The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis

Objectives

This systematic review determined whether the duloxetine can get more benefits versus placebo in managing women with stress urinary incontinence (SUI) all over the world.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing duloxetine with placebo in these patients. The eligible RCTs were identified from the following electronic databases: Cochrane CENTRAL, Medline and EMBASE. We treated the incontinence episode frequency (IEF) as the main outcome, and the secondary outcomes were cured, average voiding interval, incontinence quality of life (I-QOL), treatment-emergent adverse events (TEAEs) and discontinuation.

Results

The review contained ten trials including 5,738 women who were randomized to take duloxetine or placebo. All arms in individual trials were comparable for various baseline characteristics. Individual studies showed a significantly greater decrease in IEF than placebo group. The total IEF responders (defined as a woman who had at least a 50 % decrease in IEF with treatment) within the duloxetine-treated women were more than the placebo-treated women (52.5 vs. 33.7 %; RR = 1.56; 95 %CI, 1.46–1.66; p < 0.00001). TEAEs were commonly experienced by both two groups (62.7 vs. 45.3 %) though they were not critical.

Authors’ conclusions

Our meta-analysis showed that significant efficacy can be found in women treated with a certain dose of duloxetine. The adverse events like nausea, constipation, dry mouth, fatigue etc. are common.     

Modified posterior soft tissue repair for the prevention of early postoperative dislocation in total hip arthroplasty

Purpose

Dislocation following total hip arthroplasty (THA) with the posterior approach has been quite a common and bothering complication. Previous researches suggest that careful repair of the posterior structures significantly reduces this risk. The purposes of the present study were to describe a modified posterior soft tissue repair procedure in THA using a suture anchor (TwinFix Ti 5.0, Smith & Nephew, Andover, MA) and evaluate the early postoperative dislocation rate.

Methods

From July 2004 to June 2008, 220 consecutive primary total hip arthroplasties were performed using the modified surgical approach. The average age in the group was 46.4 years (range from 21 to 90) at the time of the procedure. The rate of postoperative hip dislocation, as well as any signs of complications related to the technique, has been observed and analyzed in this study.

Results

There was no postoperative dislocation following primary THA in 220 cases, and no signs of complications related to the technique, such as greater trochanteric fractures and sciatic nerve palsy, have been noted in any of the cases at their most recent follow-up.

Conclusions

These initial results demonstrate that the modified repair in THA using the suture anchor can serve as an effective and reliable mean for prevention of early postoperative dislocation     

Mismatch Repair Deficiency Screening via Immunohistochemical Staining in Young Asians with Colorectal Cancers

Background

The incidence of mismatch repair deficiency in colorectal cancer (CRC) in young people remains unknown in Asians. The present study assessed the clinicopathological features and efficacy of immunohistochemistry screening for Lynch syndrome in young Asian CRC patients.

Material and methods

This was a retrospective review conducted in Singapore General Hospital between January 2006 and December 2010 of 240 unrelated patients under the age of 50. All patients had immunohistochemical (IHC) staining for mismatch repair proteins in resected CRC specimen data retrieved from a prospective computerized database.

Results

A total of 21 % (n = 51) of the patients had abnormal IHC staining. Loss of staining for MLH1, MSH2, MSH6, and PMS2 proteins was observed in 10, 4, 6, and 13 % of tumors, respectively. Of the 22 patients who had abnormal staining of MLH1, 13 had concomitant abnormal staining for PMS2. One tumor specimen had abnormal staining in all four proteins. If the Amsterdam criteria alone were to be used, 86 % (n = 44) of the cohort would have not been detected for mismatch repair gene defects.

Conclusions

The overall burden of germline mismatch repair deficiency in the Singapore population may be as high as 21 %. The Amsterdam criteria alone are inadequate to detect Lynch syndrome patients. The use of IHC staining of at least four mismatch repair proteins is a useful screening strategy for Lynch syndrome diagnosis. Routine screening of mismatch repair deficiency may be recommended for all young Asian CRC patients.     

Completely Removing Solitary Intraductal Papillomas Using the Mammotome System Guided by Ultrasonography Is Feasible and Safe

Background

Because of the potential for an intraductal papilloma to progress to malignancy and the likelihood of detecting unexpected coexisting malignant disease, complete removal of the intraductal papilloma is safer than merely sampling it. The purpose of this study was to estimate the feasibility and safety of excising a solitary intraductal papilloma using the Mammotome system guided by ultrasonography (US).

Methods

We retrospectively reviewed the clinical information of 136 patients who underwent excision of solitary intraductal papillomas using the 8-gauge probe with the US-guided Mammotome system between December 2005 and December 2011 at our institution. Their lesions had been suspected preoperatively or were occasionally diagnosed postoperatively.

Results

There were no local recurrences during the follow-up period. Of the patients who showed atypia and underwent re-excision, only 2 (6.1 %) had local ductal atypia. The patients with atypia were significantly older than the patients without atypia (p < 0.05).

Conclusions

Using the US-guided 8-gauge probe Mammotome system to completely remove a solitary intraductal papilloma is feasible and safe. Close follow-up may be considered for those whose lesions exhibit atypia.     

Characteristics of the sound systems of monolingual Vietnamese‐speaking children with phonological impairment

There has been little or no research on Vietnamese phonological development, let alone on phonological disorders of Vietnamese‐speaking children. The goal of this study is to evaluate the sound systems of monolingual Vietnamese‐speaking children with phonological impairment. Independent and relational analyses of four children (ages 4;4 to 5;5) are presented in terms of error patterns, dialectal patterns, phonotactic constraints, and phonetic and phonemic inventories. The characteristics of these children's sound systems are compared to studies of phonological acquisition of other languages, in order to identify characteristics that may be universal versus those that may be language‐specific in nature.