Results of sacrospinous ligament fixation using conventional instruments for symptomatic stage 2 and 3 apical prolapse over 3 years.

OBJECTIVE: To evaluate the long-term efficacy and quality of life concerning sacrospinous ligament fixation (SSLF) using conventional instruments for Chinese women with symptomatic stage 2 and 3 apical prolapse. METHODS: This single-arm prospective cohort study was conducted at our hospital between October 2011 and December 2018. Eligible participants were followed up over 3 years after surgery. The primary surgical outcome was composite surgical failure. Secondary outcomes included rate of satisfaction, quality of life (QoL) scores, and long-term complications. RESULTS: Fifty-nine patients were enrolled (mean age 57.1 years), of whom 55 (93.22%) completed the 3-year follow up. At year 3, the composite failure rate was 21.34% (95% confidence interval [CI] 9.30%-31.79%), and satisfaction rate was 81.40% (95% CI 66.09%-91.08%). Right thigh pain and de novo dyspareunia occurred in 1.8% and 14.6% patients after year 1, respectively, but at year 3 there were no complications. Lower urinary tract symptoms were present in 5.5% of patients. Improvement was found in urinary symptoms and prolapse symptoms, but sexual function showed no significant change. CONCLUSIONS: Compared with results at year 1, complication rates of SSLF decreased at year 3. The composite failure rate was relatively low and satisfaction rate was relatively high at year 3. Prolapse and urinary symptoms improved significantly after surgery.

Changes in Type II NRG-1 Expression during Regeneration Following Autologous Nerve Transplantation in Rats.

AIM: To investigate the changes in type II neuregulin-1 (NRG-1) during the regeneration process following autologous sciatic nerve transplantation in rats. MATERIAL AND METHODS: In total, 40 healthy male Sprague-Dawley (SD) rats of clean grade with body weights between 250 g and 300 g were randomly divided into an experimental and control group, with 20 rats per group. Five time points were set, including the 3 < sup > rd < /sup > , 7 < sup > th < /sup > , 14 < sup > th < /sup > , 21 < sup > st < /sup > and 28 < sup > th < /sup > days after surgery. In the experimental group, reversed autologous transplantation of the sciatic nerve was performed, while in the control group, the sciatic nerve was simply exposed without autologous transplantation. At the different time points, changes in the rat footprints were observed, the sciatic functional index (SFI) was calculated, changes in the regeneration of the myelin sheath at the nerve end after transplantation were observed by transmission electron microscopy, changes in type II NRG-1 protein expression were detected by a western blot analysis, and changes in type II NRG-1 mRNA expression were detected by real-time PCR. RESULTS: The SFI in the experimental group was lower than that in the control group at all time points after surgery, and the SFI in the experimental group gradually increased; these differences were statistically significant (p < 0.05). The expression of type II NRG-1 protein in the experimental group was significantly increased on the 3rd day after nerve transplantation and peaked on the 7 < sup > th < /sup > day, which continued until the 28 < sup > th < /sup > day after surgery, indicating a significant difference from the control group (p < 0.01). NRG-1 mRNA expression was markedly increased on the 7th day after nerve transplantation, further increased, and peaked on the 14 < sup > th < /sup > day (p < 0.01). The area of medullated nerve fibers (?m2) in the experimental group significantly differed from that in the control group on the 7 < sup > th < /sup > , 14 < sup > th < /sup > , 21 < sup > st < /sup > and 28 < sup > th < /sup > days (p < 0.01), and the diameters of the axons in the experimental group notably differed from those in the control group on the 7 < sup > th < /sup > , 14 < sup > th < /sup > and 21 < sup > st < /sup > days (p < 0.01). CONCLUSION: Type II NRG-1 expression peaked between the 3 < sup > rd < /sup > day and 14 < sup > th < /sup > day after autologous nerve transplantation and is likely involved in the regulation of myelin sheath regeneration during this period.

Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

OBJECTIVE: Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. METHODS: We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. RESULTS: From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate (odds ratio = 0.54; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE (mean difference = -0.10; 95% CI -0.17, -0.03; P = 0.007). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. CONCLUSION: Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.