Background
Use of quantitative fetal fibronectin (fFN) testing to predict spontaneous preterm birth (sPTB) is gaining attention owing to its absolute measurement of fFN concentration and increased positive predictive value compared with qualitative testing.
Objective
To assess the predictive values of quantitative fFN for sPTB in different predefined thresholds using systematic review and meta‐analysis.
Search strategy
Five major databases (PubMed, ScienceDirect, Web of Science, Embase, Cochrane library) were searched for eligible studies.
Selection criteria
Observational studies of the diagnostic accuracy of different quantitative fFN thresholds on delivery outcomes were included.
Data collection and extraction
Articles were reviewed independently by two authors and data were extracted. Sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curves were extracted and calculated.
Main results
Fifteen studies were included. To detect sPTB at less than 34 weeks of gestation, pooled sensitivities for thresholds of 10, 50, 200, and 500 ng/ml were 0.78, 0.56, 0.33, and 0.11, respectively. Pooled specificities were 0.63, 0.84, 0.96, and 0.99, respectively.
Conclusions
Based on the results of the meta‐analysis, the threshold of 10 ng/ml fFN may be a new choice for the prediction of sPTB. The improved diagnostic accuracy of quantitative testing over qualitative testing can provide additional discriminatory information for clinical practice.
A new strategy for total auricular reconstruction using prelamination of extended retroauricular flap with tissue expansion,
SummaryBackground: To accomplish total ear reconstruction with aesthetic appearance is a great challenge for plastic surgeons worldwide due to insufficient skin coverage. A retroauricular fascia flap and skin graft technique are commonly used, but the results are unsatisfied due to color mismatch, severe edema, and donor site morbidity. Here, we will describe a novel strategy for total ear reconstruction, utilizing an extended retroauricular flap prelaminated with tissue expansion to obtain enough skin for ear reconstruction. Methods: About two months before ear reconstruction, kidney shaped tissue expander was inserted at the mastoid region subcutaneously. The retroauricular skin became enlarged and thinner in 2 months after expansion. Next, the expander was removed and the retroauricular flap was extended by dissecting the surrounding scalp subcutaneously. By mobilizing the scalp-extended retroauricular flap, we could encapsulate the entire framework with thin and non-hair bearing skin. Results: From August 2014 to September 2015, 36 microtia patients had undergone ear reconstruction using the novel strategy. All cases have resulted in satisfactory aesthetics with fine structure, symmetry, maintenance of the auriculocephalic angle. Conclusions: Using our novel strategy, we can obtain satisfactory aesthetic outcome by fully mobilizing the expanded skin without additional morbidities of donor sites. Patients are satisfied with the vivid ear contour and lack of groin scar.
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