Heterotopic ossification(HO) is a common complication following spinal cord injury(SCI); however, its underlying pathophysiology remains relatively unknown. Although there are options for treating HO, prophylactic treatment is limited. Additionally, evidence supporting the effectiveness of these prophylactic treatments is scarce. Electronic literature search was conducted using four databases. Studies comparing prophylactic medication for HO versus placebo for patients with acute spinal cord injury were included. A meta-analysis comparing the incidence of HO between the two groups was conducted, with a subgroup analysis of non-steroidal anti-inflammatory drugs (NSAIDs) and non-NSAIDs. A total of 5 studies and 815 patients were included. Overall incidence of HO was 9.73 % (n = 25) in the medication group versus 16.5 %(n = 92) in the placebo group. However, the two groups do not statistcally differ(p = 0.21). In the subgroup analysis for NSAIDs, those who received prophylactic treatment with NSAIDs had a lower incidence of HO compared to those who received placebo (RR[95 % CI]:0.32[0.15, 0.68]; p = 0.003). As for studies that used bisphosphonates, a statistically significant difference in incidence of HO was not found (RR[95 % CI]:1.30[0.52, 3.24];p = 0.58) and the overall evidence was inconclusive. In present systematic review and meta-analysis comparing prophylactic medications to placebo for prevention of HO, we found similar incidence rates for both groups. However, subgroup analysis showed a significantly lower incidence rate for those who recevied NSAIDs for HO prophylaxis. Altough this finding is promising for secondary prevention of HO among patients suffering from SCI, further prospective studies with longer follow-ups are required to assess other appropriate medications for HO prevention.

Pharmacologic prophylaxis for heterotopic ossification following spinal cord injury: A systematic review and meta-analysi.

Vericiguat, the newest soluble guanylate cyclase (sGC) drug, is potentially beneficial in treating heart failure (HF). However, most studies have only confirmed the significant impact of sGC in patients with reduced left ventricular ejection fraction (LVEF). Therefore, the main objective of this meta-analysis was to comparatively analyze the effects of Vericiguat in the entire LVEF range based on previous studies. According to PubMed, Web of Science, Cochrane, and Embase databases, randomized controlled studies in the full LVEF stage range were screened, and two extensive clinical studies on Vericiguat, namely VICTORIA (LVEF<45%) and VITALITY-HFpEF (LVEF≥45%) were identified for analysis and systematic evaluation. We separately assessed the rates of primary outcomes, cardiovascular death, and serious adverse events in both studies. The results of our research confirmed that although the criteria for the primary outcome were not the same in the two extensive studies, it was evident that there was no difference in the primary outcome between the experimental Vericiguat group and the placebo group in the VITALITY-HFpEF (LVEF≥45%) (P=0.45), whereas the primary outcome of VICTORIA (LVEF<45%) was significantly improved with the administration of Vericiguat showing a significant improvement (RR 0.93; 95% CI 0.87 to 1.00), but the effect of Vericiguat on cardiovascular mortality was not significant across the full range of LVEF (RR 0.97; 95% CI 0.86 to 1.09), and the incidence of total serious adverse events did not differ significantly between the two studies (RR 0.96; 95% CI 0.89 to 1.03). Surprisingly, partial subgroups analysis of serious adverse events found that vericiguat treatment reduced the incidence of all-cause death, Cardiac disorders, Hypotension, and Hypertension in patients with LVEF<45%, with a particular effect on the incidence of Cardiac disorders. Taken together, Vericiguat had a significant benefit in HF patients with LVEF<45%, especially in patients with LVEF<24%; it had a less pronounced effect in HF patients with LVEF ≥45%, but no adverse effects were observed.

Vericiguat in patients with heart failure across the spectrum of left ventricular ejection fraction: a patient-level, pooled meta-analysis of VITALITY-HFpEF and VICTORIA.

Children and adolescents are susceptible to influenza. Vaccination is the most important strategy for preventing influenza, yet there are few studies on the immunogenicity and safety of quadrivalent inactivated influenza vaccine (QIV) containing two A strains (H1N1 and H3N2) and two B lineages (Victoria and Yamagata). Therefore, to further clarify the immunogenicity and safety of QIV in children and adolescents, a meta-analysis was performed to provide a reference for the development of influenza prevention strategies.
PubMed, EMBASE and Cochrane Library were searched for articles published as of February 12, 2019. Random clinical trials comparing the immunogenicity and safety of QIV and TIV among children and adolescents were selected. The main outcomes were comparisons of immunogenicity (seroprotection rate [SPR] and seroconversion rate [SCR] and adverse events using risk ratios (RRs). The meta-analysis was performed using random-effects models.
Among the 6 months up to 3 years group, QIV showed a higher SPR for B lineages than for TIV-B/Yamagata, with pooled RRs of 3.07 (95% CI: 2.58-3.66) and 1.06 (95% CI: 1.01-1.11), respectively. For the 3 years through 18 years, QIV had a higher SCR and SPR for the Yamagata lineage than for TIV-B/Victoria, with pooled RRs of 2.30 (95% CI: 1.83-2.88) and 1.16 (95% CI: 1.03-1.30), respectively. Compared to TIV-B/Yamagata, a higher SCR and SPR for the Victoria lineage was found for QIV, with RRs of 3.09 (95% CI: 1.99-4.78) and 1.72 (95% CI: 1.22-2.41), respectively. Regarding adverse events, only pain was more frequently reported for QIV than TIV ; the RR was 1.09 (95% CI: 1.02-1.17).
The immunogenicity of QIV for common ingredients was similar to that of TIV, but the former exhibited significantly higher immunogenicity for the unique lineage. QIV also had the same reliable safety as TIV.

Comparison of the immunogenicity and safety of quadrivalent and tetravalent influenza vaccines in children and adolescents.

The transverse upper gracilis (TUG) flap is a reliable alternative to abdominally based breast reconstruction because of its advantageous anatomy. However, the limited tissue volume prevents reconstruction of large breasts. The bilateral TUG flaps for unilateral breast reconstruction can overcome this problem.
A retrospective analysis was performed regarding unilateral breast reconstruction with bilateral TUGs at the Queen Victoria Hospital from 2015 to 2019. Associations between categorical variables were examined with Fisher exact test, and any differences in continuous variables by complication status were evaluated with Mann-Whitney-Wilcoxon test for independent samples. A relevant systematic review was conducted with a meta-analysis of proportions using the Freeman-Tukey arcsine transformation for the estimation of the overall survival rates.
Ten cases were identified with 6 having a delayed reconstruction. Median age and body mass index were 50.8 years and 23.9 kg/m 2 , respectively, and average flap weight was 268.3 g. One flap was placed superiorly with its pedicle anastomosed to the retrograde internal mammary vessels, except of half of the cases where a second anterograde vein was used. The mean follow-up was 21.4 months, and all flaps survived. Two patients returned to theater, and 4 experienced donor-site problems. The presence of complications was not associated with age, ever smoking, body mass index, TUG weight, or anastomosis to retrograde internal mammary vein. The systematic review resulted in 8 eligible articles with a total sample of 156 flaps. The overall survival rate was 96.8%. In 6 cases, the indication was Poland syndrome (7.7%), and in 48.7%, axillary vessels were also used as recipient vessels. The estimated overall flap survival rate was 100% (95% confidence interval, 99%-100%), and no significant heterogeneity was noted ( I2 = 0%, P = 0.71).
The "2-in-1" technique can lead to symmetrical aesthetically pleasant results for both recipient and donor sites. Our case series and the conducted systematic review reiterate the reliability of this approach.

Bilateral Transverse Upper Gracilis Flaps for Unilateral Breast Reconstruction: A 4-Year Retrospective Study of the "2-in-1" Technique and a Systematic Review With Meta-analysis.

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