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1.
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.2.
Background
Studies have investigated the correlation between tumor necrosis factor related apoptosis-inducing ligand (TRAIL) gene polymorphisms and the susceptibility and severity of intervertebral disc degeneration (IDD), but the results were inconsistent. To evaluate the specific relationship, we performed a meta-analysis to clarify the controversies.Methods
Four databases were searched, and the pooled results were presented as odds ratios (ORs) with 95% confidence intervals (CIs).Results
Three case-control studies from Han Chinese were included (565 cases and 427 controls). All the included studies reported TRAIL 1595C/T gene polymorphisms. The recessive model (CC vs. CT?+?TT) was the optimal model, which demonstrated a significant relationship between 1595C/T polymorphisms and increased IDD risk (OR?=?2.18, 1.45 to 3.27, P?=?0.000). No significant heterogeneity was found in the recessive model (I2?=?48.6%, P?=?0.143). Patients with lower grade IDD had more genotypes or alleles including 1595TT genotype (grade II vs. grade III: OR?=?2.12, 1.18 to 3.83, P?=?0.012; grade III vs. grade IV: OR?=?2.59, 1.29 to 5.22, P?=?0.007) and 1595 T allele (grade II vs. grade III: OR?=?1.91, 1.43 to 2.55, P?=?0.000; grade II vs. grade IV: OR?=?2.46, 0.94 to 1.76, P?=?0.000).Conclusions
There is a significant relationship between 1595C/T polymorphisms and the susceptibility and severity of IDD in Han Chinese. Patients with lower grade IDD had higher frequency of the 1595TT genotype and 1595 T allele.3.
Jinqian Liang Jianhua Hu Chong Chen Hao Yin Fangliang Dong 《Journal of orthopaedic surgery and research》2017,12(1):196
Background
Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.Methods
A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.Results
The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.Conclusions
The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.4.
Zhengdao Yang Xin Zhou Bin Ma Yanan Xing Xue Jiang Zhenning Wang 《Journal of gastrointestinal surgery》2018,22(11):1890-1902
Purpose
The impact of preoperative sarcopenia on postoperative complications and overall survival has been recently debated. Our meta-analysis aims to ascertain whether preoperative sarcopenia increases the risk of poor outcomes and to attempt to provide new ideas for the prognosis of outcomes for patients with gastric cancer.Methods
We searched for all relevant articles on PubMed, the EMBASE database, and Web of Science (up to September 1, 2017). Data synthesis and statistical analysis were carried out using RevMan 5.3 software.Results
Thirteen studies involving 4262 patients who underwent gastrectomy for gastric cancer were analyzed (sarcopenia group?=?1234; non-sarcopenia group?=?3028). The results showed that preoperative sarcopenia significantly associated with poor pathological staging (high pT: OR?=?1.86, 95% CI?=?1.49–2.31; P?<?0.01; pN+: OR?=?1.61, 95% CI?=?1.33–1.94; P?<?0.01; high TNM category: OR?=?1.84, 95% CI?=?1.53–2.22; P?<?0.01). Patients with preoperative sarcopenia had an increased risk of total postoperative complications (OR?=?2.17, 95% CI?=?1.53–3.08; P?<?0.01), severe complications (OR?=?1.65, 95% CI?=?1.09–2.50; P?=?0.02), and poorer OS (HR?=?1.70, 95% CI?=?1.45–1.99; P?<?0.01). The results of subgroup analyses revealed that patients with preoperative sarcopenia over 65 years old and those from Asian populations had higher risks for total postoperative complications and severe complications.Conclusion
This meta-analysis reveals that preoperative sarcopenia may be used as a new indicator of poor pathological staging, impaired overall survival, and increased postoperative complications. Notably, patients with gastric cancer who are over 65 years old and from Asia should be routinely screened for sarcopenia before surgery to adequately assess the risk of postoperative complications in clinical practice.5.
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.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.
Aiko Okubo Ayumu Nakashima Shigehiro Doi Toshinori Ueno Kensuke Sasaki Takashi Esaki Takao Masaki 《Clinical and experimental nephrology》2018,22(5):1167-1173
Background
The definition of sepsis was updated to sepsis-3 in February 2016. Currently, direct hemoperfusion therapy using the polymyxin B-immobilized fiber cartridge (PMX-DHP) is widely performed to treat sepsis and septic shock. However, the prognostic factors of PMX-DHPs in patients with sepsis using the new definition are unclear. We retrospectively assessed prognostic factors in patients who had received PMX-DHP therapy for sepsis and septic shock.Methods
We included 71 patients with severe infection who underwent PMX-DHP treatment from January 2006 to August 2015 in this study. Participants were re-evaluated according to the criteria of sepsis-3. The patients were divided into two groups based on having survived (n?=?59) or not survived (n?=?12) for 28 days after PMX-DHP treatment. Clinical data before and after PMX-DHP treatment were compared between the two groups.Results
Non-survivors showed a lower Glasgow Coma Scale (GCS) score before PMX-DHP treatment compared with 28-day survivors [12 (6–14) vs 14 (12–15), P?<?0.01]. Furthermore, pH after the first PMX-DHP session was significantly lower in non-survivors than in survivors (7.28?±?0.23 vs 7.39?±?0.06, P?=?0.03). Multivariate logistic regression analysis showed that only lower pH after the first PMX-DHP session was a predictor of 28-day mortality independent of age, sex, GCS score, and mean arterial pressure (odds ratio per pH of 0.01, 0.93; 95% confidence interval, 0.83–0.99; P?=?0.02).Conclusion
The pH after the first PMX-DHP session is an independent risk factor for mortality in patients receiving PMX-DHP for sepsis and septic shock.8.
Jing Sun Hongjun Sun Meiyu Cui Zhijian Sun Wenyue Li Jianxin Wei Shuhua Zhou 《International urology and nephrology》2018,50(10):1835-1843
Purpose
We conducted a meta-analysis to explore the association between the use of different anti-ulcer agents and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and decline in glomerular filtration rate (GFR) in various study populations.Methods
PubMed, Embase, and the Cochrane Library were searched for relevant entries up to July 1, 2017. The primary outcomes of the meta-analysis were risk ratios (RRs) of CKD, ESRD, and decline in GFR. We also investigated the heterogeneity of the meta-analysis by subgroup analysis and meta-regression analysis.Results
A total of 662,624 individuals were enrolled in five trials. Compared with non-PPI users, PPI users had a higher trend of CKD (RR?=?1.16, 95% CI 1.07–1.25, P?<?0.001), especially ESRD (RR?=?1.81, 95% CI 1.59–2.06, P?<?0.001). There was an elevated risk of adverse renal outcome among participants receiving PPI and not H2RA (CKD: RR?=?1.28, 95% CI 1.24–1.33, P?<?0.001; ESRD: RR?=?1.39, 95% CI 1.17–1.64, P?<?0.001; GFR: RR?=?1.31, 95% CI 1.26–1.36, P?<?0.001). However, H2RA users were not associated with CKD when compared with non-H2RA users (RR?=?1.02, 95% CI 0.83–1.25, P?=?0.855). In subgroup analysis, the average age of individuals and drug dosage had no influence on the risk of CKD, while duration of PPI exposure from 31 to 720 days is a potential factor in progression to ESRD (P?<?0.001).Conclusions
Chronic PPI use, but not H2RAs, is associated with deterioration in kidney function.9.
10.
Y. Li J. Zhou Y. Wu T. Lu M. Yuan Y. Cui Y. Zhou G. Yang Y. Hong 《Osteoporosis international》2016,27(4):1485-1492
Summary
This study was designed to investigate the association of circadian gene single nucleotide polymorphisms (SNPs) with the risk of osteoporosis. We found that the rs3781638 GG genotype was positively associated with osteoporosis prevalence in females, whereas the rs2292910 AC genotype was negatively associated with osteoporosis prevalence in a geriatric cohort.Introduction
Studies have shown that disruption of endogenous circadian rhythms may increase the risk of developing type II diabetes and obesity, which are reportedly associated with osteoporosis (OP). Thus, abnormalities of circadian genes may indirectly induce OP. Here, we investigated the association of OP with 14 SNPs located in seven circadian genes.Methods
The research subjects, geriatric residents of Shanghai Minhang, China, diagnosed with OP (N?=?171) or osteopenia (N?=?226) or without specific diseases (N?=?200), were genotyped for 14 genetic variants of circadian genes by competitive allele-specific polymerase chain reaction. The prevalence of polymorphisms among the subject groups and the association between the SNPs and osteoporosis were investigated.Results
Among the 14 genotyped SNPs, we found an association between the CRY2 gene rs2292910 SNP and osteoporosis (r?=??0.082, p?=?0.045) in the geriatric cohort. We found a decreased risk between cryptochrome 2 rs2292910 and OP (A/C odds ratio?=?0.647, p?=?0.044) but an increased risk between MTNR1B rs3781638 and OP (G/G odds ratio?=?2.058, p?=?0.044).Conclusion
For the first time, we show that Cry 2 rs2292910 and MTNR1B rs3781638 are associated with osteoporosis in a Chinese geriatric cohort. Therefore, targeting the abnormalities of the CRY2 and MTNR1B genes may be a potential strategy to treat and/or to prevent osteoporosis.11.
Meng Gu Chong Liu Yan-bo Chen Huan Xu Shi Fu Qi Chen Zhong Wang 《International urology and nephrology》2018,50(5):819-823
Purpose
This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH).Methods
A retrospective chart review of 112 patients with BPH who underwent VoLEP (n?=?60) or holmium laser enucleation of the prostate (HoLEP) (n?=?56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed.Results
No significant differences were observed in pre- and perioperative parameters, including operation time (58.05?±?10.14 vs. 60.14?±?12.30 min, P?=?0.44), serum sodium decrease (3.49?±?0.83 vs. 3.48?±?0.84 mmol/L, P?=?0.97), hemoglobin decrease (1.28?±?0.38 vs. 1.24?±?0.77 g/dL, P?=?0.71), catheterization time (3.63?±?1.10 vs. 3.89?±?1.11 days, P?=?0.21) and hospital stay (4.57?±?1.25 vs. 4.68?±?1.18 days, P?=?0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22?±?10.31 vs. 59.45?±?9.65 db, P?<?0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P?>?0.05).Conclusion
Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.12.
P. Lucato C. Trevisan B. Stubbs B. M. Zanforlini M. Solmi C. Luchini G. Girotti S. Pizzato E. Manzato G. Sergi S. Giannini M. Fusaro N. Veronese 《Osteoporosis international》2016,27(11):3155-3164
Summary
Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures.Introduction
People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs).Methods
Two investigators searched major databases for articles reporting BMD (expressed as g/cm2 or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated.Results
From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD?=??0.69; 95 % CI?=??0.86 to ?0.52; I 2?=?0 %), total hip (seven studies; SMD?=??0.82; 95 % CI?=??1.11 to ?0.52; I 2?=?72 %), and femoral neck (six studies; SMD?=??0.67; 95 % CI?=???1.00 to ?0.34; I 2?=?69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR?=?1.15, 95 % CI?=?1.12–1.17, p?<?0.0001, studies?=?4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR?=?1.31, 95 % CI?=?0.95–1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR?=?4.12, p?<?0.0001).Conclusions
Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.13.
Saachi Sachdev Qi Wang Charles Billington John Connett Leaque Ahmed William Inabnet Streamson Chua Sayeed Ikramuddin Judith Korner 《Obesity surgery》2016,26(5):957-965
Background
This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.Methods
Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).Results
Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?103; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×103, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.Conclusions
BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.14.
Lizz van der Heijden Sheila R. Piner Michiel Adrianus Josephus van de Sande 《International orthopaedics》2016,40(12):2459-2468
Purpose
We aimed to ascertain the feasibility of crowdsourcing via Facebook for medical research purposes; by investigating surgical, oncological and functional outcome and quality-of-life (QOL) in patients with pigmented villonodular synovitis (PVNS) enrolled in a Facebook community (1112 members).Methods
Patients completed online open surveys on demographics, surgery and clinical outcomes (group 1); and patient-reported outcome measures (PROMs) including knee-injury osteoarthritis outcome score (KOOS), hip-disability osteoarthritis outcome score (HOOS), Toronto extremity salvage score (TESS) and SF-36 (group 2). Mean follow-up was 70 months (12–374). Consistency checks were performed with Cohen’s kappa statistic for intra-rater agreement.Results
The first survey was completed by 272 patients (group 1) and 72 patients completed the second (group 2). In group 1, recurrence-rate was 58 % (69/118) after arthroscopic, 36 % (35/97) after open and 50 % (5/10) after combined synovectomy (p?=?0.003). In group 2, recurrence-rate was 67 % (26/39) after arthroscopic and 51 % (17/33) after open synovectomy (p?=?0.19). Recurrence-risk was increased for diffuse disease (OR?=?16; 95%CI?=?3.2–85; p?<?0.001). Mean function and QOL did not differ after arthroscopic or open synovectomy: KOOS 49 vs. 58 (p?=?0.24), HOOS 62 vs. 53 (p?=?0.56), TESS 78 vs. 82 (p?=?0.86), SF-36 61 vs. 66 (p?=?0.41). Cohen’s kappa statistic for intra-rater agreement was good to outstanding (κ?=?0.68–0.95; p?<?0.001).Conclusion
Local recurrence-risk was higher for diffuse-type disease and arthroscopic synovectomy. Functional outcome and QOL were comparable for both types of surgery. Gathering data via crowdsourcing seems a promising and innovative way of evaluating rare diseases including PVNS.15.
Dimitrios Xourafas Katiuscha Merath Gaya Spolverato Stanley W. Ashley Jordan M. Cloyd Timothy M. Pawlik 《Journal of gastrointestinal surgery》2018,22(11):1920-1927
Background
The Medicare Severity-Diagnosis Related Group coding system (MS-DRG) is routinely used by hospitals for reimbursement purposes following pancreatic surgery. We aimed to determine whether specific pancreatectomy MS-DRG codes, when combined with distinct clinicopathologic and perioperative characteristics, increased the accuracy of predicting 30-day readmission after pancreaticoduodenectomy (PD).Methods
Demographic, clinicopathologic, and perioperative factors were compared between readmitted and non-readmitted patients at Brigham and Women’s Hospital following PD. Different pancreatectomy DRG codes, currently used for reimbursement purposes [407: without complication/co-morbidity (CC), 406: with CC, and 405: with major CC] were combined with clinical factors to assess their predictability of readmission. Univariate and multivariable analyses were performed to evaluate outcomes.Results
Among 354 patients who underwent PD between 2010 and 2017, 69 (19%) were readmitted. The incidence of readmission was 13, 32, and 55% for patients with assigned DRG codes 407, 406, and 405, respectively (P?=?0.0395). Readmitted patients were more likely to have had T4 disease (P?=?0.0007), a vascular resection (P?=?0.0078), and longer operative times (P?=?0.012). On multivariable analysis, combining DRG 407 with relevant clinicopathologic factors was unable to predict readmission. In contrast, DRG 406 code among patients with N positive disease (P?=?0.0263) and LOS?>?10 days (P?=?0.0505) was associated with readmission. DRG 405, preoperative obstructive jaundice (OR: 7.5, CI: 1.5–36, P?=?0.0130), vascular resection (OR: 7.7, CI: 1.1–51, P?=?0.0336), N positive stage of disease (OR: 0.2, CI: 0–0.9, P?=?0.0447), and operative time?>?410 min (OR: 5.9, CI: 1–32, P?=?0.0399) were each strongly associated with 30-day readmission after PD [likelihood ratio (LR)?<?0.0001].Conclusions
Distinct pancreatectomy MS-DRG classification codes (405), combined with relevant clinicopathologic and perioperative characteristics, strongly predicted 30-day readmission after PD. DRG classification algorithms can be implemented to more accurately identify patients at a higher risk of readmission.16.
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.17.
Ahmed El-Assmy Ahmed M. ElShal Ramy Mekkawy Hamdy El-Kappany El Housseiny I. Ibrahiem 《International urology and nephrology》2018,50(9):1569-1576
Objectives
To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) focusing on erectile and ejaculatory functions in a randomized trial.Methods
Between January 2013 and December 2014, all consecutive TURP candidates with benign prostatic hyperplasia (BPH) were prospectively randomized 1:1 into M-TURP/B-TURP arms and followed up at 2, and 4 weeks, 6 and 12 months after surgery. All patients were assessed using IIEF-15 (International index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual-health inventory). Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between both intervention groups.Results
Following M.TURP and B.TURP; 122 and 124 patients were included respectively and were considered for analysis at 1 year. Sexual function did not differ significantly between arms during follow-up (erectile function, P?=?0.82; orgasmic function, P?=?0.46; sexual desire, P?=?0.29; intercourse satisfaction, P?=?0.18; overall satisfaction, P?=?0.92). There were no differences between arms in the distribution of EF evolution at any time compared with base line (at 12 months: M-TURP vs. B-TURP?=?improved, 24.5 vs. 26.6%; stable, 66.4 vs. 64.5%; deteriorated, 9.1 vs. 8.9%; P?=?0.41). Newly developed erectile dysfunction (ED) was present in 8.2 and 7.3% of patients following M.TURP and B.TURP respectively and was related to presence of DM and obesity. Orgasm perception significantly reduced following M.TURP and B.TURP (P?<?0.001). Newly reported ejaculatory dysfunction (Ej-MSHQ?<?22) was significantly associated with low orgasm perception.Conclusions
There were no differences between M-TURP/B-TURP in any aspect of sexual function.18.
Purpose
To compare the efficacy of three chemoprophylaxis approaches in prevention of post-transrectal biopsy infectious complications (TBICs).Methods
Patients were randomly assigned to receive ciprofloxacin 3 days 500 mg B.I.D 3 days starting the night prior to biopsy (standard prophylaxis), augmented prophylaxis using ciprofloxacin and single preprocedure shot of 160 mg gentamicin IM (augmented prophylaxis) and rectal swab culture-based prophylaxis (targeted prophylaxis). Patients were assessed 2 weeks prior to biopsy, at biopsy and 2 weeks after. Primary end point was occurrence of post-TBICs that included simple UTI, febrile UTI or sepsis. Secondary end points were post-biopsy change in the inflammatory markers (TLC, ESR and CRP), unplanned visits, hospitalization and occurrence of fluoroquinolones resistance (FQ-R; bacterial growth on MacConkey agar plate with 10 μg/ml ciprofloxacin) in the fecal carriage of screened men.Results
Between April/2015 and January/2017, standard, augmented and targeted prophylaxes were given to 163, 166 and 167 patients, respectively. Post-TBICs were reported in 43 (26%), 13 (7.8%) and 34 (20.3%) patients following standard, augmented and targeted prophylaxes protocols, respectively (P?=?0.000). Post-TBICs included UTI in 23 (4.6%), febrile UTI in 41 (8.2%) and sepsis in 26 (5.2%) patients. Significantly lower number of post-biopsy positive urine culture was depicted in the augmented group (P?=?0.000). The number of biopsy cores was statistically different in the three groups (P?=?0.004). On multivariate analysis, augmented prophylaxis had independently lower post-TBICs (OR 0.2, 95% CI 0.1–0.4, P?=?0.000) when compared with the other two groups regardless of the number of biopsy cores taken (OR 1.07, 95% CI 0.95–1.17, P?=?0.229). Post-biopsy hospitalization was needed in four (2%), one (0.6%) and ten (6%) patients following standard, augmented and targeted prophylaxes, respectively (P?=?0.014). However, sepsis-related hospitalization was not statistically different. Post-biopsy changes in the inflammatory markers were significantly less in augmented prophylaxis (P?<?0.05). FQ-R was depicted in 139 (83.2%) of the screened men.Conclusion
Augmented prophylaxis with single-dose gentamicin is an effective and practical approach. Targeted prophylaxis might be reserved for cases with contraindication to gentamicin.19.
Purpose
To establish the optimal cut-off value of the preoperative prognostic nutritional index (PNI) for prognosis according to the Tumor Node Metastasis (TNM) stage of hepatocellular carcinoma (HCC) after curative resection.Methods
This retrospective study reviewed the records of 375 patients. The optimal cut-off value of the PNI was established according to the TNM stage, and overall survival was compared between the low and high PNI groups.Results
The optimal cut-off value of the PNI decreased with increasing TNM stage, with 52, 47, and 43 patients having stage I, II, and III HCC, respectively. A low preoperative PNI predicted a poorer overall survival than did a high PNI for stage I (P?<?0.001) and II (P?=?0.002), but not stage III disease (P?=?0.052). Multivariate analysis revealed that the preoperative PNI was an independent predictor of overall survival for stage I and II HCC (hazard ratios: 6.96 and 3.57, P?=?0.001 and P?=?0.001, respectively).Conclusions
The findings of this study show that the optimal cut-off value for the PNI for prognosis differs among the TNM stages and that the preoperative PNI is a favorable prognostic factor for stage I HCC.20.
Dong Jiang Xiao Luo Yingfang Ao Xi Gong Yong-jian Wang Hai-jun Wang Yu Miao Nan Li Ji-ying Zhang Jia-kuo Yu 《BMC surgery》2017,17(1):127