Candidates to salvage therapy after external-beam radiotherapy of prostate cancer: Predictors of local recurrence volume and metastasis-free survival

PurposeThe purpose of this study was to assess the predictors of metastasis-free survival (MFS) and of the volume of the local recurrence in patients with rising prostate-specific antigen (PSA) serum level after radiotherapy for prostate cancer and referred for prostate magnetic resonance imaging (MRI) and biopsy in view of salvage treatment.Materials and methodsA total of 132 consecutive men (median age, 70 years; IQR, 66–77 years) with rising PSA after prostate radiotherapy who underwent prostate MRI and biopsy in view of salvage treatment between January 2010 and July 2017 were retrospectively evaluated at a single center. MFS predictors were assessed with Cox models. Predictors of the volume of the local recurrence (number of invaded prostate sectors at biopsy) were assessed using Poisson regression among variables available at PSA relapse.ResultsAt multivariate analysis, an initial Gleason score ≥ 8 (OR = 7 [95% confidence interval (CI): 1.2–40]; P = 0.03), a recent radiotherapy (OR = 17 [95% CI: 3.9–72]; P < 0.0001), the use of androgen deprivation therapy at PSA relapse (OR = 12.5 [95% CI: 2.8–57]; P = 0.001) and the number of invaded prostate sectors (OR = 1.5 [95% CI: 1.1–2]; P = 0.007) and maximum cancer core length (OR = 0.7 [95%CI: 0.6–0.9]; P = 0.002) at biopsy performed at PSA relapse were significant MFS predictors. The PSA level at relapse was significant independent predictor of the volume of local recurrence only when used as a continuous variable (P = 0.0002) but not when dichotomized using the nadir + 2 threshold (P = 0.41).ConclusionPathological and clinical factors can help predict MFS in patients with rising PSA after prostate radiotherapy and candidates to salvage treatment. The PSA level at relapse has strong influence on the local recurrence volume when used as a continuous variable.     

Accès veineux périphériques au bloc opératoire : caractéristiques et facteurs prédictifs de difficulté

PurposeTo investigate of predictor's factors of difficult venous access device in the operating room in elective surgery.MethodsIn a prospective study in central operating room, were included all patients scheduled for a surgical or diagnostic intervention. Were excluded all patients admitted with functional venous access. For each, were recorded patient's demographic characteristics (age, gender, ASA class, BMI), history (chemotherapy, prolonged ICU stay, hospitalization for more than five days), data from the clinical examination (presence of skin lesions, arteriovenous fistulas, burns, neurological deficits) and the type of operator (trainee, nurse, resident, senior). The difficulty was judged on the number of attempts required for successful venous access. Puncture was considered easier for a number of attempts to one to two and difficult if the number of attempts was greater than two. Predictor's factors were identified after univariate and multivariate analysis.ResultsDuring one year (March 2008 to February 2009), form returns in 1500 were met, 1325 were usable. Venous catheterization was successful in 50.9% at the first attempt in 24.2% of patients at the second attempt and after three attempts in 18% of patients. Only 6.8% of patients required more than three attempts. A central venous catheter was required in seven patients. In multivariate analysis, chemotherapy (OR = 4.54, 95% CI [2.92 to 7.03]; P < 0.001), a nurse in training (OR = 2.27, 95% CI [1.40 to 3.63]; P = 0.001), a resident in training (OR = 2.14, 95% CI [1.29 to 3.58]; P = 0.003) and the presence of burns (OR = 3.59, 95% CI [2.44 to 5.27]; P < 0.001) were identified as independent predictors of difficulty of peripheral venous access.DiscussionThe optimization of venous access devices in the operating room through the search for predictors of difficulty.     

The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: A meta-analysis

ObjectiveOsteoporosis is highly prevalent among patients with chronic obstructive pulmonary disease (COPD) and most commonly presents as a vertebral compression fracture (VCF). Our objective was to quantify the effect of osteoporosis and VCFs on the mortality and pulmonary function tests (PFTs), such as forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC), of patients with COPD.MethodsA PubMed/Medline search was conducted using the search terms “chronic obstructive pulmonary disease”, “osteoporosis” and “vertebral compression fracture”. Meta-analyses were conducted to evaluate the differences in mortality and PFTs between patients with COPD with and without osteoporosis or VCFs, according to PRISMA guidelines. PROSPERO registration: CRD42019120335.ResultsOf the 896 abstracts identified, 27 studies describing 7662 patients with COPD of which 1883 (24.6%) had osteoporosis or VCFs, were included. Random effects model analysis demonstrated that patients with COPD and osteoporosis or VCFs had an increased OR for mortality of 2.40 (95% CI: 1.24; 4.64, I² = 89%, P < 0.01), decreased FEV₁/FVC with a mean difference of ?4.80% (95% CI: ?6.69; ?2.90, I² = 83%, P < 0.01) and decreased FEV₁, with a mean difference of ?4.91% (95% CI: ?6.51; ?3.31, I² = 95%, P < 0.01) and ?0.41 L (95% CI: ?0.59; ?0.24, I² = 97%, P < 0.01), compared to control subjects. Apart from FEV₁ (liters) in subgroup 1 (P = 0.06), all subgroup analyses found significant differences between groups, as did sensitivity analysis of low risk of bias studies.ConclusionOsteoporosis and VCFs are associated with a significant reduction in survival and pulmonary function among patients with COPD.     

Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19

BackgroundThe severe acute respiratory syndrome-coronavirus 2 pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation.MethodsValidation consisted of (a) testing tidal volume delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome by saline lavage.ResultsDifferences in tidal volume in the simulated models were marginally different (largest difference 33 ml [95% CI 31 to 36]; P < .001). Plateau pressure was not different (?0.3 cmH₂O [95% CI ?0.9 to 0.3]; P = .409), and positive end-expiratory pressure was marginally different (0.3 cmH₂O [95% CI 0.2 to 0.3]; P < .001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias ?0.29 [limits of agreement 0.82 to ?1.42], and mean bias 0.56 [limits of agreement 1.94 to ?0.81], at a plateau pressure of 15 and 30 cmH₂O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after acute respiratory distress syndrome induction.ConclusionsThe ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The ACUTE-19 can provide the basis for the development of a future affordable commercial ventilator.     

Evolution of hydrogels for cartilage tissue engineering of the knee: A systematic review and meta-analysis of clinical studies

IntroductionIn recent years, studies have boosted our knowledge about the biology and disorders of articular cartilage. In this regard, the design of hydrogel-based scaffolds has advanced to improve cartilage repair. However, the efficacy of knee cartilage repair using hydrogels remains unclear. The aim of systematic review and meta-analysis was to scrutinize the efficiency of hydrogel-based therapy in correcting cartilage defects of knee (femoral condyle, patella, tibia plateau and trochlea).MethodsThe search was conducted in PubMed to gather articles published from 2004/1/1 to 2019/10/01, addressing the effects of implant of hydrogel on knee joint cartilage regeneration. The Cochrane Collaboration‘s tool for estimating the risk of bias was applied to check the quality of articles. The clinical data for meta-analysis was recorded using the visual analog scale (VAS), Lysholm score, WOMAC, and IKDC. The guidelines of Cochrane Handbook for Systematic Reviews of Interventions were utilized to conduct the review and meta-analysis in the RevMan 5.3 software.ResultsThe search resulted in 50 clinical trials that included 2846 patients, 986 of whom received cell-based hydrogel implants while 1860 patients used hydrogel without cell. There were significant differences comparing the pain scores based on the VAS (MD: ?2.97; 95% CI: ?3.15 to ?2.79, P < 0.00001) and WOMAC (MD: ?25.22; 95% CI: ?31.22 to ?19.22, P < 0.00001) between pre- and post-treatment with hydrogels. Furthermore, there were significant improvements in the functional scores based on the IKDC total score (MD: 30.67; P < 0.00001) and the Lysholm knee scale (MD: 29.26; 95% CI: 26.74 to 31.78, P < 0.00001). According to the Lysholm and IKDC score and after cumulative functional analysis, there was a significant improvement in this parameter (MD: 29.25; 95% CI: 27.26 to 31.25, P < 0.00001).ConclusionsThis meta-analysis indicated clinically and statistically significant improvements in the pain score (VAS and WOMAC) and the functional score (IKDC and Lysholm) after the administration of hydrogel compared to pretreatment status. So, the current evidence shows the efficiency of hydrogel-based therapy in correcting and repairing knee cartilage defects.     

Resección transuretral en bloque vs. resección transuretral convencional para el cáncer de vejiga primario no músculo-infiltrante: metaanálisis

IntroductionWe performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer.MethodsA systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models.ResultsEn-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; P < 0.001), catheterization-time (MD: –0.66; 95%CI: –1.02-[–0.29]; P < 0.001), length of hospital stay (MD: –0.95; 95%CI: –1.55-[–0.34]; P = 0.002), postoperative bladder irrigation duration (MD: –6.06; 95%CI: –9.45-[–2.67]; P < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; P = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: P < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; P = 0.09), the operation time (MD: 0.67; 95%CI: –1.92-3.25; P = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; P = 0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects.ConclusionsEn-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.     

Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials

Background and objectiveSugammadex has been introduced for reversal of rocuronium (or vecuronium)–induced neuromuscular blockade (NMB). Although its efficacy has been established, data are conflicting whether it is safer than neostigmine traditionally used for reversing NMB.DesignMeta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology.SettingUniversity medical hospital.MethodsA comprehensive search was conducted using PubMed, Web of Science, and Cochrane Library electronic databases to identify English-language randomized controlled trials. Two reviewers independently selected the trials; extracted data on reversal times, incomplete reversals of NMB, and adverse events (AEs); and assessed the trials' methodological quality and evidence level. Only AEs that were related to study drug by a blinded safety assessor were considered for meta-analysis.PatientsA total of 1384 patients from 13 articles were included in this meta-analysis.Main resultsCompared to neostigmine, sugammadex was faster in reversing NMB (P < .0001) and more likely to be associated with higher train-of-four ratio values at extubation (mean difference, 0.18; 95% confidence interval [CI], 0.14-0.22; P < .0001) and lower risk of postoperative residual curarization after extubation (odds ratio [OR], 0.05; 95% CI, 0.01-0.43; P = .0068). Compared to neostigmine, sugammadex was associated with a significantly lower likelihood of global AEs (OR, 0.47; 95% CI, 0.34-0.66; P < .0001), respiratory AEs (OR, 0.36; 95% CI, 0.14-0.95; P = .0386), cardiovascular AEs (OR, 0.23; 95% CI, 0.08-0.61; P = .0036), and postoperative weakness (OR, 0.45; 95% CI, 0.21-0.97; P = .0409). Sugammadex and neostigmine were associated with a similar likelihood of postoperative nausea and vomiting (OR, 1.23; 95% CI, 0.70-2.15; P = .4719), pain (OR, 1.06; 95% CI, 0.15-7.36; P = .9559), neurologic AEs (OR, 1.47; 95% CI, 0.52-4.17; P = .4699), general AEs (OR, 0.75; 95% CI, 0.47-1.21; P = .2448), and changes in laboratory tests' values (OR, 0.57; 95% CI, 0.18-1.78; P = .3368).ConclusionsResults from this meta-analysis suggest that sugammadex is superior to neostigmine, as it reverses NMB faster and more reliably, with a lower risk of AEs.     

Efficacy and safety of nano-silver dressings combined with recombinant human epidermal growth factor for deep second-degree burns: A meta-analysis

ObjectiveThe purpose of this meta-analysis was to assess the efficacy and safety of nano-silver dressing combined with recombinant human epidermal growth factor for deep second-degree burns.MethodsPubMed, Web of Science, EMBASE, Cochrane Library and other databases were searched to identify relevant randomised controlled trials.ResultsTwelve studies that assessed nano-silver dressing combined with recombinant human epidermal growth factor were identified. Nano-silver dressing combined with recombinant human epidermal growth factor for deep second-degree burns could significantly reduce the duration of wound healing (mean difference ?5.68, 95% CI ?7.38 – ?3.99, P < 0.00001), the wound healing rate (risk ratio [RR] 0.34, 95% CI 0.23–0.48, P < 0.00001), the rate of scar hyperplasia (RR 0.67, 95% CI 0.54–0.84, P = 0.0004), the wound bacterial positive rate (RR 0.50, 95% CI 0.28–0.89, P = 0.02), and the adverse reactions rate (RR 0.31, 95% CI 0.16–0.58, P = 0.0003).ConclusionThis comprehensive meta-analysis of the available evidence suggest that the use of nano-silver dressing combined with recombinant human epidermal growth factor results in shorter duration of wound healing, reduced wound bacterial positive rates and adverse reactions rate, and improved wound healing rates.     

Metaanálisis sobre el protocolo de recuperación acelerada tras la cistectomía radical

IntroductionWe performed a meta-analysis to evaluate the effect of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy.MethodsA systematic literature search up to April 2021 was done and 33 studies included 6596 subjects submitted to surgery for radical cystectomy at the start of the study; 3143 of them received enhanced pharmaceutical recovery after surgery and 3453 were controls. The studies reported relationships about the effects of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy using the dichotomous and continuous methods with a random or fixed-effect model.ResultsEnhanced pharmaceutical recovery after surgery had significantly lower length of hospital stay (MD: ?2.78; 95% CI: ?3.59 to ?1.97, P < .001), complications (OR: 0.75; 95% CI: 0.60 to 0.94, P = .01), readmission within 30 days (OR: 0.80; 95% CI: 0.69 to 0.94, P = .007), and time to defecation (MD: ?1.30; 95% CI: ?2.22 to ?0.37, P = .006) compared to control in subjects submitted to radical cystectomy.ConclusionsEnhanced pharmaceutical recovery after surgery may reduce the length of hospital stay, complications, readmission within 30 days, and time to first bowel movement compared to control in subjects with surgery for radical cystectomy. Furthers studies are required to validate these findings.     

Effects of soy isoflavone supplements on bone turnover markers in menopausal women: Systematic review and meta-analysis of randomized controlled trials

IntroductionEffects of soy isoflavone supplements on bone turnover markers remain unclear. This up-to-date systematic review and meta-analysis of randomized controlled trials (RCTs) was performed primarily to more completely and precisely clarify the effects on urinary deoxypyridinoline (DPD) and serum bone alkaline phosphatase (BAP) and secondarily to evaluate the effects on other bone turnover markers, compared with placebo in menopausal women.MethodsPubMed, CENTRAL, ICHUSHI, and CNKI were searched in June 2009 for relevant studies of RCTs. Data on study design, participants, interventions, and outcomes were extracted and methodological quality of each included trial was assessed.ResultsFrom 3740 identified relevant articles, 10 (887 participants), 10 (1210 participants), and 8 (380 participants) RCTs were selected for meta-analysis of effects on DPD, BAP, and serum osteocalcin (OC), respectively, using Review Manager 5.0.22. Daily ingestion of an average 56 mg soy isoflavones (aglycone equivalents) for 10 weeks to 12 months significantly decreased DPD by 14.1% (95% CI: ? 26.8% to ? 1.5%; P = 0.03) compared to baseline (heterogeneity: P < 0.00001; I² = 93%; random effects model). The overall effect of soy isoflavones on DPD compared with placebo was a significant decrease of ? 18.0% (95% CI: ? 28.4% to ? 7.7%, P = 0.0007; heterogeneity: P = 0.0001; I² = 73%; random effects model). Subgroup analyses and meta-regressions revealed that isoflavone dose and intervention duration did not significantly relate to the variable effects on DPD. Daily supplementation of about 84 mg and 73 mg of soy isoflavones for up to 12 months insignificantly increased BAP by 8.0% (95% CI: ? 4.2% to 20.2%, P = 0.20; heterogeneity: P < 0.00001; I² = 98%) and OC by 10.3% (95% CI: ? 3.1% to 23.7%, P = 0.13; heterogeneity: P = 0.002; I² = 69%) compared with placebo (random effects model), respectively.ConclusionsSoy isoflavone supplements moderately decreased the bone resorption marker DPD, but did not affect bone formation markers BAP and OC in menopausal women. The effects varied between studies, and further studies are needed to address factors relating to the observed effects of soy isoflavones on DPD and to verify effects on other bone turnover markers.     

Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study

IntroductionWe hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery.MethodsAfter Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150 mg or 300 mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24 h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded.ResultsCompared with placebo or pregabalin 150 mg, the use of a preoperative dose of pregabalin 300 mg resulted in significantly lower cumulative morphine consumption at 24 h (mean dose: placebo 12.9 mg [95% CI 11.6 to 14.2]; pregabalin 150 mg 11.9 mg; [95% CI 10.7 to 13.1]; pregabalin 300 mg 6 mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300 mg resulted in lower pain scores at 4 h and 6 h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300 mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300 mg group (6.7%) experienced short-term poor latching-on for breastfeeding.ConclusionIn our study, preoperative administration of pregabalin 300 mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.     

La obesidad,la hipertensión y la diabetes mellitus afectan la tasa de complicaciones de las diferentes técnicas de nefrectomía

IntroductionTo investigate whether obesity, hypertension, and diabetes mellitus (DM) would increase post-nephrectomy complication rates using standardized classification method.MethodsWe retrospectively included 843 patients from March 2006 to November 2012, of whom 613 underwent radical nephrectomy (RN) and 229 had partial nephrectomy (PN). Modified Clavien classification system was applied to quantify complication severity of nephrectomy. Fisher's exact or chi-square test was used to assess the relationship between complication rates and obesity, hypertension, as well as DM.ResultsThe prevalence of obesity, hypertension, and DM was 11.51%, 30.84%, 8.78%, respectively. The overall complication rate was 19.31%, 30.04%, 35.71% and 36.36% for laparoscopic radical nephrectomy (LRN), open-RN, LPN and open-PN respectively. An increasing trend of low grade complication rate as BMI increased was observed in LRN (P = .027) and open-RN (P < .001). Obese patients had greater chance to have low grade complications in LRN (OR = 4.471; 95% CI: 1.290-17.422; P = 0.031) and open-RN (OR = 2.448; 95% CI: 1.703-3.518; P < .001). Patients with hypertension were more likely to have low grade complications, especially grade ii complications in open-RN (OR = 1.526; 95% CI: 1.055-2.206; P = .026) and open PN (OR = 2.032; 95% CI: 1.199-3.443; P = .009). DM was also associated with higher grade i complication rate in open-RN (OR = 2.490; 95% CI: 331-4.657; P = .016) and open-PN (OR = 4.425; 95% CI: 1.815-10.791; P = .013). High grade complication rates were similar in comparison.ConclusionsObesity, hypertension, and DM were closely associated with increased post-nephrectomy complication rates, mainly low grade complications.     

The effect of second-stage pushing and body mass index on postdural puncture headache

Study objectiveTo explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles.DesignRetrospective cohort.SettingObstetric ward and operating rooms at a university-affiliated hospital.PatientsOne hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014.InterventionsPatients were categorized by pushing status and body mass index (kg/m²): nonobese <30, obese 30-39.99, morbidly obese 40-49.99, and super obese ≥50.MeasurementsHeadache, number of days of headache, maximum headache score, and epidural blood patch placement.Main resultsCompared with women who did not push, women who pushed during labor had increased risk of postdural puncture headache (odds ratio [OR], 2.1 [1.1-4.0]; P = .02), more days of headache (P = .02), and increased epidural blood patch placement (P = .02). Super obese patients were less likely to develop headache compared with nonobese (OR, 0.33 [0.13-0.85]; P = .02), obese (OR, 0.37 [0.14-0.98]; P = .045], and morbidly obese patients (OR, 0.20 [0.05-0.68]; P < .01). In a multivariate logistic regression model, lack of pushing (OR, 0.57 [0.29-1.10]; P = .096) and super obesity (OR, 0.41 [0.16-1.02]; P = .056] were no longer significantly associated with reduced risk of postdural puncture headache.ConclusionsParturients who did not push before delivery and parturients with body mass index ≥50 kg/m² were less likely to develop postdural puncture headache in a univariate analysis. Similar trends were demonstrated in a multivariate model, but were no longer statistically significant.     

Meta-analysis of laparoscopy assisted distal gastrectomy and conventional open distal gastrectomy for EGC

In recent decades, laparoscopy assisted distal gastrectomy (LADG) has been introduced to treat early gastric cancer (EGC). This study evaluated the safety and efficacy of laparoscopy assisted and conventional open distal gastrectomy for EGC. Comprehensive searches of PubMed, EmBase, Cochrane Controlled Trials Register and Chinese Biomedical Database (CBM) were performed. Included literature was evaluated using the Newcastle-Ottawa Scale. Original data were extracted, pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated using RevMan 5.0. Eight RCTs of 734 patients were included in the study. Compared to CODG, LADG increases the operation time (weighted mean difference [WMD]: 63.35; 95% confidence interval [CI]: 57.96, 68.74; P < 0.01), reduces intraoperative blood loss (WMD: ?127.95; 95% CI: ?147.97, ?107.93; P < 0.01), decreases number of harvested lymph nodes (WMD: ?4.21; 95% CI: ?6.10, ?2.31; P < 0.01), forwards oral intake time (WMD:?0.43; 95% CI: ?0.61, ?0.24; P < 0.01), and shortens hospital stay(WMD: ?1.29; 95% CI: ?1.76, ?0.83; P < 0.01). There is no significant difference in postoperative complications(OR: 0.70; 95% CI: 0.46, 1.06; P = 0.09). All these findings indicate that LADG for EGC is feasible and safe.     

Rheumatoid arthritis risk in periodontitis patients: A systematic review and meta-analysis

ObjectiveMany clinical studies have been carried out to investigate the relationship between periodontitis and rheumatoid arthritis (RA). Owing to limited evidence and inconsistent findings among these studies, it is unclear whether periodontitis would increase the risk for RA. This meta-analysis was performed to evaluate whether periodontitis represents a risk factor for RA.MethodsPubMed, Cochrane Library, Embase, Web of Science, and Wanfang were searched for eligible studies that compared periodontitis patients with controls. A pooled odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association between periodontitis and RA.ResultsThirteen studies including a total of 706611 periodontitis patients and 349983 control subjects were included. The pooled OR of RA risk between periodontitis and controls was (OR: 1.69; 95% CI: 1.31–2.17; P < 0.0001), indicating that the patients in periodontitis group had a 69% greater risk for RA than people in control group. When stratified by disease type, the pooled results showed periodontitis represents a risk factor for incident RA (OR = 1.70, 95%CI: 0.75–3.85, P < 0.001) and mixed RA (OR = 1.61, 95%CI: 1.26–2.06; P < 0.001). When stratified by disease duration, the pooled results showed periodontitis represents a risk factor for RA disease duration > 5 years (OR = 2.88, 95%CI: 0.66–12.62, P = 0.018), disease duration < 5 years (OR = 2.59, 95%CI: 0.83–8.11, P < 0.001), mixed disease duration (OR = 1.53; 95%CI: 1.05–2.22, P < 0.001).ConclusionOur meta-analysis revealed an increased risk of RA in patients with periodontitis compared to healthy controls. Moreover, when stratified by disease type, there was a higher risk between incident RA and periodontitis. When stratified by disease duration, the patients with periodontitis might be more closely associated with the RA patients with disease duration >5 years.     

Bone turnover markers as predictive indicators of outcome in patients with breast cancer and bone metastases treated with bisphosphonates: Results from a 2-year multicentre observational study (ZOMAR study)

BackgroundWe evaluated the evolution and predictive value of bone turnover markers (BTMs) and circulating tumor cells (CTCs) with respect to mortality, disease progression (DP) and skeletal-related events (SREs), in patients with bone metastatic breast cancer (BmBCa). The correlation between BTMs and CTCs was also studied.MethodsIn a 2-year observational, multicenter study, the levels of three BTMs (N- and C-terminal telopeptides of collagen I [NTX and αα-CTX], and bone-specific alkaline phosphatase [BSAP]) and CTCs were analyzed every three months. Patients received zoledronic acid (4 mg every 28 days) from the baseline visit.Results234 patients were analyzed. The levels of the BTMs were increased at baseline and significantly decreased after 3 months (P < 0.05). In the Cox regression univariate analyses significant hazard ratios (HRs) for death were found for pathological BSAP values at baseline (5.03 [95% CI: 1.214–20.839; P = 0.0259]) and at 3 months (3.41 [95% CI: 1.367–8.498; P = 0.0085]). HRs > 2 were found for increased baseline and 3-month levels of NTX and CTC (P < 0.05). Only increased baseline BSAP levels were associated with DP (HR = 2.25 [95% CI: 1.391–3.626; P = 0.0009]). No biomarker was associated with SREs. In the multivariate analysis, pathologic levels at 3 months of NTX and BSAP were significantly associated with mortality (HRs = 3.59 [95% CI: 1.375–9.382; P = 0.0091] and 3.25 [95% CI: 1.293–8.189; P = 0.0120], respectively). CTC and BSAP were correlated during all study timepoints (P < 0.05).ConclusionsBaseline levels of NTX, BSAP and CTCs, and changes after treatment initiation with bisphosphonates, may be useful for the prognostic assessment of patients with BmBCa. BSAP showed the strongest prognostic value.     

Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study

Study objectiveTo compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.DesignRetrospective 2:1 matched study design.SettingLarge tertiary medical center.PatientsNarcoleptic patients who underwent general anesthesia from January 1, 2011, through September 30, 2015, were matched with controls by age, sex, and type and year of surgery.MeasurementsMedical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes.Main resultsThe perioperative courses of 76 narcoleptic patients and their controls were examined. Compared to controls, narcoleptic patients were more often prescribed central nervous system stimulants (73.7% vs 4.0%, P < 0.001) and antidepressants (46.1% vs 27.6%, P = 0.007) and more often had obstructive sleep apnea (40.8% vs 19.1%, P < 0.001). The intraoperative course was similar. The number of episodes of respiratory depression was not different between patients and controls (5 [6.6%] vs 12 [7.9%], respectively; P = 0.80). Narcoleptic patients had a higher frequency of emergency response team activations (5 of 76 [6.6%]; 95% CI, 2.2%–14.7%) compared to controls (2 of 152 [1.3%]; 95% CI, 0.2%–4.7%) (P = 0.04). Hemodynamic instability was the indication for all emergency response team activations except 1, which was for a narcoleptic patient who had excessive postoperative sedation and respiratory depression.ConclusionsNarcoleptic patients had similar intraoperative courses as the matched controls, including phase I anesthetic recovery. However, they had a higher rate of emergency response team activations than the controls, which suggests that patients with narcolepsy may be at increased perioperative risk.     

Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients?

IntroductionIndividuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma.MethodsA total of 124 orthopaedic trauma patients completed the Injustice Experience Questionnaire (IEQ), the PROMIS Physical Function Computer Adaptive Testing (CAT), the PROMIS Pain Intensity instruments, the short form Patient Health Questionnaire for depression (PHQ-2), the short form Pain Self-Efficacy Questionnaire (PSEQ-2), and the short form Pain Catastrophizing Scale (PCS-4) on a tablet computer. A stepwise linear regression model was used to identify the best combination of predictors explaining variance in PROMIS Physical Function and PROMIS Pain Intensity.ResultsThe IEQ was associated with PROMIS Physical Function (r = −0.36; P < 0.001) and PROMIS Pain Intensity (r = 0.43; P < 0.001). In multivariable analysis, however, Caucasian race (β = 5.1, SE: 2.0, P = 0.013, 95% CI: 1.1–9.2), employed work status (β = 5.1, SE: 1.5, P = 0.001, 95% CI: 2.1–8.2), any cause of injury other than sports, mvc, or fall (β = 7.7, SE: 2.1, P < 0.001, 95% CI: 3.5–12), and higher self-efficacy (PSEQ-2; β = 0.93, SE: 0.23, P < 0.001, 95% CI: 0.48–1.4) were selected as part of the best model predicting variance in PROMIS Physical Function. Only a higher degree of catastrophic thinking (PCS-4; β = 1.2, SE: 0.12, P < 0.001, 95% CI: 0.99 to 1.5) was selected as important in predicting higher PROMIS Pain Intensity.ConclusionPerceived injustice was associated with both physical function and pain intensity in bivariate correlations, but was not deemed as an important predictor when assessed along with other demographic and psychosocial variables in multivariable analysis. This study confirms prior research on the pivotal role of catastrophic thinking and self-efficacy in reports of pain intensity and physical function in patients with acute traumatic musculoskeletal pain.     

The influence of mortality rate from membrane flux for end-stage renal disease: A meta-analysis

To evaluate the influence of the high-flux hemodialysis (HFHD) and the low-flux hemodialysis (LFHD) on mortality rate for end-stage renal disease (ESRD). Four electronic databases including PubMed, EMBASE, the Cochrane Library, and ClinicalTrails were searched to identify relevant randomized clinical trials up to 31 August 2015. Seven studies enrolling a total of 4412 patients were included in this meta-analysis. For all-cause mortality comparing with LFHD, the result showed that there were significant difference (RR = 0.75; 95% CI [0.60–0.94]; I² = 84%; P < 0.00001). For death due to infection comparing with LFHD, the result showed that there was no significant difference (RR = 0.92; 95% CI [0.75–1.13]; I² = 0%; P = 0.86). For cardiovascular mortality, the overall meta-analysis result showed that there was a significant difference between the HFHD versus the LFHD (RR = 0.75; 95% CI [0.60–0.94]; I² = 55%; P = 0.11). Publication bias was not detected by funnel plot. Based on these results, our study suggests that the HFHD has superior effectiveness over LFHD for long-term survival in ESRD.