悬雍垂腭咽成形术治疗睡眠呼吸障碍的有效性与安全性的系统评价

目的系统评价悬雍垂腭咽成形术(UPPP)治疗睡眠呼吸障碍的有效性及安全性.方法电子检索MEDLINE(1966～2005)、EMBASE(1984～2005)、Cochrane图书馆(2005年第1期)、中国生物医学文献光盘数据库(1979～2005)、中文学术期刊全文数据库(1994～2005)、中文科技期刊全文数据库(1989～2005),中文生物医学期刊数据库(1994～2005)、万方数据库以及互联网资料.文献检索语种限制为英文及中文.纳入有关UPPP的随机对照试验、半随机对照试验以及前瞻性对列研究.由两名研究者独立对纳入研究的方法学进行质量评价,资料统计分析采用RevMan4.2.7软件.结果共纳入12个研究,其中随机对照研究5个,前瞻性队列研究7个.UPPP与口腔矫形器(DA)比较,DA组多导睡眠呼吸监测(PSG)参数的改变优于UPPP组,但UPPP组术后生存质量评价及治疗依从性优于DA组;UPPP与激光悬雍垂腭咽成形术(LAUP)、低温等离子射频消融术(RFTVR)比较,后两者术后疼痛较UPPP组轻,术后并发症发生率UPPP与LAUP比较差异无统计学意义,与RFTVR比较除术后1周鼻腔反流的发病率较高外,其余差异无统计学意义.没有试验对UPPP与LAUP及RFTVR术后PSG参数的改变进行比较;与持续鼻腔正压通气比较,UPPP对PSG参数改变更优.结论目前尚无充分证据表明UPPP治疗睡眠呼吸障碍疗效优于其它治疗,也无证据表明哪种治疗方式疗效最佳.由于本研究纳入的文献语种仅限于中文及英文,可能会漏掉一些有价值的文献;所纳入的文献数量少、质量低,使论证强度受到一定限制,在今后的临床工作中有必要进行大样本含量,高质量的临床随机对照研究.     

Effect of calorie restriction diet on levels of C reactive protein (CRP) in obesity: A systematic review and meta-analysis of randomized controlled trials

Background and aimsChronic inflammation in obese patients can be managed through a calorie-restricted diet, characterized by reduced C - reactive protein (CRP). This study aims to assess the role of such diet on CRP.MethodsLiterature searches were performed using search engines. Randomized controlled trials were included. Calorie-restricted diets in combination with non-diet interventions were excluded.ResultsCalorie restriction decreased CRP in obese patients with a mean difference of ?0.22 (95% CI -0.40 to ?0.04, p 0.006).ConclusionsCalorie-restricted diet reduces CRP. Diet administration >12 weeks had a beneficial effect.     

Pathophysiological domains underlying the metabolic syndrome: an alternative factor analytic strategy

PurposeFactor analysis (FA) has become part and parcel in metabolic syndrome (MBS) research. Both exploration- and confirmation-driven factor analyzes are rampant. However, factor analytic results on MBS differ widely. A situation that is at least in part attributable to misapplication of FA. Here, our purpose was (i) to review factor analytic efforts in the study of MBS with emphasis on misusage of the FA model and (ii) to propose an alternative factor analytic strategy.MethodsThe proposed factor analytic strategy consists of four steps and confronts weaknesses in application of the FA model. At its heart lies the explicit separation of dimensionality and pattern selection and the direct evaluation of competing inequality-constrained loading patterns. A high-profile MBS data set with anthropometric measurements on overweight children and adolescents is reanalyzed using this strategy.ResultsThe reanalysis implied a more parsimonious constellation of pathophysiological domains underlying phenotypic expressions of MBS than the original analysis (and many other analyses). The results emphasize correlated factors of impaired glucose metabolism and impaired lipid metabolism.ConclusionsPathophysiological domains underlying phenotypic expressions of MBS included in the analysis are driven by multiple interrelated metabolic impairments. These findings indirectly point to the possible existence of a multifactorial etiology.     

Carbohydrate beverages attenuate bone resorption markers in elite runners

ObjectiveWe evaluated the effects of carbohydrate (CHO) supplementation on markers of bone turnover in elite runners.DesignTwenty-four male runners were randomly assigned to two groups – a CHO and a control (CON) group – using a double-blind design. The participants were submitted to an overload training program (days 1–8), followed by a high-intensity intermittent running protocol (10 × 800 m) on day 9. They received a maltodextrin solution (CHO group) or a placebo solution as the CON equivalent, before, during, and after these protocols.ResultsAfter 8 days of intensive training, baseline levels of osteocalcin (OC) decreased in both CHO and CON groups (before: 28.8 ± 3.6 and 26.6 ± 2.4 ng/ml, after: 24.8 ± 3.0 and 21.9 ± 1.6 ng/ml, respectively, p < 0.01). On day 9, at 80 min of the recovery period, carboxy-terminal of telopeptide type I collagen (CTX) serum concentration was suppressed in the CHO group (0.3 ± 0.1 ng/ml) vs. 0.6 ± 0.0 ng/ml for the CON group (p < 0.01). CHO supplementation was effective in decreasing CTX levels from baseline to recovery (0.5 ± 0.1 ng/mL to 0.3 ± 0.1 ng/mL, p < 0.001), while an increase from 0.4 ± 0.0 ng/mL to 0.6 ± 0.0 ng/mL (p < 0.001) was observed in the CON group.ConclusionCHO beverage ingestion attenuated the exercise-induced increase in CTX concentration, suggesting that CHO supplementation is a potential strategy to prevent bone damage in athletes.     

The Ariadne principles: how to handle multimorbidity in primary care consultations

Multimorbidity is a health issue mostly dealt with in primary care practice. As a result of their generalist and patient-centered approach, long-lasting relationships with patients, and responsibility for continuity and coordination of care, family physicians are particularly well placed to manage patients with multimorbidity. However, conflicts arising from the application of multiple disease oriented guidelines and the burden of diseases and treatments often make consultations challenging. To provide orientation in decision making in multimorbidity during primary care consultations, we developed guiding principles and named them after the Greek mythological figure Ariadne. For this purpose, we convened a two-day expert workshop accompanied by an international symposium in October 2012 in Frankfurt, Germany. Against the background of the current state of knowledge presented and discussed at the symposium, 19 experts from North America, Europe, and Australia identified the key issues of concern in the management of multimorbidity in primary care in panel and small group sessions and agreed upon making use of formal and informal consensus methods. The proposed preliminary principles were refined during a multistage feedback process and discussed using a case example. The sharing of realistic treatment goals by physicians and patients is at the core of the Ariadne principles. These result from i) a thorough interaction assessment of the patient’s conditions, treatments, constitution, and context; ii) the prioritization of health problems that take into account the patient’s preferences – his or her most and least desired outcomes; and iii) individualized management realizes the best options of care in diagnostics, treatment, and prevention to achieve the goals. Goal attainment is followed-up in accordance with a re-assessment in planned visits. The occurrence of new or changed conditions, such as an increase in severity, or a changed context may trigger the (re-)start of the process. Further work is needed on the implementation of the formulated principles, but they were recognized and appreciated as important by family physicians and primary care researchers.Please see related article: http://www.biomedcentral.com/1741-7015/12/222.     

The reporting quality and risk of bias of randomized controlled trials of acupuncture for migraine: Methodological study based on STRICTA and RoB 2.0

ObjectivesTo investigate the reporting quality and risk of bias of randomized controlled trials (RCTs) of acupuncture for migraine, to facilitate and improve the quality of RCTs of acupuncture for migraine.MethodsThe Cochrane Library, PubMed and EMBASE were searched from inception to June 11, 2019 using a comprehensive search strategy. The reporting quality and risk of bias of included RCTs were independently evaluated by two investigators using STRICTA and RoB 2.0. Any disagreement was resolved by a third investigator.ResultsA total of 28 eligible RCTs were published in 24 academic journals from 1994 to 2018. Based on STRICTA, four sub-items including “details of other interventions’’ (1/28, 4 %), “setting and context of treatment” (9/28, 32 %), “the extent to which treatment was varied” (11/28, 39 %), and “number of needle insertions per subject per session” (13/28, 46 %), showed low reporting quality. A total of 32 different outcomes were reported in 28 RCTs, and based on RoB 2.0, nine (9/28, 32 %) RCTs were judged to be high RoB, three of which were owing to deviations from intended interventions; 11(11/28, 39 %) RCTs elicited some concerns; and eight (8/28, 29 %) RCTs were low RoB for their outcomes.ConclusionsThe reporting quality and risk of bias of RCTs of acupuncture for migraine remain suboptimal. Therefore, all stakeholders should make a contribution to improve the quality of RCTs of acupuncture for migraine using STRICTA and RoB 2.0, while not limiting this approach solely to studies on migraine, using STRICTA and RoB 2.0 tools.     

Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies

The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or – by excluding an ominous diagnosis – reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases.     

Endoscopic thyroidectomy: an evidence-based research on feasibility, safety and clinical effectiveness

Background The feasibility and safety of endoscopic thyroidectomy were evaluated by an approach of systematic review of published studies in the past decade.
Methods A database searching was performed on MEDLINE, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials. Both comparative and non-comparative studies about endoscopic thyroidectomy were selected and analyzed. For the comparative studies, RevMan 4.2 was used for statistical analysis; and for the non-comparative studies, data analysis was performed by SPSS 13.0.
Results Seven comparative studies involving 367 patients （video-assisted thyroidectomy （VAT）, 174 patients; conventional thyroidectomy （CT）, 193 patients） were included in VAT-CT group. Age, gender, operative types, and pathological diagnosis were similar. Compared with CT, the mean operative time for VAT was significantly longer （VAT, 80.0 minutes; CT, 61.9 minutes, P 〈0.01）, but the postoperative hospital stay was shorter （VAT, 1.7 days; CT, 2.5 days, P 〈0.01）. The complication rate for VAT was 6.9%, while that for CT was 9.3% （P=0.35）. Three studies analyzed the postoperative pain and cosmetic evaluation, and indicated that the VAT group was superior to the CT group, but there was no significant difference after a meta-analysis. Three comparative studies involving 273 patients （totally endoscopic thyroidectomy （TET）, 145 patients; CT, 128 patients） were included in TET-CT group and the results generally resembled that of VAT-CT group. There were 18 and 14 non-comparative studies reporting the results of VAT and TET, respectively. The mean operative time for VAT was 76.8 minutes compared with 135.8 minutes for TET. The postoperative hospital stay was 1.8 and 3.8 days for VAT and TET respectively. The rates of conversion to open surgery for VAT and TET were similar （VAT, 2.8%; TET, 3.9%, P=0.105）. The complication rate for VAT was 8.