The effect of sodium-glucose cotransporter-2 inhibitors on inflammatory biomarkers: A meta-analysis of randomized controlled trials.

AIMS: To conduct a meta-analysis of randomized controlled trials (RCTs) to assess the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on inflammatory biomarkers. METHODS: Medline, Embase and the Cochrane Library were searched for RCTs investigating the effect of SGLT2 inhibitors on inflammatory biomarkers, adipokine profiles and insulin sensitivity. RESULTS: Thirty-eight RCTs were included (14 967 participants, 63.3% male, mean age 62 ± 8.6 years) with a median (interquartile range) follow-up of 16 (12-24) weeks. Meta-analysis showed that SGLT2 inhibitors significantly improved adiponectin, interleukin-6, tumour necrosis factor receptor-1 (vs. placebo alone: standardized mean difference [SMD] 0.34 [95% confidence interval {CI} 0.23, 0.45], mean difference [MD] -0.85 pg/mL [95% CI -1.32, -0.38], SMD -0.13 [95% CI -0.20, -0.06], respectively), leptin and homeostatic model assessment of insulin resistance index (vs. CONTROL: SMD -0.20 [95% CI -0.33, -0.07], MD -0.83 [95% CI -1.32, -0.33], respectively). There were no significant changes in C-reactive protein (CRP), tumour necrosis factor-α, plasminogen activator inhibitor-1, fibroblast growth factor-21 or monocyte chemoattractant protein-1. CONCLUSIONS: Our analysis shows that SGLT2 inhibitors likely improve adipokine biomarkers and insulin sensitivity, but there is little evidence that SGLT2 inhibitors improve other inflammatory biomarkers including CRP.

The transverse upper gracilis flap for autologous breast reconstruction: patient satisfaction outcomes from a single centre experience.

Background: The transverse upper gracilis (TUG) flap procedure is an alternative procedure for autologous breast reconstruction, that is indicated in patients with a low body mass index (BMI) and small to moderate sized breasts. We investigated patient satisfaction of all TUG flap breast reconstructions at Royal Free Hospital. Methods: A retrospective review of all patients who had undergone a TUG flap procedure was performed using Electronic Patient Records between October 2010 and October 2021 in Royal Free Hospital. We collected patient demographic data and surveyed our cohort by telephone, investigating patient satisfaction with a 31-item questionnaire. Results: From 2010 to 2021, 57 TUG procedures for autologous breast reconstruction were carried out on 36 patients. One patient died 6 years postoperatively. Patient age ranged from 29-74 with an average of 49.5 years. Also, 3/57 flaps failed, and 1 patient died 6 years postoperatively. Twenty one out of 35 patients responded to the telephone call survey. Out of the survey respondents 11/21 underwent unilateral breast reconstruction and 10/21 underwent bilateral breast reconstruction. The BODY-Q scale in appraisal of thighs reported an overall patient satisfaction mean score of 75.6±27.4 points. The BREAST-Q scale in breast satisfaction reported an overall patient satisfaction mean score of 61.5±24.1 points. Overall, 19/21 of patients were satisfied with the outcome of the TUG procedure. Conclusions: Royal Free Hospital reported excellent patient satisfaction scores. The TUG procedure is a suitable method for patient's undergoing autologous breast reconstruction. However, patient expectations regarding breast satisfaction should be managed.

Reverse Flow Shunt Restricted Free Venous Flap for a Ring Avulsion Injury.

Arterialized venous flaps can be an excellent option for reconstruction of digital defects. Previously, they remained unpopular owing to the high rate of venous congestion. Different techniques of restriction of the arteriovenous shunting have been described to mitigate this problem. In this article, the authors discuss a unique case whereby a reverse flow shunt restricted venous flap was used in an Urbaniak type III ring avulsion.