Will coronal alignment postoperatively be deteriorating in adult spinal deformity after long-fusion surgery?

BACKGROUND

To investigate whether the coronal alignment (CA) will deteriorate, and identify the risk factors for coronal malalignment (CM) developing in adult spinal deformity (ASD) after long-fusion surgery.

METHODS

A multi-center retrospective study was performed, which included a total of 161 ASD patients who had undergone the surgical procedure of long-fusion (≥ 5 vertebras) with instrumentations in three medical centers. All of the participants were retrospectively reviewed, and subsequently assigned into the consistency group (C7 plumb line (C7PL) shifting towards the convex side of the main curve), and the opposition group (C7PL shifting towards the concave side). CM was considered if the coronal balance distance (CBD) being over 30 mm. A Kaplan-Meier curve and log-rank test were used to analyze the differences in CM-free survival during follow-up. Multivariate analysis via a Cox proportional hazards test was used to analyze the risk factors.

RESULTS

Patients showing CM equaled 35 (21.7%) at the pre-operation, and that increased significantly up to 51 (31.7%) at the final follow-up (P = 0.04). In the consistency group, the incidence of CM at the final follow-up was much higher than that preoperatively (35:16, P = 0.002). CM-free survival time decreased significantly in patients with larger CBD correction, pelvic fixation and more instrumented segments, respectively, during follow-up (P < 0.05, log-rank test). Age ≥ 60 years, the consistency CA, pelvic fixation, CBD-correction ≥ 30 mm and fixed-vertebra ≥ 8 were risk factors for CM happening after surgery using multivariate regression analysis (P < 0.05).

CONCLUSIONS

The coronal alignments in ASD patients underwent long-fusion surgeries may deteriorate during follow-up, for which the risk factors include the consistency CA, age ≥ 60, fixed-vertebra ≥ 8, CBD-correction ≥ 30 mm and pelvic fixation.

Mayo Adhesion Probability Score Predicts Perioperative Outcome of Partial Nephrectomy: A Systematic Review and Meta-Analysis

Objective: Assessing whether Mayo adhesive probability (MAP) levels affect perioperative outcomes after partial nephrectomy (PN). Methods: This systematic review and meta-analysis were conducted in accordance with the PRISMA statement. A systematic search of the literature published before February 1, 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included all articles evaluating adherent perirenal fat by MAP during PN. Results: A total of 1807 patients from 7 studies meeting the criteria were included. In the high MAP group, the operation time was longer, and the estimated blood loss and postoperative complications were increased. There was no significant difference in positive surgical margin, warm ischemia time, and hospitalization time. Conclusions: As a simple and easy scoring method, MAP can predict the perioperative outcome of PN patients, especially when ≥3 is the boundary. However, more cohort studies are still needed to determine the optimal cutoff point of MAP.

EGFR-Activated JAK2/STAT3 Pathway Confers Neuroprotection in Spinal Cord Ischemia-Reperfusion Injury: Evidence from High-Throughput Sequencing and Experimental Models

This study aimed to investigate the molecular mechanisms underlying spinal cord ischemia-reperfusion (SCI/R) injury. Through RNA-Seq high-throughput sequencing and bioinformatics analysis, we found that EGFR was downregulated in the spinal cord of SCI/R mice and may function via mediating the JAK2/STAT3 signaling pathway. In vitro cell experiments indicated that overexpression of EGFR activated the JAK2/STAT3 signaling pathway and reduced neuronal apoptosis levels. In vivo animal experiments further confirmed this conclusion, suggesting that EGFR inhibits SCI/R-induced neuronal apoptosis by activating the JAK2/STAT3 signaling pathway, thereby improving SCI/R-induced spinal cord injury in mice. This study revealed the molecular mechanisms of SCI/R injury and provided new therapeutic strategies for treating neuronal apoptosis.

Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis

OBJECTIVE

Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries.

METHODS

A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis.

RESULTS

There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate.

CONCLUSION

Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.

Kirschner Wire Internal Fixation of the Medial Tibiotalar Joint for Indirect Repair of Deltoid Ligament Injury: A Retrospective Comparative Study

OBJECTIVE

Ankle joint fractures are often accompanied by medial deltoid ligament rupture. There is controversy over whether or how to treat deltoid ligament rupture. This study was aimed to explore the feasibility of repairing the medial deltoid ligament using Kirschner wire internal fixation of the medial tibiotalar joint combined with external fixation.

METHODS

Forty-six patients with ankle fractures involving deltoid ligament rupture, treated between October 2012 and February 2021, were retrospectively evaluated. Twenty-five patients were treated with a Kirschner wire to fix the tibiotalar joint and indirectly repair the deltoid ligament as the repaired group. Twenty-one patients underwent reduction and fixation of internal and external malleolus fractures, and the deltoid ligament was not repaired in the unrepaired group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), Medical Outcomes Short Form 36-item questionnaire score (SF-36), and Medial clear space perpendicular (preoperative, postoperative, final follow-up) were used for functional evaluations and reduction assessments. Mann-Whitney test were used to compare the differences between the groups.

RESULTS

The follow-up time was 13-112 months with a mean of 59.32 months for the repaired group and 11-94 months with a mean of 53.43 months for the unrepaired group. There was no significant difference in the operative time or intraoperative blood loss between the two groups (p > 0.05). At the last follow-up, the AOFAS ankle-hindfoot and SF-36 scores of the repaired group were significantly higher than those of the non-repaired group (p < 0.05). Moreover, the VAS pain score was significantly lower and the Medial clear space perpendicular was significantly narrower in the repaired group than that in the unrepaired group.

CONCLUSION

Tibiotalar joint fixation using Kirschner wires is a simple and effective technique that can indirectly reduce and repair the deltoid ligament and stabilize the ankle.

Iagnosis and treatment of myelitis after lumbar reoperation: A case report

RATIONALE

At present, acute myelitis (AM) is a great challenge to diagnosis and treatment because of its complicated etiology, critical condition, and poor prognosis, and it is easy to leave different degrees of limb motor dysfunction. The report of this case is helpful to improve the understanding of AM after lumbar surgery, reduce misdiagnosis and provide reference for clinical treatment.

PATIENTS CONCERN

This study reported a case of AM after lumbar reoperation. Before the patient was diagnosed as AM, we gave high-dose hormone anti-inflammatory and detumescence symptomatic treatment according to empirical treatment, and the effect was ideal and rehabilitation treatment was actively carried out at the right time. After 10 months of follow-up, the patient recovered well.

DIAGNOSIS

Because lumbar surgery is a contraindication of lumbar puncture, the patient's diagnosis was confirmed by thoracic magnetic resonance imaging. Magnetic resonance imaging of thoracic vertebra on the 17th day after lumbar operation showed that small round T1W1 signal, slightly higher T2W1 signal and T2-fat suppression imaging equal signal were seen in the horizontal spinal cord of thoracic vertebra 10.

INTERVENTION

According to the empirical treatment, patients have been given high-dose hormone therapy after operation, and comprehensive treatment such as comprehensive training of paraplegic limbs, joint loosening training, electric massage and other rehabilitation training will be carried out when the general condition of patients improves.

OUTCOMES

After 10 months of follow-up, there were no major sequelae such as limb paralysis.

CONCLUSION

Due to the rarity of AM in clinical work, it is easy for doctors to ignore the disease and miss the best treatment stage, which will lead to serious sequelae.

[Patient-reported outcomes of locally advanced gastric cancer undergoing robotic versus laparoscopic gastrectomy: a randomized controlled study]

Objective: To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer. Methods: This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher's exact test. Results: A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant (χ2 value were 156.24, 4.08, 36.56, P value were<0.01, 0.043,<0.01). Conclusion: Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Transient spinal cord dysfunction after surgery for intraspinal tumors: A case report

RATIONALE

Limb dysfunction is not uncommon clinically after intramural tumor surgery. However, there are no relevant literature reports on the recovery of unilateral motor function caused by spinal cord dysfunction after short-term observation and treatment. The report of such cases is of great value for improving the cognition of postoperative complications of meningioma reducing misdiagnosis and providing reference for clinical treatment.

PATIENT CONCERNS

A 73-year-old female patient with numbness and weakness in both lower limbs accompanied by unstable walking for 2 months. Combined with imaging data and postoperative pathological diagnosis, it was diagnosed as thoracic spinal meningioma. The patient experienced transient unilateral limb dysfunction after surgery.

DIAGNOSES

Magnetic resonance imaging and its enhanced magnetic resonance imaging suggest a space occupying lesion on the left side of the spinal canal at the level of the thoracic 3 to 4 vertebral body, possibly a meningioma. The postoperative pathology was grade I meningioma.

INTERVENTION

Administer 10 mL of dexamethasone, 1 g of methylprednisolone, and 250 mL of mannitol for treatment.

OUTCOMES

After 3 hours, the patient's muscle strength gradually recovered, and after 12 hours, it was better than the preoperative level.

CONCLUSION

Spinal cord dysfunction may occur after surgery for intraspinal meningioma in the upper thoracic spine. Unlike spinal cord dysfunction caused by spinal cord injury, this dysfunction is short-term and transient. The use of hormones and diuretics is a feasible solution that can quickly restore patient limb function.

Research progress in the mechanism and treatment of osteosarcoma

ABSTRACT

Osteosarcoma (OS) is the most common primary malignant bone tumor that more commonly occurs in children and adolescents. The most commonly used treatment for OS is surgery combined with chemotherapy, but the treatment outcomes are typically unsatisfactory. High rates of metastasis and post-treatment recurrence rates are major challenges in the treatment of OS. This underlines the need for studying the in-depth characterization of the pathogenetic mechanisms of OS and development of more effective therapeutic modalities. Previous studies have demonstrated the important role of the bone microenvironment and the regulation of signaling pathways in the occurrence and development of OS. In this review, we discussed the available evidence pertaining to the mechanisms of OS development and identified therapeutic targets for OS. We also summarized the available treatment modalities for OS and identified future priorities for therapeutics research.

How does the correction in lumbar lordosis affect the spinopelvic realignments in degenerative lumbar scoliosis underwent scoliosis surgery?

BACKGROUND

To evaluate the effects of correction in lumbar lordosis (LL) that have on full-body realignments in patients with degenerative lumbar scoliosis (DLS) who had undergone long sacroiliac fusion surgery.

METHODS

A multi-center retrospective study including 88 DLS patients underwent the surgical procedure of long sacroiliac fusion with instrumentations was performed. Comparisons of radiographic and quality-of-life (QoL) data among that at the pre-operation, the 3rd month and the final follow-up were performed. The correlations between the LL correction and the changes in other spinopelvic parameters were explored using Pearson-correlation linear analysis and linear regression analysis. The correlation coefficient (r) and the adjusted r2 were calculated subsequently.

RESULTS

All radiographic and QoL data improved significantly (P < 0.001) after the surgical treatments. The LL correction correlated (P < 0.001) with the changes in the sacral slope (SS, r = 0.698), pelvic tilt (PT, r = -0.635), sagittal vertical axis (SVA, r = -0.591), T1 pelvic angle (TPA, r = -0.782), and the mismatch of pelvic incidence minus lumbar lordosis (PI-LL, r = -0.936), respectively. Moreover, LL increased by 1° for each of the following spinopelvic parameter changes (P < 0.001): 2.62° for SS (r2 = 0.488), -4.01° for PT (r2 = 0.404), -4.86° for TPA (r2 = 0.612), -2.08° for the PI-LL (r2 = 0.876) and -15.74 mm for SVA (r2 = 0.349). Changes in the thoracic kyphosis (r = 0.259) and pelvic femur angle (r = 0.12) were independent of the LL correction, respectively.

CONCLUSIONS

LL correction correlated significantly to the changes in spinopelvic parameters; however, those independent variables including the thoracic spine and hip variables probably be remodeled themselves to maintain the full-body balance in DLS patients underwent the correction surgery.

Identification of testicular cancer immune infiltrates and novel immune cell subtypes

Testicular germ cell tumors (TGCT) are the most common type of testicular cancer, comprising 90-95% of cases and representing the most prevalent solid malignancy in young adult men. Immune infiltrates play important regulatory roles in tumors, but their role in TGCT remains unclear. Molecular subtyping is a promising way to provide precisely personalized treatment and avoid unnecessary toxicities. This study investigated immune infiltrates, key biomarkers, and immune subtyping of TGCT. In GSE3218, 24 differentially expressed immune genes (immDEGs) were identified. A new risk signature consisting of six immDEGs was developed using these genes. Individuals in the high-risk group had poor overall survival (OS; hazard ratio of 4.61 and P-value < 0.001). We validated the six-immDEGs risk signature in pure seminoma and mixed TGCT types. Two distinct immune patterns (Cluster 1 and Cluster 2) were identified using the consensusclusterplus, and Cluster 1 possessed an unfavorable OS compared with Cluster 2 (hazard ratio, 2.56; P < 0.001). Cluster 1 patients had significantly lower naive B cells, memory B cells, plasma cells, naive CD4 T cells, gamma delta T cells, and activated dendritic cells than Cluster 2 patients. Genes relating to the WNT signaling pathway, TGF-β signaling pathway, antigen processing and presentation, and NK cell-mediated cytotoxicity were associated with TGCT. STC1 was elevated in TGCT tissues, and its high expression showed advanced clinicopathological characteristics and poor prognosis of TGCT. Our findings may contribute to an increased understanding of the onset and progression of TGCT.

Perioperative comparison between robot-assisted and laparoscopic radical cystectomy: An update meta-analysis

We conducted this study to explore the efficacy and safety of laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BC).We searched the PubMed, Embase, Cochrane Library and Web of Science databases for studies on LRC and RARC treatment of BC from the time of the databases creation to May 1, 2022. We extracted data and used Stata 16.0 for calculation and statistical analyses.Thirteen studies with 1509 patients were included. Meta-analysis showed no statistically significant differences (P > 0.05) between RARC and LRC in terms of operative time (weighted mean difference [WMD] = 14.48; 95% confidence interval [CI][-2.49, 31.44], P = 0.001), estimated intraoperative blood loss (WMD = -4.23; 95% CI [-81.48, 73.01], P = 0.001), intraoperative blood transfusion (odds ratio [OR] = 0.7; 95% CI [0.39, 1.27]; P = 0.011), positive surgical margins (OR = 1.21; 95% CI [0.61, 2.03]; P = 0.855), time to regular diet, length of hospital stay (WMD = 0.37, 95% CI [-1.73, 2.46]; P = 0.001), postoperative hospital days (WMD = -0.52; 95% CI [-1.15, 0.11], P = 0.359), intraoperative complications, 30- day postoperative complications, and 90- day postoperative complications. However the RARC lymph node yield was higher than that of LRC (WMD = 1.87; 95% CI [0.74, 2.99], P = 0.147).Our study showed that LRC and RARC have similar efficacy and safety profiles for the treatment of muscle invasive bladder cancer.

The role of robotic retroperitoneal lymph node dissection in testicular cancer: a systematic review and meta-analysis

OBJECTIVE

To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in testicular cancer.

METHODS

The statistical analysis software used Stata 17. The weighted mean difference (WMD) represents the continuous variable, and the dichotomous variable chooses the odds ratio, and calculates the 95% CI. This systematic review and cumulative meta-analysis was performed according to PRISMA criteria, and AMSTAR guidelines (assessing the methodological quality of systematic reviews). The Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases were searched. The upper limit of the search time frame was February 2023, and no lower limit was set.

RESULTS

Seven studies involving 862 patients. Compared with open retroperitoneal lymph node dissection, RA-RPLND appears to have a shorter length of stay [WMD=-1.21, 95% CI (-1.66, -0.76), P <0.05], less estimated blood loss [WMD=-0.69, 95% CI (-1.07, -0.32), P <0.05], and lower overall complications [odds ratio=0.45, 95% CI (0.28, 0.73), P <0.05]. RA-RPLND appears to have more lymph node yields than laparoscopic retroperitoneal lymph node dissection [WMD=5.73, 95% CI (1.06, 10.40), P <0.05]. However, robotic versus open/laparoscopic retroperitoneal lymph node dissection had similar results in operation time, lymph node positivity rate, recurrence during follow-up, and postoperative ejaculation disorders.

CONCLUSION

RA-RPLND appears to be safe and effective for testicular cancer, but longer follow-up and more studies are needed to confirm this.

Arginine methylation of PPP1CA by CARM1 regulates glucose metabolism and affects osteogenic differentiation and osteoclastic differentiation

BACKGROUND

The imbalance between osteoblasts and osteoclasts may lead to osteoporosis. Osteoblasts and osteoclasts have different energy requirements, with aerobic glycolysis being the prominent metabolic feature of osteoblasts, while osteoclast differentiation and fusion are driven by oxidative phosphorylation.

METHODS

By polymerase chain reaction as well as Western blotting, we assayed coactivator-associated arginine methyltransferase 1 (CARM1) expression in bone tissue, the mouse precranial osteoblast cell line MC3T3-E1 and the mouse monocyte macrophage leukaemia cell line RAW264.7, and expression of related genes during osteogenic differentiation and osteoclast differentiation. Using gene overexpression (lentivirus) and loss-of-function approach (CRISPR/Cas9-mediated knockout) in vitro, we examined whether CARM1 regulates osteogenic differentiation and osteoblast differentiation by metabolic regulation. Transcriptomic assays and metabolomic assays were used to find the mechanism of action of CARM1. Furthermore, in vitro methylation assays were applied to clarify the arginine methylation site of PPP1CA by CARM1.

RESULTS

We discovered that CARM1 reprogrammed glucose metabolism in osteoblasts and osteoclasts from oxidative phosphorylation to aerobic glycolysis, thereby promoting osteogenic differentiation and inhibiting osteoclastic differentiation. In vivo experiments revealed that CARM1 significantly decreased bone loss in osteoporosis model mice. Mechanistically, CARM1 methylated R23 of PPP1CA, affected the dephosphorylation of AKT-T450 and AMPK-T172, and increased the activities of phosphofructokinase-1 and pructose-2,6-biphosphatase3, causing an up-regulation of glycolytic flux. At the same time, as a transcriptional coactivator, CARM1 regulated the expression of pyruvate dehydrogenase kinase 3, which resulted in the inhibition of pyruvate dehydrogenase activity and inhibition of the tricarboxylic acid cycle, leading to a subsequent decrease in the flux of oxidative phosphorylation.

CONCLUSIONS

These findings reveal for the first time the mechanism by which CARM1 affects both osteogenesis and osteoclast differentiation through metabolic regulation, which may represent a new feasible treatment strategy for osteoporosis.

Duhuo Jisheng decoction alleviates neuroinflammation and neuropathic pain by suppressing microglial M1 polarization: a network pharmacology research

BACKGROUND

Neuropathic pain (NP) is the most prevalent form of chronic pain resulting from nerve damage or injury. Despite the widespread use of Duhuo Jisheng decoction (DHJSD) in traditional Chinese medicine (TCM) to treat chronic pain, the mechanism underlying its analgesic action remains unclear.

METHODS

Using network pharmacology, we obtained DHJSD and NP-related target information from public databases to construct protein-protein interactions (PPI) and compound-target networks based on common target genes. These networks were further analyzed using gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG). The interaction between molecules was verified through molecular docking using AutoDock Tools software. Additionally, we treated a chronic constriction injury (CCI) rat model with DHJSD and determined the mechanical withdrawal threshold (MWT). We used an enzyme-linked immunosorbent assay kit to determine the levels of inflammatory cytokines. Furthermore, qRT-PCR was employed to analyze ACHE, NOS2, MAPK3, PTGS2, AKT1, and PPARG mRNA expression, and immunofluorescence was used to evaluate changes in microglia.

RESULTS

Our screening of compounds and targets identified 252 potential targets of DHJSD associated with NP. PPI analysis, along with GO and KEGG analyses, revealed that the potential mechanism of DHJSD in NP treatment may be related to inflammatory reactions, the IL-17 signaling pathway, MAP kinase activity, and endocrine activity. Based on molecular docking, the core target showed significant affinity for DHJSD's active components. Moreover, DHJSD treatment repaired the CCI-induced inflammatory reaction in the spinal cord while regulating the expression of ACHE, NOS2, MAPK3, PTGS2, AKT1, and PPARG mRNA. Immunofluorescence results indicated that the active components of DHJSD may regulate microglial M1 polarization to improve neuroinflammation, PPARG may have been involved in the process.

CONCLUSION

The multi-component, multi-target, and multi-pathway actions of DHJSD provide new insights into its therapeutic mechanism in NP.

The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6 cm): a meta-analysis and systematic review

BACKGROUND

The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown.

MATERIALS AND METHODS

This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (>6 cm in diameter).

RESULTS

Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P <0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P <0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P <0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P <0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P <0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P <0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P <0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P <0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P <0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P <0.01).

CONCLUSIONS

LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.

Comparison of the perioperative outcomes of laparoscopic and open retroperitoneal lymph node dissection for low-stage (stage I/II) testicular germ cell tumors: a systematic review and meta-analysis

OBJECTIVE

Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors.

METHODS

The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17.

RESULTS

There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up.

CONCLUSION

L-RPLND is superior to O-RPLND and is worthy of clinical promotion.

Association of spinopelvic index with proximal junctional failure developing in adult spinal deformity after surgical treatment: an observational study

BACKGROUND

Those pelvic parameters of sacral slope (SS) and pelvic tilt (PT) correlated significantly to lumbar spine and hip joints respectively. We proposed the match between SS and PT, namely spinopelvic index (SPI), in order to investigate whether the SPI correlated to proximal junctional failure (PJF) in adult spinal deformity (ASD) after correction surgery.

METHODS

Ninety-nine ASD patients who had undergone long-fusion (≥ 5 vertebras) surgeries were reviewed retrospectively in two medical institutions from January 2018 to December 2019. Those SPI were calculated with the equation: SPI = SS/PT, and analyzed using the receiver operating characteristic curve (ROC) analysis. All participants were subdivided into the observational and control group. Comparisons of demographics, surgical and radiographic data between the two groups were performed. A Kaplan-Meier curve and log-rank test was used to analyze the differences in PJF-free survival time, and the 95% confidence intervals (CI) were recorded respectively.

RESULTS

Nineteen patients suffering from PJF had much smaller postoperative SPI (P = 0.015), but much larger TK postoperatively (P < 0.001). ROC analysis determined the best cutoff value of 0.82 for SPI (sensitivity = 88.5%, specificity = 57.9%; AUC = 0.719, 95%CI: 0.612-0.864; P = 0.003). There were 19 and 80 cases in the observational (SPI ≤ 0.82) and control group (SPI > 0.82) respectively. The incidence of PJF in the observational group was much higher (11/19 VS 8/80, P < 0.001); further logistic regression analysis showed that SPI ≤ 0.82 was associated with increased odds of PJF (odds ratio: 12.375; 95%CI: 3.851-39.771). PJF-free survival time in the observational group decreased significantly (P < 0.001, log-rank test), moreover, multivariate analysis demonstrated that a value of SPI ≤ 0.82 (HR 6.626, 95%CI: 1.981-12.165) was significantly associated with PJF.

CONCLUSIONS

For ASD patients underwent long-fusion surgeries, the SPI should be over 0.82. The incidence of PJF may increase by 12-fold in such individuals with the immediate SPI ≤ 0.82 postoperatively.

Comparison of Perioperative Outcomes and Complications of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with Upper-Tract Urothelial Carcinoma

BACKGROUND

For medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients.

METHODS

A systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis.

RESULTS

Nine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] -1.10 to 59.92; p = 0.22), EBL (WMD -55.30, 95% CI -171.14 to 60.54; p = 0.13), LOS (WMD -0.39, 95% CI -1.03 to 0.25; p = 0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44-3.36; p = 0.17], or complications (OR 0.91, 95% CI 0.49-1.69; p = 0.13).

CONCLUSION

The meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.

Spatial interpolation of regional PM2.5 concentrations in China during COVID-19 incorporating multivariate data

During specific periods when the PM_2.5 variation pattern is unusual, such as during the coronavirus disease 2019 (COVID-19) outbreak, epidemic PM_2.5 regional interpolation models have been relatively little investigated, and little consideration has been given to the residuals of optimized models and changes in model interpolation accuracy for the PM_2.5 concentration under the influence of epidemic phenomena. Therefore, this paper mainly introduces four interpolation methods (kriging, empirical Bayesian kriging, tensor spline function and complete regular spline function), constructs geographically weighted regression (GWR) models of the PM_2.5 concentration in Chinese regions for the periods from January-June 2019 and January-June 2020 by considering multiple factors, and optimizes the GWR regression residuals using these four interpolation methods, thus achieving the purpose of enhancing the model accuracy. The PM_2.5 concentrations in many regions of China showed a downward trend during the same period before and after the COVID-19 outbreak. Atmospheric pollutants, meteorological factors, elevation, zenith wet delay (ZWD), normalized difference vegetation index (NDVI) and population maintained a certain relationship with the PM_2.5 concentration in terms of linear spatial relationships, which could explain why the PM_2.5 concentration changed to a certain extent. By evaluating the model accuracy from two perspectives, i.e., the overall interpolation effect and the validation set interpolation effect, the results showed that all four interpolation methods could improve the numerical accuracy of GWR to different degrees, among which the tensor spline function and the fully regular spline function achieved the most stable effect on the correction of GWR residuals, followed by kriging and empirical Bayesian kriging.

Efficiency and clinical outcomes of Moses technology for holmium laser enucleation of the prostate: An evidence-based analysis

BACKGROUND

To compare the safety and clinical efficacy of Moses laser enucleation of the prostate (MoLEP) with those of holmium laser enucleation of the prostate (HoLEP) for treating benign prostatic hyperplasia (BPH).

METHODS

We systematically searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang databases, and SinoMed databases. The retrieval period was from the establishment of the database to March 2022. Stata17.0 was used for calculations and statistical analyses.

RESULTS

This study included 12 articles comprising 1160 patients for meta-analysis. Compared with those of the HoLEP group, the hemostasis time (weighted mean difference [WMD] = -4.66, 95% confidence interval [CI] [-6.47, -2.84], p < 0.001), enucleation time (WMD = -7.23, 95% CI [-10.67, -3.79], p < 0.001), operative time (WMD = -15.02, 95% CI [-20.50, -9.53], p< 0.001), length of hospital stay (WMD = -15.02, 95% CI [-20.50, -9.53], p< 0.001), intraoperative blood loss (WMD = -11.19, 95% CI [-12.94, -9.44], p< 0.001), and total postoperative complications rate (OR = 0.51, 95% CI [0.32, 0.81], p = 0.004) were shorter in the MoLEP group. Postoperative quality of life (WMD = 0.30, 95% CI [0.00, 0.59], p = 0.047) was lower in the HoLEP group, and there were no statistically significant differences in the International Prostate Symptom Score, postoperative maximum urinary flow rate, and postoperative residual urine (p > 0.05).

CONCLUSION

MoLEP has more advantages than HoLEP in terms of safety, shorter operation time and hospital stay, and fewer complications. However, this conclusion needs to be verified with a larger sample size, longer follow-up time, and multicenter randomized controlled trial data.

The association between histological prostatitis and benign prostatic hyperplasia: a single-center retrospective study

OBJECTIVE

To investigate the relationship between histological prostatitis (HP) and clinical parameters related to benign prostatic hyperplasia (BPH) in male.

METHOD

The clinical data of 196 BPH patients who underwent transurethral resection of the prostate were collected. According to the results of hematoxylin-eosin (H&E) staining of prostate tissue, patients were divided into two groups: BPH with HP group and BPH without HP group. Differences in acute urinary retention (AUR), prostate volume (PV), serum sex hormones, lower urinary tract symptoms (LUTS) related parameters, and systemic inflammation indicators were compared between the two groups. SPSS software v.25 was used for statistical analysis.

RESULTS

Compared with the BPH without HP group, the BPH with HP group had greater AUR rate, PV, total IPSS, and IPSS-storage in BPH with HP group (p < 0.05). However, there were no significant differences in IPSS-voiding, post-void residual volume, maximum urinary flow rate, serum sex hormones, and systemic inflammation indicators between the two groups (p > 0.05).

CONCLUSIONS

This study suggests that patients with HP have larger PV, more severe LUTS, and a higher risk of AUR. HP is closely related to BPH and may be a key factor in the occurrence and clinical progress of BPH.

Prognostic nutritional index before surgical treatment may serve as a prognostic biomarker for patients with upper tract urothelial carcinoma: A systematic review and meta-analysis

Objective

This meta-analysis aims to assess whether the prognostic nutritional index (PNI) score before treatment can be an independent biomarker of the prognosis of patients with upper tract urothelial carcinoma (UTUC).

Materials and methods

We systematically search PubMed, Embase, Scopus database, and Cochrane Library, and the search time is up to April 2021. Use STATA 16.0 software for data processing and statistical analysis.

Results

Six studies, including seven cohorts, were eventually included in our meta-analysis. The meta-analysis results showed that low PNI scores are associated with worse OS (HR: 1.92; 95% CI 1.60 to 2.30; P &lt; 0.01), DFS/RFS/PFS (HR: 1.57; 95% CI 1.33 to 1.85; P &lt; 0.01), and CSS/DSS (HR: 1.79; 95% CI 1.49 to 2.16; P &lt; 0.01), which supported the PNI score as an independent prognostic biomarker for survival outcomes. The subgroup analysis and Begg’s test showed that the results were stable.

Conclusion

Based on current evidence, this meta-analysis proves that the PNI score of UTUC patients before treatment is an independent prognostic biomarker. It performs well on OS, DFS/RFS/PFS, and CSS/DSS. This conclusion needs to be verified by a prospective cohort study with larger sample size and a more rigorous design.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338503], identifier [CRD42022338503].

The genome of Aechmea fasciata provides insights into the evolution of tank epiphytic habits and ethylene-induced flowering

Aechmea fasciata is one of the most popular bromeliads and bears a water-impounding tank with a vase-like rosette. The tank habit is a key innovation that has promoted diversity among bromeliads. To reveal the genomic basis of tank habit formation and ethylene-induced flowering, we sequenced the genome of A. fasciata and assembled 352 Mb of sequences into 24 chromosomes. Comparative genomic analysis showed that the chromosomes experienced at least two fissions and two fusions from the ancestral genome of A. fasciata and Ananas comosus. The gibberellin receptor gene GID1C-like was duplicated by a segmental duplication event. This duplication may affect GA signalling and promote rosette expansion, which may permit water-impounding tank formation. During ethylene-induced flowering, AfFTL2 expression is induced and targets the EIN3 binding site ‘ATGTAC’ by AfEIL1-like. The data provided here will serve as an important resource for studying the evolution and mechanisms underlying flowering time regulation in bromeliads.

The genome of <i>Aechmea fasciata <i > , a common house plant and popular bromelioid provides insights into its evolution.

The Musa troglodytarum L. genome provides insights into the mechanism of non-climacteric behaviour and enrichment of carotenoids

BACKGROUND

Karat (Musa troglodytarum L.) is an autotriploid Fe'i banana of the Australimusa section. Karat was domesticated independently in the Pacific region, and karat fruit are characterized by a pink sap, a deep yellow-orange flesh colour, and an abundance of β-carotene. Karat fruit showed non-climacteric behaviour, with an approximately 215-day bunch filling time. These features make karat a valuable genetic resource for studying the mechanisms underlying fruit development and ripening and carotenoid biosynthesis.

RESULTS

Here, we report the genome of M. troglodytarum, which has a total length of 603 Mb and contains 37,577 predicted protein-coding genes. After divergence from the most recent common ancestors, M. troglodytarum (T genome) has experienced fusion of ancestral chromosomes 8 and 9 and multiple translocations and inversions, unlike the high synteny with few rearrangements found among M. schizocarpa (S genome), M. acuminata (A genome) and M. balbisiana (B genome). Genome microsynteny analysis showed that the triplication of MtSSUIIs due to chromosome rearrangement may lead to the accumulation of carotenoids and ABA in the fruit. The expression of duplicated MtCCD4s is repressed during ripening, leading to the accumulation of α-carotene, β-carotene and phytoene. Due to a long terminal repeat (LTR)-like fragment insertion upstream of MtERF11, karat cannot produce large amounts of ethylene but can produce ABA during ripening. These lead to non-climacteric behaviour and prolonged shelf-life, which contributes to an enrichment of carotenoids and riboflavin.

CONCLUSIONS

The high-quality genome of M. troglodytarum revealed the genomic basis of non-climacteric behaviour and enrichment of carotenoids, riboflavin, flavonoids and free galactose and provides valuable resources for further research on banana domestication and breeding and the improvement of nutritional and bioactive qualities.

Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (≥5 cm): A meta-analysis and systematic review

BACKGROUND

This systematic review and meta-analysis compared the safety and effectiveness of minimally invasive adrenalectomy (MIA) with open adrenalectomy (OA) in patients with large adrenal tumors (≥5 cm).

MATERIALS AND METHODS

We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Five databases including Medline, PubMed, Cochrane Library, Scopus, and Web of Science were systematically searched. The time frame of the search was set from the creation of the database to March 2022.

RESULTS

Ten studies including 898 patients were included. Compared to OA, MIA is superior for length of stay [LOS WMD = -3.52, 95% CI (-4.61, -2.43), P < 0.01], drainage time [DT WMD = -0.68, 95% CI (-1.27, -0.09), P < 0.05] and fasting time [FT WMD = -0.95, 95% CI (-1.35, -0.55), P < 0.01], estimated blood loss [EBL WMD = -314.22, 95% CI (-494.76, -133.69), P < 0.01] and transfusion [WMD = -416.73, 95% CI (-703.75, -129.72), P < 0.01], while operative time (OT) and complications are not statistically different. For pheochromocytoma, MIA remains superior for LOS [WMD = -3.10, 95% CI (-4.61, -1.60), P < 0.01] and EBL [WMD = -273.65, 95% CI (-457.44, -89.86), P < 0.01], while OT and complications are not significantly different.

CONCLUSION

MIA offers advantages over OA in the management of large adrenal tumors, including in the case of a specific large adrenal tumor - large pheochromocytoma.

POS0286 CAN PATIENTS WITH CONTROLLED RA RECEIVING ANY CLASS OF TARGETED THERAPY WITH METHOTREXATE (MTX) SUSTAIN DISEASE CONTROL AFTER TAPERING MTX? A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Patients with RA frequently struggle with intolerance of MTX and adherence to MTX remains highly variable. Guidelines conditionally recommend the tapering of MTX before tapering biologic (b)DMARDs, but acknowledge there is an absence of direct evidence. Prior reviews on this topic have focused on tapering of MTX from combination treatment with TNF-inhibitors(i) only1. There have been no updated reviews addressing MTX tapering from other targeted therapies such as IL6-i or JAK-i, nor has there been a systematic review addressing this question.

Objectives

To determine the feasibility of tapering MTX to targeted therapy (bDMARDs or JAKi) alone in patients whose RA is controlled (LDA or remission).

Methods

A systematic literature search combing MeSH terms and keywords was conducted in Medline, Embase and Cochrane Library for studies reporting remission outcomes after tapering MTX from targeted therapies in RA. Non-English and animal studies were excluded. Meta-analyses were conducted using random effects models. Forest and funnel plots were created and heterogeneity was calculated.

Results

Our search identified 5762 citations. After removal of duplicates and screening title/abstract using the COVIDENCE platform, 504 full-text articles were reviewed. Of the 10 articles meeting our inclusion criteria of tapering MTX to monotherapy with a targeted therapy, 3 studies tapered to etanercept, 3 to tocilizumab, 1 to tofacitinib, 1 to certolizumab pegol, 1 to adalimumab and 1 to abatacept monotherapy. Nine studies were RCTs and one was a long-term extension study (LTE) (Table 1). Disease duration was longer in 7 studies (6-11 years) and early in 3 studies (1-9 months). The MTX tapering strategy was gradual in 2 and rapid in 8 studies. Follow-up ranged from 3 -18 months in RCTs, and up to 3 years in the LTE. Studies reporting outcomes up to 1 year after tapering had remission rates ranging 48-76%, but this dropped to 40% in one study reporting 18- month remission outcomes. Our meta-analysis conducted in 2000 RA participants from 10 studies showed that patients who tapered MTX to targeted therapy alone could maintain remission with an overall pooled OR of 0.81 (0.68, 0.97) (Figure 1). There was no heterogeneity among the studies in this group (I2=0.0%, p=0.788). Our funnel plot indicated high precision and potentially less publication bias. No significant difference in remission outcomes between early RA [OR 0.63 (0.33, 1.18)] and established RA [OR 0.84 (0.69, 1.03)] was observed.

Table 1.

Included Studies

Author/ YearnEarly RABaseline treatmentMTX Taper StrategyREM measureFollow-upCurtis 2020253noETA+MTXStopSDAI48 wksEmery 2019147yesABA+MTXStopSDAI48 wksCohen 2019533noTOFA+MTXStopDAS28-CRP48 wksEmery 2019411yesETA+MTXTaper 4 wksDAS2852 wksPablos 2019165noTCZ+MTXStopDAS2828 wksPope 201988noCZP+DMARDStopDAS2818 mosKremer 2018296noTCZ+MTXStopDAS2852 wksEdwards 2017272noTCZ+MTXTaper 24 wksDAS2848 wksKeystone 2016205noETA+MTXStopDAS2818 mosKeystone 2018140yesADA+MTXStopDAS28-CRP3 years

ETA etanercept, ABA abatacept, TOFA tofacitinib, TCZ tocilizumab, CZP certolizumab pegol, ADA adalimumab, REM remission, wk week, mo month, DAS28 Disease Activity Score 28, SDAI Simplified disease activity index.

Conclusion

Patients with controlled RA have a high probability of maintaining disease control after tapering their MTX to targeted therapy alone, up to 18 months. This review may inform patients with controlled disease on any of a range of targeted therapies and MTX, but who are struggling with MTX-related adverse effects and wish to taper it. Longer follow-up studies with attention to radiographic, functional and patient reported outcomes are needed. The possibility of disease worsening must be discussed with the patient in advance with careful follow-up and prompt re-treatment of disease worsening.

References

[1]Subesinghe S, Scott IC. Expert Rev Clin Pharmacol 2015;8:751-60.

Disclosure of Interests

Charis Meng: None declared, Diviya Rajesh: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, Walgreens, Omar Bruce: None declared, Bridget Jivanelli: None declared, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB., Grant/research support from: NIH (NIAID/NIAMS) grant 1UH2AR067691-01 GRANT11652401 and The Cedar Hill Foundation; institution received grants from Bristol Myers Squibb and Amgen;

POS0642 THE PROBABILITY OF SUSTAINING RHEUMATOID ARTHRITIS REMISSION IN PATIENTS TAPERING TARGETED THERAPY USED AS MONOTHERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Up to 30% of RA patients receive monotherapy with biologic (b)DMARDs or JAK inhibitors (i), often due to intolerance of methotrexate (MTX). Monotherapy with IL-6i and JAK-i has been reported to be effective. The EULAR research agenda includes addressing the question of whether tapering of targeted therapy (bDMARDs and JAK-i) used as monotherapy (targeted monotherapy) is possible1.

Objectives

To assess if it is feasible to taper (stop or reduce) targeted monotherapy with controlled RA using existing clinical trial data.

Methods

A systematic review of the literature (2014-2021), cited in Medline, Embase and the Cochrane Library, was performed. Meta-analyses were conducted using random effects models. Forest and funnel plots were created and heterogeneity calculated.

Results

Our search yielded 5762 citations. After de-duplication, screening of titles/abstracts and review of full text articles, we identified 5 studies comparing tapering of targeted monotherapy (TNF-i, tocilizumab (TCZ), abatacept (ABA) and baricitinib) to continuing therapy or other tapering regimens (Table 1). In our meta-analysis of data from 800 patients we observed a trend for lower odds of remission when tapering of targeted monotherapy vs comparator treatment regimen [pooled OR 0.72 (0.35, 1.48)]. In one study comparing stopping monotherapy to continuing MTX, we saw the lowest OR 0.55 (0.20, 1.48). In studies comparing two tapering regimens the pooled OR was higher 2.17 (1.13, 4.16). There was no heterogeneity in the studies which compared tapering to continuing therapy (I2=0.0%, p=0.437) and moderate heterogeneity in the studies that tapered different treatments in both arms (I2=53.7%, p=0.115). Trials using a gradual tapering strategy had a numerically higher odds of remission [OR 2.15 (0.94, 4.92); 3.61(1.85, 7.04)] compared to a trial implementing abrupt withdrawal [OR 1.19 (0.53, 2.68)]. There was a trend for higher remission outcomes in studies of early RA [pooled OR 1.71 (0.72, 4.05)] compared to established RA [pooled OR 1.12 (0.29, 4.27)] (Figure 1). Funnel plots indicate a paucity of studies, and perhaps publication bias.

Table 1.

Included studies.

Author/yearnEarly RAMean Age RangeBaselineTapering strategyComparison arm interventionRemission OutcomeFollow uptreatmentvan Mulligen 2020189No56-57csDMARD + TNFiTaper csDMARD then TNFiTaper in reverse orderDAS44 < 1.624 mosKaneko102No54-58TCZ+MTXStop TCZContinue MTXDAS28 < 2.6104 wks2018vs TCZBijlsma299Yes54TCZ+MTXGradual taper MTX 1st then TCZGradual taper MTXDAS28 < 2.6+SJC≤4104 wks2016vs TCZvs MTXEmery176Yes45-49ABA+MTXStop ABAStop ABA Taper MTX offDAS28-CRP<2.618 mos2015vs ABAvs MTXTakeuchi69Yes48-53Bari 4mgReduce 2mgContinue 4mgCDAI < 2.848 wks2019

ABA abatacept, Bari baricitinib, CDAI Clinical disease activity index, csDMARDS conventional synthetic DMARDs, DAS28 Disease Activity Score 28, MTX methotrexate, SJC swollen joint count, TCZ tocilizumab, wks weeks, mos months.

Conclusion

There are no trials designed to compare tapering targeted monotherapy to continuing it, indicating a significant gap in knowledge in an area of increasing clinical relevance for our patients. There was insufficient evidence to demonstrate the significant effects of tapering targeted monotherapy in RA. Only one study out of 5 compared stopping targeted monotherapy to continuing therapy (MTX), and reported a low OR of remission. Three studies tapered therapy in both arms and one study performed a dose reduction. Our review suggests that stopping targeted monotherapy is unlikely to maintain disease control. More gradual tapering schemes, dose reduction and early treatment of disease may be associated with more successful tapering. More studies are needed to better inform our patients. Currently, we do not recommend stopping targeted monotherapy in RA.

References

[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al.Ann Rheum Dis 2020;79:685-99.

Disclosure of Interests

Charis Meng: None declared, Diviya Rajesh: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, Walgreens, Omar Bruce: None declared, Bridget Jivanelli: None declared, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: NIH (NIAID/NIAMS) grant 1UH2AR067691-01 GRANT11652401 and The Cedar Hill Foundation; institution received grants from Bristol Myers Squibb and Amgen

Whether Out-of-Bed Activity Restriction in the Early Postoperative Period of PELD Is Beneficial to Therapeutic Efficacy or Reduce Recurrence

Objective

To detect the influences of postoperative out-of-bed activity restriction on recurrence rate, low back and leg pain, functional rehabilitation after percutaneous endoscopic lumbar discectomy (PELD).

Methods

In this research, 213 patients with lumbar intervertebral disc herniation (LDH) who underwent PELD were divided into the out-of-bed activity restriction group and out-of-bed activity non-restriction group. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate postoperative clinical efficacy at 1 and 3 months after the operation, and to count the recurrence rates. All of these operations were performed between August 2017 and July 2020, and they were followed in the outpatient department for 12 months at least.

Results

Both of the groups showed significantly lower VAS and higher ODI scores at 1 month and 3 months post-operation, respectively, when compared with pre-operation. At 1 month after the operation, the restriction group performed lower VAS scores of low back pain compared with the non-restriction group, but this advantage disappeared at 3months post-operation. However, there was no statistical difference in the VAS scores of leg pain and ODI scores between the two groups, neither at 1 nor 3 months after the surgery. The recurrence rate is significantly lower in the restriction group than in the non-restriction group at a 12-month follow-up after the surgery.

Conclusion

Out-of-bed activity restriction in the early postoperative period of PELD could reduce LDH recurrence effectively, and it may relieve the low back pain to some extent. It has no benefit in the recovery of leg pain and functional rehabilitation.

[The effects of robotic-assisted versus laparoscopic-assisted radical right hemicolectomy on short-term outcome and long-term prognosis based on propensity score matching]

Objective: To compare the short-term and long-term outcomes between robotic-assisted and laparoscopic-assisted radical right hemicolectomy in patients with adenocarcinoma of the right colon. Methods: Retrospective review of a prospectively collected database identified 288 right colon cancer patients who underwent either robotic-assisted (n=57) or laparoscopic-assisted right hemicolectomy (n=231) between October 2014 and October 2020 at Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University. There were 161 males and 127 females, aging (60.3±12.8) years (range: 17 to 86 years). After propensity score matching as 1∶4 between robotic-assisted and laparoscopic-assisted right hemicolectomy, there were 56 cases in robotic group and 176 cases in laparoscipic group. Perioperative outcomes and overall survival were compared between the two groups using t test, Wilcoxon rank sum test, χ² test, Fisher exact test, Kaplan-Meier method and Log-rank test, respectively. Results: The total operative time was similar between the robotic and laparoscopic group ((206.9±60.7) minutes vs. (219.9±56.3) minutes, t=-1.477, P=0.141). Intraoperative bleeding was less in the robotic group (50 (20) ml vs. 50 (50) ml, Z=-4.591, P<0.01), while the number of lymph nodes retrieved was significantly higher (36.0±10.0 vs. 29.0±10.1, t=4.491, P<0.01). Patients in robotic group experienced significantly shorter hospital stay, shorter time to first flatus, and defecation (t: -2.888, -2.946, -2.328, all P<0.05). Moreover, the overall peri-operative complication rate was similar between robotic and laparoscopic group (17.9% vs. 22.7%, χ²=0.596,P=0.465). The 3-year overall survival were 92.9% and 87.9% respectively and the 3-year disease-free survival rates were 83.1% and 82.6% with no statistical significance between the robotic and laparoscopic group (P>0.05). Conclusions: Compared to laparoscopic-assisted right hemicolectomy, robot-assisted right hemicolectomy could improve some short-term clinical outcomes. The two procedures are both achieving comparable survival.

Comparison of external stents and DJ stents techniques for pediatric pyeloplasty: A systematic review and meta-analysis

OBJECTIVE

To evaluate and compare the efficacy and safety between an external stent and a Double J stent for pediatric Pyeloplasty.

METHODS

Through a systematical search of multiple scientific databases in July 2022, we performed a systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), whose protocol was registered with PROSPERO(CRD42021274087).

RESULTS

Eleven studies involving 1,758 patients were included. No significant differences were observed in operative time (MD: 2.26; 95% CI -9.62 to 14.14; P = 0.79), operative success rate (OR: 1.10; 95% CI 0.57 to 2.10; P = 0.780), length of hospital stay (MD: 0.65; 95% CI -0.04 to 1.34; P = 0.063), or complications (OR: 0.87; 95%CI 0.48 to 1.56; P = 0.630) between external stents and DJ stents in pediatric pyeloplasty. According to the subgroup analysis, we found the external stent group had a shorter operative time than the DJ stent group in terms of robot-assisted laparoscopic pyeloplasty (MD: -17.13; 95% CI -32.8 to -1.45; P = 0.032).

CONCLUSIONS

There were no significant differences in operative time, operative success rate, length of hospital stay, or complications between external stents and DJ stents in pediatric pyeloplasty. The external stented procedure seemed to have less operative time when using robot-assisted laparoscopic pyeloplasty. However, due to the limitations of our analysis, more studies are still required to support our conclusion.

SYSTEMATIC REVIEW REGISTRATION

This systematic review has been registered on PROSPERO, the registration ID is CRD42021274087.

Potential Clinical Value of Pretreatment De Ritis Ratio as a Prognostic Biomarker for Renal Cell Carcinoma

Background

We performed this study to explore the prognostic value of the pretreatment aspartate transaminase to alanine transaminase (De Ritis) ratio in patients with renal cell carcinoma (RCC).

Methods

PubMed, EMBASE, Web of Science, and Cochrane Library were searched to identify all studies. The hazard ratio (HR) with a 95% confidence interval (CI) for overall survival (OS) and cancer-specific survival (CSS) were extracted to evaluate their correlation.

Results

A total of 6,528 patients from 11 studies were included in the pooled analysis. Patients with a higher pretreatment De Ritis ratio had worse OS (HR = 1.41, p < 0.001) and CSS (HR = 1.59, p < 0.001). Subgroup analysis according to ethnicity, disease stage, cutoff value, and sample size revealed that the De Ritis ratio had a significant prognostic value for OS and CSS in all subgroups.

Conclusions

The present study suggests that an elevated pretreatment De Ritis ratio is significantly correlated with worse survival in patients with RCC. The pretreatment De Ritis ratio may serve as a potential prognostic biomarker in patients with RCC, but further studies are warranted to support these results.

Outpatient versus inpatient robot-assisted radical prostatectomy: a meta-analysis of comparative outcomes

PURPOSE

To provide a systematic analysis of outcomes comparing outpatient and inpatient robot-assisted radical prostatectomy (RARP) for prostate cancer based on the best available evidence.

METHODS

A comprehensive search of electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted to determine eligible comparative studies as of July 2021. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Parameters including perioperative, oncological, and functional outcomes were collected.

RESULTS

Nine studies with 2721 patients were included, of which 831 underwent outpatient RARP and 1890 underwent inpatient RARP. The combined results demonstrated that compared with the inpatient group, the outpatient group had shorter operation time (WMD -8.59 95% CI -14.08 to -3.10, p = 0.002) and lower overall complication rate (OR 0.64, 95% CI 0.44 to 0.95, p = 0.03). However, there were no significant differences regarding estimated blood loss, readmission rate, positive surgical margin, and urinary continence rates between the groups.

CONCLUSIONS

Outpatient RARP does not increase the incidence of complications and readmissions compared with inpatient RARP. This suggests that routine same-day discharge after providing patients with RARP is safe and feasible.

Corilagin induces apoptosis and inhibits autophagy of HL‑60 cells by regulating miR‑451/HMGB1 axis

Corilagin is the primary active component of the Euphorbia phyllanthus plant and has significant anti-cancer properties. However, the biological effects and mechanisms of corilagin on acute myeloid leukemia (AML) have not been clarified. The Cell Counting Kit-8 and Carboxyfluorescein Diacetate Succinimidyl Ester assay results showed that corilagin significantly inhibited proliferation of the AML cell line HL-60 in a time- and dose-dependent manner. Western blotting and flow cytometry analysis were performed to determine the levels of apoptosis in HL-60 cells. The protein levels of cleaved caspase-3 and Bak were upregulated, while Bcl-xl was downregulated in cells treated with corilagin. The percentage of early- and late-stage apoptotic cells increased following corilagin treatment in a dose-dependent manner, indicating that the intrinsic mitochondrial apoptosis pathway was activated by corilagin. Simultaneously, western blotting and immunofluorescence results revealed that autophagy was suppressed; this was accompanied by a decrease in light chain 3-II (LC3-II) conversion and autophagosomes. MicroRNA (miRNA/miR) profile analysis showed that corilagin elevated the expression of the tumor suppressor miR-451, while the mRNA and protein levels of high mobility group protein B1 (HMGB1), the target of miR-451, decreased following exposure to corilagin. Knockdown of miR-451 decreased the downregulation of HMGB1 caused by corilagin, indicating negative regulation of HMGB1 by miR-451 during corilagin treatment. Furthermore, knockdown of miR-451 also attenuated corilagin-induced proliferation inhibition of HL-60 cells, implying that miR-451 was essential for the proliferation inhibitory effect of corilagin. In conclusion, these results indicated that corilagin induced apoptosis and inhibited autophagy in HL-60 cells by regulating the miR-451/HMGB1 axis, and corilagin may be a novel therapeutic drug for the treatment of AML.

Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better?

OBJECTIVE

This study aims to evaluate the overall efficacy and safety between holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) for the treatment of benign prostatic hyperplasia (BPH).

METHOD

We systematically searched electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) to identify eligible comparative studies as of July 2021. The parameters including perioperative results, complications, and functional outcomes were evaluated. RevMan version 5.4 was used for the analysis.

RESULTS

A total of 10 studies involving 1725 patients were included. HoLEP had lower operative time (p = .03), shorter catheterization time (p = .007), lower bladder irrigation time (p = .01), and higher enucleation weight (p = .01) compared with B-TUEP. However, there were no significant differences between the techniques regarding the length of stay (LOS), hemoglobin drop, transfusion rates, and complications. Furthermore, no significant differences were also observed in postoperative functional outcomes at 1, 3, 6, 12, or 24 months.

CONCLUSIONS

HoLEP has more advantages in perioperative parameters compared with B-TUEP, but no significant differences are found regarding functional outcomes and complications. Large-scale studies with long-term follow-up are required to compare the outcomes of these two techniques.