C反应蛋白诊断新生儿败血症准确性的Meta分析

目的 探讨CRP诊断新生儿败血症的诊断价值.方法 计算机检索维普中文科技期刊数据库、中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Medline、EMBASE、Cochrane图书馆、PubMed等数据库（检索时间为1989年1月至2011年7月）,获得CRP诊断新生儿确诊败血症的文献.采用QUADAS工具对纳入文献进行质量评价.采用MetaDisc 1.4和RevMan 5.0软件检验各文献间的异质性,并根据异质性结果选择相应的效应模型进行加权定量合并,计算敏感度和特异度及其95%CI.绘制受试者工作特征（SROC）曲线并计算曲线下面积（AUC）,并行敏感度分析.结果 20篇文献进入Meta分析.分析结果显示：CRP诊断新生儿败血症的汇总敏感度和特异度分别为0.69（95%CI：0.65～0.72）和0.87（95%CI：0.86～0.89）,SROC AUC为0.88,Q＊指数为0.81.CRP＞8 mg·L-1诊断新生儿败血症的汇总敏感度和特异度分别为0.88（95%CI：0.82～0.92）和0.86 （95%CI：0.81～0.90）,SROC AUC为0.94,Q＊指数为0.88;CRP≥8 mg·L-1诊断新生儿败血症的汇总敏感度和特异度分别为0.54（95%CI：0.47～0.61）和0.81（95%CI：0.76～0.85）,SROC AUC为0.80,Q＊指数为0.74;两者合并诊断新生儿败血症的汇总敏感度和特异度分别为0.70（95%CI：0.65～0.74）和0.83（95%CI：0.80～0.86）,SROC AUC为0.88,Q＊指数为0.82.在纳入文献中标本来源和检测方法的差异等非阈值效应因素是产生异质性的原因.结论 CRP对新生儿败血症诊断的敏感度和特异度较高,有助于早期诊断新生儿败血症.     

下腔静脉扩张指数评估机械通气患者 容量反应性价值的Meta分析

目的 搜集现有文献证据,对下腔静脉扩张指数对机械通气状态下患者容量反应状态的诊断价值进行系统评价。方法 全面检索中国知网全文数据库,Pubmed,Embase,the Cochrane datebase数据库,检索时限为建库至2018年10月。纳入符合要求的评估下腔静脉扩张指数对机械通气状态下,患者容量反应状态诊断价值的临床对照试验,根据I2确认各研究间的异质性,I2＞50%采用随机效应模型分析,I2＜50%采用固定效应模型分析,计算合并灵敏度,特异度,诊断比值比（95%CI）,绘制受试者工作曲线,计算曲线下面积,根据PEEP的有无进行亚组分析,以探究异质性的来源。使用Quadas-2进行质量评估。结果 研究共纳入13篇文献,QUDAS-2量表评估各文献质量均较高,其中包括992例受试者。Meta分析显示合并灵敏度,特异度,诊断比值比分别为0.66（95%CI:0.62~0.70）,0.80（95%CI:0.77~0.84）,19.72（95%CI:7.07~54.94）,合并AUROC为0.8825。各研究间异质性均较大（I2＞50%,P＜0.05）。结论 下腔静脉扩张指数对于机械通气状态下患者容量反应状态具有较高诊断价值,机械通气时给予呼气末正压会导致下腔静脉扩张指数评估容量反应性的敏感度和特异度下降。     

影响中国中学生自杀意念危险因素Meta分析

目的:探讨我国中学生自杀意念产生的相关危险因素。方法:检索至2015年1月的维普中文科技期刊全文数据库、CNKI中国学术期刊网全文数据库、中国生物医学文献数据库和万方数据库,以及PubMed、Web of Knowledge、EMbase等英文相关数据库,纳入国内中学生自杀意念影响因素的相关研究,采用Revman 5.2统计软件对纳入文献进行Meta分析,根据异质性检验结果选择相应效应模型进行数据合并,计算各影响因素合并比值比(OR)及其95%CI。结果:共纳入文献10篇,均为横断面研究。有效总体样本量为31324例。合并OR值(95%CI)有统计学意义的危险因素依次为:感到孤独(OR=2.842,95%CI:2.092~3.861),网络过度使用(OR=1.848,95%CI:1.396~2.445),受到排挤和欺侮(OR=1.805,95%CI:1.343~2.425),抑郁(OR=1.711,95%CI:1.371~2.136)。结论:与我国中学生自杀意念相关的危险因素是感到孤独、网络过度使用、受到排挤和欺侮以及抑郁等,因此,对中学生心理健康教育及自杀危机干预应围绕这些方面开展。     

血清抗-PLA_2R抗体对特发性膜性肾病诊断价值的meta分析北大核心CSCD

目的：探讨血清抗-PLA2R抗体（anti-PLA2R）在特发性膜性肾病（IMN）诊断中的价值。方法：检索Pub Med、Elsevier、Springer、中国期刊全文数据库、中国科技期刊数据库、万方数字化期刊全文数据库等数据库中2009年1月至2013年12月国内外公开发表的关于血清anti-PLA2R诊断特发性膜性肾病的相关文献,根据纳入和排除标准筛选文献并提取数据,采用诊断精确性研究的质量评估方法（QUADAS）评价文献质量,通过Meta-Disc和Stata软件进行Meta分析。通过汇总后的敏感度、特异度、似然比及汇总受试者工作曲线（ROC）综合评价血清anti-PLA2R对IMN的诊断价值。采用依次减少一篇文献的方法进行敏感性分析,通过Egger漏斗图检验文献发表偏倚。结果：共筛选出7篇文献。累计病例967例,其中IMN患者454例,对照组513例。异质性检验提示不存在阈值效应引起的异质性（Spearman相关系数为0.107,P=0.819）,但存在非阈值效应引起的异质性（Cochrane-Q为16.89,P=0.009 7）。采用随机效应模型合并诊断指标。合并后的灵敏度为69%,95%CI：0.65-0.73,特异度为98%,95%CI：0.96-0.99。汇总阳性似然比16.37,95%CI：4.06-65.95,汇总阴性似然比0.32,95%CI：0.24-0.43。SROC曲线显示AUC为0.854 0,Q＊指数为0.785 0。敏感性分析显示本研究稳定可信,Egger漏斗图显示无明显发表偏倚。结论：血清anti-PLA2R对诊断IMN具有重要的临床价值。     

MRI与~(99)Tc~m-MDP骨显像对前列腺癌骨转移诊断价值的Meta分析

为了评价磁共振成像(MRI)与99 Tcm-MDP骨显像对前列腺癌骨转移的诊断价值,计算机检索1990~2012年PubMed、EMBASE、EBSCO、Web of Knowledge、the Cochrane Library、Ovid等数据库,搜集关于MRI与99 TcmMDP骨显像诊断前列腺癌骨转移价值的试验,经过纳入标准和排除标准筛选后,根据QUADAS条目评估文献质量,然后提取数据和资料,采用Meta-Disc软件进行Meta分析,计算敏感性合并、特异性合并、诊断优势比合并(DOR合并),并绘制SROC曲线,计算曲线下面积(AUC)和Q*值。最终纳入5个研究,包括353个对象。Meta分析结果显示:MRI与99 Tcm-MDP骨显像诊断前列腺癌骨转移的敏感性合并分别为0.95(95%CI 0.90~0.98)与0.67(95%CI 0.58~0.75),特异性合并分别为0.97(95%CI 0.94~0.99)与0.88(95%CI 0.83~0.91),DOR合并分别为402.99(95%CI 119.05~1364.15)与23.85(95%CI 1.32~431.48);AUC与Q*分别为0.990 1、0.958 7和0.624 1、0.593 8。表明MRI诊断前列腺癌骨转移的效能优于99 Tcm-MDP骨显像。     

补锌对婴幼儿智力及运动发育影响的Meta分析

目的评价补锌对婴幼儿运动和智力发育改善的作用。方法检索PubMed、EMBASE、Cochrane图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等,获得补锌对婴幼儿运动和智力发育影响的RCT文献。根据随机分配方法,分配隐藏,对研究对象、治疗方案和研究结果测量者采用盲法,结果数据的完整性,选择性报告研究结果,其他偏倚来源进行文献偏倚评估。以生后6～36个月智力发育指数（MDI）、运动发育指数（PDI）和发育商（DQ）为疗效判定指标。采用RevMan5.0软件进行Meta分析,检验异质性,根据异质性结果进行原因分析,并选择相应的效应模型分析。计量资料以SMD或WMD及其95%CI表示。结果①共检索到文献84篇,共10篇RCT满足纳入条件进入Meta分析。7篇文献采用了正确的随机方法,8篇文献采用了分配隐藏,9篇文献对受试者采用了盲法,8篇文献对研究者和结局测量者采用了盲法,9篇文献提及报道数据的完整性,9篇文献未选择性报告研究结果,仅1篇文献报道了其他偏倚来源。漏斗图检验未见显著发表偏倚。②Meta分析结果显示,补锌组与对照组MDI的差异无统计学意义,WMD=-0.08（95%CI：-1.55～1.40）;补锌组与对照组PDI的差异无统计学意义,SMD=0.15（95%CI：-0.12～0.42）。但研究间均具显著统计学异质性,根据补锌的剂量、是否与其他营养物质合用、纳入对象的营养状况行亚组分析,进一步探讨异质性产生的原因。亚组分析显示不能完全消除文献间的异质性,异质性可能还与其他因素有关。③补锌组与对照组DQ评分的差异无统计学意义,WMD=-0.72（95%CI：-7.97～6.53）。补锌组与对照组干预前后Alberta运动指数的差异无统计学意义,WMD=0.30（95%CI：-2.09～2.69）。结论早期补锌并未提高MDI、PDI及DQ评分,对婴幼儿运动和智力发育未显示有改善作用。鉴于研究间存在显著的统计学异质性,结论仍需谨慎看待。     

细胞色素P450 2E1基因PstI/RsaI多态性与结直肠癌易感关系的Meta分析

背景：CYP2EI基因是该酶系重要的编码基因之一,有关CYP2E1基因多态性与结直肠癌易感性关系研究较多,但结果存在一定的差异。 目的： 探讨细胞色素P450 2E1基因PstI/RsaI单核苷酸多态性与结直肠癌易感性的关系。 方法：检索EMBASE、PubMed、Ovid、Highwire press等西文生物医学文献数据库; CNKI、CBM、万方数据库等中文数据库。获取发表的CYP2E1基因PstI/RsaI单核苷酸多态性与结直肠癌易感性关系的研究。病例组及对照组CYP2E1等位基因分布的比值比为效应指标, 根据异质性检验结果选择随机效应模型或固定效应模型对OR进行合并。 结果与结论：按照文献入选标准共查到9篇病例对照研究,其中病例组4 760例,对照组5 812例。以野生型纯合子为参照,评估突变纯合子患结直肠癌的风险OR=1.24(OR=1.24,95%CI:0.93~1.66,P=0.15);以野生纯合子加突变杂合子为参照,评估突变纯合子患结直肠癌的风险OR=1.26(OR=1.26,95%CI:0.94~1.68,P=0.12);以野生纯合子为参照,评估突变纯合子加突变杂合子患结直肠癌的风险OR=1.00(OR=1.00,95%CI:0.90~1.12,P=0.97)。亚组分析,按不同种族分为高加索人群和东亚人群,除高加索人群在c1c1 vs. c2c2模式下显示CYP2E1基因PstI/RsaI单核苷酸多态性与结直肠癌易感性有关(OR=2.67,95%CI:1.03~6.89,P=0.04),其他各种模式下Meta分析结果均未显示与结直肠癌易感性有关。说明整体上CYP2E1基因PstI/RsaI单核苷酸多态性与结直肠癌易感性间不存在明显相关性,但高加索人群中携带c2c2突变基因型的个体可能是结直肠癌的易感人群。     

孕早期胎儿颈项透明层在产前超声筛查胎儿畸形中价值的Meta分析

目的探讨孕早期胎儿颈项透明层（NT）在产前超声筛查胎儿畸形（特别是心脏畸形）中的价值。方法检索Cochrane图书馆、PubMed、OVID、Springer数据库、中国期刊全文数据库和中国生物医学文献数据库（1990年1月至2008年8月）中孕早期NT产前超声筛查胎儿畸形（特别是心脏畸形）的中英文文献，按照诊断试验的纳入和排除标准筛选文献，提取纳入研究的特征信息。数据分析采用Meta—DiSc1．4软件，检验异质性，并根据异质性选择相应的效应模型。对所有研究予以加权定量合并分析，计算汇总敏感度和特异度及其95％CI。绘制汇总受试者工作特征曲线（SROC），并计算曲线下面积（AUC），最后剔除异质性文献和孕14周后检测NT厚度的文献进行敏感度分析。结果共纳入文献12篇，检查胎儿共计112099例。孕早期胎儿NT≥P95和P99对心脏畸形产前诊断的各研究间存在异质性，Meta分析合并效应量时采用随机效应模型；孕早期胎儿NT≥P95对胎儿畸形产前诊断的各研究间无异质性，Meta分析合并效应量时采用固定效应模型。9篇文献对孕早期胎儿NT≥P95对心脏畸形的诊断价值进行了分析，汇总灵敏度、特异度和SROCAUC分别为29．8％、96．9％和0．8047；7篇文献对孕早期胎儿NT≥P99对心脏畸形的诊断价值进行了分析，汇总灵敏度、特异度和SROCAUC分别为18．9％、99．3％和0．9712；5篇文献对孕早期胎儿NT≥P95对胎儿畸形的诊断价值进行了分析，汇总灵敏度、特异度和SROCAUC分别为25．0％、98．3％和0．1830。孕早期胎儿NT≥P95对心脏畸形产前诊断的汇总敏感度高于NT≥P99（x2=6．58，P〈0．05），两者的汇总特异度差异无统计学意义（P〉0．05）。剔除异质性文献和14周后检测NT厚度的文献对汇总敏感度和特异度影响不大。结论孕早期胎儿NT增厚对笼统的胎儿畸形产前筛查的准确性低?     

PCR方法检测循环肿瘤细胞对结直肠癌诊断价值的meta分析

目的系统评价PCR方法检测循环肿瘤细胞对结直肠癌的诊断价值。方法计算机检索Pub Med数据库,按照制定的纳入、排除标准确定合格研究。利用STATA 11.0软件计算合并效应量,绘制综合受试者工作特征曲线并计算曲线下面积。结果24篇研究的合并效应量结果显示,合并敏感度为0.41(95%CI0.30-0.53),特异度为0.98(95%CI 0.93-0.99),合并曲线下面积为0.81(95%CI 0.77-0.84)。亚组分析显示检测敏感度随时间逐渐增高,且CEA作为分子标志物的检测敏感度较CK20略高。结论PCR方法检测CTCs对结直肠癌诊断的特异度较高、敏感度中等,是较好的结直肠癌无创诊断指标。     

尿胰蛋白酶原-2与尿液淀粉酶早期诊断急性胰腺炎的循证评估

目的采用循证医学的方法评估尿胰蛋白酶原-2（TPS-2）和尿液淀粉酶（UAmy）早期诊断急性胰腺炎（AP）的诊断价值与诊断效能,为临床医生和检验人员选择AP生化标志物提供最佳临床决策证据。方法检索MEDLINE、EMBASE、中国生物医学文献数据库（CBMDISC）、中国生物医学期刊文献数据库（CMCC）、中文期刊全文数据库（CNKI）等数据库,按照纳入标准收集TPS-2与UAmy诊断AP的研究文献,采用QUADAS量表进行严格的文献质量评价,利用MetaDisc软件进行异质性分析及定量合成,绘制SROC曲线,计算相应的验后概率。结果39篇TPS-2与UAmy诊断AP的研究结果异质性分析,前者无明显异质性（P=0.5641,I2=0%）;后者有中等程度的异质性（P=0.0086,I2=38.5%）。合并敏感度Sen分别为93%（95%CI：92%～94%）与81%（95%CI：79%～83%）;合并特异度Spe分别为94%（95%CI：94%～95%）与82.0%（95%CI：81%～83%）;SROCAUC分别为0.9788（SE=0.0024）与0.8680（SE=0.0084）,差异有统计学意义,前者的综合诊断效能优于后者。TPS-2与UAmy结果阳性时诊断AP的验后概率分别约为56.88%与26.62%,阴性验后概率分别为0.69%与2.38%。结论检测尿液TPS-2诊断AP比UAmy具有更高的诊断价值,可作为AP诊断的过筛试验,阴性结果有99.31%的概率可排除AP的可能性。     

Diagnostic value of circular RNAs in colorectal cancer: A systematic review and meta-analysis

PurposeMounting studies has revealed that circular RNAs (circRNAs) play a key role in tumorigenesis and might serve as promising biomarkers for cancer diagnosis. However, the diagnostic value of circRNAs in colorectal cancer (CRC) remains to be precisely elucidated.MethodsAll relevant literatures were searched using Cochrane Library, PubMed, Web of Science, EMBASE, CNKI, and WanFang databases up to June 2019. The quality of eligible studies was assessed in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 system. The summary receiver operator characteristic curve (SROC) and area under SROC (AUC) were applied for the quantitative assessment of diagnostic performance. Threshold effect, subgroup analysis, and meta-regression were adopted to explore the sources of heterogeneity. Deeks’ funnel plot and sensitivity analysis were conducted to examine the publication bias and stability of meta-analysis, respectively.ResultsA total of 13 eligible studies involving 2190 subjects and 14 different kinds of circRNAs were enrolled. The pooled sensitivity, specificity, and AUC were 0.78 [95% confidential interval (CI): 0.70-0.84], 0.71 (95% CI: 0.65-0.76), and 0.80 (95% CI: 0.76-0.83), respectively. Subgroup analysis showed that studies involving ≥ 100 cases had higher sensitivity but lower specificity than those involving < 100 cases. Meta-regression revealed that sample size might be the potential source of heterogeneity. Sensitivity analysis and Deeks’ funnel plot indicated that our results were relatively robust and had no publication bias.ConclusionCircRNAs possess relatively moderate diagnostic accuracy and might serve as potential diagnostic biomarkers for colorectal cancer. Future large-scale studies are needed to confirm the diagnostic value of circRNAs.     

Positron emission tomography alone,positron emission tomography-computed tomography and computed tomography in diagnosing recurrent cervical carcinoma: a systematic review and meta-analysis

Introduction

The aim of the study was to assess systematically the accuracies of positron emission tomography (PET), PET/computed tomography (CT), and CT in diagnosing recurrent cervical cancer.

Material and methods

We searched for articles published from January 1980 to June 2013 using the following inclusion criteria: articles were reported in English; the use of PET, interpreted with or without the use of CT; use of CT to detect recurrent cervical cancer; and histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months. We extracted data to calculate sensitivity, specificity, summary receiver operating characteristic curves, and the area under the receiver operating characteristic curve (AUC) as well as test for heterogeneity.

Results

In 23 included studies, PET had the highest pooled specificity at 92% (95% CI: 90–94), whereas PET/CT had the highest pooled sensitivity at 94% (95% CI: 90–97). The area under the curve (AUC) of PET alone, PET/CT, and CT were 0.9594, 0.9508, and 0.9363, respectively. Results of the pairwise comparison between each modality show that the specificity of PET was higher than that of PET/CT (p < 0.05). The difference in the pooled sensitivities and AUC of PET alone and PET/CT showed no statistical significance. No evidence of publication bias was found. However, evidence of heterogeneity was observed.

Conclusions

The PET/CT may be a useful supplement to current surveillance techniques, particularly for patients with negative CT imaging. However, in terms of diagnostic accuracy, interpreted CT images may have limited additional value to PET in detecting recurrent cervical cancer.     

Association between fecal bile acids and colorectal cancer: a meta-analysis of observational studies

Purpose

To provide a systematic review with meta-analysis for addressing the relationship between fecal bile acids (FBAs) and colorectal cancer.

Materials and Methods

Electronic databases were searched for all observational studies that examined the relationship between FBAs and colorectal cancer or adenoma, and calculated weighted mean difference (WMD) and 95% confidence interval (CI). Publication bias was assessed with funnel plot.

Results

Twenty case-control or cohort studies were identified. All studies were pooled to assess the relationship between total FBAs and cancer/adenoma of the large bowel, however, no association was seen (WMD 0.61 mg/g freeze-dried feces; 95% CI: - 0.35 - 1.57). Significantly increased concentration of chenodeoxycholic acid (CDCA) was seen while pooling to assess the relationship between CDCA and cancer/adenoma of the large bowel (WMD 0.13 mg/g freeze-dried feces; 95% CI: 0.01 - 0.25), especially for colorectal cancer (WMD 0.28 mg/g freeze-dried feces; 95% CI: 0.10 - 0.46). However, no significant differences in deoxycholic acid (DCA), lithocholic acid (LCA), and primary and secondary bile acids, were seen between patients with cancer and patients with matched controls regardless of fixed and random effects models.

Conclusion

CDCA might play a role in the etiology of colorectal cancer.     

Lack of association between p.Ser167Asn variant of Parkin and Parkinson's disease: a meta-analysis of 15 studies involving 2,280 cases and 2,459 controls

Previous clinical trials have evaluated the association between Parkin p.Ser167Asn (c.601G>A) variant and Parkinson's disease (PD) risk. However, the results remain conflicting rather than conclusive. Therefore, we performed this meta-analysis to assess whether pooled results show the association. We performed structured literature searches for studies addressing the association between the Parkin p.Ser167Asn variant and PD risk. We conducted analyses of study characteristics, heterogeneity, and funnel plot asymmetry in analyses analogous to additive, dominant, recessive, and general genetic models with the odds ratio (OR) as the measure of association. When 15 eligible studies (n?=?4,739 subjects) were pooled into the meta-analysis, there was no evidence for significant association in additive genetic model between Parkin p. Ser167Asn variant and PD risk (OR?=?1.02, 95% confidence interval (CI)?=?0.83-1.25; P?=?0.866). The OR for the dominant model was 1.06 (95% CI?=?0.80-1.41) while the OR for the recessive model was 0.90 (95% CI?=?0.71-1.14). The OR for the heterozygous was 1.07 (95% CI?=?0.80-1.43) while the OR for the homozygotes was 1.19 (95% CI?=?0.81-1.74). In the subgroup analysis by ethnicity, no significant association was found in any genetic model. Begg's funnel plot and Egger's test provided visual and statistical evidences for funnel plot symmetry, suggesting no presence of publication bias. In summary, the meta-analysis strongly suggests that Parkin p. Ser167Asn variant is not associated with PD risk.     

降钙素原对儿童细菌性脑膜炎鉴别诊断的Meta分析

目的探讨降钙素原（PCT）对儿童细菌性脑膜炎的诊断价值。方法采用计算机检索获得PCT对儿童细菌性脑膜炎的诊断性研究文献,检索时间为建库至2013年7月,按照QUADAS标准评价纳入文献质量。采用Meta—Disc1．4软件进行Meta分析,对敏感度、特异度、阳性似然比、阴性似然比进行汇总和异质性检验,绘制综合受试者特征曲线（SROC）,行敏感性分析和异质性原因分析。使用Stata12．0软件判断发表偏移并绘制漏斗图。结果12篇文献进入Meta分析（中文5篇,英文7篇）。①汇总敏感度0．95（95％CI：0．92—0．97）,特异度0．89（95％CI：0．86—0．92）,阳性似然比11．09（95％CI：5．73～21．49）,阴性似然比0．07（95％CI：0．05～0．11）,诊断比值比122．01（95％CI：65．08—228．75）,SROC曲线下面积（AUC）0．9777,Q’指数0．933。②分别剔除样本量〈50文献、中文文献和回顾性研究文献的敏感性分析显示,上述诊断参数的95％CI与原数据有较大重叠。③特异度、阳性似然比的文献间存在显著的异质性,研究地域、PCT检测方法和细菌性脑膜炎诊断标准可能不是异质性产生的原因。④以PCT5肛g·L。界值诊断儿童细菌性脑膜炎的敏感度、特异度,SROCAUC和Q’指数最大。结论PCT在鉴别诊断儿童细菌性脑膜炎与病毒性脑膜炎中有较高的敏感度和特异度,但各研究间存在异质性,使用PCT鉴别诊断儿童细菌性脑膜炎仍需结合具体的临床情况。     

rs798766 C＞T多态性与膀胱癌易感性的Meta分析

目的 对rs798766 C>T多态性与膀胱癌易感性的关联进行Meta分析.方法 在Pubmed与百度学术数据库中检索相关病例对照研究,根据纳入与排除标准进行筛选.提取研究基本情况,提取或计算T等位基因比值比ORCT+TT vs.CC及其95 %可信区间,进行Meta分析.结果 共纳入9项病例对照研究,涉及10 647名膀胱癌患者与53 588名健康对照.Meta分析有显著异质性(I2=75 %,P<0.1),合并结果为1.34[1.19,1.51].亚组分析结果显示,亚洲人与白人的合并结果无显著差异(χ2=0.65,P=0.42).漏斗图对称,无发表偏倚.结论 rs798766 C>T多态性增加膀胱癌易感性.     

Serum microRNA-21 as a potential diagnostic biomarker for breast cancer: a systematic review and meta-analysis

Serum microRNA-21 (miR-21) expression has been shown to be significantly up-regulated in breast cancer, which implies that it could be a biomarker to discriminate breast cancer patients from healthy controls. We therefore performed this meta-analysis to assess the diagnostic value of miR-21 for breast cancer. Relevant articles were collected from PubMed, Scopus, Embase, the Cochrane Library, BioMed Central, ISI Web of Knowledge, China National Knowledge Infrastructure, Wan Fang Data and Technology of Chongqing databases, from inception to June 10, 2014 by two independent researchers. Diagnostic capacity of miR-21 for breast cancer was assessed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (AUC) and Fagan’s nomogram. Meta-Disc software and Stata SE 12.0 were used to investigate the source of heterogeneity and to perform the meta-analysis. We used six studies with a total of 438 patients and 228 healthy controls in this meta-analysis. The pooled sensitivity, specificity and DOR were 0.79 [95 % confidence interval (CI) 0.66–0.87], 0.85 (95 % CI 0.75–0.91) and 19.46 (95 % CI 8.74–43.30), respectively; positive and negative likelihood ratios were 5 and 0.25, and AUC was 0.89 (95 % CI 0.86–0.91). In addition, heterogeneity was clearly apparent but was not caused by the threshold effect. This meta-analysis suggests that miR-21 is a potential biomarker for early diagnosis of breast cancer with high sensitivity and specificity, and its clinical application warrants further investigation.     

IL-6-174G／C多态性与肺癌无相关性：基于2901例肺癌患者和3234例对照的Meta分析

目的为准确评估IL-6-174G／C多态性与肺癌危险度的关系。我们采用了Meta分析的方法。通过检索Medline、EMBASE、OVID和中国生物医学数据库中至2012年12月为止发表的所有病例对照研究文献,筛选数据,计算合并的OR值和95％可信区间（95％CI）。最终纳人5篇文献,包括病例2901例,对照3234例。meta分析后发现,IL-6-174C等位基因并不能明显升高肺癌危险度（CCvs．GG：OR=1.06,95％CI=0．92-1．23;GCVS．GG：OR=1．05,95％CI=0．83～1．32;CC＋GCVS．GG：OR=1．01,95％CI=1．90-1．13;CCVS．GC＋GG：OR=1．08,95％CI=0．95～1．23）。漏斗图和Egger＇s检验没有发现发表偏倚,肺癌病理学和吸烟状态亚组分析示：IL-6-174G／C多态性与肺癌危险度无明显相关性。尽管存在一些局限,确切评估IL-6-174G／C与肺癌的危险度,有待于今后设计更好,样本量更大的研究。     

High-flexion implants in primary total knee arthroplasty: a meta-analysis

BackgroundWe asked whether a high-flexion design implant improves patient functional outcomes or range of motion (ROM) after primary knee arthroplasty.MethodsWe searched the major medical databases for randomized trials and comparison observational studies comparing high-flexion and conventional knee implants. After testing for publication bias and heterogeneity, the data were aggregated by random effect modeling. We estimated the weighted mean differences of functional outcomes scores and ROM with 95% confidence intervals.ResultsSix studies met our inclusion criteria for review. We found no evidence of publication bias. The pooled mean difference for KSS scores was 0.144 (95% CI: ? 0.018 to 0.306), p = 0.081. The pooled mean difference for the mean changes in ROM was 0.404 (95% CI: 0.139 to 0.669), p = 0.003.ConclusionHigh-flexion implant design improves overall ROM as compared to traditional implants but offers no clinical advantage over traditional implant designs in primary knee arthroplasty.     

Effect of COVID-19 vaccination on semen parameters: A systematic review and meta-analysis

The aim of this study was to investigate the effect of coronavirus disease 2019 (COVID-19) vaccination on semen parameters through systematic review and meta-analysis. PubMed, EMBASE, Web of Science, and Cochrane Library were comprehensively searched by June 2022. Studies were considered eligible if they compared semen parameters before and after COVID-19 vaccination or between vaccinated and unvaccinated men, with no restrictions on vaccine types or doses. The effect size was calculated as mean difference (MD) with 95% confidence interval (CI) using a random-effects model. Subgroup and sensitivity analyses were conducted to assess the sources of heterogeneity measured by the I² statistic, with publication bias evaluated by Egger's test. Twelve cohort studies involving 914 participants fulfilled the inclusion criteria. In a comparison of vaccinated versus unvaccinated group, the pooled data revealed no significant differences in semen volume (MD = 0.18 ml, 95% CI −0.02 to 0.38), sperm concentration (MD = 1.16 million/ml, 95% CI −1.34 to 3.66), total sperm motility (MD = −0.14%, 95% CI −2.84 to 2.56), progressive sperm motility (MD = −1.06%, 95% CI −2.88 to 0.77), total sperm count (MD = 5.92 million, 95% CI −10.22 to 22.05), total motile sperm count (MD = 2.18 million, 95% CI −1.28 to 5.63), total progressively motile sperm count (MD = −3.87 million, 95% CI −13.16 to 5.43), and sperm morphology (MD = 0.07%, 95% CI −0.84 to 0.97). The results also remained similar across messenger ribonucleic acid, viral-vector, and inactivated COVID-19 vaccines. Sensitivity analysis identified two individual studies that contributed to heterogeneity, while the effect size was not materially altered. No obvious publication bias was detected among included studies. Our finding suggested that COVID-19 vaccination had no detrimental impact on semen quality, which could be potentially helpful to reduce male vaccine hesitancy and increase vaccination coverage.