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Background: In previous observational studies, food-derived antioxidant vitamins have been suggested to be associated with breast cancer. However, the findings were inconsistent and the causal relationship could not be clearly elucidated. To confirm the potential causal relationship between food-derived antioxidants (retinol, carotene, vitamin C and vitamin E) and the risk of breast cancer, we conducted a two-sample Mendelian randomization (MR) study. Methods: The instrumental variables (IVs) as proxies of genetic liability to food-derived antioxidant vitamins were obtained from the UK Biobank Database. We extracted breast cancer data (122,977 cases and 105,974 controls) from the Breast Cancer Consortium (BCAC). In addition, we studied estrogen expression status categorically, including estrogen receptor positive (ER+) breast cancer (69,501 cases and 105,974 controls) and versus estrogen receptor (ER−) negative breast cancer (21,468 cases and 105,974 controls). We performed two-sample Mendelian randomization study, and inverse variance–weighted (IVW) test was regarded as main analysis. Sensitivity analyses were further conducted to assess heterogeneity and horizontal pleiotropy. Results: The results of IVW showed that among the four food-derived antioxidants, only vitamin E had protective effect on the risk of overall breast cancer (OR = 0.837, 95% CI 0.757–0.926, P = 0.001) and ER+ breast cancer (OR = 0.823, 95% CI 0.693–0.977, P = 0.026). However, we found no association between food-derived vitamin E and ER− breast cancer. Conclusions: Our study suggested food-derived vitamin E can decrease the risk of breast cancer overall and ER+ breast cancer, and the robustness of our results was confirmed by sensitivity analyses. [ABSTRACT FROM AUTHOR]

Objective. To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal calculi or staghorn stones through a comprehensive literature review. Methods. A comprehensive literature review of articles investigating the clinical efficacy and safety of single- versus multiple-tract percutaneous nephrolithotomy was performed. Relevant literature was obtained by systematically searching PubMed, EMBASE, and the Cochrane Library through May 2020. We followed the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes, including the stone-free rate (SFR), and secondary outcomes (peri- and postoperative complications and operative data) were evaluated using RevMan 5.3 statistical software. Results. Ten studies involving 1844 patients with complex caliceal calculi or staghorn stones met the inclusion criteria. Single-tract percutaneous nephrolithotomy (STPCNL) had noninferior clinical efficacy with respect to the immediate SFR (odds ratio OR = 0.80 , 95% confidence interval (CI) (0.46 to 1.38), p = 0.42) and 3-month SFR (OR = 1.22 , 95% CI (0.38 to 3.92), p = 0.74) compared with multiple-tract percutaneous nephrolithotomy (MTPCNL). In addition, pooled analyses showed that STPCNL resulted in significantly lower hemoglobin decreases (MD = − 0.46 , 95% CI (-0.68 to -0.25), p < 0.0001), fewer blood transfusions (OR = 0.48 , 95% CI (0.34 to 0.67), p < 0.0001), and fewer pulmonary complications (OR = 0.28 , 95% CI (0.09 to 0.83), p = 0.02) than MTPCNL. However, the overall evidence was insufficient to suggest a statistically significant difference for other adverse events. Conclusion. This meta-analysis indicated that STPCNL is an effective method for treating complex caliceal calculi or staghorn stones. Compared with MTPCNL, STPCNL not only yields similarly high SFRs but also is associated with many advantages, less blood loss, fewer blood transfusions, and fewer pulmonary complications without an increase in other complications. However, the findings of this study should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with a larger patient series. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the current evidence on the effectiveness and safety of ureteric stent removal using strings compared to conventional methods. Materials and Methods. The electronic databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and the Cochrane Library were systematically searched up to March 2020. Two reviewers searched the literature, independently extracted the data, and evaluated the quality of the studies according to the inclusion and exclusion criteria. The data analysis was performed with the software program Review Manager 5.3. Results. Eleven studies with a total of 1809 patients were included in the analysis based on the inclusion criteria. Our meta-analysis showed that visual analogue scale (VAS) scores were significantly lower in the string group than in the conventional group (weighted mean difference (WMD) -2.63; 95% confidence interval (CI) -3.68, -1.58; P < 0.00001). In terms of stent dwell time, the string group had an advantage (WMD -9.53; 95% CI -14.20, -4.86; P < 0.0001). In addition, no significant differences in the occurrence of urinary tract infection (UTI) (odds ratio (OR) 1.03; 95% CI 0.62, 1.72; P = 0.92), emergency room visits (OR 0.99; 95% CI 0.59, 1.67; P = 0.97), or other complications (P > 0.05) were observed between the two groups. Conclusion. Our findings suggest that an extraction string is an effective and safe method for the removal of ureteric stents. This method gives patients the benefits of reduced pain and shortened stent dwell time without increasing the risk of UTI. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs). [ABSTRACT FROM AUTHOR]

Objective: To assess the current evidence on the effectiveness and safety of retrograde intrarenal surgery (RIRS) under regional anaesthesia (RA) compared with the effectiveness and safety of RIRS under general anaesthesia (GA).Methods: A systematic search was performed using the electronic databases PubMed, Embase, CNKI and the Cochrane Library through May 2020. Two reviewers searched the literature, independently extracted data and evaluated the study quality based on inclusion and exclusion criteria. The data analysis was performed with the software program Review Manager 5.3.Results: Six randomized controlled trials (RCTs) with a total of 580 patients were included in the analysis. The pooled data showed that RIRS under RA achieved a similar stone-free rate (SFR) as that under GA (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.91, 1.02; p = 0.22) but reduced the postoperative visual analogue scale (VAS) score (mean difference (MD) -0.86, 95% CI -1.29, -0.42; p = 0.0001). No significant differences were observed in terms of operation duration (MD 1.71, 95% CI -10.61,14.03; p = 0.79) or hospital stay (MD 0.08, 95% CI -0.18, 0.34; p = 0.54). In addition, the evidence was insufficient to suggest a significant difference in the occurrence of complications associated with RA compared with those associated with GA.Conclusion: Our findings suggest that RA is an effective and safe anaesthesia method for RIRS. Compared with GA, RA is associated with less postoperative pain. Moreover, patients may benefit from RA in terms of economic factors. Nevertheless, large-sample, multi-centric RCTs with strict standards should be performed to confirm these findings. [ABSTRACT FROM AUTHOR]