BACKGROUND: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).METHODS: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.FINDINGS: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I 2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. INTERPRETATION: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.FUNDING: Dutch Association for Quality Funds Medical Specialists.
Fingermarks are highly relevant in criminal investigations for individualization purposes. In some cases, the question in court changes from ‘Who is the source of the fingermarks?’ to ‘How did the fingermark end up on the surface?’. In this paper, we explore evaluation of fingermarks given activity level propositions by using Bayesian networks. The variables that provide information on activity level questions for fingermarks are identified and their current state of knowledge with regards to fingermarks is discussed. We identified the variables transfer, persistency, recovery, background fingermarks, location of the fingermarks, direction of the fingermarks, the area of friction ridge skin that left the mark and pressure distortions as variables that may provide information on how a fingermark ended up on a surface. Using three case examples, we show how Bayesian networks can be used for the evaluation of fingermarks given activity level propositions.
High consumption of carbohydrates is linked to metabolic syndrome, possibly via the endogenous formation of advanced glycated end-products. Many Dutch elementary school children have a carbohydrate intake of >130g/day, the estimated minimum requirement. In this observational study, 126 Dutch elementary school children (5-12y of age) from two schools differing in frequency of gym lessons (2 or 5 times a week) were included. In all participants, height, weight, waist circumference, autofluorescence of skin glycated end-products (AGE-score), sports activity and carbohydrate consumption were recorded once. Sports activities in leisure time differentiated participants in ‘sportsmen’ and ‘non-sportsmen’. Carbohydrate intake and AGE score were positively associated in non-sportsmen (p<0.003), but negatively in sportsmen (p<0.002). In sportsmen, but not in non-sportsmen (p>0.50), a positive association was found (p<0.002) between carbohydrate intake and subject age. The intake of total carbohydrate and carbohydrates from juices and soft drinks was lower (p<0.001) at the Wassenberg School relative to the Alexander School. Based on waist to height ratio, >95% of the children had normal fat mass. No correlations were found between waist to height ratio or BMI and carbohydrate intake. Waist to height ratio was positively associated with BMI (p<0.001)) and subject age (p<0.001). Of all principal parameters, AGE score is most affected by being sportsmen or not (p<0.001). This study indicates that an increased intake of carbohydrates can be counteracted by sufficient physical activity (>2.5 hours per week). This implies that skin autofluorescence is a fast and non-invasive method to screen children for life style.
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