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1.
Dengpiao Xie Jianting Wang Xinping Wu Mingquan Li 《International urology and nephrology》2018,50(12):2201-2206
Background
The efficacy of daprodustat for the treatment of anemic patients with chronic kidney disease (CKD) remains controversial. The aim of the study is to perform a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of daprodustat for anemic patients with chronic kidney disease.Methods
We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing daprodustat with placebo for anemic patients with CKD.Results
Four studies were included. Compared with placebo groups, daprodustat groups significantly increased hemoglobin (WMD 1.29 g/dL; 95% CI 0.96–1.62, p?<?0.00001), transferrin (WMD 0.67 g/dL; 95% CI 0.45–0.89, p?<?0.00001), and total iron binding capacity (WMD 9.97 g/dL; 95% CI 6.07–13.8, p?<?0.00001). Daprodustat groups significantly decreased hepcidin (WMD ??76.1 μg/L; 95% CI ??91.8 to ??60.3, p?<?0.00001) and ferritin (WMD ??63.6 μg/L; 95% CI ??96.6 to ??30.7, p?=?0.0002) compared with that of placebo groups. In addition, there was no significant difference in adverse events between the two groups.Conclusion
Daprodustat could improve hemoglobin without increasing adverse events in the short term. Daprodustat may be another valuable choice for anemic patients with chronic kidney disease in the future.2.
Aim
To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients.Methods
We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients.Results
Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, ? 7.97 pill; 95% CI, ? 11.28 to ? 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, ? 0.07 mmol/L; 95% CI, ? 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, ? 0.63 to 1.17, p = 0.55).Conclusion
PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.3.
Mauro Podda Francesco Maria Polignano Andreas Luhmann Michael Samuel James Wilson Christoph Kulli Iain Stephen Tait 《Surgical endoscopy》2016,30(3):845-861
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.4.
Moo-Ho Song Bu-Hwan Kim Seong-Jun Ahn Seong-Ho Yoo Suk-Woong Kang Yeong-Joon Kim Dong-Hwan Kim 《International orthopaedics》2016,40(2):295-299
Purpose
In recent years, there has been an increasing interest in peri-articular injections (PAI) to control post-operative pain after total knee arthroplasty (TKA). Previous studies have evaluated the effect of PAI using multimodal analgaesic protocols, but the concomitant use of patient-controlled analgesia (PCA) may has masked the genuine effects of PAI. We investigated the efficacy of PAI compared with PCA and determined whether conventional PCA can be effectively replaced with PAI after TKA.Methods
Eighty patients undergoing unilateral TKA were randomised into two groups. The PCA group consisted of patients who used PCA after surgery, while the PAI group included patients who did not use PCA post-operatively but were given PAI during surgery. We measured changes in visual analogue scale (VAS) scores, straight leg raising (SLR), range of motion (ROM) and consumption of antiemetics or analgaesics.Results
Pain levels in the PAI group were significantly lower than in the PCA group during two weeks post-operatively (p?<?0.05).; functional recovery in the SLR test showed no difference between groups (p?>?0.05).; mean ROM showed no difference; (p?>?0.05) and there was no difference in the number of patients who needed additional analgaesics. However, antiemetic use was significantly lower for the PAI group (p?<?0.05).Conclusions
PAI offered improved pain control and minimal side effects compared with PCA. Thus, PAI can replace conventional PCA for controlling post-operative pain after TKA.5.
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.6.
Purpose
To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.Methods
An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.Results
Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = ?151.01 (?288.22, ?13.80), P = 0.03], shorter length of hospital stay [WMD = ?69.33 (?110.39, ?28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].Conclusions
Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.7.
Rashid Tikhilov Svetlana Bozhkova Alexey Denisov Dmitry Labutin Igor Shubnyakov Vadim Razorenov Vasilii Artyukh Olga Klitsenko 《International orthopaedics》2016,40(7):1381-1387
Purpose
The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence.Methods
In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI.Results
Patients with infection recurrence had increased levels of ESR and CRP (P?<?0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P?<?0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P?<?0.01) where Gram-negative bacteria were predominant (61.5 %, P?<?0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P?<?0.01).Conclusions
Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.8.
Background
Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves.Materials and methods
A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB?+?IPACK (Group 1, n?=?60), and the subsequent 60 patients received ACB alone (Group 2, n?=?60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance.Results
VAS score showed significantly (p?<?0.005) better values in ACB?+?IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB?+?IPACK group compared to the ACB group.Conclusion
ACB?+?IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.9.
Objective
We performed this meta-analysis of randomised controlled trials to compare the efficacy and safety of unilateral with bilateral fixation in short-segment lumbar spinal fusion.Methods
Predefined terms were used to search electronic databases to identify relevant research. Randomised controlled trials (RCTs) published in English and Chinese during 1990–2015 investigating efficacy and safety of unilateral and bilateral fixation in short-segment lumbar spinal fusion were included. Data of fusion rate, complications, visual analogue scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL) and length of hospital stay were extracted and analysed. Two reviewers independently searched information sources, selected eligible research, analysed data and evaluated risk of bias.Results
Eleven RCTs comprising 756 participants were analysed. There was no significant difference in fusion rate, device-related complication, ODI, VAS and length of hospital stay between bilateral and unilateral groups. The unilateral group had the obvious advantage of reduced blood loss [mean difference (MD)??143.57, 95 % confidence interval (Cl) -206.61 to -80.54, P?<?0.0001) and operation time (MD -52.72, 95 % Cl -73.58 to -31.87, P?<?0.00001).Conclusion
Unilateral pedicle screw fixation is equally as effective as bilateral pedicle screw fixation in short-segment lumbar spinal fusion and may reduce operation time and blood loss.10.
Giovanni Merolla Giovanni Ciaramella Elisabetta Fabbri Gilles Walch Paolo Paladini Giuseppe Porcellini 《International orthopaedics》2016,40(11):2355-2363
Aim of the study
To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC).Methods
Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45–75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24–39). Early and late follow-up CT scans were available for 21/30 shoulders.Results
Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p?<?0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p?<?0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p?<?0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05).Discussion
The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth.Conclusions
The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.11.
Luca Papavero Carlos J. Marques Jens Lohmann Thies Fitting 《BMC musculoskeletal disorders》2018,19(1):452
Background
Up to 40% of patients diagnosed with lumbar spinal stenosis (LSS) show evidence of redundant nerve roots (RNR) of the cauda equina on their magnetic resonance images (MRI). The etiology of RNR is still unclear. Preoperative evidence of RNR is associated with a worse postsurgical outcome. Consequently, potential predictors of RNR could have a prognostic value. The aim was to test whether patient demographics and MRI-based measurements can predict RNR in LSS patients.Methods
In a retrospective database-based cohort study the preoperative data of 300 patients, 150 with (RNR+) and 150 without (RNR-) evidence of RNR on their MRI were analyzed. Three independent researchers performed the MRI reads. Potential predictors were age, gender, body height (BH), length of lumbar spine (LLS), segmental length of lumbar spine (SLLS), lumbar spine alignment deviation (LSAD), relative LLS (rLLS), relative SLLS (rSLLS), number of stenotic levels (LSS-level), and grade of LSS severity (LLS-grade, increasing from A to D). Binomial logistic regression models were performed.Results
RNR+ patients were 2.6?years older (p?=?0.01). Weak RNR+ predictors were a two-years age increase (OR 1.06; p?=?0.02), 3?cm BH decrease (OR 1.09; p?=?0.01) and a 5?mm SLLS decrease (OR 1.34; p?<?0.001). Strong RNR+ predictors were a 1% rLLS decrease (OR 2.17; p?<?0.001), LSS-level?≥?2 (OR 2.59; p?=?0.001), LLS-grade C (OR 5.86; p?=?0.02) and LLS-grade D (OR 18.4; p?<?0.001). The mean rSLLS of RNR+ patients was 0.6% shorter (p?<?0.001; 95% C.I. 0.4 to 0.8) indicating a disproportionate shorter lumbar spine.Conclusions
We identified LSS severity grade and LSS levels as the strongest predictors of RNR. In addition to previous studies, we conclude that a shortened lumbar spine by degeneration is involved in the development of RNR.12.
V. V. Zhukouskaya C. Ellen-Vainicher A. Gaudio F. Privitera E. Cairoli F. M. Ulivieri S. Palmieri V. Morelli V. Grancini E. Orsi B. Masserini A. M. Spada C. E. Fiore I. Chiodini 《Osteoporosis international》2016,27(1):49-56
Summary
The objective of the study was to evaluate the usefulness of trabecular bone score (TBS) and bone mineral density (BMD) for identifying vertebral fractures (VFx) in well-compensated type 2 diabetic (T2D) patients. TBS and femoral neck BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.Introduction
In T2D, the prevalence of VFx is increased, especially in poorly compensated and complicated diabetic patients. The possibility of predicting the fracture risk in T2D patients by measuring BMD and TBS, an indirect parameter of bone quality, is under debate. Therefore, the objective was to evaluate the usefulness of TBS and BMD for identifying VFx in well-compensated T2D patients.Methods
Ninety-nine T2D postmenopausal women in good metabolic control (glycosylated haemoglobin 6.8?±?0.7 %) and 107 control subjects without T2D were evaluated. In all subjects, we evaluated the following: the BMD at the lumbar spine (LS) and the femoral neck (FN); the TBS by dual X-ray absorptiometry; and VFx by radiography. In T2D subjects, the presence of diabetic retinopathy, neuropathy, and nephropathy was evaluated.Results
T2D subjects had increased VFx prevalence (34.3 %) as compared to controls (18.7 %) (p?=?0.01). T2D subjects presented higher BMD (LS ?0.8?±?1.44, FN ?1.06?±?1.08), as compared to controls (LS ?1.39?±?1.28, p?=?0.002; FN ?1.45?±?0.91, p?=?0.006, respectively). TBS was not different between diabetics and controls. In fractured T2D patients, LS-BMD, FN-BMD, and TBS were reduced (?1.2?±?1.44; ?1.44?±?1.04; 1.072?±?0.15) and the prevalence of retinopathy (15.4 %) was increased than in nonfractured T2D subjects (?0.59?±?1.4, p?=?0.035; ?0.87?±?1.05, p?=?0.005; 1.159?±?0.15, p?=?0.006; 1.8 %, p?=?0.04, respectively). The combination of TBS ≤1.130 and FN-BMD less than ?1.0 had the best diagnostic accuracy for detecting T2D fractured patients (SP 73.8 %, SN 63.6 %, NPV 78.9 %, PPV 56.8 %).Conclusions
TBS and FN-BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.13.
Yu Bao Yi-An Wang Hua Xiao Ying Wang Yan Wu Yue Yan Zhu Zhu Mei Ni Cheng-Xian Pi Ming-Yue Liu Jun-Hua Yang Yan-Ting Li Xin-Kui Tian Tao Wang Xing-Wei Zhe 《International urology and nephrology》2018,50(11):2061-2066
Background
Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that elevated heart rate (HR) is a risk factor for cardiovascular mortality. We investigated the link between serum endocan and circadian heart rate variability in non-dialysis stage 5 CKD patients.Methods
In a cross-sectional study, we enrolled 54 prevalent n non-dialysis stage 5 CKD patients (32 males, aged 48.2?±?14.92 years). HR was measured with an automatic system. Serum endocan level was analyzed by ELISA.Results
Night/day HR ratio was independently predicted by serum endocan level (P?<?0.01) and hypertension history (P?<?0.05). Adjusted R2 of the model was 0.222.Conclusion
Increased serum endocan is significantly associated with circadian heart rate variability in non-dialysis stage 5 CKD patients. Further investigation is needed to explore the potential benefits of serum endocan lowering therapy in this patient group.14.
M. P. Mosti G. Flemmen J. Hoff A. K. Stunes U. Syversen E. Wang 《Osteoporosis international》2016,27(3):1003-1010
Summary
This study examined musculoskeletal health in amphetamine users, compared with healthy age-matched controls. We show that amphetamine users have reduced bone mass at several skeletal sites and attenuated maximal muscle strength and force development capacity in the lower extremities.Introduction
Amphetamine use may cause poor bone quality and elevated risk of osteoporosis. The purpose of this study was to investigate whether amphetamine users exhibit reduced regional and whole body bone mineral density (BMD), altered bone metabolism, and how muscle function may relate to the patient groups’ skeletal health.Methods
We assessed hip, lumbar spine and whole body BMD, and trabecular bone score (TBS) by dual x-ray absorptiometry (DXA), and bone metabolism markers in serum and maximal strength and force development capacity in 36 amphetamine users (25 men, 30?±?7 years; 11 women 35?±?10 years) and in 37 healthy controls (23 men, 31?±?9 years; 14 women, 35?±?7 years).Results
Whole body BMD was lower in amphetamine users (8 % in males and 7 % females, p?<?0.01), as were BMD at the total hip and sub-regions of the hip (9–11 % in men and 10–11 % in women, p?<?0.05). Male users had 4 % lower TBS (p?<?0.05) and higher serum level of type 1 collagen amino-terminal propeptide (p?<?0.01). This coincided with reduced lower extremity maximal strength of 30 % (males, p?<?0.001) and 25 % (females, p?<?0.05) and 27 % slower muscular force development in males compared to controls (p?<?0.01).Conclusions
These findings demonstrate that amphetamine users suffer from a generalized reduction in bone mass, which was associated with attenuated maximal muscle strength and force development capacity in the lower extremities.15.
Takuya Ueda Kenji Suzuki Takeshi Matsunaga Kazuya Takamochi Shiaki Oh 《General thoracic and cardiovascular surgery》2018,66(2):95-100
Objective
The aim of this study was to elucidate the characteristics and predictors of postoperative atrial fibrillation (POAF) from the standpoint of surgical mode.Methods
Retrospective analysis was carried out on 607 patients who underwent lobectomy or segmentectomy for clinical stage IA lung cancer. We investigated the clinical factors to determine the predictors of the development of POAF.Results
Of the 607 patients, 443 underwent lobectomy, and 164 underwent segmentectomy. POAF developed in 37 patients. Of these, 34 (7.7%) were in the lobectomy group, and 3 (1.8%) in the segmentectomy group. In the univariate analysis for predictors of POAF, age (p?<?0.01), history of ischemic heart disease (p?=?0.03), FEV1.0% (p?<?0.01) and surgical mode (p?=?0.01) showed significant differences between the groups. The multivariate analysis revealed that increasing age (p?<?0.01, HR 1.059, CI 1.015–1.106), surgical mode (p?=?0.02, HR 5.734, CI 1.350–24.361) and FEV1.0%?<?70% (p?=?0.03, HR 2.182, CI 1.067–4.461) were independent predictors of POAF.Conclusion
POAF was significantly less following segmentectomy compared with lobectomy.16.
Kathryn Jaap Marcus Fluck Marie Hunsinger Jeffrey Wild Tania Arora Mohsen Shabahang Joseph Blansfield 《Journal of gastrointestinal surgery》2018,22(8):1358-1364
Importance
Management of pancreatic cancer is complex, requiring coordination of multiple providers. National Comprehensive Cancer Network guidelines, developed for standardization and quality improvement, recommend a multimodal approach.Objective
This study analyzed national rates of compliance with National Comprehensive Cancer Network recommendations, assessed factors affecting compliance, and evaluated whether compliance with evidence-based guidelines improved overall survival.Design
This is a retrospective review of adults diagnosed with pancreatic cancer entered into the National Cancer Database. Patients included had stage I and II pancreatic cancer, and complete data in the database. Patients were classified as compliant if they underwent both surgery and a second treatment modality (chemotherapy, radiation, or chemoradiation). Clinico-pathologic variables were analyzed using univariate and multivariate models to predict overall survival.Setting
Hospital-based national study population.Participants
Patients with stage I or II pancreatic cancer.Main Outcomes and Measures
Compliance with National Comprehensive Cancer Network recommendations, factors affecting compliance, and overall survival based on compliance.Results
A total of 52,450 patients were included; 19,272 patients (37%) were compliant. Patients were found to be most compliant in the 50–59-year-old range (49% complaint), with decreased compliance at the extremes of age. Male patients were more compliant than female patients (39 vs 34%, p?<?0.0001). Caucasians were more compliant (39%) than African Americans (32%) or other races (32%, p?<?0.0001). Patients treated at academic/research centers were more compliant than patients treated at other facilities (39% compliant, p?<?0.0001). Patients with stage II disease were more compliant compared with stage I disease (43 vs 18%, p?<?0.0001). Compliance was shown to improve overall survival (p?<?0.0001).Conclusion
Adherence to National Comprehensive Cancer Network guidelines for pancreatic cancer patients improves survival. Compliance nationwide is low, especially for older patients and minorities and those treated outside academic centers. More studies will need to be performed to identify factors that hinder compliance.17.
Manabu Mikamori Atsushi Miyamoto Tadafumi Asaoka Sakae Maeda Naoki Hama Kazuyoshi Yamamoto Motohiro Hirao Masataka Ikeda Mitsugu Sekimoto Yuichiro Doki Masaki Mori Shoji Nakamori 《Journal of gastrointestinal surgery》2016,20(3):611-618
Background
Nutritional status is one of the most important clinical determinants of outcome after surgery. The aim of this study was to compare changes in the body composition of patients undergoing pancreaticoduodenectomy (PD), distal gastrectomy (DG), or total gastrectomy (TG).Methods
The parameters of body composition were measured using multifrequency bioelectrical impedance analysis with an inBody 720 (Biospace Inc. Tokyo. Japan) in 60 patients who had undergone PD (n?=?18), DG (n?=?30), or TG (n?=?12). None of the patients had recurrence or were treated with chemotherapy. Changes between the preoperative data and results and those obtained 12 months after surgery were evaluated.Results
Twelve months after surgery, the body weight change in the PD group was significantly lower than in the TG and DG groups (?1.2?±?3.8 vs ?7.4?±?4.4 and ?4.0?±?3.2 kg, respectively; p?<?0.01 vs TG, p?<?0.05 vs DG). The body weight change correlated with the fat mass change in all groups.Conclusions
The type and extent of surgery has a different effect on long-term body weight and body composition. Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone these surgeries.18.
J. P. Roux S. Belghali J. Wegrzyn E. S. Rendu R. Chapurlat 《Osteoporosis international》2016,27(8):2507-2513
Summary
We investigate the predictive role of vertebral anterior cortical curvature and height heterogeneity in the occurrence of vertebral fractures in postmenopausal women. Women who will fracture had shorter vertebral height, greater heterogeneity of height than those who will not fracture, and their anterior vertebral body edge was less concave.Introduction
Vertebral morphology has been demonstrated to be associated with further risk of fracture. The aim of this study was to analyze vertebral anterior cortical curvature (Ct.curv) and vertebral height heterogeneity in postmenopausal women before the occurrence of a vertebral fracture.Methods
This case–control study included 29 postmenopausal women who have underwent incident lumbar vertebral fractures (mean age 71?±?9 years, mean time to fractures 9?±?4 years), age-matched with 57 controls. From lateral X-rays of lumbar spine radiographs (T12 to L4), the following parameters were measured: (1) the posterior, middle, and anterior vertebral heights; (2) the heterogeneity of heights evaluated by the coefficient of variation of these three variables; (3) antero-posterior width, a 2D estimator of cross-sectional area; and (4) Ct.curv.Results
Mean vertebral heights were significantly lower among women who fractured than in controls (p?<?0.05). The anterior and middle heights were significantly lower at L4 and L3 levels in fracture group (p?=?0.02). The heterogeneity of vertebral height was significantly greater in the fracture group (p?=?0.003). In addition, fractured patients had a significantly higher Ct.curv on L3 (p?=?0.04). After adjustment for bone mineral density (BMD), only the heterogeneity of vertebral height remained significant (p?=?0.005).Conclusion
The current case–control study confirmed the association between vertebral height and occurrence of future vertebral fracture in postmenopausal women. The vertebrae with the smallest Ct.curv tended to fracture less often, and the heterogeneity of vertebral heights was associated with future fracture independently of BMD. An additional validation in a prospective study would be needed to confirm these initial results.19.
Background
Female athletes are at significantly higher risk of noncontact ACL injury than males, particularly in pivoting sports such as soccer and basketball. Sex-based differences in proprioception and core stability may contribute to this elevated risk.Questions/Purpose
This study evaluates a novel method of assessing dynamic stability to test the hypothesis that healthy adolescent controls have sex-based differences in postural stability.Methods
Seventy-nine male and 72 female subjects completed three rounds of dynamic postural stability testing. During the assessment, subjects attempted to stabilize their torso and upper body in response to random movements of the platform. The total time a subject lasted on the platform and dynamic motion analysis (DMA) score, a summation of motion in five planes throughout testing, was calculated for each subject. The average score for each subject was included in the analysis.Results
Males lasted longer on the platform (98?±?14 s) than females (94?±?13 s) (p?=?0.04). Coronal plane and rotation stability differed significantly between genders (323?±?126 vs. 365?±?128, p?=?0.04) and (318?±?82 vs. 403?±?153, p?=?0.0002), respectively. No statistically significant difference was seen in the other planes of motion.Conclusions
Females have less dynamic postural stability than their male counterparts in the coronal plane based on a novel assessment tool. This finding may contribute to better understanding of sex-based differences in rates of injury such as noncontact ACL tears.20.
Meng Gu Chong Liu Yan-bo Chen Huan Xu Shi Fu Qi Chen Zhong Wang 《International urology and nephrology》2018,50(5):819-823