Purpose
Meta-analysis was conducted to estimate whether MiTLIF could reduce the complication rate while maintaining the similar clinical result to that of open procedures.
Methods
A search of the ...literature was conducted on pubmed or EMBASE. A database including patient clinical information was created. A systematic review of eligible studies with multivariate regression analysis was performed to quantitatively review the correlation of VAS improvement rate and the performance of MiTLIF.
Results
Fourteen articles with a minimum of 12-month follow-up met our inclusion criteria. The hypothesis of homogeneity could be accepted. The fixed-effects model was used to calculate the summary risk ratio (odds ratio). In the pooled analysis, the summary risk ratio (odds ratio) in patients with MiTLIF against those with open procedure for fusion rate, complication rate and revision/readmission rate was 0.99 (
p
= 0.36), 1.15 (
p
= 0.5) and 2.59 (
p
= 0.003), respectively, suggesting that MiTLIF was a risk factor for revision/readmission. Multivariate regression analysis showed that the percentage of male patients and the length of surgery exert a significant impact on VAS improvement rate. The selection of MiTLF was not significant.
Conclusion
Fusion rate and complication rate for both open and MiTLIF were similar. Moreover, the MiTLIF group tended to have a higher revision/readmission rate, which might be associated with the deep learning curve. Therefore, to achieve the level of surgical skill required of an MiTLIF surgeon, many years of training and experience are necessary. Otherwise, MiTLIF may yield unsatisfactory result upon patients.
Patients with endometriosis are known to have altered pain perceptions. Cesarean delivery (CD) is one of the most prevalent surgeries performed worldwide. Appropriate pain control following CD is ...clinically important to the recovery and relief of patients. This study assessed pain perception and analgesic use after CD among women with or without endometriosis.
This retrospective case control study included women diagnosed with endometriosis, based on clinical or surgical findings, who underwent CD from 2014 to 2022. Controls were matched to the study group by maternal age, BMI (kg/m2), parity, number of previous CDs and by CD indication, in a 2:1 ratio. Post-operative visual analogue scale (VAS) pain scores, on each post-operative day (POD) were compared between groups. Pain intensity was measured and compared using the VAS, range 0 (no pain) to 10 (worst pain). The standard pain relief analgesia protocol in our department includes fixed oral treatment with paracetamol and diclofenac, with the addition of morphine sulphate on POD 0. Analgesic dosages used and the percentage of patients not using the full standard analgesic protocol were compared between groups.
As compared to controls (n = 142), the endometriosis group (n = 71) was characterized by higher rates of in-vitro fertilization (IVF) pregnancies and previous abdominal surgeries other than CD (p < .001 for both). Other maternal characteristics between groups did not differ. On POD 0, mean morphine dosage was significantly higher in the endometriosis group compared to the control group (24 mg vs. 22.8 mg, respectively; p = .044). More patients in the endometriosis group used the full standard analgesia protocol or more, as compared to controls. VAS scores were not significantly different between groups.
Increased use of analgesics after CD was more common among women with endometriosis. These findings imply that pain relief protocols should be personalized for women with endometriosis.
Background
Conventional open herniorrhaphy in children has been reported to have 0.3–3.8% recurrence and 5.6–30% postoperative contralateral hernia rates. We developed a unique technique to achieve ...completely extraperitoneal ligation of PPV without any skip areas under laparoscopic control. This report introduces our technique and results compared with the cut-down herniorrhaphy.
Methods
A consecutive series of 1,585 children with inguinal hernia/hydrocele (1996–2006) was analyzed. In laparoscopic patent processus vaginalis (PPV) closure (LPC), an orifice of PPV was encircled with a 2–0 suture extraperitoneally by a specially devised Endoneedle and tied up from outside of the body achieving completely extraperitoneal ligation of the ring. The round ligament was included in the ligation, whereas the spermatic cord and testicular vessels were excluded by advancing the needle across them behind the peritoneum. Cut-down herniorrhaphy (CD), with or without diagnostic laparoscopy, or LPC was selected according to parental preference under informed consent.
Results
Parents gave more preference to LPC (LPC in 1,257 children, CD in 308, and miscellaneous in 20). Age ranges were equal for both groups. Sex distribution showed female preponderance in the LPC group (44.8% vs. 26.6%,
p
< 0.001) and umbilical hernia/cysts were predominantly included in the LPC group (11.9% vs. 2.9%,
p
< 0.001). Mean operation times were equal for both groups for unilateral repair (28.2 ± 9.2 for LPC vs. 27.8 ± 13.5 for CD) and were shorter for bilateral repair in the LPC group (35.8 ± 11.6 vs. 46.7 ± 17.7). The incidence of postoperative hernia recurrence and contralateral hernia in the LPC group was 0.2% and 0.8%. Two children in the CD group had injuries to their reproductive system during the operation (0.6%).
Conclusions
The advantages of our technique include following: technically simple, short operation time, inspection of bilateral IIRs with simultaneous closure of cPPV, reproductive systems remain intact, routine addition of umbilicoplasty if desired, and essentially indiscernible wounds.
The andrological study of a species comprises from the macro- and microscopic analysis of the internal reproductive organs to the evaluation of seminal parameters and ultrastructural characteristics ...of the spermatozoa. As in other vertebrates, the male reproductive tract in chondrichthyans is composed of testes and reproductive ducts (efferent duct, epididymis, Leydig's gland, ductus deferens and seminal vesicle). In this study we used three adult specimens of Zapteryx brevirostris from wild capture and kept at the Ubatuba Aquarium, Brazil. Semen collection was performed by abdominal massage, over the location of the seminal vesicle, preceded by ultrasonographic evaluation. The semen collected was diluted 1:200 and submitted to quantitative and morphological analysis. Ultrastructural analysis was performed by transmission and scanning electron microscopy. Correlation was observed between successful collection and ultrasonographic image of an engorged seminal vesicle, as well as testicles with easily delimitable margins and higher echogenicity. It was possible to identify free spermatozoa with helical filiform appearance, as well as spermatozeugmata. The average sperm concentration resulted in 5 million packets per ml and 140 million spermatozoa per ml. The sperm nucleus showed cone shape, parachromatin sheath less dense than the chromatin of the nucleus, smooth depression of the nuclear fossa, abaxial axoneme 9+2 and accessory axonemal columns in position 3 and 8 and oval shaped, with flattened inner surface in cross section. These results broaden the knowledge about the andrology of this species, contributing to ex situ breeding programs.
We aimed to find out whether the combined treatment of acupuncture and oral medication is more effective than sole oral medication in reducing pain and improving knee function at the end of treatment ...and after short-term period (4-6 weeks after treatment). Second, if it is effective, we investigated whether the effect surpasses the minimal clinically important difference.
Articles published between January 1, 1992, and August 31, 2022, were searched in PubMed, Cochrane, and Embase. The PICO (population, intervention, comparison, and outcome) of this study are as follows: Population: knee osteoarthritis patients; Intervention: acupuncture (non-sham acupuncture) + oral medication (analgesic or non-steroidal anti-inflammatory drugs); Comparison: oral medication (analgesic or non-steroidal anti-inflammatory drugs); Outcome: visual analog scale (VAS) or Western Ontario and McMaster University (WOMAC) osteoarthritis index.
The combined treatment of oral medication and adjuvant acupuncture showed statistically significant improvement in VAS and WOMAC scores at the end of acupuncture treatment and short-term follow-up time (between 4 and 6 weeks after acupuncture). In addition, the degree of improvement of VAS and WOMAC index showed effects beyond minimal clinically important differences compared to pretreatment at both the end of acupuncture treatment and the short-term follow-up of acupuncture treatment.
The existing evidence suggests that adjuvant acupuncture may play a role in the treatment of knee osteoarthritis. However, physicians should be aware of adverse effects such as hematoma in adjuvant acupuncture treatment.
ABSTRACT The aim of this study was to elucidate histological characteristics of the vesicular glands as well as to investigate vesiculitis and its association with ampolititis and prostatitis. Sex ...gland samples from 40 bulls were collected. The vesicular glands were descriptively evaluated, the number of acini was counted in an area of 25mm2, compared to the number of acini between healthy and pathological glands, the data were submitted to the Student's T test at 5%. Inflammatory tissue was investigated in the ampullae of the vas deferens and in the prostates, the chi-square test at 5% was performed to assess the association between the inflamed glands. Regarding inflammation in the gland (vesiculitis), 30 animals (75%) were positive. The vesicular glands presented an average of 355 ±76.4 acini/25mm2. When comparing the amounts of acini between the glands with and without vesiculitis, no significant difference was observed, p=0.930. When performing the chi-square test to assess the association between vesiculitis and ampolititis or vesiculitis and prostatitis, the results were p=0.356 and p=0.300 respectively. Despite the high incidence of inflammatory reaction in the glands, no association was observed between the accessory sex glands studied here.
RESUMO O objetivo deste estudo foi elucidar características histológicas das glândulas vesiculares bem como pesquisar sobre a vesiculite e sua associação com a ampolite e a prostatite. Amostras de glândulas sexuais de 40 touros foram coletadas. As glândulas vesiculares foram avaliadas descritivamente. Realizou-se a contagem da quantidade de ácinos em uma área de 25mm2, e comparou-se a quantidade de ácinos entre glândulas sadias e patológicas. Os dados foram submetidos ao teste T de student a 5%. Foi pesquisado tecido inflamatório nas ampolas do ducto deferente e nas próstatas e realizou-se o teste qui-quadrado a 5% para se avaliar a associação entre as glândulas inflamadas. Com relação à inflamação na glândula (vesiculite), 30 animais (75%) foram positivos. As glândulas vesiculares apresentaram uma média de 355±76,4 ácinos/25mm2. Quando comparadas as quantidades de ácinos entre as glândulas com e sem vesiculite, não foi observada diferença significativa (P=0,930). Ao se realizar o teste de qui-quadrado para se avaliar a associação entre a vesiculite e a ampolite ou a vesiculite e a prostatite, os resultados foram P=0,356 e P=0,300, respectivamente. Apesar da alta incidência de reação inflamatória nas glândulas, não foi observada uma associação entre as glândulas sexuais acessórias aqui estudadas.
Thus far, only a few longitudinal studies investigated the impact of social engagement on health-related quality of life (HRQoL) and depressive symptoms in old age. Therefore, we aimed to examine the ...impact of social engagement on HRQoL and depressive symptoms in late life.
Individuals aged 75 years and over at baseline were interviewed every 1.5 years in a multicenter prospective cohort study in Germany. While HRQoL was quantified by using the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, depressive symptoms was assessed by using the Geriatric Depression Scale (GDS). Individuals reported the frequency ("never" to "every day") of social engagement (e.g., engagement in the church, as a volunteer, in a party, or in a club) in the last four weeks. Fixed effects regressions were used to estimate the effect of social engagement on the outcome variables.
After adjusting for age, marital status, functional status and chronic diseases, fixed effects regressions revealed that the onset of social engagement markedly increased HRQoL and considerably decreased depressive symptoms in the total sample and in women, but not men.
Our findings corroborate the relevance of social engagement for HRQoL and depressive symptoms in old age. Encouraging the individuals to start, maintain and expand social engagement in late life might help to maintain and improve HRQoL and decrease depressive symptoms.
Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers ...advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post-operative congestion pain.
To compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens.
A retrospective chart review of 85 patients who underwent MSCD from 2017-2023 was performed. Patients' demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain.
Eighty-five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 (6-31) months. Thirty-seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty-one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p = 0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p = 0.968), with similar rates of post-operative complications (p-value = 0.132).
In men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy.
Prurigo nodularis (PN) is a chronic, pruritic, debilitating disease. Previous studies found that chronic pruritus in general negatively affects patients’ quality of life (QoL). However, results about ...the impact of PN on QoL are conflicting. Our objective was to assess the QoL burden of PN. A systematic review was conducted of all published studies that assessed QoL measures in PN. OVID MEDLINE, EMBASE, SCOPUS, and Web of Science were searched. Pooled meta-analysis (means) was performed using random-effects weighting. Overall, 13 studies met inclusion criteria. All studies identified QoL reductions in patients suffering from PN compared to control groups. The most common QoL instrument used was the Dermatology Life Quality Index
n
= 9 studies; pooled mean (95% confidence interval): 13.8 (10.6–16.9), denoting a very large effect. In particular, PN was associated with substantial impact on multiple domains of QoL. No publication bias was detected. In conclusion, QoL is negatively impacted in PN. Future studies are necessary to determine the best instruments of measuring QoL in PN patients, better understand this association, and assess the impact in males and females separately. PROSPERO CRD42019136193.
This is a multicenter retrospective review of prospectively collected cases.
Our objective was to evaluate the relationship between patient satisfaction, health-related quality of life (HRQoL) ...scores, complications, and radiographic measures at 2 years postoperative follow-up.
For patients receiving operative management for adult spine deformity (ASD), the relationship between HRQoL measures, radiographic parameters, postoperative complications, and self-reported satisfaction remains unclear.
Data from 248 patients across 11 centers within the United States who underwent thoracolumbar fusion for ASD and had a minimum of 2 years follow-up was collected. Pre- and postoperative scores were obtained from the Scoliosis Research Society 22-item (SRS-22r), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Visual Analogue Scale. Sagittal vertical axis, coronal C7 plumbline, lumbar lordosis, pelvic tilt, T1 pelvic angle, and the difference between pelvic incidence and lumbar lordosis were assessed using postoperative radiographic films. Satisfaction (SAT) was assessed using the SRS-22r; patients were categorized as highly satisfied (HS) or less satisfied (LS). The correlation between SAT and HRQoL scores, radiographic parameters, and complications was determined.
When compared with LS (n = 60) patients, HS (n = 188) patients demonstrated greater improvement in final ODI, SF-36 component scores, SRS-Total, and Visual Analogue Scale back scores (P < 0.05). The correlations between SAT and the final follow-up and 2 year change from baseline values were moderate for Mental Component Summary, Physical Component Summary, and ODI or weak for HRQoL scores (P < 0.0001). The HS and LS groups were equal in pre- or final postoperative radiographic parameters. Occurrence of complications had no effect on satisfaction.
Among operatively treated ASD patients, satisfaction was moderately correlated with some HRQoL measures, and not with radiographic changes or postoperative complications. Other factors, such as patient expectations and relationship with the surgeon, may be stronger drivers of patient satisfaction.
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