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1.
Nat Methods ; 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877315

RESUMO

The growth of omic data presents evolving challenges in data manipulation, analysis and integration. Addressing these challenges, Bioconductor provides an extensive community-driven biological data analysis platform. Meanwhile, tidy R programming offers a revolutionary data organization and manipulation standard. Here we present the tidyomics software ecosystem, bridging Bioconductor to the tidy R paradigm. This ecosystem aims to streamline omic analysis, ease learning and encourage cross-disciplinary collaborations. We demonstrate the effectiveness of tidyomics by analyzing 7.5 million peripheral blood mononuclear cells from the Human Cell Atlas, spanning six data frameworks and ten analysis tools.

2.
Biostatistics ; 2023 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-37257175

RESUMO

In complex tissues containing cells that are difficult to dissociate, single-nucleus RNA-sequencing (snRNA-seq) has become the preferred experimental technology over single-cell RNA-sequencing (scRNA-seq) to measure gene expression. To accurately model these data in downstream analyses, previous work has shown that droplet-based scRNA-seq data are not zero-inflated, but whether droplet-based snRNA-seq data follow the same probability distributions has not been systematically evaluated. Using pseudonegative control data from nuclei in mouse cortex sequenced with the 10x Genomics Chromium system and mouse kidney sequenced with the DropSeq system, we found that droplet-based snRNA-seq data follow a negative binomial distribution, suggesting that parametric statistical models applied to scRNA-seq are transferable to snRNA-seq. Furthermore, we found that the quantification choices in adapting quantification mapping strategies from scRNA-seq to snRNA-seq can play a significant role in downstream analyses and biological interpretation. In particular, reference transcriptomes that do not include intronic regions result in significantly smaller library sizes and incongruous cell type classifications. We also confirmed the presence of a gene length bias in snRNA-seq data, which we show is present in both exonic and intronic reads, and investigate potential causes for the bias.

3.
Hippocampus ; 33(9): 1009-1027, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37226416

RESUMO

Activity-regulated gene (ARG) expression patterns in the hippocampus (HPC) regulate synaptic plasticity, learning, and memory, and are linked to both risk and treatment responses for many neuropsychiatric disorders. The HPC contains discrete classes of neurons with specialized functions, but cell type-specific activity-regulated transcriptional programs are not well characterized. Here, we used single-nucleus RNA-sequencing (snRNA-seq) in a mouse model of acute electroconvulsive seizures (ECS) to identify cell type-specific molecular signatures associated with induced activity in HPC neurons. We used unsupervised clustering and a priori marker genes to computationally annotate 15,990 high-quality HPC neuronal nuclei from N = 4 mice across all major HPC subregions and neuron types. Activity-induced transcriptomic responses were divergent across neuron populations, with dentate granule cells being particularly responsive to activity. Differential expression analysis identified both upregulated and downregulated cell type-specific gene sets in neurons following ECS. Within these gene sets, we identified enrichment of pathways associated with varying biological processes such as synapse organization, cellular signaling, and transcriptional regulation. Finally, we used matrix factorization to reveal continuous gene expression patterns differentially associated with cell type, ECS, and biological processes. This work provides a rich resource for interrogating activity-regulated transcriptional responses in HPC neurons at single-nuclei resolution in the context of ECS, which can provide biological insight into the roles of defined neuronal subtypes in HPC function.


Assuntos
Hipocampo , Neurônios , Camundongos , Animais , Hipocampo/fisiologia , Neurônios/fisiologia , Aprendizagem/fisiologia , Regulação da Expressão Gênica/genética , Convulsões , Expressão Gênica
4.
Biostatistics ; 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36063544

RESUMO

A standard unsupervised analysis is to cluster observations into discrete groups using a dissimilarity measure, such as Euclidean distance. If there does not exist a ground-truth label for each observation necessary for external validity metrics, then internal validity metrics, such as the tightness or separation of the clusters, are often used. However, the interpretation of these internal metrics can be problematic when using different dissimilarity measures as they have different magnitudes and ranges of values that they span. To address this problem, previous work introduced the "scale-agnostic" $G_{+}$ discordance metric; however, this internal metric is slow to calculate for large data. Furthermore, in the setting of unsupervised clustering with $k$ groups, we show that $G_{+}$ varies as a function of the proportion of observations assigned to each of the groups (or clusters), referred to as the group balance, which is an undesirable property. To address this problem, we propose a modification of $G_{+}$, referred to as $H_{+}$, and demonstrate that $H_{+}$ does not vary as a function of group balance using a simulation study and with public single-cell RNA-sequencing data. Finally, we provide scalable approaches to estimate $H_{+}$, which are available in the $\mathtt{fasthplus}$ R package.

5.
Nat Methods ; 17(2): 137-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792435

RESUMO

Recent technological advancements have enabled the profiling of a large number of genome-wide features in individual cells. However, single-cell data present unique challenges that require the development of specialized methods and software infrastructure to successfully derive biological insights. The Bioconductor project has rapidly grown to meet these demands, hosting community-developed open-source software distributed as R packages. Featuring state-of-the-art computational methods, standardized data infrastructure and interactive data visualization tools, we present an overview and online book (https://osca.bioconductor.org) of single-cell methods for prospective users.


Assuntos
Análise de Célula Única/métodos , Perfilação da Expressão Gênica , Genoma , Sequenciamento de Nucleotídeos em Larga Escala , Software
7.
Bioinformatics ; 38(11): 3128-3131, 2022 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-35482478

RESUMO

SUMMARY: SpatialExperiment is a new data infrastructure for storing and accessing spatially-resolved transcriptomics data, implemented within the R/Bioconductor framework, which provides advantages of modularity, interoperability, standardized operations and comprehensive documentation. Here, we demonstrate the structure and user interface with examples from the 10x Genomics Visium and seqFISH platforms, and provide access to example datasets and visualization tools in the STexampleData, TENxVisiumData and ggspavis packages. AVAILABILITY AND IMPLEMENTATION: The SpatialExperiment, STexampleData, TENxVisiumData and ggspavis packages are available from Bioconductor. The package versions described in this manuscript are available in Bioconductor version 3.15 onwards. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.


Assuntos
Software , Transcriptoma , Genômica
8.
PLoS Comput Biol ; 18(3): e1009954, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35353807

RESUMO

Estimates of correlation between pairs of genes in co-expression analysis are commonly used to construct networks among genes using gene expression data. As previously noted, the distribution of such correlations depends on the observed expression level of the involved genes, which we refer to this as a mean-correlation relationship in RNA-seq data, both bulk and single-cell. This dependence introduces an unwanted technical bias in co-expression analysis whereby highly expressed genes are more likely to be highly correlated. Such a relationship is not observed in protein-protein interaction data, suggesting that it is not reflecting biology. Ignoring this bias can lead to missing potentially biologically relevant pairs of genes that are lowly expressed, such as transcription factors. To address this problem, we introduce spatial quantile normalization (SpQN), a method for normalizing local distributions in a correlation matrix. We show that spatial quantile normalization removes the mean-correlation relationship and corrects the expression bias in network reconstruction.


Assuntos
Perfilação da Expressão Gênica , Fatores de Transcrição , Análise de Sequência de RNA/métodos , Fatores de Transcrição/genética , Sequenciamento do Exoma
9.
BMC Genomics ; 23(1): 434, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35689177

RESUMO

BACKGROUND: Spatially-resolved transcriptomics has now enabled the quantification of high-throughput and transcriptome-wide gene expression in intact tissue while also retaining the spatial coordinates. Incorporating the precise spatial mapping of gene activity advances our understanding of intact tissue-specific biological processes. In order to interpret these novel spatial data types, interactive visualization tools are necessary. RESULTS: We describe spatialLIBD, an R/Bioconductor package to interactively explore spatially-resolved transcriptomics data generated with the 10x Genomics Visium platform. The package contains functions to interactively access, visualize, and inspect the observed spatial gene expression data and data-driven clusters identified with supervised or unsupervised analyses, either on the user's computer or through a web application. CONCLUSIONS: spatialLIBD is available at https://bioconductor.org/packages/spatialLIBD . It is fully compatible with SpatialExperiment and the Bioconductor ecosystem. Its functionality facilitates analyzing and interactively exploring spatially-resolved data from the Visium platform.


Assuntos
Ecossistema , Transcriptoma , Genômica , Software
10.
PLoS Comput Biol ; 17(1): e1008625, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497379

RESUMO

Single-cell RNA-Sequencing (scRNA-seq) is the most widely used high-throughput technology to measure genome-wide gene expression at the single-cell level. One of the most common analyses of scRNA-seq data detects distinct subpopulations of cells through the use of unsupervised clustering algorithms. However, recent advances in scRNA-seq technologies result in current datasets ranging from thousands to millions of cells. Popular clustering algorithms, such as k-means, typically require the data to be loaded entirely into memory and therefore can be slow or impossible to run with large datasets. To address this problem, we developed the mbkmeans R/Bioconductor package, an open-source implementation of the mini-batch k-means algorithm. Our package allows for on-disk data representations, such as the common HDF5 file format widely used for single-cell data, that do not require all the data to be loaded into memory at one time. We demonstrate the performance of the mbkmeans package using large datasets, including one with 1.3 million cells. We also highlight and compare the computing performance of mbkmeans against the standard implementation of k-means and other popular single-cell clustering methods. Our software package is available in Bioconductor at https://bioconductor.org/packages/mbkmeans.


Assuntos
Análise por Conglomerados , Análise de Sequência de RNA/métodos , Análise de Célula Única/métodos , Software , Algoritmos , Animais , Encéfalo/citologia , Encéfalo/metabolismo , Biologia Computacional/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Camundongos , Aprendizado de Máquina não Supervisionado
11.
PLoS Comput Biol ; 17(8): e1009290, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34428202

RESUMO

Single-cell RNA-sequencing (scRNA-seq) has made it possible to profile gene expression in tissues at high resolution. An important preprocessing step prior to performing downstream analyses is to identify and remove cells with poor or degraded sample quality using quality control (QC) metrics. Two widely used QC metrics to identify a 'low-quality' cell are (i) if the cell includes a high proportion of reads that map to mitochondrial DNA (mtDNA) encoded genes and (ii) if a small number of genes are detected. Current best practices use these QC metrics independently with either arbitrary, uniform thresholds (e.g. 5%) or biological context-dependent (e.g. species) thresholds, and fail to jointly model these metrics in a data-driven manner. Current practices are often overly stringent and especially untenable on certain types of tissues, such as archived tumor tissues, or tissues associated with mitochondrial function, such as kidney tissue [1]. We propose a data-driven QC metric (miQC) that jointly models both the proportion of reads mapping to mtDNA genes and the number of detected genes with mixture models in a probabilistic framework to predict the low-quality cells in a given dataset. We demonstrate how our QC metric easily adapts to different types of single-cell datasets to remove low-quality cells while preserving high-quality cells that can be used for downstream analyses. Our software package is available at https://bioconductor.org/packages/miQC.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala/métodos , Probabilidade , Controle de Qualidade , Análise de Sequência de RNA/métodos , Análise de Célula Única/métodos , DNA Mitocondrial/genética , Humanos
12.
Stat Med ; 41(18): 3492-3510, 2022 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-35656596

RESUMO

The performance of computational methods and software to identify differentially expressed features in single-cell RNA-sequencing (scRNA-seq) has been shown to be influenced by several factors, including the choice of the normalization method used and the choice of the experimental platform (or library preparation protocol) to profile gene expression in individual cells. Currently, it is up to the practitioner to choose the most appropriate differential expression (DE) method out of over 100 DE tools available to date, each relying on their own assumptions to model scRNA-seq expression features. To model the technological variability in cross-platform scRNA-seq data, here we propose to use Tweedie generalized linear models that can flexibly capture a large dynamic range of observed scRNA-seq expression profiles across experimental platforms induced by platform- and gene-specific statistical properties such as heavy tails, sparsity, and gene expression distributions. We also propose a zero-inflated Tweedie model that allows zero probability mass to exceed a traditional Tweedie distribution to model zero-inflated scRNA-seq data with excessive zero counts. Using both synthetic and published plate- and droplet-based scRNA-seq datasets, we perform a systematic benchmark evaluation of more than 10 representative DE methods and demonstrate that our method (Tweedieverse) outperforms the state-of-the-art DE approaches across experimental platforms in terms of statistical power and false discovery rate control. Our open-source software (R/Bioconductor package) is available at https://github.com/himelmallick/Tweedieverse.


Assuntos
Perfilação da Expressão Gênica , Análise de Célula Única , Perfilação da Expressão Gênica/métodos , Humanos , RNA-Seq , Análise de Sequência de RNA , Software
13.
Annu Rev Public Health ; 42: 79-93, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33467923

RESUMO

Advances in computing technology have spurred two extraordinary phenomena in science: large-scale and high-throughput data collection coupled with the creation and implementation of complex statistical algorithms for data analysis. These two phenomena have brought about tremendous advances in scientific discovery but have raised two serious concerns. The complexity of modern data analyses raises questions about the reproducibility of the analyses, meaning the ability of independent analysts to recreate the results claimed by the original authors using the original data and analysis techniques. Reproducibility is typically thwarted by a lack of availability of the original data and computer code. A more general concern is the replicability of scientific findings, which concerns the frequency with which scientific claims are confirmed by completely independent investigations. Although reproducibility and replicability are related, they focus on different aspects of scientific progress. In this review, we discuss the origins of reproducible research, characterize the current status of reproducibility in public health research, and connect reproducibility to current concerns about the replicability of scientific findings. Finally, we describe a path forward for improving both the reproducibility and replicability of public health research in the future.


Assuntos
Análise de Dados , Pesquisa , Humanos , Saúde Pública , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Biostatistics ; 19(4): 562-578, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29121214

RESUMO

Until recently, high-throughput gene expression technology, such as RNA-Sequencing (RNA-seq) required hundreds of thousands of cells to produce reliable measurements. Recent technical advances permit genome-wide gene expression measurement at the single-cell level. Single-cell RNA-Seq (scRNA-seq) is the most widely used and numerous publications are based on data produced with this technology. However, RNA-seq and scRNA-seq data are markedly different. In particular, unlike RNA-seq, the majority of reported expression levels in scRNA-seq are zeros, which could be either biologically-driven, genes not expressing RNA at the time of measurement, or technically-driven, genes expressing RNA, but not at a sufficient level to be detected by sequencing technology. Another difference is that the proportion of genes reporting the expression level to be zero varies substantially across single cells compared to RNA-seq samples. However, it remains unclear to what extent this cell-to-cell variation is being driven by technical rather than biological variation. Furthermore, while systematic errors, including batch effects, have been widely reported as a major challenge in high-throughput technologies, these issues have received minimal attention in published studies based on scRNA-seq technology. Here, we use an assessment experiment to examine data from published studies and demonstrate that systematic errors can explain a substantial percentage of observed cell-to-cell expression variability. Specifically, we present evidence that some of these reported zeros are driven by technical variation by demonstrating that scRNA-seq produces more zeros than expected and that this bias is greater for lower expressed genes. In addition, this missing data problem is exacerbated by the fact that this technical variation varies cell-to-cell. Then, we show how this technical cell-to-cell variability can be confused with novel biological results. Finally, we demonstrate and discuss how batch-effects and confounded experiments can intensify the problem.


Assuntos
Perfilação da Expressão Gênica/normas , Sequenciamento de Nucleotídeos em Larga Escala/normas , Análise de Sequência de RNA/normas , Análise de Célula Única/normas , Transcriptoma , Animais , Humanos
15.
Biostatistics ; 19(2): 185-198, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29036413

RESUMO

Between-sample normalization is a critical step in genomic data analysis to remove systematic bias and unwanted technical variation in high-throughput data. Global normalization methods are based on the assumption that observed variability in global properties is due to technical reasons and are unrelated to the biology of interest. For example, some methods correct for differences in sequencing read counts by scaling features to have similar median values across samples, but these fail to reduce other forms of unwanted technical variation. Methods such as quantile normalization transform the statistical distributions across samples to be the same and assume global differences in the distribution are induced by only technical variation. However, it remains unclear how to proceed with normalization if these assumptions are violated, for example, if there are global differences in the statistical distributions between biological conditions or groups, and external information, such as negative or control features, is not available. Here, we introduce a generalization of quantile normalization, referred to as smooth quantile normalization (qsmooth), which is based on the assumption that the statistical distribution of each sample should be the same (or have the same distributional shape) within biological groups or conditions, but allowing that they may differ between groups. We illustrate the advantages of our method on several high-throughput datasets with global differences in distributions corresponding to different biological conditions. We also perform a Monte Carlo simulation study to illustrate the bias-variance tradeoff and root mean squared error of qsmooth compared to other global normalization methods. A software implementation is available from https://github.com/stephaniehicks/qsmooth.


Assuntos
Bioestatística/métodos , Interpretação Estatística de Dados , Genômica/estatística & dados numéricos , Sequenciamento de Nucleotídeos em Larga Escala/estatística & dados numéricos , Modelos Estatísticos , Humanos
17.
J Mol Cell Cardiol ; 123: 92-107, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30193957

RESUMO

Several inherited arrhythmias, including Brugada syndrome and arrhythmogenic cardiomyopathy, primarily affect the right ventricle and can lead to sudden cardiac death. Among many differences, right and left ventricular cardiomyocytes derive from distinct progenitors, prompting us to investigate how embryonic programming may contribute to chamber-specific conduction and arrhythmia susceptibility. Here, we show that developmental perturbation of Wnt signaling leads to chamber-specific transcriptional regulation of genes important in cardiac conduction that persists into adulthood. Transcriptional profiling of right versus left ventricles in mice deficient in Wnt transcriptional activity reveals global chamber differences, including genes regulating cardiac electrophysiology such as Gja1 and Scn5a. In addition, the transcriptional repressor Hey2, a gene associated with Brugada syndrome, is a direct target of Wnt signaling in the right ventricle only. These transcriptional changes lead to perturbed right ventricular cardiac conduction and cellular excitability. Ex vivo and in vivo stimulation of the right ventricle is sufficient to induce ventricular tachycardia in Wnt transcriptionally inactive hearts, while left ventricular stimulation has no effect. These data show that embryonic perturbation of Wnt signaling in cardiomyocytes leads to right ventricular arrhythmia susceptibility in the adult heart through chamber-specific regulation of genes regulating cellular electrophysiology.


Assuntos
Arritmias Cardíacas/etiologia , Arritmias Cardíacas/metabolismo , Ventrículos do Coração/metabolismo , Ventrículos do Coração/fisiopatologia , Proteínas Wnt/metabolismo , Via de Sinalização Wnt , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Biomarcadores , Biologia Computacional/métodos , Simulação por Computador , Suscetibilidade a Doenças , Eletrocardiografia , Elementos Facilitadores Genéticos , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Genótipo , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Imuno-Histoquímica , Mutação , Miócitos Cardíacos/metabolismo , Imagem Óptica , Fenótipo , Ligação Proteica , Proteínas Repressoras/metabolismo , Proteínas Wnt/genética , beta Catenina
18.
BMC Genomics ; 19(1): 799, 2018 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400812

RESUMO

BACKGROUND: Count data derived from high-throughput deoxy-ribonucliec acid (DNA) sequencing is frequently used in quantitative molecular assays. Due to properties inherent to the sequencing process, unnormalized count data is compositional, measuring relative and not absolute abundances of the assayed features. This compositional bias confounds inference of absolute abundances. Commonly used count data normalization approaches like library size scaling/rarefaction/subsampling cannot correct for compositional or any other relevant technical bias that is uncorrelated with library size. RESULTS: We demonstrate that existing techniques for estimating compositional bias fail with sparse metagenomic 16S count data and propose an empirical Bayes normalization approach to overcome this problem. In addition, we clarify the assumptions underlying frequently used scaling normalization methods in light of compositional bias, including scaling methods that were not designed directly to address it. CONCLUSIONS: Compositional bias, induced by the sequencing machine, confounds inferences of absolute abundances. We present a normalization technique for compositional bias correction in sparse sequencing count data, and demonstrate its improved performance in metagenomic 16s survey data. Based on the distribution of technical bias estimates arising from several publicly available large scale 16s count datasets, we argue that detailed experiments specifically addressing the influence of compositional bias in metagenomics are needed.


Assuntos
Algoritmos , Biologia Computacional/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Microbiota , RNA Ribossômico 16S/genética , Teorema de Bayes
19.
J Surg Res ; 192(2): 426-31, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24980854

RESUMO

BACKGROUND: Repair of primary ventral hernias (PVH) such as umbilical hernias is a common surgical procedure. There is a paucity of risk-adjusted data comparing suture versus mesh repair of these hernias. We compared preperitoneal polypropylene (PP) repair versus suture repair for elective umbilical hernia repair. METHODS: A retrospective review of all elective open PVH repairs at a single institution from 2000-2010 was performed. Only patients with suture or PP repair of umbilical hernias were included. Univariate analysis was conducted and propensity for treatment-adjusted multivariate logistic regression. RESULTS: There were 442 elective open PVH repairs performed; 392 met our inclusion criteria. Of these patients, 126 (32.1%) had a PP repair and 266 (67.9%) underwent suture repair. Median (range) follow-up was 60 mo (1-143). Patients who underwent PP repair had more surgical site infections (SSIs; 19.8% versus 7.9%, P < 0.01) and seromas (14.3% versus 4.1%, P < 0.01). There was no difference in recurrence (5.6% versus 7.5%, P = 0.53). On propensity score-adjusted multivariate analysis, we found that body mass index (odds ratio [OR], 1.10) and smoking status (OR, 2.3) were associated with recurrence. Mesh (OR, 2.34) and American Society of Anesthesiologists (OR, 1.95) were associated with SSI. Only mesh (OR, 3.41) was associated with seroma formation. CONCLUSIONS: Although there was a trend toward more recurrence with suture repair in our study, this was not statistically significant. Mesh repair was associated with more SSI and seromas. Further prospective randomized controlled trial is needed to clarify the role of suture and mesh repair in PVH.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Antibioticoprofilaxia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Herniorrafia/efeitos adversos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peritônio/cirurgia , Polipropilenos , Recidiva , Estudos Retrospectivos , Seroma/etiologia
20.
J Surg Res ; 190(2): 504-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24560428

RESUMO

BACKGROUND: The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias. METHODS: A systematic review identified studies published between January 1, 1980, and December 31, 2012, reporting the incidence of incisional hernia after stoma reversal at either the stoma site or at the midline incision (in cases requiring laparotomy). Pediatric studies were excluded. Assessment of risk of bias, detection method, and essential study-specific characteristics (follow-up duration, stoma type, age, body mass index, and so forth) was done. RESULTS: Sixteen studies were included in the analysis; 1613 patients had 1613 stomas formed. Fifteen studies assessed stoma site hernias and five studies assessed midline incisional hernias. The median (range) incidence of stoma site incisional hernias was 8.3% (range 0%-33.9%) and for midline incisional hernias was 44.1% (range 8.7%-58.1%). When evaluating only studies with a low risk of bias, the incidence for stoma site incisional hernias is closer to one in three and for midline incisional hernias is closer to one in two. CONCLUSION: Stoma site and midline incisional hernias are significant clinical complications of stoma reversals. The quality of studies available is poor and heterogeneous. Future prospective randomized controlled trials or observational studies with standardized follow-up and outcome definitions/measurements are needed.


Assuntos
Gastroenterostomia/efeitos adversos , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/etiologia , Estomas Cirúrgicos/efeitos adversos , Humanos , Doença Iatrogênica/epidemiologia
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