Risk factors of microtia: A systematic review and meta-analysis

Background

The pathogenesis of microtia is still unclear. Various risk factors have been studied but they remain inconclusive. We conducted the first ever systematic review and meta-analysis to look for the association between microtia and various environmental risk factors.

Methods

Relevant case-control studies published between January 2000 to October 2014 were identified through a systematic search in PubMed and EMBASE. Reference lists from relevant review articles were also searched. Studies were included if they meet our selection criteria. Out of 1706 potential articles, 12 were included in the systematic review and 8 in the meta-analysis.

Results

Risk factors which showed significant positive association with microtia were: cold-like syndrome during pregnancy (OR?=?2.15; 95 % CI?=?1.36, 3.41, P?=?0.001); multiple gestation (OR?=?1.55; 95 % CI?=?1.05, 2.29, P?=?0.03); and gestational diabetes (OR?=?1.48; 95 % CI?=?1.04, 2.10, P?=?0.03). Risk factors which showed positive association but statistically insignificant were: threatened abortion (OR?=?1.22; 95 % CI?=?0.69, 2.15, P?=?0.50); smoking during pregnancy (OR?=?1.05; 95 % CI?=?0.63, 1.77, P?=?0.84); alcohol during pregnancy (OR?=?1.08; 95 % CI?=?0.65,1.80 P?=?0.77); urinary tract infection (OR?=?1.04; 95 % CI?=?0.59, 1.84, P?=?0.89); essential hypertension (OR?=?1.04; 95 % CI?=?0.74, 1.47, P?=?0.82); maternal diabetes (OR?=?3.98; 95 % CI?=?0.72, 21.96, P?=?0.11); respiratory tract infection (OR?=?1.26,95 % CI?=?0.84,1.88, P?=?0.26); chronic disease during pregnancy (OR?=?1.29,95 % CI?=?0.99,1.69, P?=?0.06); severe nausea/vomiting (OR?=?1.16; 95 % CI?=?0.66, 2.04, P?=?0.61); NSAIDs during pregnancy (OR?=?1.17, 95 % CI?=?0.61,2.22, P?=?0.64); antihypertensives during pregnancy (OR?=?1.84,95 % CI?=?0.94,3.62, P?=?0.08); and illegal drugs during pregnancy (OR?=?1.69; 95 % CI?=?0.65, 4.39, P?=?0.28). Reduced risk for microtia was found with these factors: folic acid (OR?=?0.55; 95 % CI?=?0.33, 0.92, P?=?0.02); advanced maternal age (OR?=?0.94; 95 % CI?=?0.79, 1.11, P?=?0.45); ampicillin during pregnancy (OR?=?0.80,95 % CI?=?0.50, 1.28, P?=?0.35); and metronidazole during pregnancy (OR?=?0.77,95 % CI?=?0.40, 1.48 P?=?0.44).

Conclusions

Our study indicates cold-like syndrome, multiple gestation, and gestational diabetes as significant risk factors for microtia; whereas folic acid consumption during pregnancy is shown to be a protective factor. Studies on risk factors for microtia are still very limited to establish the definitive risk factors. Further large-scale and multicentre studies are needed to clarify the role of key risk factors for the development of microtia.Level of Evidence: Level II, risk / prognostic study.

     

Meta-analysis of epidural analgesia versus peripheral nerve blockade after total knee joint replacement

Background

Postoperative pain after major knee surgery can be severe. Our aim was to compare the outcomes of epidural analgesia and peripheral nerve blockade (PNB) in patients undergoing total knee joint replacement (TKR). Moreover, we aimed to compare outcomes of adductor canal block (ACB) with those of femoral nerve block (FNB) after TKR.

Methods

We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; and the Cochrane Central Register of Controlled Trials (CENTRAL). We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above databases. Pain intensity assessed on visual analogue scale (VAS), nausea and vomiting, systolic hypotension, and urinary retention was the reported outcome parameters.

Results

We identified 12 randomised controlled trials (RCTs) comparing outcomes of epidural analgesia and PNB reporting a total of 670 patients. There was no significant difference between two groups in VAS scores at 0–12 h (MD ?0.48; 95 % CI ?1.07–0.11, P = 0.11), 12–24 h (MD 0.04; 95 % CI ?0.81–0.88, P = 0.93), and 24–48 h (MD 0.16; 95 % CI ?0.08–0.40, P = 0.19). However, epidural analgesia was associated with significantly higher risk of postoperative nausea and vomiting (RR 1.65; 95 % CI, 1.20–2.28, P = 0.002), hypotension (RR 1.76; 95 % CI, 1.26–2.45, P = 0.0009), and urinary retention (RR 4.51; 95 % CI, 2.27–8.96, P < 0.0001) compared to PNB. Moreover, pooled analysis of data from 6 RCTs demonstrated no significant difference in VAS score between ACB and FNB at 24 h (MD ?0.00; 95 % CI, ?0.56–0.56, P = 0.99) and 48 h (MD ?0.06; 95 % CI, ?0.14–0.03, P = 0.23).

Conclusions

PNB is as effective as epidural analgesia for postoperative pain management in patients undergoing TKR. Moreover, it is associated with significantly lower postoperative complications. ACB appears to be an effective PNB with similar analgesic effect to FNB after TKR. Future RCTs may provide better evidence regarding knee range of motion, length of hospital stay, and neurological complications.

     

Factors associated with urinary incontinence in middle-aged women: a population-based household survey

Introduction and hypothesis

The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women.

Methods

A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression.

Results

The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45–2.49; P?<?0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35–2.50; P?<?0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02–1.06; P?=?0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23–2.08; P?=?0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06–1.81; P?=?0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06–1.91; P?=?0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03–1.92; P?=?0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24–0.78; P?=?0.006).

Conclusions

Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

     

One-port video-assisted thoracic surgery versus three-port video-assisted thoracic surgery for primary spontaneous pneumothorax: a meta-analysis

Objective

To further understand the effects of video-assisted thoracic surgery (VATS) with one-port versus three-port VATS for primary spontaneous pneumothorax (PSP).

Methods

In this study, we searched information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases from inception to September 2015 to collect data of randomized controlled trials (RCTs) and cohort studies about one-port VATS versus three-port VATS for PSP. Two independent authors were committed to screen literature, extract data, and assess the risk of bias of related studies. Then, we used the RevMan 5.20 software for a meta-analysis of one-port VATS versus three-port VATS for PSP.

Results

Six cohort studies involving 310 patients were finally selected in this meta-analysis. The results of our study indicate that one-port VATS had a shorter hospital stay (SMD = ?0.39, 95 % CI ?0.69 to 0.09, P = 0.01), lower VAS score of 24-h post-operative pain (SMD = ?0.78, 95 % CI ?1.40 to ?0.52, P < 0.00001), shorter chest drainage time (SMD = ?0.68, 95 % CI ?1.15 to ?0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR = 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS. However, one-port VATS had a lower patient satisfaction score at 24 h (SMD = ?0.65, 95 % CI ?0.95 to ?0.35, P < 0.0001) and 48 h (SMD = ?0.46, 95 % CI ?0.71 to ?0.21, P = 0.0002). No differences in the recurrence of pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation time (SMD = 1.01, 95 % CI ?4.63 to 2.60, P = 0.58), and the satisfaction score at 72 h (SMD = ?0.11, 95 % CI ?0.44 to 0.22, P < 0.00001) were noted between the groups.

Conclusion

Current evidence suggests that one-port VATS may have certain advantages over three-port VATS for PSP. More large-scale and high-quality studies are needed for authentication.

     

Nephrolithiasis,bone mineral density,osteoporosis, and fractures: a systematic review and comparative meta-analysis

Summary

Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures.

Introduction

People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs).

Methods

Two investigators searched major databases for articles reporting BMD (expressed as g/cm² or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated.

Results

From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD?=??0.69; 95 % CI?=??0.86 to ?0.52; I ²?=?0 %), total hip (seven studies; SMD?=??0.82; 95 % CI?=??1.11 to ?0.52; I ²?=?72 %), and femoral neck (six studies; SMD?=??0.67; 95 % CI?=???1.00 to ?0.34; I ²?=?69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR?=?1.15, 95 % CI?=?1.12–1.17, p?<?0.0001, studies?=?4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR?=?1.31, 95 % CI?=?0.95–1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR?=?4.12, p?<?0.0001).

Conclusions

Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.

     

Locked plate versus retrograde intramedullary nail for periprosthetic femur fractures above total knee arthroplasty: a meta-analysis

Purpose

Locked plate (LP) and retrograde intramedullary nail (RIN) are the most commonly used treatment options for periprosthetic femur fracture above total knee arthroplasty (TKA). Controversy still exists regarding which is better. Therefore we performed a meta-analysis to compare their clinical results.

Methods

A comprehensive search was conducted through PubMed, EMBase and the Cochrane Collaboration Library. Six comparative studies (265 patients) were included for the meta-analysis.

Results

No statistically significant differences were found between the LP group and RIN group in terms of six month union rate (OR, 1.19; 95 % CI, 0.52–2.69; P?=?0.68), union time (WMD, 0.22; 95 % CI, ?0.41 to 0.84; P?=?0.50), operation time (WMD, 0.54; 95 % CI, ?13.09 to 14.17; P?=?0.94) or complication rate (OR, 0.79; 95 % CI, 0.22–2.91; P?=?0.73). The LP fixation may have a relatively higher re-operation rate (OR, 5.17; 95 % CI, 1.02–26.27; P?=?0.05) compared with RIN. The mean union time was 4.0 months in the LP group and 3.7 months in the RIN group.

Conclusion

This meta-analysis found no statistically significant difference in six month union rate, union time, operation time and complication rate between the LP group and RIN group. The RIN fixation may have a potential of lower re-operation rate compared with LP. The mean union time was 4.0 months in the LP group and 3.7 months in the RIN group.

     

Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes

Introduction and hypothesis

The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years after midurethral sling surgery.

Methods

Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n?=?176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher’s exact tests, continuous data by Mann–Whitney U test. Primary outcome was objective cure defined as <1 g urine lost on pad-test at 5 years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores.

Results

Non-obese women had a higher rate of objective cure, 87.4 % (n?=?83 out of 95) compared with 65.9 % (n?=?29 out of 44) in the obese group (P?=?0.003, risk difference [RD] 21.5 %, 95 % CI 5.9–37.0 %). Subjectively, non-obese women also reported higher rates of cure, 76.7 % (n?=?89 out of 116) compared with 53.6 % (n?=?30 out of 56) of obese women (P?=?0.002, RD 23.2 %, 95 % CI 8.0–38.3 %). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9 % vs 42.1 %, P?=?0.039, RD 16.8 % 95 % CI 1.1–32.6).

Conclusions

Five years after surgery, obese women continued to experience lower rates of cure compared with non-obese women.

     

Male Gender Is Associated with a High Risk for Chronic Antibiotic-Refractory Pouchitis and Ileal Pouch Anastomotic Sinus

Background and Aims

The impact of gender on the development of chronic ileal pouch disorders following ileal pouch-anal anastomosis (IPAA) has not been evaluated. This study was aimed to assess the association between gender and pouch outcomes.

Methods

Comparisons of long-term pouch outcomes between male and female patients were performed using both univariate and multivariate analyses.

Results

Of all patients enrolled (n?=?1564), 881(56.3 %) were males. Male patients were older at the time of inflammatory bowel disease (IBD) diagnosis and pouch construction. The frequencies of neoplasia as the indication for colectomy and significant comorbidity were higher in males, while fewer male patients had IBD-related extra-intestinal manifestations or concurrent autoimmune disorders. There was no significant difference between the genders in other clinicopathological characteristics. More male patients (n?=?144, 16.3 %) developed chronic antibiotic-refractory pouchitis (CARP) than females (n?=?73, 10.7 %) (P?=?0.001). Seventy-four males (8.4 %) had ileal pouch anastomotic sinus versus 22 female patients (3.2 %) (P?<?0.001). Multivariate logistic regression analyses confirmed the association between male gender and CARP (odds ratio (OR) 1.64, 95 % confidence interval (CI) 1.21–2.24, P?=?0.002) and male gender and ileal pouch anastomotic sinus (OR 2.85, 95 % CI 1.48–5.47, P?=?0.002). After a median follow-up of 9.0 (interquartile range 4.0–14.0) years, pouch failed in a total of 126 patients (8.1 %). No significant difference was identified between male and female patients in pouch failure (P?=?0.61).

Conclusions

Among the pouch patients referred to our subspecialty Pouch Center, male patients were found to have an increased risk for the CARP and ileal pouch sinus. The pathogenic mechanisms of the association warrant further study.

     

Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis

Purpose

The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation.

Methods

Studies were searched on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINHAL from their inception to April 2015. All randomized controlled clinical trials comparing surgical versus conservative treatment after first patellar dislocation were included. Primary outcomes were: recurrent dislocation, subluxation, overall instability and subsequent surgery. Secondary outcomes included imaging, and subjective and objective clinical assessment tools. Methodological quality of the studies was assessed using Cochrane Collaboration’s “Risk of Bias” tool. Pooled analyses were reported as risk ratio (RR) using a random effects model. Continuous data were reported as standardized mean difference (SMD) and 95 % confidence intervals (CIs). Heterogeneity was assessed using I².

Results

Nine studies were included in the meta-analyses. Methodological quality of the studies was moderate to low. Meta-analyses showed that surgical treatment significantly reduces the redislocation rate (RR?=?0.62; 95% CI?=?0.39, 0.98, p?=?0.04) and provides better results on Hughston VAS score (SMD?=??0.32; 95% CI?=??0.61, ?0.03; p?=?0.03) and running (OR?=??0.52; 95% CI?=?0.31, 0.88; p?=?0.01). Conservative treatment showed less occurrence of minor complications (OR?=?3.46; 95% CI?=?2.08, 5.77; p?=?0.01) and better results in the figure-of-8 run test (SMD?=?0.42; 95% CI?=?0.06, 0.77; p?=?0.02) and in the squat down test (SMD?=??0.45; 95% CI?=??0.81, ?0.10; p?<?0.00001). No other significant differences could be found.

Conclusions

Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.

     

Dynamic Change of Total Bilirubin after Portal Vein Embolization is Predictive of Major Complications and Posthepatectomy Mortality in Patients with Hilar Cholangiocarcinoma

Objectives

This study aims to evaluate the role of dynamic change in total bilirubin after portal vein embolization (PVE) in predicting major complications and 30-day mortality in patients with hilar cholangiocarcinoma (HCCA).

Methods

Retrospective analysis of prospectively maintained data of 64 HCCA patients who underwent PVE before hepatectomy in our institution was used. Total bilirubin and other parameters were measured daily in peri-PVE period. The difference between them and the baseline value from days 0–5 to day ?1 (?D₁) and days 5–14 to day ?1 (?D₂) were calculated. The relationship between ?D₁ and ?D₂ of total bilirubin and major complications as well as 30-day mortality was analyzed.

Results

Out of 64 patients, 10 developed major complications (15.6 %) and 6 patients (9.3 %) had died within 30 days after surgery. The ?D₂ of total bilirubin after PVE was most significantly associated with major complications (P?<?0.001) and 30-day mortality (P?=?0.002). In addition, it was found to be an independent predictor of major complications after PVE (odds ratio (OR)?=?1.050; 95 % CI 1.017–1.084). ASA >3 (OR?=?12.048; 95 % CI 1.019–143.321), ?D₂ of total bilirubin (OR?=?1.058; 95 % CI 1.007–1.112), and ?D₂ of prealbumin (OR?=?0.975; 95 % CI 0.952–0.999) were associated with higher risk of 30-day mortality after PVE. Receiver operating characteristic curves showed that ?D₂ of total bilirubin were better predictors than ?D₁ for major complications (AUC (?D₂) 0.817; P?=?0.002 vs. AUC (?D₁) 0.769; P?=?0.007) and 30-day mortality (ACU(?D₂) 0.868; P?=?0.003 vs. AUC(?D₁) 0.721;P?=?0.076).

Conclusion

Patients with increased total bilirubin in 5–14 days after PVE may indicate a higher risk of major complications and 30-day mortality if the major hepatectomy were performed.

     

Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Purpose

Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior–posterior approach to posterior-only approach, we conducted a meta-analysis.

Methods

We searched electronic database for relevant studies that compared anterior–posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data.

Results

A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI ?0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI ?6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72–6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI ?2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior–posterior group (95 % CI ?13.18 to ?4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75–17.49, P < 0.0001), blood loss (95 % CI 363.28–658.91, P < 0.00001), operative time (95 % CI 2.65–3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98–22.94, P = 0.02) were found in posterior group.

Conclusions

Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior–posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.

     

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.

     

The impact of overweight in the efficiency and complications of midurethral sling in patients with stress urinary incontinence: a systematic review and meta-analysis

Aims

To compare the efficiency and complications of normal weight and overweight women with stress urinary incontinence (SUI) after surgery.

Methods

We searched the PubMed, Embase, and Cochrane Library Databases to identify all compared results, including those involving the terms normal weight, overweight, body mass index (BMI), and SUI. After treatment with surgery, the efficiency (subjective cure rate, objective cure rate, UDI-6, and IIQ-7) and complications were compared between the normal weight and overweight groups.

Results

The study inclusion criteria were met by 20 studies involving 3829 patients. The data synthesized from these studies indicated that the subjective and objective cure rates in the normal weight group were significantly more effective than those in the overweight group (RR 1.07; 95% CI 1.04–1.10; P?<?0.00001; RR 1.24; 95% CI 1.18–1.30; P?<?0.00001), while the IIQ-7 and UDI-6 were no different between the two groups (MD 0.07; 95% CI ? 1.44 to 1.58; P?=?0.93; MD 0.18; 95% CI ? 1.24 to 1.60; P?=?0.81). For the data of complications, only the urgency was more in the overweight group (RR 0.68, 95% CI 0.55–0.84, P?=?0.0003).

Conclusions

The objective success rate and subjective success rate of the surgery were higher in normal weight patients than those in overweight patients. Also, the side effects between the two groups were not significantly different.

     

Discontinuation of antiviral prophylaxis increased the risk of hepatitis B virus reactivation in glomerulonephritis patients under immunotherapy: a real-life observation

Purpose

Antiviral prophylaxis is proved to be effective in reducing the risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients under immunotherapy. But outcomes referring to discontinuation of antiviral prophylaxis in these patients are lacking.

Methods

We performed a retrospective study of 105 HBsAg-positive patients under immunotherapy for glomerulonephritis and evaluated the incidence and risk factors for HBV reactivation.

Results

Among 105 patients, 55.24% completed antiviral prophylaxis, while 20.00% discontinued and 24.76% rejected antiviral prophylaxis. HBV reactivation was significantly different among completion, discontinuation, and rejection of antiviral prophylaxis: 5.17% versus 38.10% versus 15.38% in the incidence of HBV reactivation (P?=?0.001), 3.45% versus 23.81% versus 11.54% in HBV DNA?≥?5 Log copies/ml (P?=?0.023), and 0 versus 14.29% versus 3.85% in hepatitis B e antigen seroconversion from negative to positive (P?=?0.014). Survival curve showed the median occurrence time of HBV reactivation in discontinuation group was 32 months (95% CI 24–39 months), earlier than 69 months (95% CI 65–72 months) of completion group and 43 months (95% CI 37–49 months) of rejection group (χ²?=?13.780, P?=?0.001). Univariate and multivariate analysis identified two independent risk factors for HBV reactivation: baseline HBV DNA detectable (OR 5.009, 95% CI 1.717–16.335, P?=?0.012) and discontinuation of antiviral prophylaxis (OR 5.213, 95% CI 1.688–18.105, P?=?0.011).

Conclusions

Discontinuation of antiviral prophylaxis increased the risk of HBV reactivation in HBsAg-positive patients under immunotherapy for glomerulonephritis.

     

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

Background

With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis.

Methods

A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications.

Results

Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95 % CI 0.06–0.76, P = 0.02), operating time (WMD, ?22.27, 95 % CI ?33.26 to ?11.28, P < 0.00001), postoperative hospital stay (WMD, ?3.22; 95 % CI ?4.52 to ?1.92, P < 0.00001), and median hospital expenses (SMD, ?1.37, 95 % CI ?1.96 to ?0.77, P < 0.00001). Postoperative hospital stay was significantly decreased in the primary duct closure with internal biliary drainage (PDC + BD) group when compared to TTD group (WMD, ?2.68; 95 % CI ?3.23 to ?2.13, P < 0.00001).

Conclusions

This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered as the optimal procedure for dochotomy closure after LCBDE.

     

Predictors of vaginal mesh exposure after midurethral sling placement: a case–control study

Introduction and hypothesis

Female stress urinary incontinence is highly prevalent, and synthetic midurethral sling placement is the most common type of anti-incontinence surgery performed in the USA. We aimed to identify risk factors associated with surgery used to treated vaginal mesh exposure after midurethral sling placement for stress urinary incontinence.

Methods

We identified women who underwent anti-incontinence procedures from January 2002 through December 2012. Patients with vaginal mesh exposure undergoing surgical repair after midurethral sling placement were compared with a control group without mesh exposure in a 1:3 ratio. Patients with ObTape sling placement (Mentor Corporation) were excluded. Logistic regression models were used to evaluate associations between clinical risk factors and vaginal mesh exposure.

Results

Overall, 2,123 patients underwent primary sling placement, with 27 (1.3 %) having vaginal mesh exposure necessitating surgical repair. Patients with mesh exposure were more likely to have undergone previous bariatric surgery (P?=?0.008), hemoglobin <13 g/dL (P?=?0.006), premenopausal status (P?=?0.008), age <50 years (P?=?0.001), and the retropubic approach to sling placement (P?=?0.03). Multivariate analysis identified these risk factors: previous bariatric surgery (odds ratio [OR], 7.0; 95 % CI, 1.1–61.4), retropubic approach (OR, 5.7; 95 % CI, 1.1–107.0), preoperative hemoglobin <13 g/dL (OR, 2.8; 95 % CI, 1.1–7.5), and premenopausal status (OR, 2.6; 95 % CI, 1.0–7.3). Among postmenopausal patients, those with mesh exposure were significantly more likely to receive preoperative estrogen therapy (OR, 12.4; 95 % CI, 2.7–57.8).

Conclusions

Previous bariatric surgery, retropubic approach, premenopausal status, and lower preoperative hemoglobin were associated with a significantly increased risk of surgery for vaginal mesh exposure after midurethral sling placement. Recognizing these factors can improve preoperative patient counseling.

     

The effect of onabotulinumtoxinA according to site of injection in patients with overactive bladder: a systematic review and meta-analysis

Purpose

This study assessed the efficacy and safety of onabotulinumtoxinA according to injection site for treatment of overactive bladder.

Methods

A systematic literature review located randomized controlled trials of onabotulinumtoxinA treatment for neurogenic detrusor overactive bladder and idiopathic overactive bladder in adults. We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register using the Ovid platform. Meta-analysis was based on Cochrane Review Methods.

Results

Eight studies (419 participants) were included. Trigone-including injection demonstrated a significant improvement in symptom score (SMD = ? 0.53, 95% CI ? 1.04 to ? 0.02, P = 0.04, I ² = 78%), higher complete dryness rates (OR = 2.19 patients, 95% CI 1.32–3.63, P = 0.002, I ² = 41%), and lower frequency of incontinence episodes (WMD = ? 0.85 per day, 95% CI ? 1.55 to ? 0.16, P = 0.02, I ² = 87%) in patients. Comparing trigone-including injection to trigone-sparing injection, lower detrusor pressure (WMD = ? 2.55 cm H₂O, 95% CI ? 4.16 to ? 0.95, P = 0.002, I ² = 0%) and higher volume at first desire to void (WMD = 17.54 ml, 95% CI 1.00–34.07, P = 0.04, I ² = 0%) were observed with trigone-including injection. Between intradetrusor and suburothelial injection sites, there were no differences in efficacy or safety regarding the incidence of vesicoureteral reflux, hematuria, general weakness, bladder discomfort, large post-void residual, and urinary tract infection.

Conclusion

Trigone-including onabotulinumtoxinA injection has superior efficacy to trigone-sparing injection without increased complications. The depth of injection does not influence the efficacy or safety of onabotulinumtoxinA.

     

A retrospective comparison of two vaginal mesh kits in the management of anterior and apical vaginal prolapse: long-term results for apical fixation and quality of life

Introduction and hypothesis

To compare apical correction in stage ≥3 cystocele between two mesh kits.

Methods

This was a retrospective, nonrandomized study that compared two groups matched on anterior/apical POP-Q stage: 84 received Elevate Ant? single-incision mesh (Elevate Ant group) and 42 Perigee? transvaginal mesh (Perigee group). Follow-up at 1 and 2 years comprised objective (POP-Q) and subjective (PFDI-20, PFIQ-7, PISQ-12) assessments. The primary endpoint was objective success: 2-year apical POP-Q stage ≤1. Secondary endpoints were anterior POP-Q stage, subjective results and complications.

Results

Groups were comparable in terms of age (66.6 and 64.7 years, respectively; p?=?0.19), BMI (both 25.4 kg/m²; p?=?0.93), and history of hysterectomy (7.2 % and 14.3 %; p?=?0.21) or prolapse surgery (12 % and 14.3 %; p?=?0.72). Operative time was shorter in the Elevate Ant group (54.1 vs. 62.5 min; p?=?0.048), and the 2-year objective apical success rate was higher (92.9 % vs. 66.7 %; p?<?0.0001), with better point C correction (?5 vs. ?3.8; p?=?0.006). Function improved in both groups, with significantly better PFIQ-7 (p?=?0.03) and PFDI-20 (p?=?0.02) scores in the Elevate Ant group at 2 years. Vaginal exposure was not seen in the Elevate Ant group but occurred in two patients in the Perigee group (p?=?0.33). Factors associated with success were age >65 years (OR 7.16, 95 % CI 1.83?–?27.97) and treatment with Elevate Ant mesh (OR 10.16, 95 % CI 2.78?–?37.14). Postoperative stress urinary incontinence rate was greater with the Elevate Ant group (29.8 % and 16.7 %; p?=?0.11).

Conclusions

The use of the Elevate Ant mesh was associated with significantly better apical correction at 2 years. Function improved in both groups, but with a significantly better PFDI-20 score in the Elevate Ant group at 1 and 2 years. The postoperative stress urinary incontinence rate, however, tended to be greater in the Elevate Ant group. The results need confirming with longer follow-up of these cohorts and in randomized studies.

     

Risk factors for predicting increased surgical drain output in patients after anterior cervical corpectomy and fusion

Background

Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.

Methods

A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.

Results

The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.

Conclusions

The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.

     

FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes

Background

This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.

Methods

Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).

Results

Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?10³; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×10³, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×10³, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.

Conclusions

BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.