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BACKGROUND: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been known to result in better functional outcomes, joint stability, and lower revision rates compared to single-bundle (SB) ACLR. However, given the increased invasiveness and damage to the surrounding tissue area, it is proposed that it may be associated with increased pain. AIM: This review aims to gather all studies and literature that reported pain as an outcome when comparing SB versus DB ACLR. METHODS: Literature searching was conducted across seven search engines for studies reporting pain as an outcome and comparing SB versus DB ACLR. RESULTS: Eight studies met the eligibility criteria and were included in the study. Overall, the studies show variable findings regarding pain in DB compared to SB ACLR, with the only statistically significant results from two studies indicating that DB ACLR is associated with more pain than SB ACLR. CONCLUSION: Based on the limited evidence available, no conclusions can be made regarding the pain experienced between people receiving either procedure. This constitutes a need for additional studies with increased follow-up time periods, larger sample size, and better study design.

Bladder cancer is one of the most frequent cancers of the urinary tract, associated with high recurrence rates and metastasis. Cancer stem cells (CSCs) are a subpopulation of cancer cells characterized by high self-renewal and differentiation capacities, resulting in increased cancer recurrence, larger tumor size, higher rates of metastasis, higher resistance to treatment, and overall poorer prognosis. This study aimed to evaluate the role of CSCs as a prognostic tool to predict the risks of metastasis and recurrence in bladder cancer. A literature search was conducted across seven databases from January 2000 to February 2022 for clinical studies investigating the use of CSCs to determine the prognosis of bladder cancer. The following keywords were used: (“Bladder Cancer” OR “Transitional Cell Carcinoma” OR “Urothelial Carcinoma”) AND (“Stem Cell” OR “Stem Gene”) AND (“Metastasis” OR “Recurrence”). A total of 12 studies were deemed eligible for inclusion. SOX2, IGF1R, SOX4, ALDH1, CD44, Cripto-1, OCT4, ARRB1, ARRB2, p-TFCP2L1, CDK1, DCLK1, and NANOG, which were all identified as CSC markers, have been implicated in the recurrence and metastasis of tumor in bladder cancer, which played a role as prognostic factor of bladder cancer. Given the pluripotent and highly proliferative properties of CSCs. CSCs may play a role in the complex biological behavior of bladder cancer, including, but not limited to, its high rates of recurrence, metastasis, and resistance to treatment. The detection of cancer stem cell markers offers a promising approach in determining the prognosis of bladder cancer. Further studies in this area are thus warranted and may contribute significantly to the overall management of bladder cancer.

Background: The outcome for TKA (total knee arthroplasty) upon whether the posterior cruciate ligament is preserved with cruciate retaining (CR) prostheses or sacrificed with posterior stabilized (PS) prostheses are still debated between studies. Materials and Methods: We included a total of 144 knees operated with cemented fixed bearing primary CR or PS TKAs. Independent t-tests were conducted for the outcomes and possible confounding variables between groups where relevant, with analyses using Chi-squared tests for nominal data. Results: Operation on patients with age of lower than 65 years predicts increased intraoperative bleeding volume (p = 0.037), pre-operative range of motion (ROM) of less than 90 degrees was a predictor for better improved post-operative ROM (p 0.001) and PS prostheses is superior to CR in terms of ROM improvement (p = 0.04), however with both groups achieving similar maximum ROM (p = 0.308). Conclusion: Improvement of ROM is increased by the use of PS prostheses compared to CS prostheses, with pre-operative ROM as a possible confounding factor and the maximum ROM achieved for both prostheses being similar. Lower age of the operation is also related to increased intraoperative bleeding

Background: Variceal bleeding is a serious complication of portal hypertension in liver cirrhosis. Current guidelines recommend non-selective beta blockers (NSBBs) and endoscopic variceal ligation for primary prophylaxis of variceal bleeding. However, NSBBs are associated with low response rates and systemic adverse effects. Simvastatin has been shown to reduce portal hypertension in previous studies. Our aim was to assess its clinical efficacy and safety in reducing portal hypertension in cirrhotic patients. Method: We searched PubMed , The Cochrane Library , ScienceDirect , ProQuest , CINAHL , Scopus , and Clinicaltrials.gov , and manually browsed abstracts of major hepatology conferences for selection of studies. We selected randomized controlled trials with a population of cirrhotic patients, simvastatin as an intervention, HVPG change as an outcome, and English as the primary language. The quality of selected studies was assessed using the Cochrane Risk of Bias tool. We extracted change in HVPG from baseline to post-treatment as the principal summary measure, with safety as the secondary outcome. Results: Two full articles were included for qualitative analysis. Both studies reported reductions in HVPG from baseline to post-treatment in the simvastatin group, with this reduction being significantly higher as compared to the control group. Adverse effects were homogenously distributed in both groups, and good safety was reported by both studies. Simvastatin’s HVPG lowering effects are possibly additive to those of NSBBs. Conclusion: Simvastatin effectively reduces HVPG in cirrhotic patients with portal hypertension, although more clinical trials are needed to validate these results. Simvastatin could potentially be combined with NSBBs to achieve greater results.

Platelet to lymphocyte ratio (PLR) is a candidate prognostic marker for metastatic castration‐resistant prostate cancer patients receiving abiraterone acetate and evidence demonstrates that a high PLR is associated with poor survival. More studies are required to verify current findings and establish a definite cutoff point.

Background Chronic Achilles Tendinopathy is a common condition that can be challenging to treat. There are many modalities used as treatment ranging from physiotherapy, injections, shockwave therapy to surgical intervention. Platelet Rich Plasma (PRP) has increased in popularity recently as a treatment option for Achilles Tendinopathy. It contains growth factors that might accelerate healing and speed up the recovery of this condition. Many studies have been conducted in the last few years to assess the effectiveness of this treatment method. However, there was controversy as to whether PRP had a beneficial effect on chronic Achille tendinopathy. Aim This systematic review of the literature was conducted to ascertain the efficacy of Platelet Rich Plasma (PRP) as a treatment option in chronic Achilles tendinopathy. Methods PRISMA reporting item for systematic review has been used to conduct the selection, Electronic databases included PubMed, EMBASE, Cochrane collaborate, Google scholar, the web of science and Cochrane Library were searched for all RCT, prospective and retrospective studies conducted between January 2010 to February 2019. The quality of each study was evaluated using the Oxford CEBM tool to assess the articles for validity, relevance, and applicability of the results. A total number of 288 were found, and only 11 met the inclusion criteria. Results 5 Randomised control trials, 4 prospective and 2 retrospective cohort study were included in this systematic review. A total number of 406 patients were treated for non-insertional Achilles tendinopathy of which 230 patients had PRP local injection under Ultrasound guide. Conclusion Although many of the retrospective studies suggested an advantage of using PRP, the higher level of evidence studies do not support a significant efficacy. This systematic review showed very promising results from the use of Platelet Rich Plasma demonstrated by a significant improvement in the VAST-A score, but we certainly need decent size randomised control trials to show better and more accurate results., Highlights • Platelet rich plasma (PRP) has increased in popularity as a treatment option for Achilles Tendinopathy as it contains growth factors that might accelerate healing and speed up the recovery of this condition. • Results of this systematic review showed significant improvement in the VISA-A score of the overall studies 28.9 point, comparing the VISA-A score using PRP with the most recent systematic review studied the effectiveness of heavy eccentric calf training (Murphy et al., 2019) [20]. • Most of the RCTs were characterised by their small sample sizes which might resulted in the insignificant results.

Background The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. Methods Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. Results Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA Conclusion PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. Level of evidence Level 2, systematic review of Level 1 and 2 studies.