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1.
Ignazio Tarantino Rene Warschkow Bruno M. Schmied Ulrich Güller Markus Mieth Thomas Cerny Markus W. Büchler Alexis Ulrich 《Journal of gastrointestinal surgery》2016,20(6):1213-1222
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.2.
Erin A Brennand Selphee Tang Colin Birch Magnus Murphy Sue Ross Magali Robert for the Calgary Women’s Pelvic Health Research Group 《International urogynecology journal》2017,28(4):621-628
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.3.
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.4.
Jing Fang Wenge Li Min Tan Wen Chen Cong Zhang Wenbo Wang Qianqian Xu Xinzhen Guo 《International urology and nephrology》2018,50(9):1653-1660
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.5.
Brian J. Linder Sherif A. El-Nashar Daniel A. Carranza Leon Emanuel C. Trabuco 《International urogynecology journal》2016,27(9):1321-1326
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.6.
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.7.
Xian-rui Wu Jean Ashburn Feza H Remzi Yi Li Hagar Fass Bo Shen 《Journal of gastrointestinal surgery》2016,20(3):631-639
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.8.
Summary
The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias.Introduction
This study aimed to assess whether KP was superior to VP in treating patients with OVCFs.Methods
The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model.Results
Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, ?0.70; 95 % confidence interval [CI]: ?1.30, ?0.10; P?=?0.023) visual analog scale (VAS); short-term (SMD, ?1.50; 95 % CI: ?2.94, ?0.07; P?=?0.040) and long-term (SMD, ?1.03; 95 % CI: ?1.88, ?0.18; P?=?0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, ?0.74; 95 % CI: ?1.42, ?0.06; P?=?0.032) and long-term (SMD, ?0.71; 95 % CI: ?1.19, ?0.23; P?=?0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P?=?0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P?=?0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P?=?0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P?=?0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures.Conclusion
Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.9.
G. Paul Wright Katherine E. Poruk Mazen S. Zenati Jennifer Steve Nathan Bahary Melissa E. Hogg Amer H. Zuriekat Christopher L. Wolfgang Herbert J. ZehIII Matthew J. Weiss 《Journal of gastrointestinal surgery》2016,20(11):1830-1835
Introduction
Patients with metastatic pancreatic adenocarcinoma have traditionally been offered palliative chemotherapy alone, and the role of surgery in these patients remains unknown.Methods
A bi-institutional retrospective review was performed for patients with metastatic pancreatic adenocarcinoma who underwent resection of the primary tumor from 2008 to 2013. The primary outcome measured was postoperative overall survival. Secondary outcomes included postoperative disease-free survival and overall survival from the time of diagnosis.Results
Twenty-three patients were identified who met the study criteria with a median follow-up of 30 months. Metastatic sites included the liver (n?=?16), the lung (n?=?6), and the peritoneum (n?=?2). Chemotherapy included FOLFIRINOX (n?=?14) and gemcitabine-based regimens (n?=?9), with a median of 9 cycles (range 2–31) prior to surgical treatment. Median time from diagnosis to surgery was 9.7 months (IQR 5.8–12.8). Median overall survival (OS) from surgery, disease-free survival, and OS from diagnosis were 18.2 months (95 % CI 11.8–35.5), 8.6 months (95 % CI 5.2–16.8), and 34.1 months (95 % CI 22.5–46.2), respectively. The 1- and 3-year OS from surgery were 72.7 % (95 % CI 49.1–86.7) and 21.5 % (95 % CI 4.3–47.2), respectively.Conclusion
Resection of the primary tumor in patients with metastatic pancreatic adenocarcinoma may be considered in highly selected patients with favorable imaging and CA 19-9 response following chemotherapy at high-volume centers providing multidisciplinary care. These patients should be enrolled in prospective clinical trials or institutional registries to better quantify the potential benefits of such a strategy.10.
Georgios Antonios Margonis Kazunari Sasaki Yuhree Kim Mario Samaha Stefan Buettner Neda Amini Efstathios Antoniou Timothy M. Pawlik 《Journal of gastrointestinal surgery》2016,20(11):1821-1829
Introduction
The interplay of tumor biology and surgical margin status after resection for colorectal liver metastasis (CRLM) remains controversial. Consequently, we sought to determine the impact of surgical margin status on overall survival (OS) stratified by KRAS mutational status.Materials and Methods
Four hundred eighty-five patients with known KRAS mutational status were identified. Clinicopathologic and long-term survival data were collected and assessed.Results
On pathology, most patients (n?=?380; 78.3 %) had an R0 margin, while 105 (21.7 %) had an R1. Roughly two thirds of tumors were KRAS wild type (wtKRAS) (n?=?307, 63.3 %), while 36.7 % (n?=?178) had KRAS mutations (mutKRAS). Median and 5-year OS of the entire cohort was 65.8 months and 53.8 %, respectively. An R1 resection was associated with worse 5-year OS compared with R0 (42.4 % vs. 57.1 %; hazard ratio (HR) 1.82, 95 % CI 1.28–2.57; P?=?0.001). After controlling for KRAS status, the survival benefit associated with an R0 resection persisted only among patients with wtKRAS tumors (HR 2.16, 95 % CI 1.42–3.30; P?<?0.001). In contrast, surgical margin had no impact on OS among patients with mutKRAS tumors (5-year OS R0, 40.7 % vs. R1, 46.7 %; HR 1.34, 95 % CI 0.73–2.48; P?=?0.348).Conclusion
The impact of margin status differed by KRAS mutation status. An R0 margin only provided a survival benefit to patients with wtKRAS tumors. Tumor biology and not surgical technique determined prognosis.11.
Patrick Dällenbach Sara Sofia De Oliveira Sandra Marras Michel Boulvain 《International urogynecology journal》2016,27(9):1347-1355
Introduction and hypothesis
The objective of our study was to estimate the incidence and identify the risk factors for mesh erosion after laparoscopic repair of pelvic organ prolapse (POP) by lateral suspension with mesh.Methods
We conducted a nested case–control study among 480 women who underwent POP repair by laparoscopic lateral suspension with mesh from January 2004 to October 2012. Cases (n?=?18) were women who showed mesh erosion following the first intervention through December 2014. Controls (n?=?133) were women randomly selected from the same cohort who did not have any erosion.Results
The risk of mesh erosion was 3.8 % with a mean follow-up of 82.3 months (range 28.2 – 130.6 months). The main risk factor was the use of a type 3 mesh (macroporous with either multifilamentous or microporous components) rather than a type 1 mesh (macroporous and monofilamentous; adjusted OR 13.0, 95 % CI 1.5 – 110.6; P?=?0.02). Risk factors included smoking (adjusted OR 10.4, 95 % CI 2.3 – 46.5; P?<?0.01) and posterior mesh placement (adjusted OR 5.1, 95 % CI 1.2 – 21.8 P?=?0.03).Conclusions
The risk of mesh erosion is low and may be further reduced by using the appropriate mesh material, and by identifying specific patient characteristics such as tobacco use. As conventional vaginal surgery is effective for the treatment of the posterior compartment, the use of posterior mesh during laparoscopic pelvic floor repair needs to be questioned.12.
Allison N. Martin Deepanjana Das Florence E. Turrentine Todd W. Bauer Reid B. Adams Victor M. Zaydfudim 《Journal of gastrointestinal surgery》2016,20(9):1554-1564
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.13.
Hong-xiang Lu Jian-hui Sun Da-lin Wen Juan Du Ling Zeng An-qiang Zhang Jian-xin Jiang 《World journal of emergency surgery : WJES》2018,13(1):52
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.14.
Introduction
While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained.Methods
We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy.Results
Prevalence of any urinary leakage was 34.8% before and 38.7% during pregnancy. Prevalence of UI, leaking urine at least once per month, was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5–5.6, p =?0.001) and a body mass index (BMI) ≥30 kg/m2 (AOR 4.2, 95% CI 1.9–9.4, p?<0.001). Women aged ≥35 years (AOR 2.8, 95% CI 1.4–5.9, p =?0.005), women whose pre-pregnancy BMI was 25–29.99 kg/m2 (AOR 2.0, 95% CI 1.2–3.5, p =?0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6–4.1, p ?<0.005) were significantly more likely to report new-onset UI in pregnancy.Conclusion
Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.15.
Yi Sun Guo-Lin Lei Cai Tang Lu Yang Hong Shen Qiang Wei 《International urology and nephrology》2018,50(9):1597-1606
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.16.
Bernhard Widmann Rene Warschkow Bruno M. Schmied Lukas Marti Thomas Steffen 《Journal of gastrointestinal surgery》2016,20(8):1493-1502
Background
Whereas the poor prognosis of signet ring cell adenocarcinomas of the appendix is well known, the significance of mucinous histology remains unclear. The aim of this population-based study was to evaluate if mucinous histology is an independent prognostic factor in appendiceal adenocarcinomas.Methods
Patients with stage I–III adenocarcinoma of the appendix who underwent surgery between 2004 and 2012 were identified in the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cancer-specific survival (CSS) were assessed using risk-adjusted Cox proportional hazards regression models and propensity score methods.Results
Overall, 980 patients with appendix cancer were included, of which 449 (45.8 %) had a mucinous histology. In an unadjusted analysis, the 5-year OS and CSS in patients with a mucinous adenocarcinoma (MC) was 76.8 % (95 % confidence interval (95 %CI): 72.1–81.7 %) and 81.0 % (95 %CI: 76.6–85.6 %), respectively, compared with 70.0 % (95 %CI: 65.1–75.3 %) and 76.2 % (95 %CI: 71.5–81.2 %) in patients with non-mucinous adenocarcinoma (NMC) (P?=?0.082 and P?=?0.368). In multivariable analysis, no impact on survival was observed for OS (HR?=?1.22, 95 %CI: 0.89–1.68, P?=?0.208) and CSS (HR?=?1.21, 95 %CI: 0.84–1.74, P?=?0.296). After propensity score matching, nearly identical survival rates were observed (OS: HR?=?1.03, 95 %CI: 0.71–1.49, P?=?0.881 and CSS: HR?=?1.05, 95 %CI: 0.70–1.59, P?=?0.803).Conclusions
The present population-based, propensity score matched analysis shows that mucinous histology does not affect survival in stage I–III appendiceal adenocarcinoma patients. Therefore, the same treatment strategies can be applied for patients with NMC and MC of the appendix.17.
Purpose
To assess the available evidence on the prognostic factors for the 5-year survival for patients with distal cholangiocarcinoma (DCC) following surgical resection.Methods
We performed a comprehensive search of abstracts included in databases where relevant studies were published between January 2000 and August 2015. Risk ratios (RRs), 95 % confidence intervals (95 % CIs), and random-effects model were calculated using RevMan 5.3 software.Results
A total of 23 observational studies involving 2063 patients with DCC were analyzed. The meta-analysis showed that postoperative adjuvant chemotherapy was not confirmed as a prognostic factor, with similar 5-year survival rates between those receiving and not receiving chemotherapy (RR 0.71; 95 % CI 0.21–2.36; P = 0.57). Perineural invasion (RR 0.51; 95 % CI 0.40–0.64; P < 0.00001), lymph node metastasis (RR 0.51; 95 % CI 0.38–0.70; P < 0.0001), positive resection margin status (RR 2.11; 95 % CI 1.36–3.30; P = 0.001), and not-well-differentiated adenocarcinoma (RR 1.77; 95 % CI 1.39–2.25; P < 0.00001) were associated with shorter survival.Conclusions
Perineural invasion, lymph node metastasis, resection margin status, and tumor differentiation were the significant prognostic factors for the 5-year survival.18.
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.19.
Background
Recent NICE guidelines recommend open surgical approaches for the treatment of primary unilateral inguinal hernias. However, many surgeons perform a laparoscopic approach based on the advantages of less post-operative pain and faster recovery. Our aim was to examine current evidence comparing transabdominal pre-peritoneal (TAPP) laparoscopic repair and open surgical repair for primary inguinal hernias.Methods
A systematic search of six electronic databases was conducted for randomised controlled trials (RCTs) comparing TAPP and open repair for primary unilateral inguinal hernia. A random-effects model was used to combine the data.Results
A total of 13 RCTs were identified, with 1310 patients receiving TAPP repair and 1331 patients receiving open repair. There was no significant difference between the two groups for rates of haematoma (RR 0.92; 95% CI 0.49–1.71; P = 0.78), seroma (RR 1.90; 95% CI 0.87–4.14; P = 0.10), urinary retention (RR 0.99; 95% CI 0.36–2.76; P = 0.99), infection (RR 0.61; 95% CI 0.29–1.28; P = 0.19), and hernia recurrence (RR 0.67; 95% CI 0.42–1.07; P = 0.10). TAPP repair had a significantly lower rate of paraesthesia (RR 0.20; 95% CI 0.08–0.50; P = 0.0005), shorter bed stay (2.4 ± 1.4 vs 3.1 ± 1.6 days, P = 0.0006), and shorter return to normal activities (9.5 ± 7.9 vs 17.3 ± 8.4 days, P < 0.00001).Conclusions
Our findings demonstrated that TAPP repair did not have higher rate of morbidity or hernia recurrence and is an equivalent approach to open repair, with the advantages of faster recovery and reduced paraesthesia.20.
Qing Ou Yang Sheng Zhang Qing-Bao Cheng Bin Li Fei-Ling Feng Yong Yu Xiang-Ji Luo Zhao-Fen Lin Xiao-Qing Jiang 《Journal of gastrointestinal surgery》2016,20(5):960-969