Abstract
The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, ...especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio HR 4.78, 95% confidence interval CI 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.
Background
Despite the evolution of biologic agents, the use of traditional systemic immunosuppressants still account for a considerable proportion of systemic anti‐psoriasis therapy. The risk of ...tuberculosis among psoriasis patients receiving such conventional immunosuppressants is not clearly understood.
Methods and Materials
We used the retrospectively‐collected data from the Taiwan National Health Insurance Research Database to perform this prospective cohort study. We included 94,585 adult patients with newly diagnosed psoriasis between January 1, 2001 and December 31, 2013. We documented the exposure of systemic anti‐psoriasis therapies. The outcome is incident mycobacterium tuberculosis infection.
Results
During a mean 6.8 years follow‐up, 703 (0.74%) incident tuberculosis was diagnosed and treated. The crude incidence of tuberculosis was 1.11 (95% confidence interval CI 1.03‐1.19) events per 1000 person‐years. The result demonstrated that MTX (Hazard ratio HR 2.16, 95% CI 1.47‐3.16) and tacrolimus (HR 5.31, 95% CI 1.66‐17.01) were significantly associated with increased risks of tuberculosis. Noticeably, azathioprine was a borderline significant risk factor of tacrolimus (HR 2.63, 95% 0.96‐7.21, P = 0.059). The risk of TB in patients receiving adalimumab was twofold (HR 2.07) though not significant because of only one TB event was detected. The steroid was also associated with a dose‐dependent increase of tuberculosis risk (HR 1.09, 95% CI 1.09‐1.12, for every 1 mg of prednisolone equivalent dose per day).
Conclusion
The study found that among systemic anti‐psoriasis therapy, methotrexate, tacrolimus, azathioprine and steroid may be associated with an increased risk of tuberculosis.
Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy and long-term effects of the ...procedures used to address curvature. This study aimed to evaluate the effects of urethral plate transection alone with tissue traction therapy on penile curvature in two-stage repair of proximal hypospadias.
This was a prospective study of primary hypospadias patients who underwent a two-stage repair with urethral plate transection as the sole straightening procedure. After stage 1, taping was applied as tissue traction therapy and continued until stage 2. Penile curvature was measured using a goniometer under artificial erection before and immediately after urethral plate transection and during the second stage of repair. The primary focus of this investigation is the angle of curvature after 6-month taping.
The study included 46 patients with a median age of 13 months at the start of treatment. The median angle of penile ventral curvature was 70° after degloving, 60° after urethral plate transection, and 0° during the second stage of repair. Full correction of ventral curvature was achieved in 42 patients (91 %).
This publication is the first of its kind to propose taping as a method for penile traction therapy in hypospadias. The study reveals that penile ventral lengthening can be achieved through tissue traction therapy following UP transection alone. These findings challenge the current consensus that complete straightening of the penis in the first stage is necessary to prevent recurrent curvature and that ventral lengthening is required to correct corporal disproportion. However, further validation and long-term data are needed to definitively confirm the effectiveness of tissue traction therapy after urethral plate transection.
This study demonstrated significant resolution rate of penile ventral curvature in proximal hypospadias following urethral plate transection alone with taping. Long-term follow-up studies are needed to confirm the sustainability of the results through puberty.
Clean intermittent catheterization (CIC) through the urethra is the treatment of choice for patients with neurogenic bladder (NGB) or other etiologies that lead to incomplete bladder emptying. ...However, urethral catheterization can be problematic. Vesicocutaneous fistula (VCF) is a continent catheterizable channel with a low rate of complications. The aim of the study was to evaluate the safety and effectiveness of VCF as a route for CIC.
The authors retrospectively reviewed patients who underwent creation of the VCF for bladder drainage from November 2001 to December 2017. Demographics, indication for VCF, pre-operative and postoperative laboratory/radiologic studies, incidence of febrile urinary tract infection (UTI), and adherence to CIC through VCF were examined.
Vesicocutaneous fistula was created in a total of 20 patients (nine males and 11 females; median age, 13.2 years range: 3.8 months–22.8 years). The median follow-up time was 30.5 months (range: 5.9 months–16.9 years). The underlying etiologies that resulted in NGB included spina bifida (n = 10), cerebral palsy (n = 2), caudal regression syndrome (n = 2), and others (n = 6). Before creation of the VCF, 13 patients (65%) had either grade ≥3 unilateral or bilateral hydronephrosis as per the Society for Fetal Urology grading system. Thirteen patients (65%) had experienced at least one febrile UTI the year before the creation of the VCF. At the last follow-up, renal function was improved or stabilized in 14 patients (70%). Fifteen patients (75%) had experienced no febrile UTI in the last 1 year. Upper urinary tract dilatation resolved or improved in 10 patients (77%). The VCF continence rate was 88%. In this study, bladder augmentation or the Mitrofanoff procedure was not performed. During maturation, nine patients (45%) had granuloma; five of those cases subsided within 2 years without any intervention. Five patients had VCF stricture, and only one required revision surgery (5%).
The VCF continence rate was comparable with that of the Mitrofanoff procedure. Adherence to CIC through VCF lowered the rate of UTI and preserved the upper urinary tract. Bladder emptying by CIC through VCF provided the same benefits as those of the Mitrofanoff procedure: extra privacy, social independence, and reduction of parental burden. Although a long maturation stage of 6 months was required, the rate of major complications was low. Most complications were conservatively manageable and seldom required revision surgery.
Vesicocutaneous fistula is a continent catheterizable conduit, an alternative option for bladder management in patients with NGB who cannot undergo urethral CIC smoothly.Summary TableOutcomes of CIC through VCF.Summary TableVariablesBefore creation of the VCF, number of patients (%)After creation of the VCF (last f/u), number of patients (%)CKD stageStage 17 (35)7 (35)Stage 23 (13)1 (5)Stage 38 (40)5 (25)Stage 40 (0)2 (10)Stage 52 (10)0 (0)n/a0 (0)5 (25)aSFU gradeNormal0 (0)5 (25)Grade 1–27 (35)6 (30)Grade 3–413 (65)8 (40)n/a0 (0)1 (5)UTI episode(s) per year07 (35)14 (70)1–28 (40)3 (15)>35 (25)2 (10)n/a0 (0)1 (5)bCIC, clean intermittent catheterization; CKD, chronic kidney disease; f/u, follow-up; n/a, not available; SFU, Society for Fetal Urology; UTI, urinary tract infection; VCF, vesicocutaneous fistula.aWe did not routinely check the level of creatinine if the CKD stage before creation of the VCF was <1.bOne patient was lost to follow-up for >1 year; therefore, the data of UTI episode(s) in the last 1 year were not available.
Early diagnosis and surgical intervention for midgut malrotation with bowel obstruction are crucial. We aimed to identify risk factors for adverse outcomes in infants with midgut malrotation and to ...develop a prediction model.
We reviewed the operation records of infants surgically diagnosed with midgut malrotation at Chang Gung Children's Medical Center between January 2000 and December 2020. Patients were classified into the poor-outcome group (PO) if they underwent bowel resection or experienced mortality; all others were categorized as the favorable-outcome group (FO). Data on demographics, initial presentations, laboratory results, radiographic or sonographic findings, maternal conditions, and outcomes were collected and analyzed. Fisher's exact test, the independent sample t-test, and the Mann-Whitney test were utilized for comparative analysis when suitable.
The study included 103 infants. Eleven were in the PO group, and 92 were in the FO group. Initial presentations such as respiratory distress, poor activity, and shock status were notably more prevalent in the PO group. The INR, hemoglobin, HCO3, base excess, and aspartate transaminase values showed significant variation between the two groups. Multivariate analysis identified that lower hemoglobin (OR 0.677, p = 0.043) and higher AST (OR 1.036, p = 0.044) were independent predictors of adverse outcomes. An AST/Hb ratio of <3.78 demonstrated a high negative predictive value (98.6%) for an adverse outcome in midgut malrotation.
Prompt diagnosis and surgical treatment of midgut malrotation are vital to prevent bowel resection or mortality. The independent predicting factors for poor outcomes include low hemoglobin and elevated AST levels.
Highlights • A method in manage extreme difficult ureteropelvic junction obstruction situations. • Provide long term urinary diversion without infection and decrease tube dislodgement related ...complications. • Possible bladder cycling effect.
The best surgical approach to ectopic ureters and ureteroceles is yet to be determined. The objective of this study is to provide an alternative lower tract surgical approach to ectopic ureters and ...duplex system ureteroceles that can be safely performed in young children.
The “in-and-out” bladder approach was performed via an open intravesical incision. The upper and lower pole ureters were mobilized and brought into the bladder. The dilated ureter/ureterocele was cut open, and the distal part was deuroepithelialized. Subsequently, common sheath reimplantation was performed. The ureterocele wall was not involved during the whole procedure. We retrospectively reviewed all patients who underwent surgery for ureteroceles and ectopic ureters between January 1, 2004, and December 31, 2019. Patients with intravesical ureteroceles were excluded. Outcome parameters included the presence of hydronephrosis or reflux, split renal function on DMSA scan, incidence of urinary tract infection, and urinary incontinence.
A total of 32 patients with ectopic duplex system ureterocele who underwent the “in-and-out” bladder approach between 2004 and 2019 were included in the retrospective study. The median age at operation was 7.8 months (range: 1.5 months–3.0 years). The median length of follow-up was 6.1 years (range: 1.0 years–14.3 years). Sixteen patients (55%) had ipsilateral vesicoureteral reflux. Five patients postoperatively developed a urinary tract infection within 1–3 years. No patients required further endoscopic treatment or surgeries. During long-term follow-up, two patients (6.3%) had intermittent day wetting at the ages of 4 and 5 years and were managed conservatively. The symptoms of intermittent day wetting subsided during follow-up.
The “in-and-out bladder” approach can be performed in complex duplex system ureteroceles and enables early intervention; it is a single and simple operation with a satisfactory long-term continence rate. Display omitted
To reduce drain leakage current, carbon doping is introduced in the GaN layer of the p-GaN HEMT device. The focus of this study is on the discussion of the abnormal current behavior that occurs in ...the saturation region of carbon-doped p-GaN HEMT. This abnormal phenomenon disappears when the device is heated up to 150°C. The abnormal current behavior corresponds to the hot electron stress (HES) result, which indicates that electron trapping causes this abnormal current behavior. An energy band is proposed to describe the lesser trapping effect that occurs in the saturation region.
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