ObjectiveTo investigate the clinical efficacy of unilateral antegrade selective cerebral perfusion (UASCP) compared to bilateral antegrade selective cerebral perfusion (BASCP) in aortic surgery.MethodsPubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database were searched from establishment of each database to January 2019 to identify clinical studies on prognosis of UASCP versus BASCP in aortic surgery patients. The quality of randomized controlled trials was assessed by Cochrane risk assessement tool. The quality of non-randomized controlled trials was assessed by the Newcastle-Ottawa Scale ( NOS). Meta-analyses were presented in terms of odds ratio (OR) with 95% confidence interval (CI) by using RevMan 5.3 software.ResultsSixteen eligible studies including 3 randomized controlled trials, 2 propensity matching score studies, and 11 retrospective case control studies including4 490 patients were identified. The 3 randomized controlled trials were with high bias risk. The NOS score of the other 13 studies was more than 6 stars. Pooled analysis showed no significant difference between the UASCP and BASCP groups in terms of permanent neurological dysfunction (PND) (OR=0.93, 95%CI 0.74 to 1.18, P=0.57), temporary neurological dysfunction (TND) (OR=1.26, 95%CI 0.94 to 1.69, P=0.12), acute kidney injury rate (OR=1.11, 95%CI 0.79 to 1.55, P=0.55), 30-day mortality (OR=0.94, 95%CI 0.67 to 1.32, P=0.72), length of ICU stay (OR=–0.64, 95%CI –1.66 to 0.37, P=0.22) and hospital stay (OR=–0.35, 95%CI –2.38 to 1.68, P=0.74).ConclusionThis meta-analysis shows that UASCP and BASCP administration do not result in different mortality and neurologic morbidity rates. However, more studies with good methodologic quality and large sample are still needed to make further assessment.
摘要:目的:采用Meta分析的方法评价甲状腺球蛋白在甲状腺良性疾病和甲状腺癌中的临床意义。方法:通过检索MEDLINE、EMBASE、The Cochrane Library, 中国生物医学文献数据库、中国学术期刊全文数据库和其他方式广泛收集文献。根据QUADAS质量评价标准评价纳入文献的质量,用MetaDisc软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线(summary receiver operator characteristic curve,SROC)。结果:最终纳入5篇文献。合并敏感度0.60,合并特异度0.83,合并比值比2.68, SROC下面积(AUC)=0.645 4。结论:现有研究证实:甲状腺球蛋白在甲状腺癌中的阳性率是甲状腺良性疾病中的2.68倍,有统计学差异,但敏感度不高。尚需更多设计严谨、科学的临床试验进一步证实。Abstract: Objective: To evaluate the quality of the current studies involving the value of serum thyroglobulin in the diagnosis of thyroid benign diseases and thyroid carcinoma. Methods: We comprehensive collected current studies about serum thyroglobulin in thyroid benign diseases and thyroid carcinoma by computer and manual searches. QUADAS items were used for quality assessment in our systematic review. Metadisc software was used to analyze pooled sensitivity, pooled specificity,pooled positive likelihood ratio and pooled negative likelihood ratio,pooled diagnostic test odds ratio and heterogeneity test,and draw summary receiver operator characteristic curve (SROC). Results: Totally 5 studies were included. To identify thyroid benign diseases and thyroid carcinoma, pooled sensitivity was 0.60, pooled specificity was 0.83,pooled odds ratio was 2.68, the area under curve (AUC) was 0.645 4.Conclusion: The results of statistic alanalysis showed that the positive rate of thyroglobulin in thyroid carcinoma is 2.68 times more than in benign thyroid diseases. There was significant difference. But sensitivity was not high and reporting quality of the studies was relatively poor. The conclusion still need more clinical trials to confirm.
ObjectiveTo evaluate the effect of surgical and traditional treatments for multiple rib fractures through systematic review and meta-analysis.MethodsCNKI, Wanfang, VIP, PubMed, OVID, EMbase, The Cochrane Library, Thieme and Springer Link database for information from inception to July 2019 were screened by computer. Randomized controlled trials (RCTs) of surgical and conventional methods for the treatment of multiple rib fractures were screened, assessed and extracted. RevMan 5.3 software was used for meta-analysis.ResultsTwelve studies were included, including 1 039 patients. There were 512 patients in the operation group and 527 patients in the traditional treatment group. The results of meta-analysis showed that there was a significant difference between the two groups in the incidence of pneumonia (RR=0.41, 99%CI 0.29 to 0.58, P<0.000 01), incidence of atelectasis (RR=0.24, 99%CI 0.06 to 0.94, P=0.007), duration of mechanical ventilation (SMD=–2.64, 99%CI –4.38 to –0.91, P<0.000 1), duration of intensive care unit stay (SMD=–1.33, 99%CI –2.26 to –0.40, P=0.000 2), duration of hospital stay (SMD=–2.25, 99%CI –3.30 to –1.19, P<0.000 01)and incidence of chest wall deformity (RR=0.08, 99%CI 0.04 to 0.17, P<0.000 01). There was no significant difference between the two groups in the hospital mortality (RR=0.75, 99%CI 0.23 to 2.46, P=0.53), incidence of tracheostomy (RR= 0.69, 99%CI 0.39 to 1.21, P=0.09), ventilator support rate (RR=0.65, 99%CI 0.41 to 1.05, P=0.02) and chest drainage time (SMD=–2.58, 99%CI –6.41 to 1.25, P=0.08).ConclusionSurgical treatment of multiple rib fractures can reduce pulmonary complications, shorten hospital stay, and reduce the incidence of chest wall deformity, which is conducive to rapid recovery and improves quality of life.
ObjectiveTo systematically review the impact of chronic kidney disease (CKD) at different stages on prognosis of transcatheter aortic valve replacement (TAVR).MethodsDatabases including PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, Wanfang and the Chinese Biomedical Literature Database (CBM) were searched by computer to collect cohort studies on impact of different stages of CKD on prognosis of TAVR from inception to July 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using Stata 15.0 software. Risk of study bias was assessed using the Newcastle-Ottawa Scale (NOS).ResultsA total of 17 cohort studies were included with NOS score≥6 points. The results of meta-analysis indicated that: compared with the patients without CKD, all-cause mortality of CKD stage 3 patients at 30 day (RR=1.29, 95%CI 1.22-1.37, P<0.001) and 1 year (RR=1.24, 95%CI 1.19-1.28, P<0.001), all-cause mortality of CKD stage 4 patients at 30 day (RR=2.10, 95%CI 1.90-2.31, P<0.001) and 1 year (RR=1.89, 95%CI 1.62-2.19, P<0.001), and all-cause mortality of CKD stage 5 patients at 30 day (RR=2.22, 95%CI 1.62-2.19, P<0.001) and 1 year (RR=2.24, 95%CI 1.75-2.87, P<0.001) were significantly increased and were associated with the severity of CKD. The occurrence rates of 1-year cardiovascular mortality, postoperative acute kidney injury and bleeding events were all higher in patients with CKD.ConclusionCKD at stages 3, 4 and 5 is associated with increased all-cause mortality after TAVR, and the higher the stage of CKD is, the higher the risk of all-cause mortality at 30-day and 1-year follow-up is. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective The purpose of this study, which focuses on the number of the Cochrane Systematic Review’s (CSR) full texts, protocols and registered titles from Chinese authors, is to show the development of evidence-based medicine (EBM) and promote EBM’s further development in China. Methods On the basis of The Cochrane Library (Issue 1, 2009) and the Cochrane Collaboration (March 2009) periodicals, we performed statistical analysis of different countries that released CSR’s full texts, protocols and registered titles, as well as the time, authors and distribution of the CSR’s full texts, protocols and registered titles in China. Results The publishing rates of the CSR’s full texts, protocols and registered titles in China ranked the seventh, fifth and second, respectively. Although the number of CSR’s full texts and protocols showed an increased annual trend in China, the development of area distribution was unbalanced. Moreover, China’s published articles contained 47 Cochrane collaboration groups, without effective practice and health care groups, consumers and communication groups, and methodology and multiple stenosis groups. Conclusions The current Chinese EBM situation has a great potential in writing CSR. However, there are still many problems that need to be resolved.
ObjectiveTo systematically evaluate the clinical outcomes of minimally invasive lung segment resection (MILSR) and lobe resection (MILLR) for stageⅠA non-small cell lung cancer (NSCLC) to provide reference for clinical application. MethodsOnline databases including The Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, and Wanfang were searched from inception to January 21, 2023 by two researchers independently. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The prognostic indicators included the overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The meta-analysis was performed using STATA 14.0. ResultsA total of 13 studies with 1 853 patients were enrolled in the final study, with NOS scores ≥7 points. The results of meta-analysis showed that compared with the MILLR group, the blood loss was less [SMD=−0.36, 95%CI (−0.49, −0.23), P<0.001], postoperative drainage tube retention time [SMD=−0.34, 95%CI (−0.62, −0.05), P=0.019] and hospitalization time [SMD=−0.28, 95%CI (−0.40, −0.15), P<0.001] were shorter in the MILSR group. More lymph nodes [SMD=−0.65, 95%CI (−0.78, −0.53), P<0.001] and shorter operation time [SMD=0.20, 95%CI (0.07, 0.33), P=0.003] were found in the MILLR group. There were no statistical differences in the incidence of postoperative complications, postoperative recurrence rate, OS, DFS or RFS between the two groups. ConclusionAlthough the number of lymph nodes removed by MILSR is limited compared with MILLR, it does not affect the prognosis. MILSR has advantages in reducing intraoperative blood loss and shortening postoperative drainage tube retention time and hospital stay. For the surgical treatment of stageⅠA NSCLC, MILSR may be a more appropriate surgical approach.
Objective To systematically evaluate the effect of the timing of left ventricular (LV) unloading on the outcomes of patients with cardiogenic shock (CS) receiving extracorporeal membrane oxygenation (ECMO). MethodsA systematic literature search was conducted in PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), SinoMed, and the VIP databases from their inception to February 2025. Literature screening was conducted according to predefined inclusion and exclusion criteria. Two researchers independently assessed the study quality and extracted the data. Patients were divided into an early unloading group and a late unloading group based on the timing of LV unloading. RevMan 5.4 software was used to perform the heterogeneity test and meta-analysis. Results A total of 8 studies involving 2 117 patients were included (1 338 in the early unloading group and 779 in the late unloading group). The meta-analysis showed no statistically significant differences between the two groups in the rates of successful ECMO weaning, in-hospital mortality, or 30-day all-cause mortality (all P>0.05). Compared with the late unloading group, the early unloading group had a lower risk of sepsis [RR=0.79, 95% CI (0.64, 0.96), P=0.02] and abdominal complications [RR=0.67, 95% CI (0.46, 0.96), P=0.03]. ConclusionCompared with late LV unloading, early LV unloading does not significantly improve the successful ECMO weaning rate or early survival. However, early LV unloading is associated with a reduced risk of sepsis and abdominal complications.
Background Acute pancreatitis is one of the most severe acute abdominal conditions. Recently with the understanding of pathophysiology and pathogenesis of acute pancreatitis, cytokines, especially platelet-activating factor (PAF), have been shown to play an important role. Lexipafant is a potent inhibitor of PAF. It has shown exiting results in the animal experiments, so randomized controlled studies are needed to assess the impact of lexipafant for acute pancreatitis. Objectives To determine whether lexipafant can alter the course, prevent or treat organ failure and reduce mortality in acute pancreatitis. Search strategy Electronic databases were searched and reference lists from included studies were also handsearched. Published abstracts from conference proceedings and ten kinds of Chinese medical journals were handsearched for additional citations. Personal contaction with colleagues and experts in the field of pancreatitis was performed to identify potentially relevant trials. Selection criteria Randomized, controlled trials, In which participants went in hospital within 72 hours of belliache episode, comparing lexipafant to placebo or other interventions on organ failure rate or mortality of acute pancreatitis. Data collection and analysis Data related to the clinical outcomes were extracted by two reviewers independently, if there was any divarication, they would have a discussion. Main Results Three studies meet the inclusion criteria up to 2001. Compared with control group, lexipafant had the tendency of reducing the early deaths (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.23 to1.38, P=0.2), accelerating the recovery of organ failure (OR 0.40, 95%CI 0.12 to 1.32, P=0.13) and reducing the occurrence of new organ failure OR 0.34, but these results had no statistical significance. A large-scale multicentre randomized controlled trial including 1 500 patients has been completed in America, but the result has not been published. Reviewers’ Conclusions Current evidence couldn’t draw the final conclusion. So the large-scale of randomized controlled trials is required.
ObjectiveTo compare the surgical efficacy of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted minimally invasive esophagectomy (VAMIE) on esophageal cancer.MethodsOnline databases including PubMed, the Cochrane Library, Medline, EMbase and CNKI from inception to 31, December 2019 were searched by two researchers independently to collect the literature comparing the clinical efficacy of RAMIE and VAMIE on esophageal cancer. Newcastle-Ottawa Scale was used to assess quality of the literature. The meta-analysis was performed by RevMan 5.3.ResultsA total of 14 studies with 1 160 patients were enrolled in the final study, and 12 studies were of high quality. RAMIE did not significantly prolong total operative time (P=0.20). No statistical difference was observed in the thoracic surgical time through the McKeown surgical approach (MD=3.35, 95%CI –3.93 to 10.62, P=0.37) or in surgical blood loss between RAMIE and VAMIE (MD=–9.48, 95%CI –27.91 to 8.95, P=0.31). While the RAMIE could dissect more lymph nodes in total and more lymph nodes along the left recurrent laryngeal recurrent nerve (MD=2.24, 95%CI 1.09 to 3.39, P=0.000 1; MD=0.89, 95%CI 0.13 to 1.65, P=0.02) and had a lower incidence of vocal cord paralysis (RR=0.70, 95%CI 0.53 to 0.92, P=0.009).ConclusionThere is no statistical difference observed between RAMIE and VAMIE in surgical time and blood loss. RAMIE can harvest more lymph nodes than VAMIE, especially left laryngeal nerve lymph nodes. RAMIE shows a better performance in reducing the left laryngeal nerve injury and a lower rate of vocal cord paralysis compared with VAMIE.