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Introduction Intra-abdominal testis (IAT) remains a challenging and controversial subset within the management of cryptorchidism. While Fowler–Stephens orchidopexy (FSO) is still being advocated as the gold standard for the treatment of this entity, there is new and conflicting evidence on the comparative outcomes between single- or two-stage laparoscopic FSO (LFSO). The aim of the study is to investigate whether staging has benefits in children receiving LFSO. Methods We searched the PubMed, Medline, Embase, and Cochrane Trials databases for studies comparing single- with two-stage LFSO in children from January 1, 1995 to December 31, 2023. We assessed the identified studies for quality and performed a systematic review and meta-analysis in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses. The main outcome measures examined were success rate (in terms of the scrotal position of the testis) and testicular atrophy, which were analyzed using fixed effect models. Results We included 17 eligible studies that involved a total of 499 operated testes. The overall success rates of single- and two-stage LFSO were 79.4 and 90.3%, respectively. The overall testicular atrophy rates of single- and two-stage LFSO were 17.3 and 11%, respectively. Fixed effect model analysis showed that two-stage LFSO is significantly superior to single-stage LFSO in overall success rate (odds ratio [OR: 2.57]; 95% confidence interval [CI]: 1.50–4.39, p = 0.0006) and testicular atrophy rate (OR: 0.48; 95% CI: 0.28–0.79, p = 0.004). There is no heterogeneity in the reports, and the funnel plot showed no publication bias. Conclusions Two-stage LFSO remains the first choice of operation for children with a high IAT, with a significantly higher success rate and a lower testicular atrophy rate. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To investigate the long‐term quality of life and surgical outcome of female patients with congenital adrenal hyperplasia (CAH).Questionnaires for health‐related quality of life (HRQoL) outcome (WHO‐5, SF‐36), lower urinary tract symptoms (ICIQ‐FLUTS) and sexual outcome (ICIQ‐FLUTSsex) were administered to adult CAH patients. Paediatric CAH patients and their parents were invited to complete WHO‐5, PedsQL‐4.0‐SF15‐Generic Core Scales and ICIQ‐CLUTS.Six (46%) adults and 7 (54%) children with 21‐hydroxylase‐deficiency (age ranged from 8 years to 53 years) were recruited. Eleven (85%) had undergone a feminising genitoplasty. In the adult group, no statistically significant difference was identified in the HRQoL and ICIQ‐FLUTS scores. Mean overall score of ICIQ‐FLUTSsex was lower but not significantly in adult patients compared to controls (7.3 ± 2.9 vs. 2.9 ± 3.4, P = 0.06). A statistically significant negative correlation (r = −0.98, P = 0.02) was found between age at first operation and role limitations due to emotional problems in SF‐36. No statistically significant difference was identified in the self‐reported HRQoL and ICIQ‐CLUTS scores in the paediatric group compared to controls. However, parent's report showed a statistically significant difference in school functioning (73.8 ± 18.9 vs. 91.2 ± 18.7, P = 0.02) and emotional functioning (80.3 ± 15.9 vs. 94.7 ± 12.7, P = 0.007).Our data did not show an impaired HRQoL nor long‐term lower urinary tract symptoms in CAH patients' self‐reports. Healthcare team should pay more attention to adult patient's sexual function. [ABSTRACT FROM AUTHOR]

Background Low back pain (LBP) is a leading cause of disability worldwide and has posed numerous health and socioeconomic challenges. This study compared whether nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with tramadol, tizanidine or placebo would be the best treatment regime to improve the Roland Morris Disability Questionnaire (RMDQ) scores at 1 week. Methods This was a multi-center, double-blind, randomized, and placebo-controlled trial including adult patients with acute LBP and sciatica in three emergency departments in Hong Kong. Patients were randomized to the receive tramadol 50 mg, tizanidine 2 mg, or placebo every 6 hours for 2 weeks in a 1:1:1 ratio. The RMDQ and other secondary outcomes were measured at baseline, Day 2, 7, 14, 21, and 28. Data were analyzed on an intention to treat basis. Crude and adjusted mean differences in the changes of RMDQ and NRS scores from baseline to Day 7 between tizanidine/tramadol and placebo were determined with 95% confidence intervals. Results Two hundred and ninety-one patients were analyzed with the mean age of 47.4 years and 57.7% were male. The primary outcome of mean difference in RMDQs on Day 7 (compared with baseline) was non-significant for tizanidine compared with placebo (adjusted mean difference − 0.56, 95% CI -2.48 to 1.37) and tramadol compared with placebo (adjusted mean difference − 0.85, 95% CI -2.80 to 1.10). Only 23.7% were fully compliant to the treatment allocated. Complier Average Causal Effect analysis also showed no difference in the primary outcome for the tizanidine and tramadol versus placebo. Conclusion Among patients with acute LBP and sciatica presenting to the ED, adding tramadol or tizanidine to diclofenac did not improve functional recovery. What is already known on this topic There was no clear evidence of efficacy for cyclobenzaprine, methocarbamol, and metaxalone in addition to nonsteroidal anti-inflammatory drugs alone in patients with acute low back pain in the emergency department setting. What this study adds Among Chinese patients with acute low back pain and sciatica presenting to the emergency department, adding tramadol or tizanidine to diclofenac did not improve functional recovery at one week. The compliance to the analgesic drugs were low in this trial, with only 23.7% has taken at least 75% of the recommended doses, and 53.6% of patients has taken less than 25% of the recommended doses. Significant adverse events related to tramadol and tizanidine were found, with the most common being sleepiness and dizziness. How this study might affect research, practice or policy The lack of compliance would drive the effect estimate towards the null hypothesis (i.e. no difference), and further studies on relevant drugs should take into account of these low compliance rates. [ABSTRACT FROM AUTHOR]

Patients with dizziness commonly present to Emergency Departments (ED) and 6% of these patients will be diagnosed with acute stroke. The TriAGe+ score comprises of eight clinical parameters and stratifies patients into four risk groups. The Japanese authors reported that the tool performed well, so our aim was to validate this diagnostic tool in our ED in Hong Kong. A single-center retrospective observational study was conducted in the ED of our university hospital in Hong Kong. The primary outcome was the diagnosis of an acute cerebrovascular event. Receiver operator characteristic (ROC) analysis was performed to determine the best cut-off score. Secondary outcomes included univariable and multivariable analyses of stroke predictors. 455 patients aged 18 years or above with dizziness or vertigo at ED triage were recruited between 19 July and 30 September 2021. The overall prevalence of stroke was 11.9%. The median TriAGe+ score was 7 (IQR = 4–9). The AUC was 0.9. At a cut-off >5, sensitivity was 96.4% (95%CI: 87.3–99.5) and the negative likelihood ratio was 0.09 (95%CI: 0.02–0.3). At a cut-off >10, specificity was 99.8% (95%CI: 98.6–100.0), and the positive likelihood ratio was 237.6 (95%CI: 33.1–1704). On multivariable analyses, atrial fibrillation, blood pressure, gender, dizziness (not vertigo) and no history of dizziness, vertigo or labyrinth/vestibular disease were found to be positively associated with stroke outcomes significantly. The TriAGe+ score is an efficient stroke prediction score for patients presenting to the ED with dizziness. • What is already known on this topic – Dizziness or vertigo is a common presenting complaint in the emergency department (ED). The TriAGe+ score can help identify patients who are at risk of stroke. • What this study adds – The TriAGe+ score is an efficient stroke prediction score for patients presenting to the ED with dizziness or vertigo. • How this study might affect research, practice or policy – The TriAGe+ score can be used to aid decision making on disposal of ED patients presenting with dizziness or vertigo. [ABSTRACT FROM AUTHOR]

【Abstract】Objective: Focused Abdominal Sono-graphy for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT). This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre. Methods: This was a retrospective study of BAT pa-tients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, ab-dominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperi-toneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete docu-mentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predic-tive values (PV), likelihood ratios (LR) and accuracy. Results: FAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients. Conclusion: FAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use. Key words: Laparotomy; Autopsy; Tomography, X-ray computed; Tomography, spiral computed; Ultra-sonography