Method’s corner: Allergist’s guide to network meta-analysis

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.     

经口腔前庭腔镜甲状腺癌根治术的临床实践及与开放性手术比较

目的 经口腔前庭腔镜甲状腺癌根治术的临床实践及与开放性手术进行比较。方法 回顾性收集并比较分析自2019年3月至2019年12月中国科学院大学宁波华美医院甲状腺外科行经口腔前庭腔镜甲状腺切除术和传统开放性甲状腺切除术的甲状腺肿瘤患者各45例临床资料（行经传统开放术式患者样本量较大,随机抽样选择45例）,比较分析两组在性别、年龄、BMI、病理类型,清扫淋巴结数量以及手术时长,术后引流量,术后出现相关并发症,远期预后等指标。结果 两种术式患者术前术后相关临床资料无明显统计学差异,术中指标如出血量,淋巴清扫方面两组亦无统计学差异,但术中手术时间较开放组延长（P<0.05）,手术费用较开放组更多,住院时长较开放组更短。结论 选择合适的患者,行经口腔前庭入路腔镜甲状腺癌根治术安全可行,在美容效果上有优势。     

Transcervical approach with endoscopic assistance for surgical treatment of patient with irreducible atlantoaxial dislocation: a case report

We demonstrate the case of a surgery in a patient with irreducible atlantoaxial dislocation (IrAAD) after C2 fracture. The challenges of this case were the flexed head in a forced position, impossibility of neck extension, and revision operation after posterior occipito-cervical fixation. The patient underwent the following surgeries: 1. A ventral release of C1-C2 using transcervical endoscopy; 2. Removal of occipito-cervical system and fibrous block resection in the posterior surfaces of the C1-C2; 3. Reducing of AAD and odontoid screw fixation; 4. Posterior C1-C2-C3 screw fixation. Ankylosing of C1-C2 and C2-C3-C4 fusion was verified by computed tomography scan. There was an improvement in patient status as observed by the increase of the SF-36 scale scores.The use of endoscopic transcervical approach is a good alternative to the transoral approach. Comparative studies of these methods should be performed regarding the choice of an optimal method of decompression in cases of IrAAD.     

液晶数字显示角度仪在全髋关节置换术中的应用价值

目的:探讨在全髋关节置换术中使用液晶数字显示角度仪控制前倾角的应用价值。方法:回顾分析自2018年1月至2019年12月83例行初次全髋关节置换术的患者,其中男28例,女55例;年龄42~81(70.4±7.9)岁。股骨颈骨折63例,股骨头缺血性坏死20例。所有患者术中使用液晶数显角度仪控制髋臼杯假体的前倾角,术后采用CT扫描,测量髋臼杯的前倾角,两者进行比较,了解使用液晶数显角度仪的准确性。结果:术后CT测量提示患者的髋臼前倾角均位于Lewinnek提倡的安全区内,术中使用液晶数显角度仪测量髋臼杯的前倾角度中位数为14.20°(12.80~15.40)°,术后CT扫描测量的髋臼杯的前倾角中位数为14.20°(13.40~15.50)°,两者比较差异无统计学意义(Z=-1.725,P=0.085)。结论:应用液晶数显角仪器对术中控制髋臼杯的前倾角是一种准确可靠的方法,具有良好的辅助参考价值。