Impact of spinal anaesthesia vs. general anaesthesia on peri‐operative outcome in lumbar spine surgery: a systematic review and meta‐analysis of randomised,controlled trials

Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta‐analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% CI ) with spinal anaesthesia for intra‐operative hypertension was 0.31 (0.15–0.64), I² = 0% (p = 0.002); for intra‐operative tachycardia 0.51 (0.30–0.84), I² = 0% (p = 0.009); for analgesic requirement in the postanaesthesia care unit 0.32 (0.24–0.43), I² = 0% (p < 0.0001); and for nausea/vomiting within 24 h postoperatively 0.29 (0.18–0.46), I² = 12% (p < 0.00001). The standardised mean difference (95% CI ) for hospital stay was ?1.15 (?1.98 to ?0.31), I² = 89% (p = 0.007). There was no evidence of a difference in intra‐operative hypotension and bradycardia, blood loss, surgical time, analgesic requirement within 24 h postoperatively, and nausea/vomiting in the postanaesthesia care unit. We conclude that spinal anaesthesia appears to offer advantages over general anaesthesia for lumbar spine surgery.     

Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta‐Analysis of 7023 Patients

In aortic arch surgery, deep hypothermic circulatory arrest (DHCA) combined with cerebral perfusion is employed worldwide as a routine practice. Even though antegrade cerebral perfusion (ACP) is more widely used than retrograde cerebral perfusion (RCP), the difference in benefit and risk between ACP and RCP during DHCA is uncertain. The purpose of this meta‐analysis is to compare neurologic outcomes and early mortality between ACP and RCP in patients who underwent aortic surgery during DHCA. PubMed, EMBASE, and the Cochrane Library were searched using the key words “antegrade,” “retrograde,” “cerebral perfusion,” “cardiopulmonary bypass,” “extracorporeal circulation,” and “cardiac surgery” for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction (TND), and permanent neurologic dysfunction (PND) in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed with the Cochrane Q statistic and I² statistic. Publication bias was tested with Begg's funnel plot and Egger's test. Thirty‐four studies were included in this meta‐analysis, with 4262 patients undergoing DHCA + ACP and 2761 undergoing DHCA + RCP. The overall pooled relative risk for TND was 0.722 (95% CI = [0.579, 0.900]), and the z‐score for overall effect was 2.9 (P = 0.004). There was low heterogeneity (I² = 18.7%). The analysis showed that patients undergoing DHCA + ACP had better outcomes than those undergoing DHCA + RCP in terms of TND, while there were no significant differences between groups in terms of PND, stroke, and early mortality. This meta‐analysis indicates that DHCA + ACP has an advantage over DHCA + RCP in terms of TND, while the two methods show similar results in terms of PND, early mortality, and stroke.     

Platelet‐rich plasma for the treatment of diabetic foot ulcers: A meta‐analysis

Foot ulcer is a major complication of diabetes mellitus and often precedes leg amputation. Among the different methods to achieve ulcer healing, the use of platelet‐rich plasma, which is rich in multiple growth factors and cytokines and may have similarities to the natural wound healing process, is gaining in popularity. A systematic review with meta‐analyses was performed to evaluate the safety and clinical effectiveness of platelet‐rich plasma for the treatment of diabetic foot ulcers compared to standard treatment or any other alternative therapy. The electronic databases Medline, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were consulted in March 2017 with no restrictions placed on the publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. Eight randomized clinical trials and two prospective longitudinal‐observational studies with control group were included. Platelet‐rich plasma treatment increased the likelihood of chronic wound healing (RR = 1.32; 95% CI: 1.11, 1.57, I² = 15%) while the volume of the ulcer (MD = 0.12 cm²; 95% CI: 0.08, 0.16; p < 0.01; I² = 0%) and time to complete wound healing (MD = ?11.18 days; 95% CI: ?20.69, ?1.68; I² = 53%) decreased. Regarding safety profile, platelet‐rich plasma did not differ from standard treatment in terms of probability of occurrence of wound complications (RR = 0.57; 95% CI: 0.25, 1.28; I² = 0%) or recurrences (RR = 2.76; 95% CI: 0.23, 33.36; p = 0.43; I² = 82%) but it decreased the rate of adverse events (RR = 0.80; 95% CI: 0.66, 0.96; p = 0.02; I² = 0%). Cumulative meta‐analysis revealed that there is enough evidence to demonstrate a statistically significant benefit. However, studies included presented serious methodologic flaws. According to the results, platelet‐rich plasma could be considered a candidate treatment for nonhealing of diabetic foot ulcers.     

Comparison of iASSIST Navigation System with Conventional Techniques in Total Knee Arthroplasty: A Systematic Review and Meta‐Analysis of Radiographic and Clinical Outcomes

The iASSIST navigation system is a handheld accelerometer‐based navigation system that has been applied in clinical practice in recent five years. This meta‐analysis aimed to compare the radiographic and clinical outcomes of iASSIST navigation with conventional surgical techniques for patients undergoing total knee arthroplasty (TKA) and to compare the surgery time between an iASSIST group and a conventional treatment group. This systematic review and meta‐analysis included all comparative prospective and retrospective studies published in Pubmed, Embase, the Cochrane Central Register of Controlled Trials, the Web of Science and the CNKI databases over the past 20 years. Inclusion criteria were studies that compared the iASSIST navigation system with conventional TKA. The primary outcomes were mechanical axis (MA) and outliers, which means postoperative MA varus or valgus of more than 3°. Secondary outcomes were coronal femoral angle (CFA) and coronal tibial angle (CTA). Knee Society Score (KSS) was used to evaluate functional outcome. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Eight studies involving 558 knees were included in this meta‐analysis. Of these, 275 patients used the iASSIST navigation system and 283 used conventional surgical techniques. A total of 5 studies were considered high quality and the other 3 were considered to be of moderate quality. The occurrence of malalignment of >3° in the iASSIST group was 13.3%, compared with 29.04% in the conventional group. Postoperative MA of the iASSIST group was significantly better than that of the conventional group (I² = 19%, OR = ?0.92, 95% CI = ?1.09 to ?0.75, P < 0.00001). The iASSIST navigation system provided significantly increased accuracy in the coronal femoral angle (I² = 79%, OR = ?0.88, 95% CI = ?1.21 to ?0.54, P < 0.00001) and the coronal tibial angle (I² = 34%, OR = 0.39, 95% CI = ?0.48 to ?0.30, P < 0.00001) compared with conventional techniques. However, the duration of surgery using the iASSIST procedure was longer and there was no significant difference in the short‐term KSS in the iASSIST group compared with the conventional group. We found that when pooling the data of included studies, the number of outliers was fewer in the iASSIST group, and compared with conventional TKA techniques, the iASSIST system significantly improved the accuracy of lower limb alignment but the duration of surgery was prolonged in addition to there being no apparent advantage in terms of short‐term functional score.     

Comparison of Intramedullary Nail Versus Conventional Ilizarov Method for Lower Limb Lengthening: A Systematic Review and Meta‐Analysis

The objective of this systematic review and meta‐analysis was to compare the lengthening and then nailing (LATN) technique to the conventional Ilizarov method for limb lengthening. A systemic search of potential relevant literature was performed in databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and the ISI Web of Knowledge, from their inception to 22 May 2015 using medical subject heading (MeSH) terms “Ilizarov,” “bone lengthening,” or “intramedullary nail.” A total of 89 titles and abstracts were preliminarily reviewed, of which 4 studies eventually satisfied the eligibility criteria, consisting of one randomized controlled trial (RCT), two clinical controlled trials and one retrospective cohort study. A total of 354 limbs were included in the study, among which 183 were lengthened over an intramedullary nail, and 171 limbs were lengthened conventionally. The mean difference (MD) was ?50.21 for the external fixation index between the two groups (95% CI, ?51.83 to ?48.59; P < 0.00001) with high heterogeneity (I² = 99%); no significant difference in length was gained (MD = ?0.30, 95% CI = ?0.72 to 0.12; P = 0.16) with high heterogeneity (I² = 80%); and there was high significant difference for the consolidation index (MD = ?19.97; 95% CI, ?21.59 to ?18.35; P < 0.00001) with high heterogeneity (I² = 100%). The overall rate of complications was relatively low, and differed significantly between the two groups. Through this meta‐analysis, we find that LATN is superior to the conventional method in regards to the external fixation index and the consolidation index, which means that LATN is an effective technique that can decrease the time needed in external fixation.     

Neurosurgical Post‐Operative Wound Infections: A retrospective study on surgical site infections for quality improvement

Despite efforts to maintain a meticulous aseptic environment, wound infection is one of the most common complications following surgery and may be related to dehiscence, haemorrhage, infection, and/or poor surgical technique. With the appearance of new wound closure techniques and suture materials, we felt compelled to perform a retrospective study on our institution's neurosurgical population to determine how our institution compared to others in terms of incidence of surgical site infection (SSI). A retrospective analysis was performed at our single institution for all patients that had cranial or spine surgery by a neurosurgeon for the past 15 years. The data were extracted via Crimson Continuum of Care software program and analysed using χ² and relative risk. The data retrieval software program collected a total of 1184 cranial and spinal surgeries. Of these 1184 cases, 12 resulted in post‐operative wound infections. Using these collected values, we compared the results with published values in the literature. Prior studies have shown that up to 33% of surgical cases have post‐operative infections. Using this reported value in comparison with our data, χ² testing equals 547.893 with 1 df, P = .0001 (confidence interval = 0.05), which demonstrated statistical significance when compared with surgical literature. The results from this retrospective analysis demonstrated that the rate of neurosurgical post‐operative SSI falls within the range consistent with the literature, which has shown rates of infection from <1% up to 15% depending on the type of surgery, surgical technique, and patient characteristics. SSIs can be an unfortunate and costly post‐operative complication. Risks factors in the past have been studied, but introspection by each institution is an important metric to ensure accountability and provide optimal patient care in comparison with established data and guidelines. No deviation from current techniques is deemed necessary at our institution based on the results.     

Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta-analysis

We performed a meta-analysis to evaluate the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery. A systematic literature search up to July 2022 was performed and 24 137 subjects with neurosurgery at the baseline of the studies; 10 496 of them were using the powdered vancomycin, and 13 641 were not using the powdered vancomycin as a control. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery using dichotomous methods with a random or fixed-effect model. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery (OR, 0.53; 95% CI, 0.41-0.70, P < .001), deep surgical site wound infections after spinal surgery (OR, 0.45; 95% CI, 0.35-0.57, P < .001), superficial surgical site wound infections after spinal surgery (OR, 0.60; 95% CI, 0.43-0.83, P = .002), and surgical site wound infections after cranial surgery (OR, 0.37; 95% CI, 0.22-0.61, P < .001) compared to control in subjects with neurosurgery. The powdered vancomycin had significantly lower surgical site wound infections after spinal surgery, deep surgical site wound infections after spinal surgery, superficial surgical site wound infections after spinal surgery, and surgical site wound infections after cranial surgery compared to control in subjects with neurosurgery. The analysis of outcomes should be done with caution even though the low number of studies with low sample size, 3 out of the 42 studies, in the meta-analysis, and a low number of studies in certain comparisons.     

Age‐ and Sex‐Dependent Changes of Intra‐articular Cortical and Trabecular Bone Structure and the Effects of Rheumatoid Arthritis

The objective of this cross‐sectional study was to define normal sex‐ and age‐dependent values of intra‐articular bone mass and microstructures in the metacarpal heads of healthy individuals by high‐resolution peripheral quantitative computed tomography (HR‐pQCT) and test the effect of rheumatoid arthritis (RA) on these parameters. Human cadaveric metacarpal heads were used to exactly define intra‐articular bone. Healthy individuals of different sex and age categories and RA patients with similar age and sex distribution received HR‐pQCT scans of the second metacarpal head and the radius. Total, cortical, and trabecular bone densities as well as microstructural parameters were compared between 1) the different ages and sexes in healthy individuals; 2) between metacarpal heads and the radius; and 3) between healthy individuals and RA patients. The cadaveric study allowed exact definition of the intra‐articular (intracapsular) bone margins. These data were applied in measuring intra‐articular and radial bone parameters in 214 women and men (108 healthy individuals, 106 RA patients). Correlations between intra‐articular and radial bone parameters were good (r = 0.51 to 0.62, p < 0.001). In contrast to radial bone, intra‐articular bone remained stable until age 60 years (between 297 and 312 mg HA/cm³) but decreased significantly (p < 0.001) in women thereafter (237.5 ± 44.3) with loss of both cortical and trabecular bone. Similarly, RA patients showed significant (p < 0.001) loss of intra‐articular total (263.0 ± 44.8), trabecular (171.2 ± 35.6), and cortical bone (610.2 ± 62.0) compared with sex‐ and age‐adjusted controls. Standard sex‐ and age‐dependent values for physiological intra‐articular bone were defined. Postmenopausal state and RA led to significant decrease of intra‐articular bone. © 2016 American Society for Bone and Mineral Research.     

Negative‐pressure wound dressings to secure split‐thickness skin grafts in the perineum

Several researches have shown that negative‐pressure wound dressings can secure split‐thickness skin grafts and improve graft survival. However, in anatomically difficult body regions such as the perineum it is questionable whether these dressings have similar beneficial effects. In this study, we evaluated the effects of negative‐pressure wound dressings on split‐thickness skin grafts in the perineum by comparing wound healing rate and complication rate with that of tie‐over dressings. A retrospective chart review was performed for the patients who underwent a split‐thickness skin graft to reconstruct perineal skin defects between January 2007 and December 2011. After grafting, the surgeon selected patients to receive either a negative‐pressure dressing or a tie‐over dressing. In both groups, the initial dressing was left unchanged for 5 days, then changed to conventional wet gauze dressing. Graft success was assessed 2 weeks after surgery by a single clinician. A total of 26 patients were included in this study. The mean age was 56·6 years and the mean wound size was 273·1 cm². Among them 14 received negative‐pressure dressings and 12 received tie‐over dressings. Negative‐pressure dressing group had higher graft taken rate (P = 0·036) and took shorter time to complete healing (P = 0·01) than tie‐over dressing group. The patients with negative‐pressure dressings had a higher rate of graft success and shorter time to complete healing, which has statistical significance. Negative‐pressure wound dressing can be a good option for effective management of skin grafts in the perineum.     

Pre‐operative anaemia,intra‐operative hepcidin concentration and acute kidney injury after cardiac surgery: a retrospective observational study

Acute kidney after cardiac surgery is more common in anaemic patients, whereas haemolysis during cardiopulmonary bypass may lead to iron‐induced renal injury. Hepcidin promotes iron sequestration by macrophages: hepcidin concentration is reduced by anaemia and increased by inflammation. We analysed the associations in 525 patients between pre‐operative anaemia (haemoglobin < 130 g.l^?1 in men and < 120 g.l^?1 in women), intra‐operative hepcidin concentration and acute kidney injury (dialysis or > 26.4 μmol.l^?1 or > 50% creatinine increase during the first two days after cardiac surgery. Rates of pre‐operative anaemia and postoperative kidney injury were 109/525 (21%) and 36/525 (7%), respectively. The median (IQR [range]) intra‐operative hepcidin concentration was 20 (10–33 [0–125]) μg.l^?1 and was lower in anaemic patients than those who were not: 15 (4–28 [0–125]) μg.l^?1 vs. 21 (12–33 [0–125]) μg.l^?1, respectively, p = 0.002. Four variables were independently associated with postoperative kidney injury, for which the beta‐coefficients (SE) were: minutes on cardiopulmonary bypass, 0.016 (0.004), p < 0.001; intra‐operative hepcidin concentration, 0.032 (0.008), p < 0.001; pre‐operative anaemia, 1.97 (0.56), p < 0.001; and Cleveland clinic risk score, 0.88 (0.35), p = 0.005. Contrary to generally increased rates of kidney injury in patients with higher hepcidin concentrations, rates of kidney injury in anaemic patients were lower in patients with higher hepcidin concentrations, beta‐coefficient (SE) ?0.037 (0.01), p = 0.007. In cardiac surgical patients the rate of postoperative acute kidney injury predicted by the Cleveland risk score might be adjusted for pre‐operative anaemia and intra‐operative cardiopulmonary bypass time and hepcidin concentration. Pre‐operative correction of anaemia, reduction in intra‐operative bypass time and modification of iron homeostasis and hepcidin concentration might reduce acute kidney injury.     

Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta‐analysis

Experimental studies suggest that the regenerating liver provides a “fertile field” for the growth of hepatocellular carcinoma (HCC). However, clinical studies report conflicting results comparing living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) for HCC. Thus, disease‐free survival (DFS) and overall survival (OS) were compared after LDLT and DDLT for HCC in a systematic review and meta‐analysis. Twelve studies satisfied eligibility criteria for DFS, including 633 LDLT and 1232 DDLT. Twelve studies satisfied eligibility criteria for OS, including 637 LDLT and 1050 DDLT. Altogether, there were 16 unique studies; 1, 2, and 13 of these were rated as high, medium, and low quality, respectively. Studies were heterogeneous, non‐randomized, and mostly retrospective. The combined hazard ratio was 1.59 (95% confidence interval [CI]: 1.02–2.49; I² = 50.07%) for DFS after LDLT vs. DDLT for HCC, and 0.97 (95% CI: 0.73–1.27; I² = 5.68%) for OS. This analysis provides evidence of lower DFS after LDLT compared with DDLT for HCC. Improved study design and reporting is required in future research to ascribe the observed difference in DFS to study bias or biological risk specifically associated with LDLT.     

The Estimation of Second‐Generation HR‐pQCT From First‐Generation HR‐pQCT Using In Vivo Cross‐Calibration

Second‐generation high‐resolution peripheral quantitative computed tomography (HR‐pQCT) provides the highest resolution in vivo to assess bone density and microarchitecture in 3D. Although strong agreement of most outcomes measured with first‐ (XCTI) and second‐ (XCTII) generation HR‐pQCT has been demonstrated, the ability to use the two systems interchangeably is unknown. From in vivo measurements, we determined the limits of estimating XCTII data from XCTI scans conducted in vivo and whether that estimation can be improved by linear cross‐calibration equations. These data are crucial as the research field transitions to the new technology. Our study design established cross‐calibration equations by scanning 62 individuals on both systems on the same day and then tested those cross‐calibrations on the same cohort 6 months later so that estimated (denoted as XCTII*) and “true” XCTII parameters could be compared. We calculated the generalized least‐significant change (GLSC) for those predictions. There was strong agreement between both systems for density (R² > 0.94), macroarchitecture (R² > 0.95), and most microarchitecture outcomes with the exception of trabecular thickness (Tb.Th, R² = 0.51 to 0.67). Linear regression equations largely eliminated the systematic error between XCTII and XCTII* and produced a good estimation of most outcomes, with individual error estimates between 0.2% and 3.4%, with the exception of Tt.BMD. Between‐system GLSC was similar to within‐XCTI LSC (eg, 8.3 to 41.9 mg HA/cm³ for density outcomes). We found that differences between outcomes assessed with XCTI and XCTII can be largely eliminated by cross‐calibration. Tb.Th is poorly estimated because it is measured more accurately by XCTII than XCTI. It may be possible to use cross‐calibration for most outcomes when both scanner generations are used for multicenter and longitudinal studies. © 2017 American Society for Bone and Mineral Research.     

Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: Systematic review and meta‐analysis

To investigate whether bilateral surgery can bring more benefits to infertile patients with bilateral varicocele than unilateral surgery. A search of PubMed, Web of Science, EMBASE and the Cochrane Library on 13 January 2019 was conducted to identify studies published in English that used varicocelectomy. The protocol of the present meta‐analysis was pre‐published on PROSPERO (registration number CRD42019093894). Primary outcomes were spontaneous pregnancy rates. A total of eleven articles were finally enrolled in, with a total of 1,743 patients. Spontaneous pregnancy rate was higher in patient with bilateral varicocelectomy than unilateral varicocelectomy with an odds ratio (OR) of 1.89 (95% CI 1.52–2.35; I² = 0%; p < .00001). The results indicated bilateral is superior than unilateral varicocelectomy concerning sperm concentration (SMD: 2.88 × 10⁶/ml; 95% CI: 1.06, 4.70; I² = 93%), sperm motility (SMD: 5.08; 95% CI: 2.65, 7.50; I² = 0%), progression of sperm motility (SMD: 6.48; 95% CI: 5.16, 7.81; I² = 0%) and sperm morphology (SMD: 2.38%; 95% CI: 0.72, 4.03; I² = 94%) between bilateral and unilateral varicocelectomy. Bilateral varicocelectomy may be superior to unilateral in regard to spontaneous pregnancy rate and sperm motility for infertile male with bilateral varicocele (both left clinical and right subclinical varicocele and bilateral clinical varicocele).     

A rabbit model demonstrates the influence of cartilage thickness on intra‐articular drug delivery and retention within cartilage

For evaluation of new approaches to drug delivery into cartilage, the choice of an animal model is critically important. Since cartilage thickness varies with animal size, different levels of drug uptake, transport and retention should be expected. Simple intra‐articular injection can require very high drug doses to achieve a concentration gradient high enough for drug diffusion into cartilage. New approaches involve nanoparticle delivery of functionalized drugs directly into cartilage; however, diffusion‐binding kinetics proceeds as the square of cartilage thickness. In this study, we demonstrate the necessity of using larger animals for sustained intra‐cartilage delivery and retention, exemplified by intra‐articular injection of Avidin (drug‐carrier) into rabbits and compared to rats in vivo. Penetration and retention of Avidin within cartilage is greatly enhanced by electrostatic interactions. Medial tibial cartilage was the thickest of rabbit cartilages, which generated the longest intra‐cartilage half‐life of Avidin (τ_1/2 = 154 h). In contrast, Avidin half‐life in thinner rat cartilage was 5–6 times shorter (τ_1/2 ～ 29 h). While a weak correlation (R² = 0.43) was found between Avidin half‐lives and rabbit tissue GAG concentrations, this correlation improved dramatically (R² = 0.96) when normalized to the square of cartilage thickness, consistent with the importance of cartilage thickness to evaluation of drug delivery and retention. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:660–667, 2015.     

High inspired oxygen versus low inspired oxygen for reducing surgical site infection: a meta‐analysis

To perform a meta‐analysis of published literature to assess the role of high‐concentration inspired oxygen in reducing the incidence of surgical site infections (SSIs) following all types of surgery, a comprehensive search for published randomized controlled trials (RCTs) comparing high‐ with low‐concentration inspired oxygen for SSIs was performed. The related data were extracted by two independent authors. The fixed and random effects methods were used to combine data. Twelve RCTs involving 6750 patients were included. Our pooled result found that no significant difference in the incidence of SSIs was observed between the two groups, but there was high statistic heterogeneity across the studies [risk ratio (RR): 0·91; 95% confidence interval (CI): 0·72–1·14; P = 0·40; I² = 54%]. The sensitivity analysis revealed the superiority of high‐concentration oxygen in decreasing the SSI rate (RR: 0·86; 95% CI: 0·75–0·98; P = 0·02). Moreover, a subgroup analysis of studies with intestinal tract surgery showed that patients experienced less SSI when high‐concentration inspired oxygen was administrated (RR: 0·53; 95% CI: 0·37–0·74; P = 0·0003). Our study provided no direct support for high‐concentration inspired oxygen in reducing the incidence of SSIs in patients undergoing all types of surgery.     

Deliberate Self‐Harm and Suicidal Ideation Among Male Iraq/Afghanistan‐Era Veterans Seeking Treatment for PTSD

The objectives of the present research were to examine the prevalence of deliberate self‐harm (DSH) among 214 U.S. male Iraq/Afghanistan‐era veterans seeking treatment for posttraumatic stress disorder (PTSD) and to evaluate the relationship between DSH and suicidal ideation within this population. Approximately 56.5% (n = 121) reported engaging in DSH during their lifetime; 45.3% (n = 97) reported engaging in DSH during the previous 2 weeks. As hypothesized, DSH was a significant correlate of suicidal ideation among male Iraq/Afghanistan‐era veterans, OR = 3.88, p < .001, along with PTSD symptom severity, OR = 1.03, p < .001, and combat exposure, OR = 0.96, p = .040. A follow‐up analysis identified burning oneself, OR = 17.14, p = .017, and hitting oneself, OR = 7.93, p < .001, as the specific DSH behaviors most strongly associated with suicidal ideation. Taken together, these findings suggest that DSH is quite prevalent among male Iraq/Afghanistan‐era veterans seeking treatment for PTSD and is associated with increased risk for suicidal ideation within this population. Routine assessment of DSH is recommended when working with male Iraq/Afghanistan veterans seeking treatment for PTSD.     

Increased mid‐abdominal circumference is a predictor for surgical wound complications in kidney transplant recipients: A prospective cohort study

Kidney transplant recipients are at an increased risk of developing surgical site wound complications due to their immunosuppressed status. We aimed to determine whether increased mid‐abdominal circumference (MAC) is predictive for wound complications in transplant recipients. A prospective study was performed on all kidney transplant recipients from October 2014 to October 2015. “Controls” consisted of kidney transplant recipients without a surgical site wound complication and “cases” consisted of recipients that developed a wound complication. In total, 144 patients underwent kidney transplantation and 107 patients met inclusion criteria. Postoperative wound complications were documented in 28 (26%) patients. Patients that developed a wound complication had a significantly greater MAC, body mass index (BMI), and body weight upon renal transplantation (P<.001, P=.011, and P=.011, respectively). On single and multiple logistic regression analyses, MAC was a significant predictor for developing a surgical wound complication (P=.02). Delayed graft function and a history of preformed anti‐HLA antibodies were also predictive for surgical wound complications (P=.003 and P=.014, respectively). Increased MAC is a significant predictor for surgical wound complications in kidney transplant recipients. Integrating clinical methods for measuring visceral adiposity may be useful for stratifying kidney transplant recipients with an increased risk of a surgical wound complication.     

Dynamic Fixation versus Static Fixation in Treatment Effectiveness and Safety for Distal Tibiofibular Syndesmosis Injuries: A Systematic Review and Meta‐Analysis

To compare the effectiveness and safety of dynamic fixation (DF) and static fixation (SF) in distal tibiofibular syndesmosis injuries (DTSI) by a system review and meta‐analysis. PubMed, Cochrane, and EMBASE were systematically searched by computer to select clinical randomized controlled trials (RCT) and cohort trials comparing DF and SF in treating patients with DTSI. RCT and cohort trials comparing DF and SF for patients with DTSI were included. Inclusion criteria: (i) prospective or retrospective study of patients with DTSI; (ii) patients were diagnosed as having DTSI by imageology and only received DF treatment or SF treatment; (iii) the study compared DF and SF in DTSI; and (iv) one or more of the following outcomes were reported: ankle joint functional score, surgical complications, malreduction of syndesmosis, and second operations. Exclusion criteria: (i) non‐human studies; (ii) DTSI patients accompanied with other complications or other joints injuries; and (iii) full text unavailable. RevMan V5.3 software was used to perform the statistical analysis. Outcomes analyzed by Revman software showed that there were no statistically significant differences between DF and SF in the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score (MD, 1.90; 95% CI, ?0.23 to 4.03; P = 0.08; I² = 0%), Olerud–Molander (OM) score (MD, 1.92; 95% CI, ?7.96 to 11.81; P = 0.70; I² = 55%), incidence of syndesmotic malreduction (RR, 0.19; 95% CI, 0.03 to 1.09; P = 0.06; I² = 0%), and overall postoperative complication rate (RR, 0.30; 95% CI, 0.09 to 0.99; P = 0.05, I² = 75%) and the rate of second procedure was significantly lower with DF (RR, 0.17; 95% CI, 0.07 to 0.43; P = 0.0002, I² = 54%). Compared to SF, DF has an advantage, with a low rate of second procedures to treat DTSI.     

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta‐Analysis

An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and meta‐analysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to August 1, 2016, for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures. The association between low BMD, fractures, and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs) ±95% confidence intervals (CIs) with a random‐effects meta‐analysis. Twenty‐eight studies (18 regarding BMD and 10 fractures) followed a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow‐up (11 studies; HR = 1.33; 95%CI, 1.27 to 1.38; I² = 53%), after adjusting for a median of eight confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR = 1.16; 95% CI, 1.09 to 1.24; I² = 69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR = 1.20; 95% CI, 1.06 to 1.37; I² = 91%). Regarding specific CVDs, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD‐associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death. © 2017 American Society for Bone and Mineral Research.     

Prevalence and Correlates of Posttrauma Distorted Beliefs: Evaluating DSM‐5 PTSD Expanded Cognitive Symptoms in a National Sample

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association [APA], 2013) modified the diagnostic criteria for posttraumatic stress disorder (PTSD), including expanding the scope of dysfunctional, posttrauma changes in belief (symptoms D2—persistent negative beliefs and expectations about oneself or the world, and D3—persistent distorted blame of self or others for the cause or consequences of the traumatic event). D2 and D3 were investigated using a national sample of U.S. adults (N = 2,498) recruited from an online panel. The prevalence of D2 and D3 was substantially higher among those with lifetime PTSD than among trauma‐exposed individuals without lifetime PTSD (D2: 74.6% vs 23.9%; D3: 80.6% vs 35.7%). In multivariate analyses, the strongest associates of D2 were interpersonal assault (OR = 2.39), witnessing interpersonal assault (OR = 1.63), gender (female, OR = 2.11), and number of reported traumatic events (OR = 1.88). The strongest correlates of D3 were interpersonal assault (OR = 3.08), witnessing interpersonal assault (OR = 1.57), gender (female, OR = 2.30), and number of reported traumatic events (OR = 1.91). The findings suggested the expanded cognitive symptoms in the DSM‐5 diagnostic criteria better capture the cognitive complexity of PTSD than those of the DSM‐IV.