The use of anti-ulcer agents and the risk of chronic kidney disease: a meta-analysis

Purpose

We conducted a meta-analysis to explore the association between the use of different anti-ulcer agents and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and decline in glomerular filtration rate (GFR) in various study populations.

Methods

PubMed, Embase, and the Cochrane Library were searched for relevant entries up to July 1, 2017. The primary outcomes of the meta-analysis were risk ratios (RRs) of CKD, ESRD, and decline in GFR. We also investigated the heterogeneity of the meta-analysis by subgroup analysis and meta-regression analysis.

Results

A total of 662,624 individuals were enrolled in five trials. Compared with non-PPI users, PPI users had a higher trend of CKD (RR?=?1.16, 95% CI 1.07–1.25, P?<?0.001), especially ESRD (RR?=?1.81, 95% CI 1.59–2.06, P?<?0.001). There was an elevated risk of adverse renal outcome among participants receiving PPI and not H2RA (CKD: RR?=?1.28, 95% CI 1.24–1.33, P?<?0.001; ESRD: RR?=?1.39, 95% CI 1.17–1.64, P?<?0.001; GFR: RR?=?1.31, 95% CI 1.26–1.36, P?<?0.001). However, H2RA users were not associated with CKD when compared with non-H2RA users (RR?=?1.02, 95% CI 0.83–1.25, P?=?0.855). In subgroup analysis, the average age of individuals and drug dosage had no influence on the risk of CKD, while duration of PPI exposure from 31 to 720 days is a potential factor in progression to ESRD (P?<?0.001).

Conclusions

Chronic PPI use, but not H2RAs, is associated with deterioration in kidney function.

     

Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD]?=??0.04; 95 % CI ?0.06 to ?0.02; P?<?0.001), femoral neck (WMD?=??0.06; 95 % CI ?0.07 to ?0.04; P?<?0.001), lumbar spine (WMD?=??0.06; 95 % CI ?0.09 to ?0.03; P?<?0.001), and total hip (WMD?=??0.05; 95 % CI ?0.06 to ?0.03; P?<?0.001). In addition, the meta-analysis also showed that SLE was significantly associated with increased fracture risk of all sites (relative risk [RR]?=?1.97, 95 % CI 1.20–3.25; P?=?0.008). Subgroup analysis by adjustment showed that SLE was significantly associated with increased fracture risk of all sites before and after adjusting for confounding factors (unadjusted RR?=?2.07, 95 % CI 1.46–2.94, P?<?0.001; adjusted RR?=?1.22, 95 % CI 1.05–1.42, P?=?0.01). Subgroup analysis by types of fracture showed that SLE was significantly associated with increased risks of hip fracture (RR?=?1.99, 95 % CI 1.55–2.57; P?<?0.001), osteoporotic fracture (RR?=?1.36, 95 % CI 1.21–1.53; P?<?0.001), and vertebral fracture (RR?=?2.97, 95 % CI 1.71–5.16; P?<?0.001). This systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk.     

The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

Background

The major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA).

Methods

After measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups.

Results

The failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p?<?0.001). However, the difference disappeared after the PFNA was implanted (p?=?0.990). The axial stiffness in all defect model femora showed the same results (p?<?0.001). After the PFNA implantation, the axial stiffness of the lateral wall group remained higher than that of the medial wall group (p?=?0.001). However, the axial stiffness of the lateral wall group showed that the femora removed from the lateral wall were higher than the PFNA-stabilized femora (p?=?0.020). For the axial strain in the anterior wall after the PFNA implantation, the strain of the lateral wall group was significantly lower than that of the medial group (p?=?0.003). Nevertheless, for the axial strain of the posterior wall after the PFNA implantation, the strain of the medial wall group was significantly lower than that of the lateral group (p?<?0.001).

Conclusions

In summary, this study demonstrated that PFNA is an effective intramedullary fixation system for treating unstable intertrochanteric fractures. Compared with the lateral wall, the medial femoral wall is a more important part in the intertrochanteric region. We suggest that in treating intertrochanteric femoral fractures with medial wall fractures, the medial wall fragment should be reset and fixed as much as possible.

     

LBP rs2232618 polymorphism contributes to risk of sepsis after trauma

Background

Previous study revealed that rs2232618 polymorphism (Phe436Leu) within LBP gene is a functional variant and associated with susceptibility of sepsis in traumatic patients. Our aim was to confirm the reported association by enlarging the population sample size and perform a meta-analysis to find additional evidence.

Methods

Traumatic patients from Southwest (n?=?1296) and Southeast (n?=?445) of China were enrolled in our study. After genotyping, the relationship between rs2232618 and the risk of sepsis was analyzed. Furthermore, we proceeded with a comprehensive literature search and meta-analysis to determine whether the rs2232618 polymorphism conferred susceptibility to sepsis.

Results

Significance correlation was observed between rs2232618 and risk of sepsis in Southwest patients (P?=?0.002 for the dominant model, P?=?0.006 for the recessive model). The association was confirmed in Southeast cohort (P?=?0.005 for the dominant model) and overall combined cohorts (P =?4.5?×?10^?4, P?=?0.041 for the dominant and recessive model). Multiple logistical regression analyses suggested that rs2232618 polymorphism was related to higher risk of sepsis (OR?=?1.77, 95% CI?=?1.26–2.48, P?=?0.001 in Southwest patients; OR?=?2.11, 95% CI?=?1.24–3.58, P?=?0.006 in Southeast cohort; OR?=?1.54, 95% CI?=?1.34–2.08, P?=?0.006 in overall cohort). Furthermore, meta-analysis of four studies (including the present study) confirmed that rs2232618 within LBP increased the risk of sepsis (OR?=?1.75, P?<?0.001 for the dominant model; OR?=?6.08, P?=?0.003 for the recessive model; OR?=?2.72, P?<?0.001 for the allelic model).

Conclusions

The results from our replication study and meta-analysis provided firm evidence that rs2232618T allele significantly increased the risk of sepsis.

     

Meniscus suture provides better clinical and biomechanical results at 1-year follow-up than meniscectomy

Background

Surgery of meniscus tear results in limitation of function. The aim of study was functional assessment of knee 1 year after surgery with two techniques in cases of the medial meniscus tear followed by the same supervised rehabilitation.

Materials and methods

A total of 30 patients with good KOSS scores constituted two equal groups after partial meniscectomy or meniscus suture. Measurements of knee extensors and flexors muscles peak torques were performed with angular velocities 60, 180, 240 and 300 s^?1 using Biodex IV system. One-leg-hop and one-leg-rising tests ascertained the function of operated knee. Results of examinations were compared with reference to healthy volunteers. Results of biomechanical and clinical studies were correlated to create complex and objective method evaluating treatment.

Results

Extensors peak torque values at 60 s^?1 angular velocity and H/Q coefficient were decreased after meniscectomy more than meniscus suture in comparison to healthy volunteers (P ≤ 0.001; P ≤ 0.05). Analysis of functional tests revealed that patients after meniscectomy showed difference between operated and non-operated knee (P ≤ 0.01) while patients with meniscus suture differed the least to controls (P ≤ 0.05). Extensors peak torque values at 60 s^?1 angular velocity correlated with results of one-leg-rising test.

Conclusion

Results suggest worse functional effects when meniscectomy is applied which implies modification of the rehabilitative methods in a postoperative period.     

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Background

Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy.

Methods

This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission, and reoperation.

Results

Three thousand six hundred and seventy-eight patients underwent gastrectomy. A majority of patients had distal gastrectomy (N?=?2,799, 76.1 %) and had resection for malignancy (N?=?2,316, 63.0 %). Seven hundred and ninety-eight patients (21.7 %) experienced a major complication. Reoperation was required in 290 patients (7.9 %). Thirty-day mortality was 5.2 %. Age (OR?=?1.01, 95 % CI?=?1.01–1.02, p?=?0.001), preoperative malnutrition (OR?=?1.65, 95 % CI?=?1.35–2.02, p?<?0.001), total gastrectomy (OR?=?1.63, 95 % CI?=?1.31–2.03, p?<?0.001), benign indication for resection (OR?=?1.60, 95 % CI?=?1.29–1.97, p?<?0.001), blood transfusion (OR?=?2.57, 95 % CI?=?2.10–3.13, p?<?0.001), and intraoperative placement of a feeding tubes (OR?=?1.28, 95 % CI?=?1.00–1.62, p?=?0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR?=?1.23, 95 % CI?=?0.99–1.53, p?=?0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p?<?0.001).

Conclusions

Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

     

Predictive Value of Preoperative Sarcopenia in Patients with Gastric Cancer: a Meta-analysis and Systematic Review

Purpose

The impact of preoperative sarcopenia on postoperative complications and overall survival has been recently debated. Our meta-analysis aims to ascertain whether preoperative sarcopenia increases the risk of poor outcomes and to attempt to provide new ideas for the prognosis of outcomes for patients with gastric cancer.

Methods

We searched for all relevant articles on PubMed, the EMBASE database, and Web of Science (up to September 1, 2017). Data synthesis and statistical analysis were carried out using RevMan 5.3 software.

Results

Thirteen studies involving 4262 patients who underwent gastrectomy for gastric cancer were analyzed (sarcopenia group?=?1234; non-sarcopenia group?=?3028). The results showed that preoperative sarcopenia significantly associated with poor pathological staging (high pT: OR?=?1.86, 95% CI?=?1.49–2.31; P?<?0.01; pN+: OR?=?1.61, 95% CI?=?1.33–1.94; P?<?0.01; high TNM category: OR?=?1.84, 95% CI?=?1.53–2.22; P?<?0.01). Patients with preoperative sarcopenia had an increased risk of total postoperative complications (OR?=?2.17, 95% CI?=?1.53–3.08; P?<?0.01), severe complications (OR?=?1.65, 95% CI?=?1.09–2.50; P?=?0.02), and poorer OS (HR?=?1.70, 95% CI?=?1.45–1.99; P?<?0.01). The results of subgroup analyses revealed that patients with preoperative sarcopenia over 65 years old and those from Asian populations had higher risks for total postoperative complications and severe complications.

Conclusion

This meta-analysis reveals that preoperative sarcopenia may be used as a new indicator of poor pathological staging, impaired overall survival, and increased postoperative complications. Notably, patients with gastric cancer who are over 65 years old and from Asia should be routinely screened for sarcopenia before surgery to adequately assess the risk of postoperative complications in clinical practice.

     

Translation and validation of ICIQ-FLUTS for Tamil-speaking women

Aims

Research in to lower urinary tract symptoms (LUTS) in women in South Asia is hampered by lack of validated tools. Our aim was to validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) from English to Tamil.

Method

After translation to Tamil, a validation study was carried out among women attending the gynecology clinic at District General Hospital-Mannar.

Results

Content validity assessed by the level of missing data was <2%. Construct validity was assessed by the ability of the questionnaire to identify patients with incontinence (n?=?45) from controls (n?=?93) using the incontinence score [patients?=?7.7 standard deviation (SD)?=?4.7, controls?=?1.4 SD?=?2.2, p?<?0.001] and those with symptomatic anterior wall prolapse (n?=?16) from controls (n?=?93) using voiding symptoms score (patients?=?4.8 SD?=?2.3, controls?=?0.3 SD?=?0.8, p?<?0.001). Internal consistency was assessed using Cronbach’s coefficient alpha score [0.80 (0.77–0.81)]. Test–retest reliability assessed by weighted kappa (κ) ranged from 0.73 to 0.87. Patients with incontinence (n?=?30, pretreatment incontinence score?=?7.9, SD?=?4.9 versus posttreatment incontinence score?=?3.3, SD?=?3.1) and symptomatic anterior wall prolapse (n?=?14, preoperative voiding symptoms score?=?4.9 SD?=?2.5 versus postoperative voiding symptoms score?=?0.9 SD?=?1.5) showed an improvement with treatment (Wilcoxon matched-–pairs signed-rank test p?<?0.001 and p?<?0.01, respectively). An incontinence score?≥?3 (sensitivity?=?86.7%, specificity?=?78.4%) and a voiding symptoms score?≥?3 (sensitivity?=?87.5%, specificity?=?96.2%) detected any form of incontinence and symptomatic anterior wall prolapse, respectively.

Conclusion

Tamil translation of ICIQ-FLUTS retained the psychometric properties of the original English questionnaire and will be an invaluable tool to detect LUTS among Tamil-speaking women.

     

The role of social constraints and catastrophizing in pelvic and urogenital pain

Introduction and hypothesis

Pelvic and urogenital pain is complex and highly prevalent in women, and increased attention to psychosocial influences can guide more effective treatments. This study tested the hypothesis that social constraints (the perception that close others inhibit, discourage, or dissuade a person from disclosing one’s feelings or talking about one’s problems) would be associated with distress, pain, and problems with functioning, beyond the influence of the widely recognized risk factor of pain catastrophizing.

Methods

A total of 122 women completed psychosocial and pain questionnaires during an initial evaluation at a multidisciplinary urology center. Correlational and multiple regression analyses examined pain catastrophizing and social constraints in association with general distress, general pain severity, urogenital pain, and pain interference with functioning.

Results

In zero-order correlations, pain catastrophizing and social constraints were significantly associated with all pain measures (p?<?0.05) and distress. In regressions, both pain catastrophizing and social constraints were simultaneously independent predictors of general distress (β?=?0.48 and 0.33, p?<?0.001 respectively), general pain severity (β?=?0.55 and 0.21, p?<?0.001 and 0.01 respectively), and pain interference with functioning (β?=?0.65, p?<?0.001, and β?=?0.16, p?<?0.05 respectively), and together explained a moderate portion of the variance in outcome variables. Pain catastrophizing (but not social constraints) also significantly predicted urogenital pain (β?=?0.43, p?<?0.001).

Conclusions

Both pain catastrophizing and social constraints are important to the experience of pelvic and urogenital pain, and effective pain treatment should include attention to these psychological and social factors.

     

Equivalent results of medial and lateral parapatellar approach for total knee arthroplasty in mild valgus deformities

Purpose

When performing total knee arthroplasty (TKA) in valgus knee deformities, a medial or lateral parapatellar approach can be performed, but the lateral approach is often considered technically more difficult. The purpose of this study was to compare intra-operative, early clinical and radiological outcomes of medial and lateral parapatellar approaches for TKA in the setting of moderate knee valgus (<10°).

Methods

We prospectively analysed 424 knees with pre-operative valgus deformity between 3° and 10° that underwent TKA over an 18-year period; 109 were treated with a medial approach and 315 with a lateral approach. Intra- and post-operative outcomes and complication rates after a minimum follow-up of one year were compared.

Results

Tourniquet (p?=?0.25) and surgical (p?=?0.62) time were similar between groups. The popliteus tendon was released more frequently in the medial-approach group (p?=?0.04), while the iliotibial band was released more frequently in the lateral-approach group (p?<?0.001). A tibial tuberosity osteotomy was performed more frequently in the lateral- than medial-approach group (p?=?0.003). No significant differences in limb alignment (p?=?0.78), or Knee Society Score (KSS) knee (p?=?0.32) and function (p?=?0.47) results were noted based on surgical approach, and complication rates were similar between groups (p?=?0.53).

Conclusions

Lateral parapatellar approach is a safe and effective surgical technique for performing TKA in moderately valgus knees. These equivalent early results are encouraging for systematic use of the lateral approach in moderately valgus knees.

     

Benign prostatic hyperplasia surgical scoring (BPHSS): an novel scoring system for the perioperative outcomes of holmium laser enucleation of the prostate

To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na⁺ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6–8 points) showed significant increase in the OT (74.61, 95%CI?=?16.98–327.84, P?<?0.001), hemochrome reduction (416.50, 95%CI?=?35.48–4889.88, P?<?0.001), hospital stay (1.80, 95%CI?=?1.35–2.41, P?<?0.001), and bladder irrigation duration (4.04, 95%CI?=?1.35–12.10, P?=?0.013) compared with the low BPHSS group (0–2 points). In the prospective study, there also existed significant differences between the three scoring grades (P?<?0.01) in OT, hemochrome decrease, and the hospital stay. The BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. Further studies are needed to validate this scoring system in BPH patients in multiple centers.     

Minimally Invasive Ivor-Lewis Esophagectomy (MIILE): A Single-Center Experience

With the development of minimally invasive procedures, minimally invasive Ivor-Lewis esophagectomy (MIILE) has been proposed as a safe and feasible surgical choice for the treatment of esophageal cancer. This retrospective study evaluated MIILE results from a single medical center. A total of 619 patients were selected as candidates for Ivor-Lewis esophagectomy from December 2011 to May 2015, in which 334 patients accepted MIILE and 285 patients accepted open Ivor-Lewis esophagectomy (OILE). General characteristics, surgical data, complication rates, and survival were analyzed. Differences in general characteristics between groups were not significant. Intraoperative blood loss (P?<?0.01), postoperative volume of drainage for the first day (P?<?0.01), time to drain removal (P?≤?0.01), wound infection rate (P?=?0.04), and length of hospital stay (P?<?0.01) were significantly reduced in the MIILE group. There were no statistically significant differences in general morbidity (P?=?0.56), the total swept lymph nodes (P?=?0.47), mortality (P?=?0.34), and survival rate at 3 years (P?=?0.63). MIILE is a safe and feasible method for the treatment of esophageal cancer, in which good outcomes were reported and some advantages were found over the open procedure.     

Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes

Purpose

With the increasing number of primary total hip arthroplasties (THA) being performed, the frequency of revision surgery is also expected to increase. We analysed the immediate in-hospital complications and epidemiologic data of 3,469 revision and 18,186 primary THA cases.

Methods

The National Hospital Discharge Survey (NHDS) was evaluated between 2001 and 2010 for patients who underwent revision and primary THA. Patients were identified and included in our retrospective study based on ICD-9 procedure codes.

Results

The number of primary and revision THAs increased steadily from 2001 to 2010. The revision burden decreased for the same studied period (r?=?–0.92) to reach 13.9 % in 2010. The South region had higher revision burden of 17.4 % (p?<?0.001). The primary THA group was more likely to be obese, morbidly obese, and have hypertension (p?<?0.001). The revision THA group had an increased rate of blood transfusions (p?<?0.001), deep venous thrombosis (p?=?0.008), post-operative sepsis (p?<?0.001), and wound complications (p?<?0.001). The in-hospital mortality rate was also higher for the revision THA group (0.6 % versus 0.2 %, p?<?0.001).

Conclusions

The revision burden has undergone a steady decrease over the ten years studied and the reason for this is likely multifactorial. The South region had a significantly higher revision burden when compared to the rest of the United States. Larger hospitals tend to perform relatively more revisions. Revision THA patients are associated with longer hospital stay, higher complications rate, and higher in-hospital mortality rate.

     

Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis

Background

The aim of the study was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall- and cancer-specific survival in stage I rectal cancer.

Methods

Stage I rectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 2004 and 2011. The impact of an elevated preoperative CEA level (C1-stage) compared with a normal CEA level (C0-stage) on overall and cancer-specific survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.

Results

Overall, 1932 stage I rectal cancer patients were included, of which 328 (17 %) patients had C1-stage. The 5-year overall and cancer-specific survival for patients with C0-stage were 85.7 % (95 % CI 83.2–88.2 %) and 94.7 % (95 % CI 93.1–96.3 %), versus 76.8 % (95 % CI 70.9–83.1 %) and 88.1 % (95 % CI 83.3–93.2 %) for patients with C1-stage (P?<?0.001 and P?=?0.001). The negative impact of C1-stage on overall and cancer-specific survival was confirmed by risk-adjusted Cox proportional hazard regression analysis (hazard ratio [HR]?=?1.57, 95 % CI?=?1.15–2.16, P?=?0.007 and 2.04, 95 % CI?=?1.25–3.33, P?=?0.006), and after propensity score matching (overall survival [OS]: HR?=?1.46, 95 % CI?=?1.02–2.08, P?=?0.044 and cancer-specific survival [CSS]: HR?=?3.28, 95 % CI?=?1.78–6.03, P?<?0.001).

Conclusion

This is the first population-based investigation of a large cohort of exclusively stage I rectal cancer patients providing compelling evidence that elevated preoperative CEA level is a strong predictor of worse overall and cancer-specific survival.

     

Low-level laser therapy in the management of plantar fasciitis: a randomized controlled trial

This study aimed at estimating the extent to which a combination therapy of low-level laser therapy (LLLT) with exercise and orthotic support (usual care) affects functional ability in the patient with plantar fasciitis (PF) when compared to usual care alone. Participants with PF were randomly allocated into two groups: LLLT (n?=?27) and control (n?=?22). All the participants received home exercise program with orthotic support. In addition, the LLLT group received a gallium-aluminum-arsenide laser with a 850-nm wavelength for ten sessions, three times a week. Functional outcomes were measured by function subscale of American Orthopedic Foot and Ankle Society Score (AOFAS-F) and 12-min walking test including walking speed, cadence, and activity-related pain using visual analog scale (VAS).The scores were recorded at baseline, third week, and third month after the treatment. Analysis was performed using repeated measures ANOVA and an intention to treat approach using multiple imputations. There was a significant improvement in AOFAS-F total score at 3 weeks in both groups (LLLT, p?<?0.001; control, p?=?0.002), but the improvements were seen only for the LLLT group for AOFAS-F total score (p?=?0.04) and two individual items of AOFAS-F (walking distance (p?<?0.001) and walking surface (p?=?0.01)) at 3 months. The groups were comparable with each other for both walking speed and cadence at all assessment times (p?>?0.05). Both groups showed significant reduction in pain over 3 months (LLLT, p?<?0.001; control, p?=?0.01); however, the LLLT group had lower pain than the control group at 3 months (p?=?0.03). The combination therapy of LLLT with usual care is more effective to improve functional outcomes and activity-related pain when compared to usual care alone.     

Multifactorial Analysis of Prognostic Factors and Survival Rates Among 706 Mucosal Melanoma Patients

Background

The hypothesis that mucosal melanomas from different anatomic sites would have different prognostic features and survival outcome was tested in a multifactorial analysis.

Methods

Complete clinical and pathological information from 706 mucosal melanoma patients from different anatomical sites was compared for overall survival (OS) and prognostic factors.

Results

Mucosal melanomas arising from different anatomical sites did not have any significant differences in OS in a multivariate analysis (p?=?0.721). Among all 706 stage I–IV mucosal melanoma patients, depth of tumor invasion (p?<?0.001), number of lymph node metastases (p?<?0.001), and sites of distant metastases (p?<?0.001) were independent prognostic factors for OS; among 543 stage I–III patients, depth of tumor invasion (p?<?0.001) and number of lymph node metastases (p?<?0.001) were independent prognostic factors for OS; and among 547 stage IV patients, depth of tumor invasion (p?=?0.009), number of lymph node metastases (p?<?0.001), and combined distant metastases and elevation of serum lactate dehydrogenase (LDH; p?<?0.001) were independent prognostic factors for OS. The presence of c-KIT or BRAF mutations was not predictive of survival.

Conclusions

This is the first large-scale study comparing outcomes of mucosal melanomas from different anatomic sites in a multifactorial analysis. There were no significant survival differences among mucosal melanomas arising at different sites when matched for staging and prognostic and molecular factors, thus rejecting our hypothesis. We concluded that prognostic characteristics of mucosal melanomas can be staged as a single histological group, regardless of the anatomic site of the primary tumor.

     

Peripheral arterial disease (PAD) assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis

Background

Peripheral arterial disease is associated with high cardiovascular morbidity and mortality. The objective of this study was to identify unrecognized patients with peripheral arterial disease using ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis.

Material and methods

One hundred fifty-four patients with 94 males and 60 females underwent assessment of peripheral arterial disease using ankle-brachial index by pulse Doppler. Correlation between peripheral arterial disease and various variables (history of cardiovascular disease or various risk factors for atherosclerosis) was established using Pearson coefficient correlation test and linear-by-linear association.

Results

Peripheral arterial disease was present in 24.03 % (n?=?37) of patients in the study population. A total of 22.08 % (n?=?34) patients in study population had ankle-brachial index between 0.41 and 0.90, i.e., mild to moderate peripheral arterial disease, and 1.95 % (n?=?3) had ankle-brachial index between 0.00 and 0.40, indicating severe peripheral arterial disease. Advancing age (p?<?0.001; linear-by-linear association?=?24.448), smoking (p?<?0.001), diabetes (p?=?0.005), hypertension (p?=?0.008), hyperlipidemia (p?<?0.001), cardiovascular disease (p?=?0.003), and number of risk factors (p?<?0.001; linear-by-linear association?=?50.099) showed a statistically significant correlation with peripheral arterial disease. No significant difference was found between men and women (59.46 vs. 40.54 %, respectively, p?=?0.051) in terms of peripheral arterial disease.

Conclusion

Peripheral arterial disease is highly prevalent in patients with established cardiovascular disease or who have at least one risk factor for atherosclerosis. Screening of patients for peripheral arterial disease by pulse Doppler (which is cheap, rapid, and precise method to detect peripheral arterial disease) would allow identification of high-risk patients who could benefit from an appropriate treatment strategy.

     

Effects of a novel magnetic orthopedic appliance (MOA-III) on the dentofacial complex in mild to moderate skeletal class III children

Introduction

The objective of this study was to evaluate the changes of skeletal and dental structures in mild to moderate skeletal Class III children following the use of a new magnetic orthopedic appliance (MOA-III).

Methods

A total of 36 patients (14 boys and 22 girls, mean age 9 years and 5 months) who presented with a mild to moderate skeletal Class III jaw discrepancy were treated with MOA-III. Another group of 20 untreated patients (9 boys and 11 girls, mean age 9 years and 2 months) with the same level of deformity served as the control group. The average treatment time was 6.6 months. Radiographs were taken at the same time intervals for both groups. A paired t test was used to determine the significant differences before and after treatment, and a two-sample t test was used to analyze the differences between the treatment and control groups.

Results

The anterior crossbite in all subjects was corrected after MOA-III therapy. The maxillomandibular relationship showed favorable changes (ANB, Wits, overjet increased significantly, P < 0.001). The maxilla was anteriorly positioned (SNA, ptm-A, ptm-S increased significantly, P < 0.001) with clockwise rotation (PP-FH increased, P < 0.001). The mandible showed a slight downward and backward rotation (SNB decreased, P < 0.05, MP-SN, Y-axis increased, P < 0.05). The length of the mandibular body showed no significant changes (Go-Pg, P?>?0.05). Significant upper incisor proclination and lower incisor retroclination were observed (UI-NA increased, P < 0.001, LI-NB, FMIA decreased, P < 0.001). The upper lip moved forward, and the lower lip moved backward (UL-EP increased, P?<?0.001, LL-EP decreased, P?<?0.05). In the control group, most of the parameters showed normal growth, except for some unfavorable mandibular skeletal and soft tissue changes (Go-Pg, Go-Co, MP-SN, N′-SN-Pg′ increased, P < 0.001). Significant positive changes were induced with the MOA-III appliance compared to the untreated group.

Conclusions

The MOA-III was effective for the early treatment of a mild to moderate Class III malocclusion in children.

     

Independent Predictors of Increased Operative Time and Hospital Length of Stay Are Consistent Across Different Surgical Approaches to Pancreatoduodenectomy

Background

While minimally invasive approaches are increasingly being utilized for pancreatoduodenectomy (PD), factors associated with prolonged operative time (OpTime) and hospital length of stay (LOS) remain poorly defined, and it is unclear whether these factors are consistent across surgical approaches.

Methods

The ACS-NSQIP targeted pancreatectomy database from 2014 to 2016 was used to identify all patients who underwent open (OPD), laparoscopic (LPD), or robotic (RPD) pancreatoduodenectomy. Multivariable linear regression analyses were used to evaluate predictors of OpTime and LOS, as well as quantify the changes observed relative to each surgical approach.

Results

Among 10,970 patients, PD procedure types varied: 9963 (92%) open, 418 (4%) laparoscopic, and 409 (4%) robotic. LOS was longer for the open and laparoscopic approaches (11 vs. 11 vs. 10 days, P?=?0.0068), whereas OpTime was shortest for OPD (366 vs. 426 vs. 435 min, P?<?0.0001). Independent predictors of a prolonged OpTime were ASA class?≥?3 (P?=?0.0002), preoperative XRT (P?<?0.0001), pancreatic duct <?3 mm (P?=?0.0001), T stage?≥?3 (P?=?0.0108), and vascular resection (P?<?0.0001) for OPD; T stage?≥?3 (P?=?0.0510) and vascular resection (P?=?0.0062) for LPD; and malignancy (P?=?0.0460) and conversion to laparotomy (P?=?0.0001) for RPD. Independent predictors of increased LOS were age?≥?65 years (P?=?0.0002), ASA class?≥?3 (P?=?0.0012), hypoalbuminemia (P?<?0.0001), and preoperative blood transfusion (P?<?0.0001) for OPD as well as an OpTime?>?370 min (all p?<?0.05) and specific postoperative complications (all p?<?0.05) for all surgical approaches.

Conclusions

Perioperative risk factors for prolonged OpTime and hospital LOS are relatively consistent across open, laparoscopic, and robotic approaches to PD. Particular attention to these factors may help identify opportunities to improve perioperative quality, enhance patient satisfaction, and ensure an efficient allocation of hospital resources.

     

Do manual cutting guides for total knee arthroplasty introduce systematic error?

Introduction

Conventional cutting guides in total knee arthroplasty can potentially cause unintentional deviation from the planned direction and depth of bone resection resulting in malaligned components. The purpose of this study was therefore to investigate the accuracy of bone cutting jigs for both the femur and tibia using imageless navigation.

Material and methods

A total of 125 patients with a mean age of 66.7?±?9.9 years underwent primary total knee arthroplasty with a Stryker Triathlon? fixed bearing posterior cruciate retaining implant using imageless navigation. Coronal and sagittal position of the secured cutting jig was recorded and bone resection was checked with a rectangular probe attached to a navigation tracker.

Results

There were significant within group differences for the femoral sagittal cut (mean δ?=?0.9° [31 %]; p?=?0.00001), femoral depth medial compartment (mean δ?=?0.5 mm [5 %]; p?=?0.001), femoral depth lateral compartment (mean δ?=?0.7 mm [7 %]; p?=?0.00001), proximal tibial cut (mean δ?=?0.3 mm [25 %]; p?=?0.001), tibial depth medial compartment (mean δ?=?0.6 mm [10 %]; p?=?0.0001) and tibia depth lateral cut (mean δ?=?0.4 mm [5 %]; p?=?0.002). Deviation of more than 2° was observed for the distal cut in the sagittal plane in 17 % and in 9.6 % for the proximal tibial cut in the sagittal plane of all patients.

Conclusion

The results of this study demonstrated significant differences between the dialed in cut and “actual” bone resection achieved for all planes for both the femur and tibia. The femur sagittal cut demonstrated a tendency for an extended cut and the tibia showed a tendency for varus.