Meta-analysis of the efficacy of a single stage laparoscopic management versus two-stage endoscopic management of symptomatic gallstones with common bile duct stones.

Background. The optimal treatment of gallstones with associated common bile duct stones in the laparoscopic era is controversial. Various reviews and decision based algorithms have been published, but the superior treatment modality is unclear. Therefore, a metaanalysis was conducted to compare the two most commonly used treatment strategies. Methods. A systematic review was conducted to compare single stage laparoscopic cholecystectomy with common bile duct exploration versus a combined endoscopic and laparoscopic treatment. Eligible studies were identified using a search of Medline, Embase, Cochrane and Science Citation Index Expanded databases. Appropriately selected articles were independently reviewed and data was extracted and cross referenced. A meta-analysis was conducted of the pooled trial data to determine difference in outcomes. Results. A total of seven randomized trials were identified with 746 patients with 366 in the laparoscopic only treatment group and 380 in the combined endoscopic and laparoscopic treatment arms. There was no significant difference in successful bile duct clearance between the two groups (OR 1.23; 95% CI 0.55 to 2.75, P = 0.61). There was no statistical difference in morbidity (RR 1.23; 95% CI 0.92 to 1.66; P = 0.17), mortality (RD -0.00; 95% CI -0.02 to 0.01, P = 0.59) or length of hospital stay (MD -0.31; 95% CI -1.68 to 1.06, P = 0.66). However, there was a statistically significant difference in the duration of procedure in favour of the single stage laparoscopic treatment (MD -6.83; 95% CI -9.59 to -4.07, P \u3c 0.00001). Conclusion. Both the laparoscopic alone or the combined endoscopic and laparoscopic treatment approaches show comparative efficacy in management of symptomatic gallstones with associated choledocholithiasis

Meta-analiza učinkovitosti laparoskopskog liječenja u jednom aktu u usporedbi s endoskopskim liječenjem simptomatskih žučnih kamenaca i žučnih kamenaca u glavnom žučovodu u više akata

Background The optimal treatment of gallstones with associated common bile duct stones in the laparoscopic era is controversial. Various reviews and decision based algorithms have been published, but the superior treatment modality is unclear. Therefore, a meta-analysis was conducted to compare the two most commonly used treatment strategies. Methods A systematic review was conducted to compare single stage laparoscopic cholecystectomy with common bile duct exploration versus a combined endoscopic and laparoscopic treatment. Eligible studies were identified using a search of Medline, Embase, Cochrane and Science Citation Index Expanded databases. Appropriately selected articles were independently reviewed and data was extracted and cross referenced. A meta-analysis was conducted of the pooled trial data to determine difference in outcomes. Results A total of seven randomized trials were identified with 746 patients with 366 in the laparoscopic only treatment group and 380 in the combined endoscopic and laparoscopic treatment arms. There was no significant difference in successful bile duct clearance between the two groups (OR 1.23; 95% CI 0.55 to 2.75, P = 0.61). There was no statistical difference in morbidity (RR 1.23; 95% CI 0.92 to 1.66; P = 0.17), mortality (RD -0.00; 95% CI -0.02 to 0.01, P = 0.59) or length of hospital stay (MD -0.31; 95% CI -1.68 to 1.06, P = 0.66). However, there was a statistically significant difference in the duration of procedure in favour of the single stage laparoscopic treatment (MD -6.83; 95% CI -9.59 to -4.07, P < 0.00001). Conclusion Both the laparoscopic alone or the combined endoscopic and laparoscopic treatment approaches show comparative efficacy in management of symptomatic gallstones with associated choledocholithiasis.Pozadina Optimalno liječenje žučnih kamenaca uz prateće žučne kamence u glavnom žučovodu u eri laparoskopske kirurgije je kontroverzno. Objavljeni su razni pregledni radovi i algoritmi odlučivanja, no pitanje odluke o odabiru preporučenog načina liječenja ostaje neriješeno. S ciljem usporedbe dva najčešće korištena načina liječenja provedena je meta-analiza. Metode Sistematsko istraživanje provedeno je kako bi se usporedila kolecistektomija s eksploracijom glavnog žučovoda u jednom aktu u odnosu na kombinirano endoskopsko i laparoskopsko liječenje. Dostupne studije nađene su pomoću sljedećih baza podataka: Medline, Embase, Cochrane i Science Citation Index Expanded. Probrani relevantni radovi zasebno su pregledani, a podaci izdvojeni i međusobno uspoređeni. Provedena je meta-analiza svih prikupljenih podataka da bi se odredila razlika u ishodima. Rezultati Pronađeno je sveukupno sedam randomiziranih studija sa 746 pacijenata od kojih je 366 u skupini liječenoj isključivo laparoskopski te 380 liječenih kombinirano endoskopski i laparoskopski. Nije utvrđena značajna razlika u uspješnom čišćenju žučnih vodova između dvije skupine (OR 1,23; 95% CI 0,55 do 2,75, P = 0,61). Nije nađena značajna razlika u morbiditetu (RR 1,23; 95% CI 0,92 do 1,66; P = 0,17), smrtnosti (RD -0,00; 95% CI -0.02 do 0,01, P = 0,59) ili trajanju hospitalizacije (MD -0,31; 95% CI -1,68 to 1,06, P = 0,66). Međutim, postojala je statistički značajna razlika u trajanju zahvata (MD -6,83; 95% CI -9,59 do -4,07, P < 0,00001). Zaključak Laparoskopski ili kombinirani endoskopski i laparoskopski pristup liječenju pokazuje značajnu učinkovitost u liječenju simptomatskih žučnih kamenaca s pratećom koledoholitijazom

Safety and Efficacy of Long-Term Co-Administration of Fenofibrate and Ezetimibe in Patients With Mixed Hyperlipidemia

ObjectivesThis study sought to determine the long-term safety and efficacy of co-administered fenofibrate (FENO) and ezetimibe (EZE) in patients with mixed hyperlipidemia.BackgroundBoth EZE and FENO offer complementary benefits to the lipid profile of patients with mixed hyperlipidemia.MethodsAfter completing the 12-week randomized, double-blind base study that compared EZE 10 mg, FENO 160 mg, FENO 160 mg plus EZE 10 mg, and placebo in patients with mixed hyperlipidemia, patients continued into a double-blind, 48-week extension phase. Those patients in the FENO plus EZE and FENO groups continued on their respective base study treatment, and patients in the EZE and placebo groups were switched to FENO plus EZE and FENO, respectively.ResultsOf the 587 patients who completed the base study, 576 continued into the extension study (n = 340 in FENO plus EZE and n = 236 in FENO). The FENO plus EZE produced significantly greater reductions in low-density lipoprotein-cholesterol compared with FENO (−22% vs. −9%, respectively; p < 0.001). There were also significantly greater improvements in triglycerides, high-density lipoprotein cholesterol (HDL-C), total cholesterol, non–HDL-C, and apolipoprotein B with FENO plus EZE compared with FENO. Changes in apolipoprotein A-I and high-sensitivity C-reactive protein were similar between groups. Overall, FENO plus EZE was well tolerated during the extension study. The proportion of patients with consecutive elevations of alanine aminotransferase/aspartate aminotransferase ≥3 times upper limit of normal were similar between the FENO plus EZE (1.2%) and FENO (1.7%) groups. No cases of creatine phosphokinase elevations ≥10 times upper limit of normal or myopathy were observed in either group.ConclusionsLong-term, 48-week co-administration of FENO plus EZE was well tolerated and more efficacious than FENO in patients with mixed hyperlipidemia

Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study

Background: The need for effective, long-term treatment for recurrent or chronic, treatment-resistant depression is well established. Methods: This naturalistic follow-up describes outpatients with nonpsychotic major depressive (n = 185) or bipolar (I or II) disorder, depressed phase (n = 20) who initially received 10 weeks of active (n = 110) or sham vagus nerve stimulation (VNS) (n = 95). The initial active group received another 9 months, while the initial sham group received 12 months of VNS. Participants received antidepressant treatments and VNS, both of which could be adjusted. Results: The primary analysis (repeated measures linear regression) revealed a significant reduction in 24-item Hamilton Rating Scale for Depression (HRSD24) scores (average improvement, .45 points [SE = .05] per month (p \u3c .001). At exit, HRSD24 response rate was 27.2% (55/202); remission rate (HRSD24 ≤ 9) was 15.8% (32/202). Montgomery Asberg Depression Rating Scale (28.2% [57/202]) and Clinical Global Impression-Improvement (34.0% [68/200]) showed similar response rates. Voice alteration, dyspnea, and neck pain were the most frequently reported adverse events. Conclusions: These 1-year open trial data found VNS to be well tolerated, suggesting a potential long-term, growing benefit in treatment-resistant depression, albeit in the context of changes in depression treatments. Comparative long-term data are needed to determine whether these benefits can be attributed to VNS

Effects of 12 Months of Vagus Nerve Stimulation in Treatment-Resistant Depression: A Naturalistic Study

Background: The need for effective, long-term treatment for recurrent or chronic, treatment-resistant depression is well established. Methods: This naturalistic follow-up describes outpatients with nonpsychotic major depressive (n = 185) or bipolar (I or II) disorder, depressed phase (n = 20) who initially received 10 weeks of active (n = 110) or sham vagus nerve stimulation (VNS) (n = 95). The initial active group received another 9 months, while the initial sham group received 12 months of VNS. Participants received antidepressant treatments and VNS, both of which could be adjusted. Results: The primary analysis (repeated measures linear regression) revealed a significant reduction in 24-item Hamilton Rating Scale for Depression (HRSD24) scores (average improvement, .45 points [SE = .05] per month (p \u3c .001). At exit, HRSD24 response rate was 27.2% (55/202); remission rate (HRSD24 ≤ 9) was 15.8% (32/202). Montgomery Asberg Depression Rating Scale (28.2% [57/202]) and Clinical Global Impression-Improvement (34.0% [68/200]) showed similar response rates. Voice alteration, dyspnea, and neck pain were the most frequently reported adverse events. Conclusions: These 1-year open trial data found VNS to be well tolerated, suggesting a potential long-term, growing benefit in treatment-resistant depression, albeit in the context of changes in depression treatments. Comparative long-term data are needed to determine whether these benefits can be attributed to VNS

Attitudes and Performance: An Analysis of Russian Workers

This paper investigates the relationship between locus of control and performance among Russian employees, using survey data collected at 28 workplaces in 2002 in Taganrog and at 47 workplaces in 2003 in Ekaterinburg. We develop a measure that allows us to categorize the Russian employees participating in our survey as exhibiting an internal or external locus of control. We then assess the extent to which there are significant differences between “internals” and “externals” in work-related attitudes that may affect performance. In particular, we focus on (1) attitudes about outcomes associated with hard work, (2) level of job satisfaction, (3) expectation of receiving a desired reward, and (4) loyalty to and involvement with one’s organization. In each case we identify where gender and generational differences emerge. Our main objective is to determine whether Russian employees who exhibit an internal locus of control perform better than employees with an external locus of control. Our performance measures include earnings, expected promotions, and assessments of the quantity and quality of work in comparison to others at the same organization doing a similar job. Controlling for a variety of worker characteristics, we find that (1) individuals who exhibit an internal locus of control perform better, but this result is not always statistically significant; (2) even among “internals,” women earn significantly less than men and have a much lower expectation of promotion; (3) even among “internals,” experience with unemployment has a negative influence on performance.http://deepblue.lib.umich.edu/bitstream/2027.42/40144/3/wp758.pd

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

Aim: Demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recom-mendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BRPeer reviewe