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To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. A systematic review and random effects meta-analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III-V complications, reoperations (all-cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study-level factors with periprocedural outcomes and reoperation rates. The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P <.001) longer with GreenLight, while catheterization time (mean difference = −1.3 days; 95% CI: −1.7 to −0.9; P <.001) and hospital stay (mean difference = −2.1 days; 95% CI: −2.5 to −1.7; P <.001) were shorter. Bleeding-related complications, including clot retention (risk ratio [RR] = 0.12; 95% CI: 0.05 to 0.32; P <.001) and transfusion (RR = 0.26; 95% CI: 0.12 to 0.58; P =.001), as well as sexual dysfunction (RR = 0.66; 95% CI: 0.45 to 0.98; P =.04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P =.38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P =.79) did not differ. GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding-related complications compared to TURP. [ABSTRACT FROM AUTHOR]

To determine the safety and effectiveness of water vapor thermal therapy (Rezum) in men with large prostate volumes of at least 80 cm3. We performed systematic searches for studies of Rezum therapy in men with prostate volume of at least 80 cm3. Meta-analysis outcomes included the International Prostate Symptom Score (IPSS), IPSS Quality of Life (IPSS-QOL), Qmax, postvoid residual, International Index of Erectile Function-Erectile Function (IIEF-EF), and serious (Clavien-Dindo grade III-V) complications, surgical retreatments. Outcomes were analyzed using a random effects meta-analysis model. The review included 15 studies (11 retrospective) of 471 men with prostate volume at least 80 cm3 treated with Rezum therapy and followed for a median of 6 months (range: 3-17 months). Rezum therapy resulted in statistically significant improvements in IPSS (mean change: − 11.0; 95% CI: − 12.2, − 9.7; P <.001), IPSS-QOL (mean change: − 2.9; 95% CI: − 3.5, − 2.4; P <.001), Qmax (mean change: 6.5 mL/s; 95% CI: 4.8, 8.2 mL/s; P <.001), and postvoid residual (mean change: − 101 mL; 95% CI: − 145, − 57; P <.001). No change in IIEF-EF was observed (mean change: 0.3; 95% CI: − 1.1, 1.6; P =.71). Serious complications occurred in <0.1% (95% CI: 0.0%, 0.4%) and surgical retreatment in 1.2% (95% CI: 0.0%, 3.5%) of patients. Rezum therapy provides a statistically significant and clinically important short-term improvement in lower urinary tract symptoms with low complication rates in men with prostate volume of at least 80 cm3. Long-term outcomes with Rezum therapy in large prostates remain unclear. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine long-term survival of inflatable penile prosthesis (PP) and identify potential factors that may influence device survival. We performed a systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies of men treated with inflatable PP with at least 5 years of device survival data. We performed a random effects meta-analysis to estimate device survival at 1, 3, 5, 10, 15, and 20 years of follow-up. The robustness of the meta-analysis results was evaluated in a 1-study removed sensitivity analysis and sources of heterogeneity among studies were investigated with subgroup analysis. In 12 studies (20,161 patients; median age 57 years), PP device survival was 93.3% at 1 year, 91.0% at 3 years, 87.2% at 5 years, 76.8% at 10 years, 63.7% at 15 years, and 52.9% at 20 years. The results of the meta-analysis were not significantly influenced by single study effects in a 1-study removed sensitivity analysis. In a subgroup analysis, 5-year device survival rates were 90.6% vs 82.1% (P = .01) comparing newer vs older studies; no other patient or study design characteristic was statistically associated with device survival rates. In conclusion, the median device survival time of an inflatable PP is approximately 20 years. The factors responsible for improved device survival in newer studies remain unclear and warrant further study. [ABSTRACT FROM AUTHOR]

Abstract Immune function declines with advancing age. Probiotic supplementation has been proposed to slow or reverse these age-related changes. The primary objective of this study was to evaluate the effect of probiotic supplementation on cellular innate immune activity in healthy elderly subjects. We hypothesized that probiotic supplementation would enhance immune function. We performed a systematic review and meta-analysis of controlled trials that reported polymorphonuclear cell phagocytic capacity or natural killer (NK) cell tumoricidal activity following short-term probiotic supplementation in the elderly. Effect size was reported as the standardized mean difference (SMD) between probiotic and control groups, where values of 0.2, 0.5, 0.8, and 1.0 corresponded to small, medium, large, and very large effect sizes, respectively. A total of 17 prospective controlled studies (18 comparisons) of 733 subjects were included. Probiotic supplementation duration ranged from 3 to 12 weeks. Probiotic supplementation increased polymorphonuclear phagocytic capacity (SMD = 1.37, 95% confidence interval: 0.86-1.88, P <.001) and NK cell tumoricidal activity (SMD = 0.55, 95% confidence interval: 0.37-0.73, P <.001) relative to controls. In a subgroup analysis of NK cell activity, heterogeneity among studies was not explained by variability in study design or probiotic characteristics. Main limitations of this research were short-term supplementation durations and unclear clinical benefit of the immune changes. In conclusion, short-term probiotic supplementation enhances cellular immune function in healthy elderly adults. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to report healthcare payer costs of dual-mobility (DM) and large femoral head (LFH) constructs in revision total hip arthroplasties (THAs).Methods: A Markov model was constructed to analyze costs of re-interventions incurred by Medicare and private payers over a 3-year time horizon in patients who underwent unilateral revision THA with DM (n = 126) or LFH (n = 176) implants. Model states and probabilities were derived from prospectively collected registry data. Medicare costs were estimated as the weighted-average national Medicare payment for revision THA. Private payer costs were estimated by using a multiplier of Medicare costs.Results: Over a 3-year period following revision THA, re-interventions were performed in 11 (9%) DM patients and 34 (19%) LFH patients, costing $263-$1898 in DM THAs and $1285-$3946 in LFH THAs for Medicare. When compared to LFH implants, DM constructs were less costly to Medicare and private payers, resulting in cost differentials of $1536 and $2611, respectively.Conclusions: At mid-term follow-up, DM constructs utilized in revision THAs were associated with 11% lower absolute risk of re-intervention and payer savings of $1500-$2500 per case when compared to LFH constructs.Level Of Evidence: Economic and decision analysis, Level III. [ABSTRACT FROM AUTHOR]

Background: The choice between anterior approach (AA) and posterior approach (PA) in primary total hip arthroplasty (THA) is controversial. Previous reviews have predominantly relied on data from retrospective studies.Methods: This systematic review included prospective studies comparing postoperative outcomes through 90 days of AA vs PA in primary THA. Outcomes were pain severity, narcotic usage, hip function using Harris Hip Score, and complications. Random effects meta-analysis was performed for all outcomes. Efficacy data were reported as standardized mean difference (SMD) where values of 0.2, 0.5, 0.8, and 1.0 were defined as small, medium, large, and very large effect sizes, respectively. Complications were reported as the absolute risk difference (RD) where a positive value implied higher risk with AA and a lower value implied lower risk with AA.Results: A total of 13 prospective comparative studies (7 randomized) with patients treated with AA (n = 524) or PA (n = 520) were included. The AA was associated with lower pain severity (SMD = -0.37, P < .001), lower narcotic usage (SMD = -0.36, P = .002), and improved hip function (SMD = 0.31, P = .002) compared to PA. No differences between surgical approaches were observed for dislocation (RD = 0.2%, P = .87), fracture (RD = 0.2%, P = .87), hematoma (RD = 0%, P = .99), infection (RD = 0.2%, P = .85), thromboembolic event (RD = -0.9%, P = .42), or reoperation (RD = 1.3%, P = .26). Conclusions of this study were unchanged when subjected to sensitivity analyses.Conclusion: In this systematic review and meta-analysis of prospective studies comparing postoperative outcomes through 90 days of AA vs PA in primary THA, patients treated with AA reported less pain, consumed fewer narcotics, and reported better hip function. No statistical differences in complication rates were detected between AA and PA. Ultimately, the choice of surgical approach in primary THA should consider preference and experience of the surgeon as well as preference and anatomy of the patient. [ABSTRACT FROM AUTHOR]

Purpose: To determine the degradation and performance outcomes of poly(lactide-co-glycolide)/β-tricalcium phosphate (PLGA/β-TCP) implants.Methods: A MEDLINE and Embase search for randomized or nonrandomized controlled studies and prospective or retrospective case series that used biocomposite interference screws or suture anchors composed of PLGA/β-TCP was performed. Main outcomes included volume of implant resorption and incidence of osteoconductivity at implant sites, imaging findings, adverse events, and the frequency of reoperations.Results: A total of 13 studies representing 668 patients with either knee or shoulder implants were included. Median follow-up was 28 months (range: 12-37 months). Biocomposite implants lost 88% of their original volume during follow-up. Osteoconductivity at the implant site was identified in 63% of cases. Adverse events included tunnel widening (3%), effusion (5%), and cyst formation (4%). Synovitis was not reported.Conclusions: Biocomposite interference screws or suture anchors composed of PLGA/β-TCP almost fully absorb over 3 years while promoting osteoconductivity with few reported adverse events.Level Of Evidence: Level IV, systematic review of Level I-IV studies. [ABSTRACT FROM AUTHOR]

Pedicle screw fixation is a commonly utilized adjunct for lumbar interbody fusion, yet risks include screw malposition, pullout, loosening, neurovascular injury, and stress transfers leading to adjacent segment degeneration. This report describes the preclinical and initial clinical results of a minimally invasive, metal-free cortico-pedicular fixation device used for supplemental posterior fixation in lumbar interbody fusion. Safety of arcuate tunnel creation was evaluated in cadaveric lumbar (L1–S1) specimens. A finite element analysis study evaluated clinical stability of the device to pedicular screw-rod fixation at L4–L5. Preliminary clinical results were assessed by analysis of Manufacturer and User Facility Device Experience database complications, and 6-month outcomes in 13 patients treated with the device. Among 35 curved drill holes in 5 lumbar specimens, no breaches of the anterior cortex were identified. The mean minimum distance from the anterior surface of the hole to the spinal canal ranged from 5.1 mm at L1–L2 to 9.8 mm at L5–S1. In the finite element analysis study, the polyetheretherketone strap provided comparable clinical stability and reduced anterior stress shielding compared to the conventional screw-rod construct. The Manufacturer and User Facility Device Experience database identified 1 device fracture with no clinical sequelae among 227 procedures. Initial clinical experience showed a 53% decrease in pain severity (P = 0.009), a 50% decrease in Oswestry Disability Index (P < 0.001), and no device-related complications. Cortico-pedicular fixation is a safe and reproducible procedure that may address limitations of pedicle screw fixation. Longer term clinical data in large clinical studies are recommended to confirm these promising early results. [ABSTRACT FROM AUTHOR]

Abstract: Osteoporotic vertebral compression fractures (VCFs) are common in the elderly and can result in debilitating pain, loss of function, kyphosis with resulting height loss, and reductions in quality of life. Conservative treatment of VCFs is considered the gold standard but has limited effectiveness after the initial 2‐3-week period when the majority of uncomplicated VCFs resolve. Surgical intervention is invasive and associated with morbidity, particularly in the elderly patient with poor bone quality. Percutaneous techniques such as vertebroplasty and vertebral augmentation have revolutionized the treatment of VCFs by filling the treatment gap between conservative care and surgery. A robust series of randomized controlled trials and case series have demonstrated effective pain reduction, function improvement, and acceptable safety with these procedures. However, limitations still exist with these techniques including the need for bipedicular access, inadequate vertebral height restoration, trabecular destruction with balloon-based techniques, inability to precisely control cement delivery, and significant radiation exposure to patients and physicians. New technologies are emerging that retain the clinical advantages of traditional percutaneous vertebroplasty and vertebral augmentation while minimizing these limitations. This review article discusses the history of minimally invasive VCF treatment, summarizes clinical evidence with these therapies, and highlights the most innovative experimental and commercial technologies available today. [Copyright &y& Elsevier]

Abstract: Background: Open and minimally invasive lumbar fusion procedures have inherent procedural risks, with posterior and transforaminal approaches resulting in significant soft-tissue injury and the anterior approach endangering organs and major blood vessels. An alternative lumbar fusion technique uses a small paracoccygeal incision and a presacral approach to the L5-S1 intervertebral space, which avoids critical structures and may result in a favorable safety profile versus open and other minimally invasive fusion techniques. The purpose of this study was to evaluate complications associated with axial interbody lumbar fusion procedures using the Axial Lumbar Interbody Fusion (AxiaLIF) System (TranS1, Wilmington, North Carolina) in the postmarketing period. Methods: Between March 2005 and March 2010, 9,152 patients underwent interbody fusion with the AxiaLIF System through an axial presacral approach. A single-level L5-S1 fusion was performed in 8,034 patients (88%), and a 2-level (L4-S1) fusion was used in 1,118 (12%). A predefined database was designed to record device- or procedure-related complaints via spontaneous reporting. The complications that were recorded included bowel injury, superficial wound and systemic infections, transient intraoperative hypotension, migration, subsidence, presacral hematoma, sacral fracture, vascular injury, nerve injury, and ureter injury. Results: Complications were reported in 120 of 9,152 patients (1.3%). The most commonly reported complications were bowel injury (n = 59, 0.6%) and transient intraoperative hypotension (n = 20, 0.2%). The overall complication rate was similar between single-level (n = 102, 1.3%) and 2-level (n = 18, 1.6%) fusion procedures, with no significant differences noted for any single complication. Conclusions: The 5-year postmarketing surveillance experience with the AxiaLIF System suggests that axial interbody lumbar fusion through the presacral approach is associated with a low incidence of complications. The overall complication rates observed in our evaluation compare favorably with those reported in trials of open and minimally invasive lumbar fusion surgery. [Copyright &y& Elsevier]

Abstract: Osteoarthritis affects 27 million American adults of all ages and is a leading cause of disability in middle-aged and older adults. Initial management of knee osteoarthritis symptoms utilizes conservative care although long-term efficacy is poor. Arthroplasty and high tibial osteotomy may be considered for patients with severe pain or disability. We hypothesize that a distinct treatment gap exists for the patient with symptomatic knee osteoarthritis who is unresponsive to conservative care (including simple surgical treatments) yet refuses to undergo or is not an appropriate candidate for more invasive surgical procedures. This treatment gap represents a protracted period in which the patient experiences debilitating pain, reduced quality of life, and a significant financial burden. Approximately 3.6 million Americans linger in the knee osteoarthritis treatment gap and this number will grow to about 5 million people by 2025. The typical knee osteoarthritis treatment gap extends 20years although the younger osteoarthritis patient is faced with the treatment gap throughout the majority of their adult life. There is great need for a safe, effective, and cost effective treatment option for patients with moderate to severe osteoarthritis that enjoys high patient acceptance. [Copyright &y& Elsevier]

Abstract: The use of blinding strengthens the credibility of randomized controlled trials (RCTs) by minimizing bias. However, there is confusion surrounding the definition of blinding as well as the terms single, double, and triple blind. It has been suggested that these terms should be discontinued due to their broad misinterpretation. We recommend that, instead of abandoning the use of these terms, explicit definitions of blinding should be adopted. We address herein the concept of blinding, propose standard definitions for the consistent use of these terms, and detail when different types of blinding should be utilized. Standardizing the definition of blinding and utilizing proper blinding methods will improve the quality and clarity of reporting in RCTs. [Copyright &y& Elsevier]

Abstract: Numerous studies have investigated the effects of physical activity on bone health; however, little is known about the effects of isokinetic strength training on bone. While bone mineral density (BMD) is widely used to assess bone health and fracture risk, there are several limitations of this measure that warrant new technology development to measure bone strength. The mechanical response tissue analyzer (MRTA) assesses bone strength by measuring maximal bending stiffness (EI). We hypothesized that isokinetic strength training of the elbow flexors and extensors would increase ulnar EI, BMD, and bone mineral content (BMC) in young women. Fifty-four women trained the nondominant arm 3 times per week for 20 weeks; 32 trained concentrically (CON) and 22 trained eccentrically (ECC). Subjects were assessed for the following variables pre- and post-training: CON and ECC peak torque of the elbow flexors and extensors with isokinetic dynamometry, ulnar mineral content and density using dual-energy X-ray absorptiometry, and ulnar EI using MRTA. Isokinetic training increased CON (17%) and ECC (17%) peak torque, even when controlling for changes in the untrained arm. Eccentric training increased CON and ECC peak torque while CON training improved CON peak torque only. Isokinetic training increased ulnar EI 28%, which was statistically greater than the untrained arm. Ulnar EI increased 25% with CON training and 32% with ECC training. Both training modes resulted in greater EI gains compared to the untrained limb. Isokinetic training increased ulnar BMC (2.7%) and BMD (2.3%), even when controlling for untrained ulna changes. Both training modalities resulted in BMC and BMD increases; however, only CON training yielded gains when controlling for changes in the untrained limb. In conclusion, isokinetic strength training increases ulnar EI, BMC, and BMD in young women; no statistical differences were noted between CON and ECC training modes. [Copyright &y& Elsevier]

Abstract: Dual-energy X-ray absorptiometry (DXA) is a primary clinical tool for identification of adults with low areal bone mineral density (aBMD) and who are at increased risk for future osteoporosis and fragility fractures. Procedures for several aBMD scans of clinical interest might be limited by artifact, inaccessible anatomical regions, and positioning errors. Sites for scanning that overcome these limitations need further investigation for application to large-scale screening and relevance to clinical decisions regarding diagnosis and treatment. In this study, 146 women (mean ± SE age = 20.1 ± 0.1 yr, height = 163.3 ± 0.2 cm, weight = 60.0 ± 0.2 kg) underwent DXA of the total body (TB) and right and left total proximal femurs (TPF), total forearms (TF), and distal tibiae (DT). Osteopenia was identified in 24 women. Areal BMD was positively related among all measurement sites (r = 0.55–0.81, all p < 0.001). Total body, TF, and DT aBMD each displayed low sensitivity (0.29–0.33) and high specificity (0.95–0.98) to detect osteopenia of the TPF. Addition of TB fat-free mass slightly enhanced the predictive value of DT aBMD. Overall, DT aBMD can discriminate between osteopenic and normal subjects with comparable accuracy to TB or TF aBMD. [Copyright &y& Elsevier]

This study investigated bone mineral and body composition changes after coronary artery bypass grafting (CABG) in men. Twenty-six men 50 to 79 years of age underwent CABG for multivessel coronary disease. Dual-energy x-ray absorptiometry was performed before surgery and 3 months and 1 year after treatment to assess bone mineral content (BMC), bone mineral density (BMD), and body composition. Through 3 months after treatment, BMD decreased at the total body, arms, and pelvis. BMC of the arm decreased and losses at the total body and legs approached significance. Fat-free mass decreased in the arms and total body but not in the legs. Neither total body nor regional fat mass changed. At the 1-year follow-up visit, 15 of the initial 26 subjects returned for dual-energy x-ray absorptiometry. Compared with before treatment, BMD decreased at the total body and legs, whereas losses at the arms approached significance. Arm BMC decreased over the 1-year post-treatment period. No changes were observed in body composition. In conclusion, CABG and the ensuing convalescence period results in considerable arm bone mineral losses through 1 year after treatment. [Copyright &y& Elsevier]

We compared the safety and effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to open TLIF (O-TLIF) for lumbar degenerative disease. We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of MI-TLIF versus O-TLIF. The perioperative outcomes included the procedure time, fluoroscopy time, blood loss, complications, and hospital stay. The midterm outcomes included pseudarthrosis, the Oswestry Disability Index, and pain severity—all reported at 1-year minimum follow-up. A total of 7 randomized trials including 496 patients (246 MI-TLIF; 250 O-TLIF) were included in our review. No statistically significant group differences in procedure time (mean difference [MD], −4 minutes; P = 0.70) were found. However, the fluoroscopy time was significantly longer with MI-TLIF (MD, 48 seconds; P < 0.001). MI-TLIF resulted in less perioperative blood loss (MD, −200 mL; P < 0.001) and shorter hospitalization (MD, −2.2 days; P < 0.001) compared with O-TLIF. The risk of perioperative complications was comparable between the 2 groups (risk ratio, 1.03; P = 0.94). No group differences were found in the incidence of pseudarthrosis at the 1-year minimum follow-up (risk ratio, 0.84; P = 0.67). Pain severity at midterm follow-up was comparable between the 2 groups (MD, −1; P = 0.59), and the ODI was slightly lower in the MI-TLIF group (MD, −3; P = 0.01). Relative to O-TLIF, MI-TLIF was associated with less blood loss, a shorter hospital stay, and slightly less disability, at the expense of longer fluoroscopy times. [ABSTRACT FROM AUTHOR]

To determine whether presence of a bone-anchored annular closure device (ACD) impacts reoperation strategies and subsequent outcomes. Patients with large annular defects after single-level limited lumbar discectomy were randomly allocated to receive an ACD or discectomy alone (controls) and were followed for at least 3 years. Among 550 patients, reoperation risk was lower with ACD (11.0% vs. 19.3%). The types of reoperations and operative time were similar in each group, and the ACD did not interfere with surgical planning or operative technique. Fusion success was 87% with ACD versus 85% for controls. Perioperative complications occurred in 22% and 19% of reoperations, respectively. Leg pain and back function were improved with ACD versus controls after fusion procedures, and no group differences were observed after non-fusion reoperations. In patients undergoing post-discectomy reoperation, patients with an ACD were treated with similar operative techniques, were not exposed to additional surgical risks, and reported comparable clinical outcomes versus those without an ACD. [ABSTRACT FROM AUTHOR]

Objective The effect of stent graft fixation type on renal function after endovascular aneurysm repair (EVAR) remains controversial. This systematic review and meta-analysis was conducted to determine whether suprarenal (SR) or infrarenal (IR) fixation influences the risk of renal complications after EVAR. Methods We searched MEDLINE and EMBASE with no date or language restrictions for comparative studies evaluating EVAR with SR vs IR fixation on renal dysfunction, renal artery stenosis, renal artery occlusion, renal infarction, and new need for hemodialysis. For each outcome, we calculated the absolute risk difference (RD) with a random effects meta-analysis and performed assessments of heterogeneity and publication bias. Post hoc subgroup analyses explored the influence of individual moderator variables. Results A total of 21 nonrandomized studies comparing SR vs IR fixation representing 4474 unique patients (SR, 1949; IR, 2525) were included. Baseline patient characteristics were similar between the SR and IR groups. Median patient follow-up was 12 months in each group. There were no statistically significant differences in the risk of any renal complication between SR and IR fixation groups. The absolute RD between the SR and IR fixation groups was <1%, with no evidence of heterogeneity or publication bias for renal dysfunction, renal artery stenosis, renal artery occlusion or new need for hemodialysis after EVAR. Renal infarction occurred in 6.4% of SR patients and in 2.5% of IR patients ( P = .09), with evidence of heterogeneity ( I 2 = 85%) and publication bias (Egger P = .08). Subgroup analyses revealed that older studies (median treatment period before 2000) reported greater risks of renal infarction with SR fixation (RD, 6.2%; P = .01). However, more contemporary studies (median treatment period after 2000) demonstrated no difference between SR and IR fixation on renal infarction risk (RD, 0.2%; P = .75). Conclusions There is no difference in the risk of postoperative renal complications when comparing stent grafts using SR vs IR fixation, particularly with newer-generation devices. Contemporary comparative studies with longer-term follow-up are warranted to further elucidate the influence of SR and IR fixation on renal complications. [ABSTRACT FROM AUTHOR]

Purpose The need for specialty devices to improve the technical outcome of endovascular interventions is dependent on the rate of early failure in such procedures. This meta-analysis assessed procedural outcomes of such interventions to elucidate the rate of early procedural failures and the need for such specialty devices. Materials and Methods MEDLINE and EMBASE were searched for contemporary studies (2000–2012) reporting procedural or short-term outcomes for revascularization of infrapopliteal atherosclerotic lesions. A random-effects metaanalysis was performed, which included post hoc comparisons among treatment groups. Results A total of 42 studies with 52 treatment arms representing 3,660 unique patients were included. Technical success rates were higher with bare metal stents (BMSs; 98.6%) than with atherectomy (92.2%; P < .05) or percutaneous transluminal angioplasty (PTA; 91.2%; P = .01), and higher with drug-eluting stents (DESs) than with PTA ( P < .001). DES use had higher primary patency rates than atherectomy ( P < .05), BMS use ( P < .001), and PTA ( P < .01). The 30-day rate of target lesion revascularization was significantly higher with PTA (8.1%) than with BMSs (2.2%; P < .05) and DESs (1.1%; P < .05). Thirty-day rates of major unplanned amputation (range, 1.5%–4.4%) and mortality (range, 0.9%–3.3%) were comparable among treatment groups. Significant heterogeneity among studies was noted for most PTA outcomes. Publication bias was evident for most PTA and DES outcomes. Conclusions Early failure of percutaneous therapies in patients with infrapopliteal atherosclerotic lesions is device- and technique-dependent. Specialty devices designed to reduce technical failure rates may therefore be of benefit in this selected group of patients. Study results are confounded by inconsistent data reporting, heterogeneity of treatment effects, and publication bias. [ABSTRACT FROM AUTHOR]

Highlights: [•] The tested probiotics have a dose-response effect on antibiotic associated diarrhoea (AAD). [•] The tested probiotics reduce incidence and duration of AAD in a dose dependent manner. [•] The tested probiotics reduce severity of AAD related symptoms in a dose dependent manner. [ABSTRACT FROM AUTHOR]

Abstract: Strong evidence supports the ability of dietary fibers to improve satiety. However, large variations in the physical and chemical characteristics of dietary fiber modulate the physiologic responses. We hypothesized that a nonviscous soluble dietary fiber may influence satiety. This randomized, double-blind, placebo-controlled clinical study in 100 overweight healthy adults in China investigated the effect of different dosages of dietary supplementation with a dextrin, NUTRIOSE (ROQUETTE frères, Lestrem, France), on short-term satiety over time. Subjects were randomized by body mass index and energy intake and then assigned to receive either placebo or 8, 14, 18, or 24 g/d of NUTRIOSE mixed with orange juice (n = 20 volunteers per group). On days −2, 0, 2, 5, 7, 14, and 21, short-term satiety was evaluated with a visual analog scale, and hunger feeling status was assessed with Likert scale. NUTRIOSE exhibits a progressive and significant impact on short-term satiety, which is time and dosage correlated. Some statistical differences appear for the group 8 g/d from day 5, and from day 0 for the groups 14, 18, and 24 g/d. The hunger feeling status decreases significantly from day 5 to the end of the evaluation for the group 24 g and from day 7 for the groups 14 and 18 g. By day 5, the group 24 g showed significantly longer time to hunger between meals compared with placebo. These results suggest that dietary supplementation with a soluble fiber can decrease hunger feeling and increase short-term satiety over time when added to a beverage from 8 to 24 g/d with time- and dose-responses relationship. [Copyright &y& Elsevier]