对比四维子宫输卵管超声造影与子宫输卵管造影评估输卵管通畅性效能:Meta分析

目的 采用Meta分析对比四维子宫输卵管超声造影（4D-HyCoSy）与子宫输卵管造影（HSG）评估输卵管通畅性的效能。方法 系统搜索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方医学网及维普数据库中建库至今有关4D-HyCoSy和/或HSG评估输卵管通畅性的文献。由2名研究人员依据纳入标准和排除标准筛选文献并提取信息；分别计算4D-HyCoSy和HSG评估输卵管通畅性的合并敏感度（SEN）、特异度（SPE）及诊断比值比（DOR），绘制综合受试者工作特征（SROC）曲线，获得曲线下面积（AUC），并以Medcalc 19.1.1统计软件比较AUC。结果 最终纳入19篇文献、1 358例疑似输卵管因素导致不孕患者，其中4篇同时采用4D-HyCoSy及HSG评估输卵管通畅性，10篇仅以4D-HyCoSy评估，5篇仅以HSG评估。Meta分析结果显示，4D-HyCoSy评估输卵管通畅性的合并SEN、SPE及DOR分别为0.92[95%CI（0.91，0.94）]、0.91[95%CI（0.89，0.93）]及115.06[95%CI（54.23，224.10）]；HSG评估输卵管通畅性的合并SEN、SPE及DOR分别为0.84[95%CI（0.81，0.87）]、0.80[95%CI（0.76，0.83）]及28.64[95%CI（10.08，81.35）]。4D-HyCoSy评估输卵管通畅性的AUC为0.98[95%CI（0.96，0.99）]，HSG为0.93[95%CI（0.90，0.95）]，差异有统计学意义（Z=6.97，P<0.01）。结论 4D-HyCoSy评估输卵管通畅性的效能高于HSG。     

Impact of different types of olive oil on cardiovascular risk factors: A systematic review and network meta-analysis

Background and aimThis network meta-analysis (NMA) compares the effects of different types of olive oil (OO) on cardiovascular risk factors.Methods and resultsLiterature search was conducted on three electronic databases (Medline, Web of Science, and Cochrane Central). Inclusion criteria: Randomized controlled trials (RCTs) (≥3 weeks duration of intervention) comparing at least two of the following types of OO: refined OO (ROO), mixed OO (MOO), low phenolic (extra) virgin OO (LP(E)VOO), and high phenolic (extra) virgin OO (HP(E)VOO). Random-effects NMA was performed for seven outcomes; and surface under the cumulative ranking curve (SUCRA) was estimated, using an analytical approach (P-score). Thirteen RCTs (16 reports) with 611 mainly healthy participants (mean age: 26–70 years) were identified. No differences for total cholesterol, HDL-cholesterol, triacylglycerols, and diastolic blood pressure were observed comparing ROO, MOO, LP(E)VOO and HP(E)VOO. HP(E)VOO slightly reduce LDL-cholesterol (LDL-C) compared to LP(E)VOO (mean difference [MD]: −0.14 mmol/L, 95%–CI: −0.28, −0.01). Both, HP(E)VOO and LP(E)VOO reduces SBP compared to ROO (range of MD: −2.99 to −2.87 mmHg), and HP(E)VOO may improve oxidized LDL-cholesterol (oxLDL-C) compared to ROO (standardized MD: −0.68, 95%–CI: −1.31, −0.04). In secondary analyses, EVOO may reduce oxLDL-C compared to ROO, and a dose-response relationship between higher intakes of phenolic compounds from OO and lower SBP and oxLDL-C values was detected. HP(E)VOO was ranked as best treatment for LDL-C (P-score: 0.83), oxLDL-C (0.88), and SBP (0.75).ConclusionsHP(E)VOO may improve some cardiovascular risk factors, however, public health implications are limited by overall low or moderate certainty of evidence.     

Treatment sequence network meta-analysis in Crohn’s disease: a methodological case study

Objective: Several biologic therapies are available for the treatment of mild-to-moderate Crohn’s disease (CD). This network meta-analysis (NMA) aimed to assess the comparative efficacy of ustekinumab, adalimumab, vedolizumab and infliximab in the maintenance of clinical response and remission after 1?year of treatment.

Methods: A systematic literature search was performed to identify relevant randomized controlled trials (RCTs). Key outcomes of interest were clinical response (CD activity index [CDAI] reduction of 100 points; CDAI-100) and remission (CDAI score under 150 points; CDAI < 150). A treatment sequence Bayesian NMA was conducted to account for the re-randomization of patients based on different clinical definitions, the lack of similarity of the common comparator for each trial and the full treatment pathway from the induction phase onwards.

Results: Thirteen RCTs were identified. Ustekinumab 90?mg q8w was associated with statistically significant improvement in clinical response relative to placebo and vedolizumab 300?mg. For clinical remission, ustekinumab 90?mg q8w was associated with statistically significant improvement relative to placebo and vedolizumab 300?mg q8w. Findings from sub-population analyses had similar results but were not statistically significant.

Conclusions: The NMA suggest that ustekinumab is associated with the highest likelihood of reaching response or remission at 1?year compared with placebo, adalimumab and vedolizumab. Results should be interpreted with caution because this is a novel methodology; however, the treatment sequence analysis may be the most methodologically sound analysis to derive estimates of comparative efficacy in CD in the absence of head-to-head evidence.     

Prevalence of Apical Periodontitis and Conventional Nonsurgical Root Canal Treatment in General Adult Population: An Updated Systematic Review and Meta-analysis of Cross-sectional Studies Published between 2012 and 2020

IntroductionThis study aimed to summarize data on apical periodontitis (AP) and nonsurgical root canal treatment (NSRCT) prevalence and risk factors related to age, gender, and quality of restorative and endodontic treatment in the general population from cross-sectional studies published between 2012 and 2020.MethodsAn electronic search was performed in the following databases: Web of Science, Scopus, and PubMed. The conducted literature search covered studies published between 2012 and 2020, without restrictions on language. The STROBE and NOS tools were used for quality assessment of the included studies.ResultsSixteen articles were included in the review. In total, 200,041 teeth were examined. On average, 6.3% of teeth had AP, and 7.4% had NSRCT. Forty-one percent of RCT teeth had AP, and 3.5% of untreated teeth had AP. Female patients were less prone to AP in endodontically treated teeth only, compared with male patients (P < .001). Variable stratification of age subgroups among included studies prevented us from conducting a meta-analysis. An increase in AP frequency was found in teeth with inadequate restorative and endodontic treatment (P < .001 and P < .001, respectively). Because of high heterogeneity, these results should be taken with caution.ConclusionsThere is an increased AP prevalence in the adult general population compared with data from 2012 (6.3% versus 5.4%) in both endodontically treated (41.3% versus 35.9%) and untreated teeth (3.5% versus 2.1%). In addition, AP developed less frequently in female patients with endodontically treated teeth and in teeth with inadequate compared with adequate restorative and endodontic treatment.     

正念干预改善运动员心理康复效果的系统综述和Meta分析

目的 综合评价正念干预对运动员心理康复的效果。方法 检索2010年1月1日至2019年12月31日Web of Science、EBSCO、PubMed、Medline、OpenDissertations、Psychology and Behavioral Sciences Collection、Academic Search Premier、中国知网(CNKI)、维普和万方数据库有关正念干预促进运动员心理康复的研究,对纳入文献进行质量评价,采用Review Manager 5.3软件进行Meta分析。结果 共纳入18项研究。正念干预对运动员心理康复即刻效果呈中到大效应量(d= 0.69, 95%CI 0.53~0.86, P< 0.001),但存在发表偏倚。正念组干预的追踪效应量不显著(d= -0.08, 95%CI -0.33~0.16, P= 0.50)。正念干预的康复效果受研究质量的影响(I² = 88.1%, P= 0.004)。结论 正念干预对运动员心理康复的效果主要表现为改善心境,促进流畅体验,提高消极体验的接受性,提高对目标的行动力和提高训练的投入程度。正念干预效果受研究质量的影响。     

生长抑素及其类似物联合质子泵抑制剂应用于急性非静脉曲张性上消化道出血的循证分析

目的 系统评价生长抑素及其类似物联合质子泵抑制剂（proton pump inhibitor，PPI）治疗急性非静脉曲张性上消化道出血（acute non-variceal upper gastrointestinal bleeding，ANVUGIB）的有效性和安全性，并分析其用药经济性。方法 采用循证医学方法搜集生长抑素及其类似物联合PPI治疗ANVUGIB的RCT、队列研究进行meta分析，得到相应的有效性及安全性分析结果，并进行成本-效果分析。结果 最终纳入6个RCT均未接受内镜治疗，共610例受试者。Meta分析结果显示，生长抑素及其类似物联合高、中、低剂量PPI治疗在以下方面均优于单用高、中、低剂量PPI治疗，差异有统计学意义，总有效率[OR=3.34，95%CI（2.03，5.47），P<0.000 01]、止血时间[MD=-9.04，95%CI（-11.69，-6.38），P<0.000 01]、输血量[MD=-1.10，95%CI（-1.46，-0.74），P<0.000 01]；在不良反应发生率方面，2组差异无统计学意义[OR=0.49，95%CI（0.11，2.12），P=0.34]。ANVUGIB患者予生长抑素联合高、中、低剂量奥美拉唑与单用高、中、低剂量奥美拉唑进行成本-效果分析，增量成本效果比分别为172.28，217.26，330.37，敏感性分析后显示结果稳定。而接受内镜治疗后应用生长抑素及其类似物联合PPI治疗仅1个队列研究，研究结果显示内镜治疗成功后联合治疗并不优于PPI单药治疗。结论 现有证据表明，生长抑素及其类似物联合PPI治疗未经内镜治疗的ANVUGIB患者为较有效的方案，两者安全性相当、耐受性较好，从药品直接成本考虑，高剂量PPI组联合治疗较中、低剂量PPI组联合治疗更具有成本效果性。而对于经内镜下止血治疗的患者两者疗效相当，可考虑单用PPI。