What to choose in proximal hypospadias repair: onlay island flap or tubularized preputial flap?

Response to letter to editor ‘What to choose in proximal hypospadias repair: onlay Island flap or tabularized preputial flap?’

Validation of risk prediction tools in elderly patients who initiate dialysis: methodological issues

Hydrogen sulfide-induced relaxation of the bladder is attenuated in spontaneously hypertensive rats Abstract Purpose To compare hydrogen sulfide (H2S)-induced relaxation on the bladder between normotensive and spontaneously hypertensive rat (SHR), we evaluated the effects of H2S donors (GYY4137 and NaHS) on the micturition reflex and on the contractility of bladder tissues. We also investigated the content of H2S and the expression levels of enzymes related to H2S biosynthesis [cystathionine β-synthase (CBS), 3-mercaptopyruvate sulfurtransferase (MPST), and cysteine aminotransferase (CAT)] in the bladder. Methods Eighteen-week-old male normotensive Wistar rats and SHRs were used. Under urethane anesthesia, the effects of intravesically instilled GYY4137 (10−8, 10−7 and 10−6 M) on the micturition reflex were evaluated by cystometry. The effects of NaHS (1 × 10−8–3 × 10−4 M) were evaluated on carbachol (10−5 M)-induced pre-contracted bladder strips. Tissue H2S content was measured by the methylene blue method. The expression levels of these enzymes were investigated by Western blot. Results GYY4137 significantly prolonged intercontraction intervals in Wistar rats, but not in SHRs. NaHS-induced relaxation on pre-contracted bladder strips was significantly attenuated in SHRs compared with Wistar rats. The H2S content in the bladder of SHRs was significantly higher than that of Wistar rats. CBS, MPST and CAT were detected in the bladder of Wistar rats and SHRs. The expression levels of MPST in the SHR bladder were significantly higher than those in the Wistar rat bladder. Conclusion H2S-induced bladder relaxation in SHRs is impaired, thereby resulting in a compensatory increase of the H2S content in the SHR bladder.

The relationship between vitamin D and inflammatory markers in maintenance hemodialysis patients Abstract Purpose The aim of this study was to investigate the relationship between vitamin D and novel inflammatory markers in hemodialysis patients. Methods In total, 129 eligible maintenance hemodialysis patients were enrolled in this cross-sectional study. Patients were divided into two groups according to their serum vitamin D levels. A serum 25-hydroxyvitamin D (25(OH)D) level < 20 ng/ml was identified as vitamin D deficiency and a serum level ≥ 20 ng/ml was identified as normal. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated from the complete blood cell count. Spearman correlation analysis and both logistic and linear regression analyses were used to define the relationships between the study parameters. Results The two groups showed statistically significant differences for gender and for C-reactive protein (CRP) and NLR values (p = 0.017, p = 0.010, and p = 0.013). Age and gender were independently associated with vitamin D deficiency (p = 0.003 and p = 0.030). Serum 25(OH)D levels showed significant but weak inverse correlations with CRP (r = − 0.205, p = 0.020) and with NLR (r = − 0.219, p = 0.013). Serum 25(OH)D levels also showed a significant but very weak correlation with PLR (r = − 0.182, p = 0.039). Serum 25(OH)D levels showed no correlation with mean platelet volume (p = 0.660). Gender was the only variable significantly associated with serum vitamin D levels, as determined by linear regression analysis (p = 0.003). Conclusion CRP levels and NLR values were significantly higher in the vitamin D deficiency group. A significant inverse correlation was found between serum vitamin D levels and CRP levels, and NLR and PLR values.

The effects of vitamin D treatment on glycemic control, serum lipid profiles, and C-reactive protein in patients with chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials Abstract Purpose Insulin resistance, dyslipidemia and increased systemic inflammation are important risk factors for chronic kidney disease (CKD). Hence, vitamin D administration might be an appropriate approach to decrease the complications of CKD. Randomized controlled trials assessing the effects of vitamin D supplementation or treatment on glycemic control, lipid profiles, and C-reactive protein (CRP) among patients with CKD were included. Methods Two independent authors systematically searched online databases including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science in November 2018 with no time restriction. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. Between-study heterogeneity was estimated using the Cochran’s Q test and I-square (I2) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size. Results Of the 1358 citations identified from searches, 17 full-text articles were reviewed. Pooling findings from five studies revealed a significant reduction in fasting glucose (WMD: − 18.87; 95% CI: − 23.16, − 14.58) and in homeostatic model assessment of insulin resistance (HOMA-IR) through three studies (WMD: − 2.30; 95% CI: − 2.88, − 1.72) following the administration of vitamin D. In addition, pooled analysis revealed a significant reduction in triglycerides (WMD: − 32.52; 95% CI: − 57.57, − 7.47) through six studies and in cholesterol concentrations (WMD: − 7.93; 95% CI: − 13.03, − 2.83) through five studies, following vitamin D supplementation or treatment, while there was no effect on insulin, HbA1c, LDL and HDL cholesterol, and CRP levels. Conclusions This meta-analysis demonstrated the beneficial effects of vitamin D supplementation or treatment on improving fasting glucose, HOMA-IR, triglycerides and cholesterol levels among patients with CKD, though it did not influence insulin, HbA1c, LDL and HDL cholesterol, and CRP levels.

Is there a benefit to additional neuroaxial anesthesia in open nephrectomy? A prospective NSQIP propensity score analysis Abstract Introduction Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia. Materials and methods Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay. Results Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007]. Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042–1.176, p = 0.001] after adjusting for multiple factors. Conclusion Using 2014–2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.

Treatment of hepatitis C infection among Egyptian hemodialysis patients: the dream becomes a reality Abstract Background and aims New direct-acting antiviral drugs have become the corner-stone treatment for HCV infection: they show promising results with accepted side-effects and low dropout rates. One of the available regimens is paritaprevir/ombitasvir/ritonavir (PTV/OMV/RTV). Our aim was to study the efficacy and safety of this drug regimen among HCV-positive hemodialysis patients. Methods This prospective single-center study was performed in the Urology and Nephrology Center, Mansoura University, Egypt. Ninety-six maintenance hemodialysis patients were screened for HCV antibodies. Positive results were found in 46 patients (47.9%). HCV PCR was assessed in all HCV-antibody-positive patients; positive results were found positive for 38 (82%); all patients were HCV genotype 4. Four patients were excluded due to advanced liver cirrhosis, liver malignancy, or metastatic breast cancer. Thirty-four patients were prescribed PTV/OMV/RTV for 3 months to treat HCV. Results Mean age was 43.2 ± 11.9 years. Most patients were male (67.6%). There was a rapid response to treatment: HCV PCR became negative by 4 weeks after starting treatment. By 12 and 24 weeks post-DAA therapy, there was a sustained viral response (SVR 12, SVR 24) in 100% of patients with improved liver-enzyme levels. Conclusion The PTV/OMV/RTV regimen was safe and effectively treated Egyptian HCV-positive genotype-4 hemodialysis patients.

Prognostic value of phospholipase A2 receptor in primary membranous nephropathy: a systematic review and meta-analysis Abstract Purpose We aimed to evaluate the prognostic value of serum anti-PLA2R and glomerular PLA2R deposit (gPLA2R) in predicting remission of proteinuria in Primary Membranous Nephropathy (PMN) patients. Methods PUBMED, EMBASE, WEB OF SCIENCE, COCHRANE LIBRARY and CNKI were searched from 2008 January to December 2018. Heterogeneity was assessed by Cochran Q test and I2. Source of heterogeneity was explored by subgroup analysis and sensitivity analysis. Results Totally 2345 patients from 29 cohort studies were eligible for inclusion. The results suggested that PMN patients with negative anti-PLA2R at the time of biopsy had a 1.31 times (95% CI 1.12–1.46, p < 0.05) higher possibility in achieving remission than those with positive anti-PLA2R. The clearance of anti-PLA2R at the end of immunosuppressive therapy showed an even greater chance of achieving remission (RR = 2.86, 95% CI 1.75–4.69, p < 0.05). The relative ratios for complete remission and spontaneous remission with negative anti-PLA2R were 1.65 (95% CI 1.46–1.87, p < 0.05) and 1.93, respectively (95% CI 1.53–2.45, p < 0.05), and heterogeneity percentages were I2 = 18% and 46%, respectively. The possibility for remission was significantly greater among PMN patients with negative gPLA2R (RR = 1.30, 95% CI 1.13–1.50, p < 0.05). Subgroup analyses revealed that retrospective design of study might be the potential source of heterogeneity. Conclusions Negative anti-PLA2R or gPLA2R might predict higher possibility of remission, and the presence of anti-PLA2R or gPLA2R might serve as a useful biomarker for clinical outcome and predicting response to immunosuppressive therapy in PMN.

Prediction model for acute kidney injury after coronary artery bypass grafting: a retrospective study Abstract Background Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. The aim of this study is to investigate the incidence, mortality and risk factors of AKI after CABG, and to establish a risk prediction model. Methods From January 2016 to June 2018, 541 patients who underwent CABG were enrolled. The clinical characteristics were collected to calculate the incidence and mortality of AKI after CABG. Patients were divided into AKI group and non-AKI group according to the statistical data. The differences of preoperative, intraoperative and postoperative variables between the two groups were comparatively analysed. The risk factors of AKI were obtained by binary logistic stepwise regression analyses using related factors as independent variables. Results The incidence of postoperative AKI in 541 patients was 27.9% (151 cases). The in-hospital mortality in AKI group was higher than that in non-AKI group (5.30% vs 0.00%, P < 0.001). Single factor analysis showed that the risk factors for postoperative AKI including age, BMI, hypertension, cardiac insufficiency, eGFR, serum uric acid level, CABG combined valve operation, cardiopulmonary bypass (CPB), operation time, aortic cross-clamping time, CPB time, mechanical ventilation time and postoperative low cardiac output syndrome. Multivariate regression analysis suggested that age (P = 0.006, OR 2.323), BMI (P = 0.004, OR 2.495), hypertension (P = 0.032, OR 1.712), eGFR (P = 0.002, OR 3.054), CPB time (P = 0.024, OR 1.007) and postoperative low cardiac output syndrome (P = 0.010, OR 2.640) were independent risk factors for AKI. Conclusions AKI is a common complication after CABG and is related to multiple perioperative factors. It is suggested that early recognition of these risk factors and interventions should be carried out in clinical practice. The risk prediction model can be used as a simple tool for predicting postoperative AKI.