Diagnostic ultrasound is widely used for evaluating carpal tunnel syndrome (CTS), an entrapment neuropathy of the median nerve (MN). Decreased mobility of the MN inside the carpal tunnel has been reported in CTS, and various methods have been used to evaluate MN mobility; however, there is still no conclusive understanding of its connection with CTS. The purpose of this study is to conduct a systematic review and meta-analysis of the current published literature on ultrasonographic evaluations of transverse and longitudinal MN displacement and to identify the relationship between MN mobility and CTS. This study was conducted in accordance with the 2020 PRISMA statement and the Cochrane Collaboration Handbook. Comparative studies that investigated differences in MN displacement between CTS patients and healthy controls were retrieved by searching the Cochrane Library, Embase and PubMed. A total of 15 case–control studies were included. Nine of 12 studies evaluating transverse MN displacement and 4 of 5 studies evaluating longitudinal MN gliding showed that the MN was less mobile in CTS patients than in healthy subjects. Despite the large heterogeneity among the 15 included studies, this systematic review and meta-analysis provide evidence that the mobility of the MN is significantly reduced in both transverse and longitudinal planes in CTS patients compared to healthy controls. Five of the 15 included studies reported that a decrease in transverse or longitudinal MN displacement in CTS was correlated with clinical symptoms or with severity as measured by a nerve conduction study (NCS).

Background Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) has been well-known for its advantages in the past 10 years, but little is known regarding its oncologic outcomes while the technique is being developed at an institution. This study aimed to evaluate the safety and effectiveness of LH for patients with primary HCC at favorable locations, focusing on postoperative short-, and long-term outcomes during the development period. Methods We retrospectively reviewed patients diagnosed with primary HCC that underwent hepatectomy between January 2013 and December 2019 at Hualien Tzu Chi Hospital. Patients with HCC at favorable locations (anterolateral segments) were collected and divided into laparoscopic and open hepatectomy (OH) groups. The primary end point was long-term oncologic outcomes, including overall, and disease-free survival, whereas the secondary end point was postoperative short-term outcomes. Results The review included 159 patients, and among which 42, and 44 patients with HCC in favorable locations were underwent open and laparoscopic hepatectomies. There were no significant differences in intraoperative blood loss (200 vs. 300 mL, p = 0.072), overall complication rate (57.2% vs. 36.4%, p = 0.083), major complication rate (11.9% vs. 2.3%, p = 0.080), and 90-day mortality rate (7.1% vs. 0.0%, p =0.071) between the two groups. The laparoscopic group had a lower transfusion rate (14.3% vs. 2.3%, p = 0.042), shorter post-operative hospital stay (10 days vs. 7 days, p < 0.001), and lower 90-day readmission rate (14.3% vs. 2.3%, p = 0,042). There were no significant differences in 12-, 36,- and 60-month overall survival and disease-free survival. Conclusions LH for favorably located HCC is the preferred surgical approach compared to OH due to the decreased transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. LH did not compromise the 90-day mortality rate with sustained long-term overall and disease-free survival. LH for favorably located HCC is a safe and effective surgical approach even during the development period.

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