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Radial neck fractures comprises of less than 1% of all fractures in adults. They are more common in children than adults. Majority of cases require surgical management especially in adults. Surgically preferred management comprises of closed/open reduction and internal fixation using various types of plates/wires .We have performed Metaizeau technique in seven adults with successful treatment and functional outcome. This technique is very well described in children.

Aims To evaluate the long-term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long-term success or complications. Methods A single-center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. Results Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months-20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164-0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow-up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%-90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re-intervention. The most common reason at first surgical re-intervention was lead change only (26.3%, 44/167). Conclusion SNM is a minimally invasive procedure with good long-term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long-term outcomes.

132 uncemented total hip arthroplasties (THA) were performed on 125 patients over 65 years of age; of which 102 arthroplasties, performed in 90 patients, were followed for at least 4 years. One revision was necessary following fracture of an acetabular component secondary to trauma. The post-operative Harris hip score (HHS) ranged from 87 to 99. Radio logically there were no signs of subsidence of more than 3 mm, nor of osteolysis. Five patients experienced thigh pain. Based on the clinical and radiological results, uncemented total hip arthroplasties can give satisfactory function in elderly patients

Trochanteric hip fractures in elderly patients have beneted from advances in internal xation. Early failure of internal xation occurs however in a number of cases. The failure after internal xation had been due to initial fracture pattern, communication, sub-optimal fracture xation and poor bone quality. The aim of this prospective comparative study is to analyze the short term follow up results of unstable Intertrochanteric fractures in elderly treated with bipolar hemiarthroplasty and dynamic hip screw (DHS) xation.

High-quality evidence regarding questions of diagnostic accuracy relies on transparent reporting of study results. The quality of reporting for such studies in the urologic literature is unknown. In accordance with an a priori protocol, we systematically searched for all articles on diagnostic accuracy studies published in four major urologic journals in 2015. Using the 2015 STAndards for Reporting Diagnostic accuracy studies (STARD) checklist, two of us independently abstracted data. For each article, we calculated STARD summary scores (scale of 0–30, with higher scores reflecting higher-quality reporting). We compared scores by journal, topic, and sample size. We screened 819 references of which 61 met inclusion criteria. Nearly two-thirds of studies (39/61%; 63.9%) addressed prostate cancer diagnosis or staging; less than one in ten (6/61%; 9.8%) was conducted in non-oncological disease settings. The major focus for the investigation of new index tests lay in imaging modalities (33/61%; 54.1%); over half of these imaging studies addressed magnetic resonance imaging (18/61%; 29.5%). The average STARD score was 18.9 ± 2.4 (range 12–24). Six criteria had poor reporting compliance and were met by less than 20% of studies. We found no association between reporting quality and topic, journal or study size. The reporting quality of studies of diagnostic accuracy appears modest and independent of topic, journal or study size. There is an urgent need for greater awareness for the reporting quality of these studies among readers, editors, and investigators to raise evidentiary standards on issues of diagnosis.

To date it is unclear whether the selectivity of new alpha-blockers to alpha-adrenergic receptor subtypes translates into more clinical benefits and less adverse effects in clinical practice. We performed a systematic review of the two new Abs silodosin and naftopidil. With the availability of numerous alpha-blockers to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, the findings of this review will be highly relevant to the field of urology.Silodosin was found to be more effective than placebo in improving International Prostate Symptom Score (IPSS) and quality of life scores and as effective as other alpha-blockers. Although the incidence of cardiovascular adverse events of silodosin was similar compared with placebo and other alpha-blockers (tamsulosin, naftopidil, alfuzosin), the sexual adverse events were more common with silodosin. No placebo-controlled randomized trial exists investigating the effects of naftopidil in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Naftopidil had similar efficacy with regards to IPSS and quality of life compared with tamsulosin. The rate of adverse events was similar compared with tamsulosin.The two new selective alpha-blockers, silodosin, and naftopidil showed similar efficacy in IPSS and quality of life compared with other alpha-blockers. However, silodosin has more sexual adverse events.

Introduction: There is no difference in clinical and functional outcome after total knee arthroplasty (TKA) for knee osteoarthritis between patellar resurfacing and non-resurfacing. Thus, we have performed this study to evaluate the outcome of non-patella resurfacing total knee arthroplasty. Materials and Methods: A total of 50 patients in series who came to our institute with clinical signs and symptoms of osteoarthritis confirmed radiologically, were operated. We measured the outcomes with Knee society score and VAS score. Results: There was significant difference in outcome of non-resurfaced patella pre-operatively and post-operatively. There was significant improvement in mean range of motion (ROM) 87.2 pre-op vs 104.4 post-op, KSS pre-op mean 39.66 vs post op mean 83.26. The improvement in functional score were pre-op 52.5 to post-op 83.36. The mean VAS score decreased from 7.98 to 2. Conclusion: The results showed significant difference in knee society score and VAS pre-operatively and post-operatively. Keywords: Non-patellar resurfacing, Osteoarthritis, Total knee arthroplasty.

Background Prevalence of allergic diseases in infants is approximately 10% reaching 20 to 30% in those with an allergic first-degree relative. Prebiotics are selectively fermented food ingredients that allow specific changes in composition/activity of the gastrointestinal microflora. They modulate immune responses and their supplementation has been proposed as an intervention to prevent allergies. Objective To assess in pregnant women, breastfeeding mothers, and infants (populations) the effect of supplementing prebiotics (intervention) versus no prebiotics (comparison) on the development of allergic diseases and to inform the World Allergy Organization guidelines. Methods We performed a systematic review of studies assessing the effects of prebiotic supplementation with an intention to prevent the development of allergies. Results Of 446 unique records published until November 2016 in Cochrane, MEDLINE, and Embase, 22 studies fulfilled a priori specified criteria. We did not find any studies of prebiotics given to pregnant women or breastfeeding mothers. Prebiotic supplementation in infants, compared to placebo, had the following effects: risk of developing eczema (RR: 0.68, 95% CI: 0.40 to 1.15), wheezing/asthma (RR, 0.37; 95% CI: 0.17 to 0.80), and food allergy (RR: 0.28, 95% CI: 0.08 to 1.00). There was no evidence of an increased risk of any adverse effects (RR: 1.01, 95% CI: 0.92 to 1.10). Prebiotic supplementation had little influence growth rate (MD: 0.92 g/day faster with prebiotics, 95% CI: 0 to 1.84), and the final infant weight (MD: 0.10 kg higher with prebiotics, (95% CI: -0.09 to 0.29). The certainty of these estimates is very low due to risk of bias and imprecision of the results. Conclusions Currently available evidence on prebiotic supplementation to reduce the risk of developing allergies is very uncertain. This article is protected by copyright. All rights reserved.

Introduction We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. Methods We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. Results We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low certainty of evidence [CoE]). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13-0.78; moderate CoE). Pain on postoperative days 1-3 may show little to no difference (standardized mean difference [SMD] 0.25; 95% CI -0.32-0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4-30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (risk ratio [RR] 1.15; 95% CI 0.39-3.33; low CoE). Secondary outcomes We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32-1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed 'uncomplicated.' In addition, time intervals for the grouping for the reported degree of pain were established post-hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. Conclusions Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.

OBJECTIVES To assess the quality of published systematic reviews in the urology literature (an extension of our previously reported work), as high-quality systematic reviews play a paramount role in informing evidence-based clinical practice. MATERIALS AND METHODS Our focus was on systematic reviews in the urology literature that incorporated questions of prevention and therapy. To identify such reviews published during a 36-month period (2013-2015), we systematically searched PubMed and hand-searched the table of contents of four major urology journals. Two reviewers independently assessed the methodological quality of those reviews, using the 11-point 'Assessment of Multiple Systematic Reviews' (AMSTAR) instrument. We performed protocol-driven analyses of the data from our present study's 36-month period alone, as well as in aggregate with the data from our previously reported work's study periods (2009-2012 and 1998-2008). RESULTS In our literature search of the 36-month period (2013-2015), we initially identified 490 possibly relevant reviews, of which 125 met our inclusion criteria. The most common topic of reviews for the 2013-2015 period was oncology (51.2%; n = 64), followed by voiding dysfunction (21.6%; n = 27). The mean [standard deviation (SD)] AMSTAR score in the 2013-2015 period (n = 125) was 4.8 (2.4); 2009-2012 (n = 113), 5.4 (2.3); and 1998-2008 (n = 57), 4.8 (2.0) (P = 0.127). In the 2013-2015 period, the mean (SD) AMSTAR score for the BJU International (n = 25) was 5.6 (2.9); for The Journal of Urology (n = 20), 5.1 (2.6); for European Urology (n = 60), 4.5 (2.2); and for Urology (n = 20), 4.4 (2.2) (P = 0.106). CONCLUSIONS The number of systematic reviews published in the urology literature has exponentially increased, year by year, but their methodological quality has stagnated. To enhance the validity and impact of systematic reviews, all authors and editors must apply established methodological standards.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common condition in ageing men that may cause lower urinary tract symptoms (LUTS). Treatment aims are to relieve symptoms and prevent disease‐related complications. Naftopidil is an alpha‐blocker (AB) that has a high affinity for the A1d receptor that may have advantages in treating LUTS in this setting. This is an update of a Cochrane Review first published in 2009. Since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES: To evaluate the effects of naftopidil for the treatment of LUTS associated with BPH. SEARCH METHODS: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, LILAC, and Web of Science), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up to 31 May 2018 SELECTION CRITERIA: We included all parallel RCTs. We also included cross‐over design trials. DATA COLLECTION AND ANALYSIS: Two review authors independently classified and abstracted data from the included studies. We performed statistical analyses using a random‐effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urological symptom scores, quality of life (QoL) and treatment withdrawals for any reason; secondary outcomes were treatment withdrawals due to adverse events, acute urinary retention, surgical intervention for BPH, and cardiovascular and sexual adverse events. We considered outcomes measured up to 12 months after randomisation as short term, and later than 12 months as long term. We rated the certainty of the evidence according to the GRADE approach. MAIN RESULTS: We included 22 RCTs with 2223 randomised participants across four comparisons for short‐term follow‐up. This abstract focuses on only two of four comparisons for which we found data since two comparators (i.e. propiverine and Eviprostat (phytotherapy)) are rarely used. One study comparing naftopidil to placebo did not report any relevant outcomes and was therefore excluded. There were no trials that compared to combination therapy with naftopidil or any 5‐alpha reductase inhibitors (5‐ARIs) to combination therapy with other ABs and any 5‐ARIs. All included studies were conducted in Asian countries. Study duration ranged from four to 12 weeks. Mean age was 67.8 years, prostate volume was 35.4 mL, and International Prostate Symptom Score was 18.3. We were unable to perform any of the preplanned subgroup analyses based on age and baseline symptom score. Naftopidil versus tamsulosin Based on 12 studies with 965 randomised participants, naftopidil may have resulted in little or no difference in urological symptom score (mean difference (MD) 0.47, 95% confidence interval (CI) –0.09 to 1.04 measured on a scale from 0 to 35 with higher score representing increased symptoms), QoL (MD 0.11, 95% CI –0.09 to 0.30; measured on a scale from 0 to 6 with higher scores representing worse QoL), and treatment withdrawals for any reason (risk ratio (RR) 0.92, 95% CI 0.64 to 1.34; corresponding to 7 fewer per 1000 participants, 95% CI 32 fewer to 31 more). Naftopidil may have resulted in little to no difference in sexual adverse events (RR 0.54, 95% CI 0.24 to 1.22); this would result in 26 fewer sexual adverse events per 1000 participants (95% CI 43 fewer to 13 more). We rated the certainty of evidence as moderate for urological symptom score and low for the other outcomes. Naftopidil versus silodosin Based on five studies with 652 randomised participants, naftopidil may have resulted in little or no difference in the urological symptom scores (MD 1.04, 95% CI –0.78 to 2.85), QoL (MD 0.21, 95% CI –0.23 to 0.66), and treatment withdrawals for any reason (RR 0.80, 95% CI 0.52 to 1.23; corresponding to 26 fewer per 1000 participants, 95% CI 62 fewer to 32 more). We rated the certainty of evidence as low for all these outcomes. Naftopidil likely reduced sexual adverse events (RR 0.15, 95% CI 0.06 to 0.42; corresponding to 126 fewer sexual adverse events per 1000 participants, 95% CI 139 fewer to 86 fewer). We rated the certainty of evidence as moderate for sexual adverse events. AUTHORS' CONCLUSIONS: Naftopidil appears to have similar effects in the urological symptom scores and QoL compared to tamsulosin and silodosin. Naftopidil has similar sexual adverse events compared to tamsulosin but has fewer compared to silodosin.

Objectives To use the Fragility Index to evaluate the robustness of statistically significant findings from urological randomised controlled trials (RCTs). Materials and methods The 'Fragility Index' is defined as the minimum number of patients in one arm of a trial whose status would have to change from 'event' to 'non-event', such that a statistically significant result becomes non-significant. We identified all RCTs published in four major urology journals between 2011 and 2015, and we determined the Fragility Index values for those trials reporting statistically significant results of dichotomous outcomes using the Fisher's exact test. Results In all, 332 RCTs were identified, and 41 studies met the inclusion criteria. The median (interquartile range) Fragility Index was 3 (1, 4.5), indicating that an addition of only three alternate events to one arm of a typical trial would have eliminated its statistical significance. In 27/40 cases (67.5% of cases), the number of patients lost to follow-up was larger than its Fragility Index. Conclusions The results of urology RCTs that study dichotomous outcomes and report statistically significant differences between groups are sometimes fragile and depend on few events. Urologists should interpret these RCTs cautiously, particularly when the number of participants lost to follow-up exceeds the Fragility Index. Routine reporting of Fragility Index values alongside P values may provide additional guidance about the robustness of statistically significant findings.

Background To date, a systematic review of the evidence regarding the association between vitamin D and allergic diseases development has not yet been undertaken. Objective To review the efficacy and safety of vitamin D supplementation when compared to no supplementation in pregnant women, breastfeeding women, infants, and children for the prevention of allergies. Methods Three databases were searched through January 30, 2016, including randomized (RCT) and nonrandomized studies (NRS). Two reviewers independently extracted data and assessed the certainty in the body of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results Among the 1932 articles identified, one RCT and four NRS were eligible. Very low certainty in the body of evidence across examined studies suggests that vitamin D supplementation for pregnant women, breastfeeding women, and infants may not decrease the risk of developing allergic diseases such as atopic dermatitis (in pregnant women), allergic rhinitis (in pregnant women and infants), asthma and/or wheezing (in pregnant women, breastfeeding women, and infants), or food allergies (in pregnant women). We found no studies of primary prevention of allergic diseases in children. Conclusion Limited information is available addressing primary prevention of allergic diseases after vitamin D supplementation, and its potential impact remains uncertain.

BACKGROUND: Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. OBJECTIVES: To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. SEARCH METHODS: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. SELECTION CRITERIA: We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random‐effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS: Primary outcomes Stenting may slightly reduce the number of unplanned return visits (16 trials with 1970 participants; very low CoE), but we are very uncertain of this finding. Pain on the day of surgery as measured on a visual analogue scale (scale 0 to 10; higher values reflect more pain) is probably similar (mean difference (MD) 0.32 higher, 95% confidence interval (CI) 0.13 lower to 0.78 higher; 4 trials with 346 participants; moderate CoE). Pain on postoperative days 1 to 3 may show little to no difference (standardised mean difference (SMD) 0.25 higher, 95% CI 0.32 lower to 0.82 higher; 8 trials with 683 participants; low CoE). On postoperative days 4 to 30, stented participants may experience more pain (8 trials with 903 participants; very low CoE), but we are very uncertain of this finding. Stenting may result in little to no difference in the need for secondary interventions (risk ratio (RR) 1.15, 95% CI 0.39 to 3.33; 10 studies with 1435 participants; low CoE); this corresponds to three more interventions per 1000 participants (95% CI 13 fewer to 48 more). Secondary outcomes Stenting may reduce the need for narcotics (7 trials with 830 participants; very low CoE), but we are very uncertain of this finding. Rates of urinary tract infection (UTI) up to 90 days are probably not substantially different (RR 0.94, 95% CI 0.59 to 1.51; 10 trials with 1207 participants; moderate CoE); this corresponds to three fewer infections per 1000 participants (95% CI 23 fewer to 29 more). Ureteral stricture rates up to 90 days may be slightly reduced (14 trials with 1625 participants; very low CoE), but we are very uncertain of this finding. Rates of hospital admission may be slightly reduced (RR 0.70, 95% CI 0.32 to 1.55; 13 studies with 1647 participants; low CoE). This corresponds to 15 fewer admissions per 1000 participants (95% CI 33 fewer to 27 more). AUTHORS' CONCLUSIONS: Findings of this review illustrate the trade‐offs of risks and benefits faced by urologists and their patients when it comes to decision‐making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone location, and use of ureteral dilation, which may be important effect modifiers. Given the importance of this question, higher‐quality and sufficiently large trials are needed to better inform decision‐making.

Introduction: The palliative effects of cannabis sativa (marijuana), which include appetite stimulation, attenuation of nausea and emesis, and pain relief, are well known. The active components of cannabis sativa (cannabinoids) and their derivatives have received growing interest due to their diverse pharmacological activities, such as cell growth inhibition and tumour regression. The aim of this review is to look at the current evidence on the antiproliferative effects of cannabinoids in urological malignancies, including renal, prostate, bladder, and testicular cancers.Methods: We conducted a systematic review of studies exploring the effect of cannabinoids on tumour activity, including all study types except expert opinions. A formal search was run on Medline database from 1946 to September 2016, along with a hand-search on PubMed for relevant studies.Results: The search yielded a total of 93 studies from Medline and PubMed, of which 23 studies were included in the final analysis. To date, there are various in vitro studies elucidating the potential mechanism of action of cannabinoids for urological cancers, along with population-based studies specifically for testicular malignancies. To date, no clinical trials have been conducted for urological cancer patients.Conclusions: These results demonstrate that the role of endocannabinoids for urological malignancies is an area of active research. Further research is required not only to evaluate the crosstalk between cancer signaling pathways and cannabinoids, but also large randomized clinical studies with urological patients need to be conducted before cannabinoids can be introduced as potential therapeutic options for urological neoplasms.

Objective To compare pyeloplasty outcomes in children with and without "supra-normal" differential renal function (SNDRF) defined as >55% differential renal function (DRF) in children with ureteropelvic junction obstruction. Methods Our prospectively collected pyeloplasty database (2008-2015) was reviewed (n = 151). A total of 140/151 (93%) patients had preoperative renograms and 26/140 (19%) were found to have SNDRF (DRF ≥ 55%). Of 151 patients, 51 (34%) had pre- and postoperative renograms allowing determination of change ≥5% in function. After excluding 2 patients with solitary kidneys, a total of 49 patients defined the study group. Results Of 49 patients, 12 had SNDRF and 37 did not. Baseline characteristics were similar including mean age at surgery (47.3 months vs 45.4 months) and time to surgery (8.7 months vs 9.8 months). Mean preoperative anteroposterior diameter was significantly different between groups (23.2 mm vs 31.0 mm; P = .04), but postoperative was similar (9.0 mm vs 12.1 mm; P = .14). Mean preoperative DRF was 60.2% in the SNDRF group vs 44.3% in the non-SNDRF. Mean postoperative DRF was 52.4% and 45.3%, respectively ( P = .04). There were 9/12 (75%) SNDRF patients who experienced ≥5% loss in function compared to 2/37 (5%) in the non-SNDRF group ( P Conclusion Three-quarters of SNDRF patients demonstrated a decline of ≥5%DRF postoperatively when compared to non-SNDRF. This finding may not reflect true elevated renal function, but rather hyperfiltration in the setting of obstruction, which—if unrecognized as such—could result in postponing an otherwise beneficial surgical intervention.

To the Editor Since the immunomodulatory properties of probiotics have been described, the effect of probiotic supplementation has been investigated in several trials and it has been also proposed as a preventive intervention for the development of allergic diseases. Recently two important evidence-based recommendations about the use of probiotics in the prevention of allergy were published [1, 2] with conflicting conclusions, in particular the most recent guideline [1] seems to be partially in contradiction with the previous statements about prevention of eczema. For these reasons, we tried to analyze the evidences leading to these recommendations [1] to highlight the aspects that can be more directly related or correlated with clinical practice. This clinical reading was addressed to offer some reflections about the methods used to formulate such recommendations, and the possibility to adopt in the clinical practice the proposed conclusions. We tried to retraces the path proposed by the Authors to analyse three important questions about the efficacy of probiotics in preventing allergic diseases if administrated to pregnant women (first question), to breastfeeding mothers (second question) and in healthy infants (third question). These questions have been investigated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [3], to perform a systematic review of randomized controlled trials and formulate recommendations. In summary, the GRADE method aims to define a rigorous and explicit method for the production of clinical recommendations. According to this method, the knowledge of advantages and disadvantages, benefits and risks of an intervention is necessary to make decisions in the health field. The GRADE approach also provides a three-phases decisional framework: a) formulation of a clinical question, with the choice and the formal evaluation of its related outcomes, and systematic evaluation of the scientific literature and the quality of the evidence; b) evaluation of the benefits and risks associated to the intervention, taking also in consideration its feasibility, the necessary resources and the patients’ preferences; c) formal definition of the strength of the recommendation. From a methodological point of view, it should be noted that the recommendations are directed to patients, clinicians and other health care professionals with different objectives, as clearly explained in the guidelines introduction. Each recommendation can have different levels of strength: strong recommendation indicates that patients would like to receive the intervention and that clinicians should actuate it. Conditional or weak recommendation indicates that the majority of patients would like to receive the intervention, but many other not, as well as they hope that clinicians would recognize that different choices may be appropriate for different patients, by taking advantage of decision-making tools to help patients to make consistent choices. In the results section of the guidelines we can read that “Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing * Correspondence: giampaolo.ricci@unibo.it Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy Full list of author information is available at the end of the article

Evidence to Decision table. (DOC 196 kb)

Evidence profiles. (DOCX 79 kb)

Search strategies. (DOC 152 kb)

Included studies. (PDF 140 kb)

Search strategies. (PDF 33 kb)

Conflict of interest declaration. (DOCX 506 kb)

Evidence to Decision Framework. (DOCX 163 kb)

Evidence profiles. (DOCX 131 kb)

Characteristics of included studies. (DOC 124 kb)

Background Cervical intraepithelial neoplasia (CIN) stage 2–3 is a premalignant lesion that can progress to cervical cancer in 10–20 years if untreated. Objectives To conduct systematic reviews of randomized and nonrandomized studies for effects of cryotherapy, loop electrosurgical excision procedure (LEEP), and cold knife conization (CKC) as treatment for CIN 2–3. Search strategy Medline, Embase, and other databases were searched to February 2012 for benefits, and to July 2012 for harms. Additionally, experts were contacted. Keywords for CIN, cervical cancer, and the treatments were used. Selection criteria Studies of nonpregnant women 18 years or older not previously treated for CIN were included. Data collection and analysis Two investigators independently screened and collected data. Relative risks and proportions were calculated and evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Main results Recurrence rate was 5.3% 12 months after cryotherapy or LEEP, and 1.4% after CKC. There seemed to be little or no differences in frequency of complications after LEEP or cryotherapy, but they occurred more often after CKC. Evidence suggests premature delivery is most common with CKC, but it also occurs after LEEP and cryotherapy. Conclusions Despite a comprehensive search, there is very low quality evidence and often no evidence for important outcomes, including reproductive outcomes and complications. Studies assessing these outcomes are needed.

Background Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases. Objective We sought to synthesize the evidence supporting use of probiotics for the prevention of allergies and inform World Allergy Organization guidelines on probiotic use. Methods We performed a systematic review of randomized trials assessing the effects of any probiotic administered to pregnant women, breast-feeding mothers, and/or infants. Results Of 2403 articles published until December 2014 identified in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, 29 studies fulfilled a priori specified inclusion criteria for the analyses. Probiotics reduced the risk of eczema when used by women during the last trimester of pregnancy (relative risk [RR], 0.71; 95% CI, 0.60-0.84), when used by breast-feeding mothers (RR, 0.57; 95% CI, 0.47-0.69), or when given to infants (RR, 0.80; 95% CI, 0.68-0.94). Evidence did not support an effect on other allergies, nutrition status, or incidence of adverse effects. The certainty in the evidence according to the Grading of Recommendation Assessment Development and Evaluation approach is low or very low because of the risk of bias, inconsistency and imprecision of results, and indirectness of available research. Conclusion Probiotics used by pregnant women or breast-feeding mothers and/or given to infants reduced the risk of eczema in infants; however, the certainty in the evidence is low. No effect was observed for the prevention of other allergic conditions.