骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折疗效的Meta分析

目的 :系统评价骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折的临床疗效。方法 :采用主题词和自由词(或主题词和关键词)结合的方法,通过计算机检索Pubmed、考克兰数据库(Cochrane databases)、中国知网数据库(CNKI),检索起止时间为从建库至2015年8月。收集骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折的随机对照研究和准随机对照研究。选择术后再移位、再手术率、并发症(感染和骨折不连)、功能结果、生活质量评分和肌肉力量作为结局指标。计数资料采用风险差异及95%可信区间,计量资料采用均数差和95%可信区间。当同一计量资料在不同的研究中被不同标准评估时,采用其标准均值差及95%可信区间。按照考克兰协作网推荐的方法进行系统评价。结果:共纳入11项研究677例患者。Meta分析结果显示:骨替代物加强内固定组术后较少发生再移位[SMD=-0.75,95%CI(-1.03,-0.47)],并可获得更好的功能[SMD=0.40,95%CI(0.20,-0.59)]。两组患者再手术率[RD=0.02,95%CI(-0.05,-0.09)]、术后1周疼痛[SMD=-1.79,95%CI(-13.55,-9.96)]、术后6~8周疼痛[SMD=-7.24,95%CI(-20.07,-5.59)]、术后12周疼痛[MD=-0.32,95%CI(-4.19,-3.55)],肌力[MD=1.25,95%CI(-6.98,-9.48)]、骨折不愈合[RD=0.02,95%CI(-0.01,-0.05)]、术后感染[MD=0.01,95%CI(-0.03,-0.04)]等方面比较无明显差异。结论:与单纯内固定治疗相比,采用骨替代物加强内固定治疗老年股骨近端骨折术后较少发生再移位,且可获得较好的功能恢复。     

Serum levels of malondialdehyde,vitamin C and E in idiopathic nephrotic syndrome: a meta-analysis

It is well documented that oxidative stress is involved in the pathogenesis of idiopathic nephrotic syndrome (INS). Malondialdehyde (MDA) is a measurement of lipid oxidation; vitamin C and E are important components of antioxidants. However, the association between MDA, vitamin C or E levels and INS remains elusive. A meta-analysis was performed to investigate the alteration of serum levels of MDA, vitamin C and E in INS compared with controls. Eight studies were included in our meta-analysis according to predefined criteria. Active INS patients demonstrated significantly higher level of serum MDA (SMD: 2.13, 95% CI: 1.511 to 2.749, p?10^?4), markedly lower levels of serum vitamin C (SMD: ?1.449, 95% CI: ?2.616 to ?0.281, p?=?0.015) and E (SMD: ?1.45, 95% CI: ?2.544 to ?0.356, p?=?0.009) compared with those in controls. Active steroid-sensitive nephrotic syndrome (SSNS) patients showed comparable levels of serum vitamin C and E to those in controls. INS subjects in the remission stage demonstrated significantly higher level of serum MDA (SMD: 1.028, 95% CI: 0.438 to 1.617, p?10^?4), markedly lower level of serum vitamin C (SMD: ?2.235, 95% CI: ?3.048 to ?1.421, p?10⁴) and similar level of serum vitamin E compared with those in controls. No significant publication bias was observed. In conclusion, the disorder of MDA and vitamin C persists in the remission stage of INS. It seems that the serum levels of vitamin C and E is associated with the responsiveness of INS to steroids. However, more studies should be performed in the future.     

Effects of bariatric surgery on obese polycystic ovary syndrome: a systematic review and meta-analysis

BackgroundBariatric surgery has been widely used for the treatment of obesity and its related metabolic diseases, such as type 2 diabetes (T2D), hypertension, and sleep apnea syndrome. Polycystic ovary syndrome (PCOS) is a common reproductive endocrine metabolic disease; however, little attention has been paid to the efficacy of bariatric surgery on PCOS.ObjectiveTo evaluate the efficacy of bariatric surgery on obese PCOS patients.SettingA systematic review and meta-analysis at a university hospital.MethodsOnline databases were searched for all studies reporting the efficacy of bariatric surgery for obese patients with PCOS up to October 2018.ResultsA total of 9 studies with 234 obese PCOS patients were included in this article. The results of meta-analysis showed that after bariatric surgery, there was a significant reduction of the incidence of abnormal menstruation (relative risk [RR] .23; 95% confidence interval [CI] .13–.43; P < .00001) and hirsutism (RR .47; 95% CI .28–.79; P = .004). Bariatric surgery can also cause a decrease in the serum total testosterone level (mean difference [MD] = –25.82; 95% CI –30.06 to –21.58; P < .00001), serum free testosterone level (MD = –4.10; 95% CI –6.97 to –1.23; P = .005), and body mass index (MD = –14.51; 95% CI –17.88 to –11.14; P < .00001). It also showed a significant effect on T2D (RR .09; 95% CI .03–.32; P = .0002) and hypertension (RR .21; 95% CI .05–.98; P = .05) in obese patients with PCOS.ConclusionsBariatric surgery can reduce the incidence of abnormal menstruation, improve hyperandrogenism and its clinical manifestations, and decrease the body mass index, prevalence of T2D, and hypertension in obese patients with PCOS.     

Effects of vitamin E-coated dialysis membranes on anemia,nutrition and dyslipidemia status in hemodialysis patients: a meta-analysis

Abstract

Background: This was controversial whether vitamin E-coated dialyzer therapy was beneficial for the complications associated with hemodialysis. Therefore, we performed this systematic review to evaluate the effects of vitamin E-coated dialyzer. Methods: Related trials were searched from multiple electronic databases. We conducted meta-analysis to assess changes in the predefined outcomes using RevMan 5.3 software. Results: Meta-analysis showed vitamin E-coated dialyzer therapy could decrease erythropoietin (EPO) resistance index (SMD, ?0.24; 95% CI, ?0.47 to ?0.01; p?=?0.04). However, pooled-analysis showed vitamin E-coated dialyzer therapy could not decrease weekly EPO dose (SMD, ?0.11; 95% CI, ?0.32 to 0.09; p?=?0.28) and intima–media thickness (IMT) of the carotid artery (MD, ?0.09; 95% CI, ?0.2 to 0.01; p?=?0.09), and vitamin E-coated dialyzer therapy did not improve the serum hemoglobin (MD, ?0.03; 95% CI, ?0.18 to 0.13; p?=?0.74), albumin levels (SMD, ?0.64; 95% CI, ?1.62 to 0.34; p?=?0.2), in addition, there was no significant difference in serum cholesterol (SMD, ?0.07; 95% CI, ?0.45 to 0.31; p?=?0.71), triglycerides (MD, ?2.77; 95% CI, ?32.42 to 26.87; p?=?0.85), high density lipoprotein (HDL) (SMD, 0.24; 95% CI, ?0.14 to 0.62; p?=?0.22) and low density lipoprotein (LDL) (SMD, 0.00; 95% CI, ?0.38 to 0.37; p?=?0.98) levels. Conclusions: Vitamin E-coated dialyzer may reduce the EPO resistance, but there is no conclusive evidence that vitamin E-coated dialyzer can improve the renal anemia, malnutrition, dyslipidemia and atherosclerosis status in hemodialysis (HD) patients. However, high-quality trials with hard clinical endpoints are required to fully elucidate the clinical value of vitamin E-coated dialyzer therapy.     

Effects of bariatric surgery on the menstruation- and reproductive-related hormones of women with obesity without polycystic ovary syndrome: a systematic review and meta-analysis

BackgroundBariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of women with obesity who do not have polycystic ovary syndrome (PCOS).ObjectivesTo evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of women of childbearing age with who do not have PCOS.SettingA systematic review and meta-analysis at a university hospital.MethodsOnline databases were searched for all studies reporting the efficacy of bariatric surgery for women with obesity until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive-related hormone levels were the primary outcomes.ResultsFifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: .40, 95% confidence interval [CI]: .20–.79, P = .008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = ?13.12 mIU/L, 95% CI: ?15.03 to ?11.22, P < .00001), glucose (MD = ?.91 mmol/L, 95% CI: ?1.26 to ?.56, P < .00001), triglyceride (MD = ?.61 g/L, 95% CI: ?.76 to ?.46, P < .00001), total testosterone (MD = ?.22 ng/mL, 95% CI: ?.24 to ?.20, P < .00001), dehydroepiandrosterone (DHEA) (MD = ?25.34 μg/dL, 95% CI: ?31.19 to ?19.49, P < .00001), estradiol (MD = ?25.13 pg/mL, 95% CI: ?34.13 to ?16.13, P < .00001), and anti-Mullerian hormone (AMH) (MD = ?.40 ng/mL, 95% CI: ?.67 to ?.13, P = .003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99–52.99, P < .00001).ConclusionBariatric surgery can lower fasting insulin, glucose, and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for women with obesity of childbearing age who do not have PCOS. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for women with severe obesity.     

Bone mineral density in men and children with haemophilia A and B: a systematic review and meta-analysis

Summary

Although haemophilia is not considered among the classic causes of secondary osteoporosis, the present meta-analysis provides strong evidence that men with haemophilia have a significant reduction in both lumbar spine and femoral bone mineral density, which appears to begin in childhood.

Introduction

Haemophilia is not considered among the classic causes of secondary osteoporosis. The aim of this study was to systematically review the literature for case–control trials that have studied bone mass in males with haemophilia and to meta-analyze the best evidence available.

Methods

Electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for case–control trials that have studied bone mass in men or boys with haemophilia. Standardized mean difference (SMD) for bone mineral density (BMD) in the lumbar spine was the main study outcome and SMD in femoral neck and total hip BMD the secondary ones. Patient and control characteristics, such as age, body mass index (BMI), level of physical activity and blood-borne infections were recorded as possible predictors of the main outcome.

Results

Thirteen studies were included in the systematic review and ten in the main outcome meta-analysis. Men with haemophilia demonstrated reduced lumbar spine [random effects SMD [95 % confidence interval (CI)] = ?0.56 (?0.84, ?0.28), between-study heterogeneity (I ²)?=?51 %] and femoral neck BMD [random effects SMD (95 % CI) = ?0.82 (?1.21, ?0.44), I ²?=?63 %] compared with controls, which indicated a large and clinically significant association. Similar results were obtained for children [random effects SMD (95 % CI) = ?0.92 (?1.77, ?0.07), I ²?=?92 %]. No evidence of publication bias was detected. There was no evidence that age, BMI, level of physical activity or presence of blood-borne infections predicted lumbar spine BMD.

Conclusions

This meta-analysis shows that men with haemophilia present a significant reduction in both lumbar spine and hip BMD, which appears to begin in childhood.     

Effects of vitamin E-coated dialyzer on oxidative stress and inflammation status in hemodialysis patients: a systematic review and meta-analysis

Background: Vitamin E-coated dialyzer may have an effect on oxidative stress and inflammation status in hemodialysis (HD) patients. Therefore, we performed a systematic review to assess the anti-oxidation and anti-inflammatory effects of vitamin E-coated dialyzer in HD patients. Methods: The randomized controlled trials (RCTs) and quasi-RCTs of vitamin E-coated dialyzer versus conventional dialyzer for HD patients were searched from multiple databases. We screened relevant studies according to predefined inclusion criteria and performed meta-analyses using RevMan 5.1 software. Results: Meta-analysis showed vitamin E-coated dialyzer therapy could significantly decrease the serum thiobarbituric acid reacting substances (TBARS) (SMD, ?0.95; 95% CI, ?1.28 to ?0.61; p?p?=?0.005), interleukin-6 (IL-6) (SMD, ?0.65; 95% CI, ?0.97 to ?0.32; p?p?=?0.03) compared with that of the control group. However, vitamin E-coated dialyzer did not result in increasing the total antioxidant status (TAS) (SMD, 0.23; 95% CI, ?0.16 to 0.61; p?=?0.25) and the fractional clearance of urea index (Kt/v) levels (MD, ?0.07; 95% CI, ?0.14 to 0.00; p?=?0.06), in addition, there was no significant difference in plasma superoxide dismutase (SOD) level compared with that of the conventional dialyzer &; oral vitamin E group (SMD, 0.28; 95% CI, ?0.20 to 0.75; p?=?0.26). Conclusions: Vitamin E-coated dialyzer can reduce the oxidative stress and inflammation status reflected by the decreasing of serum TBARS, oxLDL, CRP, and IL-6 levels, and this new dialyzer does not affect the dialysis adequacy.     

Optimal timing and effect of music therapy in patients with burn injuries: Systematic review and meta-analysis of randomized controlled trials

BackgroundBurn injuries may have both physiological and psychological consequences. Numerous studies have reported the use of music therapy during burn injury treatment, but the optimal timing for music therapy remains unclear. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials on patients with burn injuries to analyze the effects of music intervention on them at different timings: background (T0) and time before (T1), during (T2), and after (T3) change dressing (CD).MethodThe PubMed and EMBASE databases were searched for articles published before Novenber 2020 based on predetermined criteria. Our search focused on two keywords: music and burn. Reviewers extracted data from all eligible studies independently. The I² statistic was used to determine statistical heterogeneity. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Relevant Forest plots were also created.ResultThis study finally included seven trials recruiting a total of 524 patients. The results indicated that compared with non-music intervention, music intervention significantly reduced anxiety at T0 (SMD = ?1.32, 95% CI [?2.61, ?0.02], T1 (SMD = ?2.15, 95% CI [?4.30, ?0.00]) and T2 (SMD = ?0.39, 95% CI [?0.74, ?0.04]). Moreover, they also significantly reduced the pain levels at T0 (SMD = ?1.59, 95% CI [?2.00, ?1.17]) and T2 (SMD = ?0.47, 95% CI [?0.82, ?0.12]), improved the mental condition, and reduced the amount of opioid analgesics used at T0.ConclusionMusic therapy seems to have some effects at T0 and T1 in patients with burn injuries. Music therapy was more effective in improving psychological outcomes than physiological outcomes. However, additional high-quality studies related to music therapy for patients with burn injuries are warranted.     

Adjustable gastric band surgery or medical management in patients with type 2 diabetes and obesity: three-year results of a randomized trial

BackgroundFew randomized trials have compared surgical versus lifestyle and pharmacologic approaches for type 2 diabetes (T2D) patients with mild to moderate obesity.ObjectivesThis study examined resolution of hyperglycemia (A1C <6.5% and fasting glucose <126 mg/dL) 3 years after randomization to either a laparoscopic adjustable gastric band (LAGB) or 1-year diabetes and weight management (DWM) program.SettingUniversity medical center, United States.MethodsForty T2D patients (mean ± SD: age, 51.3 ±10.0 yr; weight 109.5 ± 15.0 kg; body mass index [BMI] 36.5 ± 3.7 kg/m²; HBA1C 8.2% ± 1.2%) were randomized to LAGB (n = 18) or DWM (n = 22).ResultsAt 3 years, 13% of 16 patients in LAGB and 5% of 17 patients in DWM achieved resolution of hyperglycemia (P = .601), with a modestly greater reduction in antidiabetic medications in the surgical group (P = .054). Reductions from baseline in A1C were sustained at 3 years in LAGB (?.82% [95% CI: ?1.62 to ?.01], P = .046) compared with DWM (+.23% [95% CI: ?.57 to 1.03], P = .567). The surgical group had greater weight loss (?12.0 kg [95% CI: ?15.9 to ?8.1] versus ?4.8 [95% CI: ?8.6 to ?.9], P = .010). HDL-cholesterol increased more after surgery (P = .003), but changes in triglycerides, LDL-cholesterol, and blood pressure did not differ between treatments. Diabetes- and obesity-specific quality of life improved comparably with both therapies.ConclusionsAchievement of American Diabetes Association targets for glucose, lipids, and blood pressure was similar with both treatment strategies. LAGB leads to greater sustained weight loss and higher HDL cholesterol compared with a DWM program. These findings may help guide patients with T2D and obesity when exploring options for diabetes and weight management.     

Negative‐pressure wound therapy for III/IV pressure injuries: A meta‐analysis

This meta‐analysis was conducted to identify the potential benefits and the efficacy of negative‐pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32‐1.70). There were significant differences in wound healing time (WMD = ?16.47 days, 95% [CI (?22.36, ? 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = ?2.39, 95% CI [?3.47, ?1.30], P ≤ .001); (SMD = ?2.55, 95% CI [?4.07, ?1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = ?3.61, 95% [CI (?4.57, ? 2.66) times, P ≤ .001]). Our meta‐analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high‐quality multicenter RCTs.     

Serum vitamin D levels and erectile dysfunction: A systematic review and meta‐analysis

Suboptimal levels of serum vitamin D levels have been implied to be associated with cardiovascular diseases and endothelial dysfunction, conditions closely associated with erectile dysfunction (ED). The present systematic review and meta‐analysis was performed to evaluate the vitamin D levels in subjects with ED compared to controls and the 5‐item version of the international index of erectile function (IIEF‐5) score in subjects with vitamin D deficiency compared to those without vitamin D deficiency in order to elucidate the role of vitamin D in the pathogenesis of ED. Studies evaluating the possible association between vitamin D levels and ED were initially screened and thus included following electronic literature search of database Cochrane Library, PUBMED, EMBASE and MEDLINE. Essential article information including outcome measures was extracted from the qualified studies by two independent authors, and STATA 12.0 software was used conducted the meta‐analysis. Subgroup analyses were conducted by vitamin D detection methods and sample size. The standard mean difference (SMD) as well as the 95% confidence intervals (95% CIs) was applied to estimate the outcome measures. A total of seven articles were included in our meta‐analysis with a total of 4,132 subjects. Pooled estimate was in favour of increased vitamin D levels in subjects without ED with a SMD of 3.027 ng/ml, 95%CI 2.290–3.314, p = 0.000. However, subgroup analysis showed an opposite trend, after one study with a sample size over 1,000 that could possibly influence the weight balance was excluded, with a SMD of 0.267, 95%CI ?0.052 to 0.585, p = 0.101. We also identified about 0.320 higher in IIEF‐5 score (95%CI = 0.146–0.494, p = 0.000) in subjects without vitamin D deficiency versus with vitamin D deficiency. Nevertheless, subgroup analysis based on vitamin D detection methods obtained differential results (radioimmunoassay subgroup, SMD(95%CI) = 0.573 (0.275–0.870), p = 0.000; immunoassay subgroup, SMD(95%CI) = 0.189 (?0.025 to 0.404), p = 0.084). In conclusion, results from the present meta‐analysis did not provide a strong relationship between vitamin D and the risk of ED. However, the results should be interpreted with caution and more high quality studies are warranted.     

Is There an Association Between Psychiatric Disorders and Adolescent Idiopathic Scoliosis? A Large-database Study

BackgroundChildren with adolescent idiopathic scoliosis (AIS) have reduced quality of life related to poor self-image, perhaps because of cosmetic concerns. However, there has not been a large-database epidemiologic study on the association between psychiatric disorders and scoliosis.Questions/purposesUsing the Korean National Health Insurance database, we asked: (1) How common are psychiatric disorders among children with AIS? (2) After controlling for gender, age, insurance type, and residential district, are psychiatric disorders more common among children with AIS than among age-matched controls?MethodsA retrospective analysis was conducted using sample datasets from the Health Insurance Review and Assessment Service from 2012 to 2016, which is a 10% randomly extracted sample of total inpatients and outpatients each year. The mean number of total patients in each dataset was 1,047,603 ± 34,534. The mean number of children with AIS was 7409 ± 158 for each year. The age criteria was 10 to 19 years for the matching. Mood disorders, anxiety disorders, and behavioral disorders were selected as disorders possibly associated with AIS. We identified children with AIS who had any of the disorders above, and we obtained the prevalence of these disorders based on diagnostic codes. As an exploratory analysis, clinically meaningful variables were selected among the available codes in the dataset, and a univariable logistic regression test was performed for each variable. A multivariable logistic regression test with advanced variables was performed to identify the adjusted odds ratios of psychiatric disorders in children with AIS.ResultsThe median (range) prevalence of psychiatric disorders in children with AIS from 2012 to 2016 was 7% (6% to 7%). Compared with children who did not have AIS, and after controlling for gender, age, insurance type, and residential district, children with AIS were more likely to have psychiatric disorders in all 5 years. The adjusted ORs of psychiatric disorders in children with AIS compared with children who did not have AIS ranged from 1.47 to 1.74 (2012: OR 1.60 [95% CI 1.46 to 1.75]; p < 0.001; 2013: OR 1.73 [95% CI 1.58 to 1.89]; p < 0.001; 2014: OR 1.74 [95% CI 1.59 to 1.91]; p < 0.001; 2015: OR 1.71 [95% CI 1.56 to 1.88]; p < 0.001; 2016: OR 1.47 [95% CI 1.33 to 1.62]; p < 0.001).ConclusionConsidering the higher prevalence of psychiatric disorders in children with AIS compared with children who did not have AIS, children with AIS and their parents should be counseled about the increased risk of deteriorating mental health of the patients, and surgeons should provide early referral to pediatric psychiatrists. Further studies should investigate the effect of the factors related to AIS, such as curve type, Cobb angle, and treatment modality.Level of EvidenceLevel III, prognostic study.     

影像引导下穿刺硬化术与腹腔镜下开窗引流术治疗非寄生虫性肝囊肿:Meta分析

目的采用Meta分析对比观察影像引导下穿刺硬化术与腹腔镜下开窗引流术治疗非寄生虫性肝囊肿的安全性和有效性。方法通过计算机检索PubMed、Web of Science、中国知网、维普、万方数据库及中国生物医学文献数据库,收集有关影像引导下穿刺硬化术及腹腔镜下开窗引流术治疗非寄生虫性肝囊肿的临床对照试验,检索时限为建库至2017年12月。严格按照纳入及排除标准筛选文献后,进行资料提取及质量评价。采用STATA 14.0统计分析软件进行Meta分析。结果最终纳入9篇文献,共659例患者。Meta分析结果显示,与腹腔镜下开窗引流术相比,影像引导下穿刺硬化术的手术时间[标准均数差(SMD)=-2.82,95%CI(-3.80,-1.83),P0.01]、患者住院时间[SMD=-1.89,95%CI(-2.54,-1.24),P0.01]均较短,且治疗费用[SMD=-28.77,95%CI(-36.89,-20.66),P0.01]较低,但复发率[比值比(OR)=2.04,95%CI(1.25,3.35),P0.01]较高。2种治疗方法术后并发症发生率差异无统计学意义[OR=0.68,95%CI(0.33,1.38),P=0.29]。结论影像引导下穿刺硬化术的安全性与腹腔镜下开窗引流术相似,虽术后复发率较高,但手术时间、患者住院时间更短,治疗费用更低,且更易于操作,适应范围更广。     

Commentary on “Predicted plasma 25-hydroxyvitamin D and risk of renal cell cancer.” Joh HK,Giovannucci EL,Bertrand KA,Lim S,Cho E,Department of Medicine,Seoul National University College of Medicine,Seoul, South Korea.: J Natl Cancer Inst 2013; 105(10):726–32. [Epub 2013 Apr 8]. doi: 10.1093/jnci/djt082.

BackgroundAlthough the kidney is a primary organ for vitamin D metabolism, the association between vitamin D and renal cell cancer (RCC) remains unclear.MethodsWe prospectively evaluated the association between predicted plasma 25-hydroxyvitamin D [25(OH)D] and RCC risk among 72,051 women and 46,380 men in the period from 1986 to 2008. Predicted plasma 25(OH)D scores were computed using validated regression models that included major determinants of vitamin D status (race, ultraviolet B flux, physical activity, body mass index, estimated vitamin D intake, alcohol consumption, and postmenopausal hormone use in women). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. All statistical tests were two-sided.ResultsDuring 22 years of follow-up, we documented 201 cases of incident RCC in women and 207 cases in men. The multivariable hazard ratios between extreme quintiles of predicted 25(OH)D score were 0.50 (95% CI = 0.32 to 0.80) in women, 0.59 (95% CI = 0.37 to 0.94) in men, and 0.54 (95% CI = 0.39 to 0.75; P trend<.001) in the pooled cohorts. An increment of 10 ng/mL in predicted 25(OH)D score was associated with a 44% lower incidence of RCC (pooled HR = 0.56, 95% CI = 0.42 to 0.74). We found no statistically significant association between vitamin D intake estimated from food-frequency questionnaires and RCC incidence.ConclusionHigher predicted plasma 25(OH)D levels were associated with a statistically significantly lower risk of RCC in men and women. Our findings need to be confirmed by other prospective studies using valid markers of long-term vitamin D status.     

A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures

Background

Acute hip fractures carry a high risk of morbidity and are associated with low vitamin D levels. Improvements in screening and treating low vitamin D levels may lead to lower fall rates and a lower likelihood of additional fragility fractures. However, patients with low vitamin D levels often remain unassessed and untreated, even after they experience these fractures.

Questions/purposes

We wished to determine whether a resident-led initiative can improve (1) screening for and (2) treatment of vitamin D deficiency in patients with acute hip fractures.

Methods

Our department initiated a housestaff-led, quality improvement project focused on screening and treating vitamin D deficiency in patients with acute hip fractures. Screening encompassed checking serum 25-hydroxyvitamin D level during the acute hospitalization, and treating was defined as starting supplementation before discharge when the serum 25-hydroxyvitamin D level was less than 30 ng/mL. To evaluate the efficacy of this program, an administrative database identified 283 patients treated surgically for an acute hip fracture between July 2010 and June 2014. This period included 2 years before program initiation (Year 1, n = 65 patients; Year 2, n = 61 patients), the initial program year (Year 3, n = 66 patients), and the subsequent program year (Year 4, n = 91 patients). Followup was extended to 6 weeks after treatment with 9.2% (26/282) of patients lost to followup. Eight patients were excluded owing to documented intolerance of vitamin D supplementation. There were no differences regarding patient demographics, fracture type, or treatment rendered across these 4 years. The primary endpoints were the proportion of patients screened and treated for vitamin D deficiency. The secondary endpoint was the continuation of vitamin D supplementation at the patient’s 6 week followup, according to the patient’s medication list at that visit. This analysis included all patients, assuming those lost to followup had not continued supplementation. ANOVA and chi-square tests were used to evaluate the differences in demographic data and in screening and treating rates.

Results

Screening for vitamin D deficiency improved after initiation of the resident-led quality improvement program, with screening performed for 31% of patients in Year 1 (20/65; odds ratio [OR], 0.44; 95% CI, 0.26–0.75), 20% of patients in Year 2 (12/61; OR, 0.24; 95% CI, 0.13–0.46), 46% of patients in Year 3 (30/66; OR, 0.83; 95% CI, 0.51–1.35), and 88% of patients in Year 4 (80/91; OR, 7.27; 95% CI, 3.87–13.7) (p < 0.001). Vitamin D supplementation was initiated for 33% of patients in Year 1 (21/63; OR, 0.5; 95% CI, 0.30–0.84), 28% in Year 2 (17/61; OR, 0.39; 95% CI, 0.22–0.68), 50% in Year 3 (32/64; OR,1.00; 95% CI, 0.61–1.63), and 76% in Year 4 (65/86; OR, 3.10; 95% CI, 1.89–5.06) (p < 0.001). At early postoperative followup, we saw substantial improvement in the proportion of patients who continued receiving vitamin D supplementation: Year 1, 12% (8/64; OR, 0.14; 95% CI, 0.07–0.30); Year 2, 15% (9/61; OR, 0.17; 95% CI, 0.09–0.35); Year 3, 26% (16/64; OR, 0.33; 95% CI, 0.19–0.59); and Year 4, 46% (40/86; OR, 0.87; 95% CI, 0.57–1.33) (p < 0.001).

Conclusions

Implementation of a resident-led quality improvement program resulted in higher rates of screening and treating vitamin D deficiency for patients with acute hip fractures. Housestaff-based initiatives may be an effective way to improve care processes that target improvements in bone health.

     

Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis

PurposeThis study carried out a meta-analysis to compare immediate surgery (IS) with conservative treatment (CT) of complicated acute appendicitis (CAA) in children.MethodsSystematic literature research was performed for relevant studies published from 1969 to date. Trials of IS compared with CT were included. Outcomes of interest were postoperative morbidity and length of hospital stay (LOS).ResultsFifteen trials were studied (1.243 patients). CT achieved better rates of any complication type (odds ratio [OR] 0.22, [95% confidence interval (CI): 0.14, 0.38], p = 0.001) and wound infection (OR: 0.40 [95% CI: 0.17, 0.96], p = 0.041). Neither intraabdominal abscess (OR: 1.03 [95% CI: 0.31, 3.37], p = 0.958) nor postoperative ileus (OR: 0.29 [95% CI: 0.06, 1.44], p = 0.130) was affected by the treatment option. The polled difference in LOS showed a trend for shorter LOS in the IS group (standard mean difference [SMD]: 0.25 [95% CI: 0.07, ? 0.43], p = 0.007).ConclusionsIS was associated with shorter LOS, while overall complication rates and wound infection declined significantly with CT. The development of intraabdominal abscess and postoperative ileus was not affected by the treatment of choice. The heterogeneity of most studies depicts the need for randomized controlled trials (RCTs) to discover safe management of CAA in children.Level of evidence: IIIType of study: Meta-analysis.     

Meta-analysis of the effect of bariatric surgery on physical activity

BackgroundObesity leads to impairment of physical activity as measured by an inability to perform activities of daily living. Literature on the effect of bariatric surgery on physical activity is conflicting.ObjectiveThe aim of this study was to perform a meta-analysis of the effect of bariatric surgery on physical activity from studies employing objective measurement and self-reporting of physical activity before and after bariatric surgery.MethodsBibliographic databases were searched systematically for relevant literature until December 31, 2018. Studies employing objective and self-reported measurement of physical activity were included. Study quality was assessed using Risk of Bias in Nonrandomized Studies - of Interventions tool. Meta-analysis was performed using random effects model and presented as standardized mean difference (SMD) with 95% confidence intervals (CI).ResultsTwenty studies identified 5886 patients suitable for the analysis. Physical activity showed significant improvement at 0–6 months (SMD: .50; 95% CI: .25–.76; P = .0001), >6–12 months (SMD: .58; 95% CI: .26–.91; P = .0004), and >12–36 months (SMD: .82; 95% CI: .27–1.36; P = .004) after bariatric surgery. Self-reported assessment after bariatric surgery showed significant improvement at 0–6 months (SMD: .65; 95% CI: .29–1.01; P = .0004), >6 to 12 months (SMD: .53; 95% CI: .18–.88; P = .003), and >12–36 months (SMD: .51; 95% CI: .46–.55; P < .00001). Objective assessment after bariatric surgery did not show improvement at 0–6 months (SMD: .31; 95%CI:?.05–.66; P = .09), but showed significant improvement at >6–12 months (SMD: .85; 95% CI:?.07–1.62; P = .03), and >12–36 months (SMD: 1.99; 95% CI: 1.13–2.86; P < .00001) after bariatric surgery.ConclusionsBariatric surgery improves physical activity significantly in a population with obesity up to 3 years after surgery. Objective measurement of physical activity does not show significant improvement within 6 months of bariatric surgery but begins to improve at >6 months. Self-reported measurement of physical activity begins to show improvement within 6 months of a bariatric procedure.     

Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis

BackgroundThe fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture.MethodsWe searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes.ResultsA total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74).ConclusionThe current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.     

3D打印技术对骨盆骨折治疗效果影响的Meta分析

目的:分析研究3D打印技术应用于骨盆骨折手术治疗的文献,评价3D打印技术对骨盆骨折手术治疗效果的影响。方法:检索Pub Med、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库维普(VIP)、万方数据库等,检索起止时间为从建库至2017年9月,收集应用3D打印技术于骨盆骨折术前规划的临床对照试验。按照事先制定的入选与剔除标准筛选文献,逐一评价纳入研究的质量,提取有效数据,采用Rev Man5.3软件进行Meta分析。结果:共纳入9个临床对照试验,共638例患者,其中3D打印技术组279例,常规组359例。Meta分析结果显示,3D技术组患者手术时间[SMD=-2.81,95%CI(-3.76,-1.85)],术中出血量[SMD=-3.28,95%CI(-4.72,-1.85)],术后并发症[OR=0.47,95%CI(0.25,0.87)]均明显小于常规组,而3D打印技术组在术后的骨盆骨折复位优良率[OR=2.09,95%CI(1.32,3.30)],骨盆功能优良率[OR=1.94,95%CI(1.15,3.28)]方面均优于常规组。结论:骨盆手术中应用3D打印技术具有缩短手术时间短、手术出血少、并发症少等优点,且能够提高骨盆骨折复位质量和促进术后骨盆功能恢复。