This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December ...This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.展开更多
In some clinical applications in oncology randomized, double armed, and double-blind trials are not possible. In case of device applications, double-blinded conditions are nonrealistic, and with many times the randomi...In some clinical applications in oncology randomized, double armed, and double-blind trials are not possible. In case of device applications, double-blinded conditions are nonrealistic, and with many times the randomization also has complications due to the high-line treatments where the reference cohort is not available;the active “arm” has mainly palliative initiative. Sometimes highly personalized therapies block the collection of the homogeneous group and limit its double-arm randomization. Our objective is to discuss the situations of the single arm evaluation and to give methods for the mining of information from this to increase the level of evidence of the measured dataset. The basic idea of the data-separation is the appropriate parameterization of the non-parametric Kaplan-Meier survival pattern by the poly-Weibull fit.展开更多
Aim:Currently,prepectoral breast reconstruction(PBR)is widely used in clinical practice,but its safety lacks high-level epidemiological evidence.This meta-analysis intended to clarify the safety of PBR for clinicians....Aim:Currently,prepectoral breast reconstruction(PBR)is widely used in clinical practice,but its safety lacks high-level epidemiological evidence.This meta-analysis intended to clarify the safety of PBR for clinicians.Methods:The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Two independent reviewers systematically searched six databases from 1 January 2000 to 27 March 2020 to identify eligible studies.Statistical analysis was performed using R GUI 3.6.3,and a random effects model was used to calculate the proportion with 95%confidence intervals(CIs).Subgroup analysis was conducted based on body mass index,proportion of patients receiving preoperative radiotherapy,surgical technique,and follow-up time.Results:In total,19 studies involving 1686 cases and 2551 breasts were included.The percentage of surgical success was 96.2%,while the total complication rate was 15.4%(95%CI:10.6%-20.9%),hematoma rate was 4.3%(95%CI:2.3%-6.9%),infection rate was 3.4%(95%CI:2.0%-5.1%),and capsular contracture rate was 0.9%(95%CI:0.1%-2.6%).The results of the subgroup analysis show that:(1)the incidence of capsular contracture was higher in patients with lower weight,while other complications were minimal;(2)compared with the patients who underwent two-stage expander-assisted PBR,those with direct to-implant PBR had lower incidences of surgical complications;(3)preoperative radiotherapy could be a risk factor for various postoperative complications;and(4)with the extension of follow-up time,the incidence of long-term complications increases.Conclusion:This present work confirmed that PBR is a safe and reliable therapy with a higher success rate and a relatively lower rate of complications.Overall,PBR can be used as an alternative for sub-pectoral breast reconstruction.展开更多
文摘This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.
文摘In some clinical applications in oncology randomized, double armed, and double-blind trials are not possible. In case of device applications, double-blinded conditions are nonrealistic, and with many times the randomization also has complications due to the high-line treatments where the reference cohort is not available;the active “arm” has mainly palliative initiative. Sometimes highly personalized therapies block the collection of the homogeneous group and limit its double-arm randomization. Our objective is to discuss the situations of the single arm evaluation and to give methods for the mining of information from this to increase the level of evidence of the measured dataset. The basic idea of the data-separation is the appropriate parameterization of the non-parametric Kaplan-Meier survival pattern by the poly-Weibull fit.
基金supported by the National Key R&D Program of China(2019YFA0110500)the National Natural Science Foundation of China(No.81873941 to Jiaming Sun,No.81901977 to Ran An,No.81701912 to Yun Xia)Natural Science Foundation of Hubei Province(No.2016CFB133 to Ke Guo,No.2019CFB561 to Nengqiang Guo).
文摘Aim:Currently,prepectoral breast reconstruction(PBR)is widely used in clinical practice,but its safety lacks high-level epidemiological evidence.This meta-analysis intended to clarify the safety of PBR for clinicians.Methods:The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Two independent reviewers systematically searched six databases from 1 January 2000 to 27 March 2020 to identify eligible studies.Statistical analysis was performed using R GUI 3.6.3,and a random effects model was used to calculate the proportion with 95%confidence intervals(CIs).Subgroup analysis was conducted based on body mass index,proportion of patients receiving preoperative radiotherapy,surgical technique,and follow-up time.Results:In total,19 studies involving 1686 cases and 2551 breasts were included.The percentage of surgical success was 96.2%,while the total complication rate was 15.4%(95%CI:10.6%-20.9%),hematoma rate was 4.3%(95%CI:2.3%-6.9%),infection rate was 3.4%(95%CI:2.0%-5.1%),and capsular contracture rate was 0.9%(95%CI:0.1%-2.6%).The results of the subgroup analysis show that:(1)the incidence of capsular contracture was higher in patients with lower weight,while other complications were minimal;(2)compared with the patients who underwent two-stage expander-assisted PBR,those with direct to-implant PBR had lower incidences of surgical complications;(3)preoperative radiotherapy could be a risk factor for various postoperative complications;and(4)with the extension of follow-up time,the incidence of long-term complications increases.Conclusion:This present work confirmed that PBR is a safe and reliable therapy with a higher success rate and a relatively lower rate of complications.Overall,PBR can be used as an alternative for sub-pectoral breast reconstruction.
