0.96 [0.90; 0.98], and sensitivity for the vault was 0.89 [0.80; 0.94] with specificity 0.96 [0.91; 0.98]. click here The mixed samples are a limitation of the review.

A recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register.

Patients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30days, 90days, and 1year after surgery, for patients 80years or older, was calculated. Overall survival was calculated using the Kaplan-Meier estimate. Risk factors for mortality were assessed with Cox's multiple regression analysis. The standardized mortality ratio was calculated.

There were 17,969 patients. Among them, 483 patients were 80years or older, and of these, 397 (82.2%) were women. The mortality rate at 0-30days, 31-90days, and at 91-365days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9-7.2) and the median (IQR) survival time was 8.0 (4.1-12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49-0.91) for men and 0.76 (0.65-0.89) for women.

Mortality after surgery for benign thyroid disease in patients 80years or older was lower than the general population with no specific risk factors for death except for age.

Mortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disorder characterized by progressive degeneration of motor neurons (MNs). Most cases are sporadic, whereas 10% are familial. The pathological mechanisms underlying the disease are partially understood, but it is increasingly being recognized that alterations in RNA metabolism and deregulation of microRNA (miRNA) expression occur in ALS. In this study, we performed miRNA expression profile analysis of iPSC-derived MNs and related exosomes from familial patients and healthy subjects. We identified dysregulation of miR-34a, miR-335 and miR-625-3p expression in both MNs and exosomes. These miRNAs regulate genes and pathways which correlate with disease pathogenesis, suggesting that studying miRNAs deregulation can contribute to deeply investigate the molecular mechanisms underlying the disease. We also assayed the expression profile of these miRNAs in the cerebrospinal fluid (CSF) of familial (fALS) and sporadic patients (sALS) and we identified a significant dysregulation of miR-34a-3p and miR-625-3p levels in ALS compared to controls. Taken together, all these findings suggest that miRNA analysis simultaneously performed in different human biological samples could represent a promising molecular tool to understand the etiopathogenesis of ALS and to develop new potential miRNA-based strategies in this new propitious therapeutic era.

The treatment of carpal tunnel syndrome (CTS) usually involves surgical decompression of the nerve or splinting and additional medication. Physiotherapy and sports therapy could be non-invasive and alternative treatment approaches with a simultaneous low risk of side effects.

The review systematically summarizes the current studies on the effectiveness of physiotherapy and sports therapeutic interventions for treatment of CTS and focuses on the reduction of symptoms and, as asecondary outcome, improvement of hand function.

The systematic review includes randomized controlled trials reporting on physiotherapy or sports therapy interventions published prior to February 2021 in the electronic databases PubMed, CINAHL and Web of Science. Following the guidelines of preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the Cochrane Collaboration, asystematic search of the literature, data extraction and evaluation of the risk of bias using the Cochrane risk of bias tool were conductematic Reviews (PROSPERO) with the number 42017073839.

For the management of mild to moderate CTS, physiotherapy and sports therapeutic interventions are characterized primarily by success after as little as 2 weeks of treatment as well as comparable success to surgery and 3 months of postoperative treatment. In addition, patients are not exposed to surgical risks. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the number 42017073839.There is currently an emphasis on the biopsychosocial concept of pain in pain therapy programs. However, the complexity of chronic pain, in particular its importance for those affected by it, can only be insufficiently captured with this concept. This is due to the fact that, to date, one core aspect of the phenomenon chronic pain has only rarely been taken into account its existential character. Chronic pain can threaten the self-image and the individual's understanding of the world, their wishes and goals in life, and ultimately the entire integrity of those affected. Statements by chronic pain sufferers show that such pain always represents an existential experience and affects the person as a whole. Two aspects make this very clear the existential despair of the pain on the one hand, as well as questions of meaning and reorientation on the other. Current treatment concepts, however, do not adequately consider the existential character of such challenges. Chronic pain should therefore always be perceived and treated from a holistic perspective.