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BackgroundStress urinary incontinence (SUI) is involuntary urine leakage during effort. Pelvic floor muscle training (PFMT) is a common physical therapy for SUI, but has low adherence and its long—term effectiveness is uncertain. Drug therapy has side-effect problems and surgery has risks. Acupuncture’s role in improving SUI is also unclear based on previous studies.ObjectivesThis systematic review and meta-analysis evaluated the efficacy and safety of acupuncture individually or combined with PFMT in improving symptoms and women’s health-related quality of life of SUI.DesignA systematic review and meta-analysis were conducted.PatientsWomen with stress urinary incontinence were treated with electroacupuncture (EA) individually or acupuncture combined with PFMT.ResultsIn the analysis comparing urinary leakage 1 h and the ICIQ-SF score, electroacupuncture (EA) intervention was significantly associated with improvements in both urine leakage (MD = 4.69, 95% CI 2.83 to 6.55, I2 = 62%) and ICIQ-SF (MD = 2.61, 95% CI 1.64 to 3.58, I2 = 65%). The results were robust for the sensitivity analyses. EA was not associated with an increased incidence of adverse events compared to placebo EA (RR = 1.08, 95% CI 0.50 to 2.35, I2 = 0%). When comparing the group receiving pelvic floor muscle training (PFMT) combined with acupuncture to the PFMT only group, the combination therapy was found to improve urine leakage 1 h (MD = 1.91, 95% CI 0.96 to 2.86, I2 = 80%) and improve ICIQ-SF (MD = 2.63, 95% CI 1.60 to 3.65, I2 = 75%) in patients with SUI, despite significant heterogeneity observed. Subgroup analyses based on urine leakage 1 h revealed that subjects with mild stress urinary incontinence showed improvements (MD = 1.46, 95% CI 0.82 to 2.10, I2 = 58%), as did those with moderate stress urinary incontinence (MD = 4.9, 95% CI 1.72 to 8.08, I2 = 77%). There were significant differences between these subgroups (I2 = 77%, p = 0.04). In the subgroup analysis of intervention types, manual acupuncture showed no significant effect when combined (MD = 1.11, 95% CI -0.61 to 2.83, I2 = 86%).ConclusionThe findings from this meta-analysis indicate that EA is more effective at improving the clinical symptoms and quality of life in patients with SUI compared to placebo EA, and it does not increase the risk of adverse events. Moreover, the therapeutic effect of SUI treatment with EA combined with pelvic floor muscle training (PFMT) elicits a more positive response than PFMT alone. This suggests that EA, either as a standalone therapy or as an adjunct to PFMT, can offer beneficial outcomes for individuals with stress urinary incontinence, expanding the range of clinical treatment options available.Systematic Review RegistrationThe meta-analysis was registered in PROSPERO (CRD42022381409).

Background: The clinical interpretation of patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) reconstruction (ACLR) can be challenging. This study aimed to establish the clinical relevance of PROMs by determining maximal outcome improvement (MOI) thresholds at mid-term follow-up after primary ACLR. Methods: A total of 343 patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institute were included. Patients were queried with a 2-option anchor question regarding satisfaction with their current knee symptom state. The MOI of a PROM was calculated for each patient as the percentage of improvement normalized by the maximal possible improvement. The MOI threshold for each PROM was determined as the optimal cutoff value for predicting patient satisfaction based on receiver operating characteristic curve analysis. Multivariable logistic regression analyses were performed to identify predictors of achieving these thresholds. Subgroup analyses that stratified the time from injury to surgery within the cohort were performed, and MOI thresholds were recalculated within each of these subgroups. The PROMs evaluated in this study were the modified Lysholm Knee Score and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) score. Results: The calculated MOI threshold was 35.1% for the Lysholm score and 46.7% for the IKDC score. A longer time from injury to surgery reduced the odds of achieving the MOI threshold for the Lysholm score (odds ratio [OR] per time bracket = 0.7114, p < 0.0001) and IKDC score (OR = 0.8038, p = 0.0003). Male sex was associated with higher odds of achieving the MOI threshold for the IKDC score (OR = 1.9645, p = 0.0143). For patients with chronicity of ≤6 months, the MOI threshold was 35.1% for the Lysholm score and 57.9% for the IKDC score, and for patients with chronicity of >6 months, the thresholds were 24.5% and 27.1%, respectively. Conclusions: The calculated MOI thresholds for the Lysholm and IKDC scores at mid-term follow-up after primary ACLR were 35.1% and 46.7%, respectively. Greater chronicity of the ACL injury was associated with lower odds of achieving the MOI thresholds for the PROMs at mid-term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that 1-year graft and recipient survival rates are above 90% in most transplant centers, improving long-term graft survival remains an important challenge. Immunosuppressant nonadherence has been recognized as one of the important risk factors for long-term graft failure. Understanding the modifiable correlates and risk factors for medication non-adherence is essential to develop interventions to improve adherence and thus long-term transplantation outcomes. Methods: This study conducted a questionnaire survey on 431 renal transplant recipients who were followed up in the outpatient clinic between January 2022 and January 2023, and 409 valid questionnaires were returned. The BAASIS questionnaire was used to assess the prevalence of nonadherence to immunosuppressive therapy (implementation phase) in Chinese renal transplant recipients and to explore the multilevel correlates of immunosuppressive nonadherence. The BAASIS questionnaire was used to categorize renal transplant recipients into adherent (n = 239) and non-adherent (n = 170) groups, and a prospective cohort study with a 1-year follow-up was conducted to explore the impact of immunosuppressant non-adherence on clinical outcomes. Results: The prevalence of nonadherence to immunosuppressant therapy in renal transplant recipients in this study was as high as 41.6%. The number of years post-transplant (OR: 1.240, 95% CI: 1.136–1.353, p < 0.001) and the frequency of twice-daily dosing (OR: 5.145, 95% CI: 2.690–9.840, p < 0.001) were positively correlated with immunosuppressive nonadherence. There was a significant difference in TAC IPV (Intra-individual Variability) between the adherent and nonadherent groups (22.7 ± 8.7 vs. 25.4 ± 11.6, p = 0.010). Renal function remained stable during the follow-up period in the recipients in the adherence group and tended to decrease in the recipients in the non-adherence group (F = 4.932, p = 0.001). The rates of graft loss (7.1% vs. 1.7%, p = 0.006) and rejection (12.4% vs. 4.2%, p = 0.002) were higher in the nonadherent group than in the adherent group. Conclusion: Longer time post-transplant and higher frequency of immunosuppressive dosing were positively associated with nonadherence to immunosuppressives medication. Immunosuppressant nonadherence was associated with adverse graft outcomes. [ABSTRACT FROM AUTHOR]

Introduction Major hepatectomy is the mainstay of curative-intent resection for perihilar cholangiocarcinoma (pCCA) patients. Textbook Outcomes in Liver Surgery (TOLS) are a new composite parameter for evaluating the short-term outcomes of surgery; however, their association with overall survival (OS) is unknown. Therefore, this study aimed to investigate the association between TOLS and OS in pCCA patients following major hepatectomy. Methods Consecutive pCCA patients who underwent major hepatectomy between 2014 and 2020 at 5 hospitals were included in this analysis. TOLS were defined as no intraoperative grade ≥ 2 incidents, no postoperative grade B/C bile leakage, no postoperative grade B/C liver failure, no postoperative major morbidity, no readmission within 90 days due to surgery-related major morbidity, no mortality within 90 days after hospital discharge, and R0 resection. The Kaplan‒Meier method was used to compare OS rates between patients who achieved TOLS and those who did not. Cox regression analysis was used to identify independent risk factors for poor OS. Results In total, 399 patients were included in this study, 214 (53.6%) of whom achieved TOLS. After excluding patients who died within 90 days, the 5-year OS rate of patients who achieved TOLS were significantly greater than that of patients who did not achieve TOLS (5-year OS rate: 26.2% vs. 17.3%, P=0.001). TOLS were independently associated with OS for pCCA patients following major hepatectomy. Conclusions TOLS were achieved in approximately half of the pCCA patients following major hepatectomy, and the patients who achieved TOLS had better survival., (S. Karger AG, Basel.)