射频消融与手术切除结直肠癌肝转移的Meta分析

目的 比较射频消融（RFA）和外科肝切除术（HR）对结直肠癌肝转移的治疗效果。方法 系统检索收集了PubMed、Cochrane Library、EMBASE、中国知网、中国生物医学文献数据库等关于RFA和HR在结直肠癌肝转移的临床对照试验,按Cochrane系统评价方法进行了评价,采用Stata 12.0软件进行Meta分析。结果 最终纳入文献13篇,共2348例患者,其中 RFA 972例,HR1376例。Meta分析结果显示,RFA患者3年、5年生存率明显高于HR患者（OR：0.56,95%CI：0.38~0.83,P=0.004;OR：0.47,95%CI：0.29~0.76,P=0.002）;RFA患者手术后总复发率明显高于HR患者（OR：2.79,95%CI：1.25~6.21,P=0.012）。结论 HR较RFA治疗结直肠癌肝转移术后生存率高,复发率低,可作为临床优先考虑的治疗方法。     

Effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis

ObjectiveTo explore the effects of morphine on P2Y₁₂ platelet inhibitors in patients with acute myocardial infarction (AMI).MethodsPubMed, Embase, Cochrane Library, and Web of Science were used to retrieve literature through 11th May 2019. Standardized weighted mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI), P-value, and I² value were used to assess the strength of the association in this meta-analysis. Outcomes included platelet reactivity, high residual platelet reactivity (HRPR), ticagrelor maximum concentration (Cmax), ticagrelor area under curve (AUC), death rate, reinfarction rate, stroke, stent thrombosis, thrombolysis in myocardial infarction (TIMI) hemorrhage, dyspnea, emesis, contrast-induced nephropathy, and pulmonary edema.ResultsA total of 13 articles were included in this study, containing 5688 patients (morphine group: n = 2014, control group: n = 3674). Results illustrated that the morphine group had a higher platelet reactivity (SMD: 0.834, 95%CI: 0.483–1.186, P < 0.001) and HRPR rate (RR: 1.994, 95%CI: 1.536–2.588, P < 0.001) than the control group, while the Cmax of ticagrelor (WMD: -481.838, 95%CI: −841.242–122.434, P = 0.009) was lower than that of the control group. The death rate of the morphine group was lower than that in the control group (RR: 0.561, 95%CI: 0.337–0.933, P = 0.026). The morphine group had a higher emesis rate than the control group (RR: 4.486, 95%CI: 2.263–8.891, P < 0.001).ConclusionMorphine effectively suppresses the inhibition effect of P2Y₁₂ platelet inhibitors in patients with AMI.     

CT灌注成像预测宫颈鳞癌新辅助化疗后微小淋巴结转移

目的 探讨CT灌注成像预测宫颈鳞癌新辅助化疗后微小淋巴结转移的价值。方法 收集在我院接受新辅助化疗并手术的46例宫颈鳞癌患者,根据术后病理是否存在微小淋巴结转移（转移淋巴结短轴径<10 mm）及短期随访淋巴结转移的情况将其分为无微小淋巴结转移组（n=32）和存在微小淋巴结转移组（n=14）,比较其CT灌注参数并分析其诊断价值。结果 存在微小淋巴结转移组的肿瘤化疗前肿瘤最大直径、血流量（BF）、血容量（BV）均大于无微小淋巴结转移组（P均<0.05）;两组间化疗后肿瘤最大直径、渗透性、达峰时间（TTP）差异无统计学意义（P均>0.05）。多因素Logistic回归分析结果显示BF、化疗前肿瘤最大直径是新辅助化疗后微小淋巴结转移的独立影响因素。ROC曲线显示BF[AUC=0.86,P<0.001,95%CI（0.75,0.96）]较化疗前肿瘤最大直径[AUC=0.70,P<0.02,95%CI（0.54,0.88）]对宫颈鳞癌新辅助化疗后是否存在微小淋巴结转移具有更高的预测价值。结论 CT灌注成像对预测宫颈鳞癌新辅助化疗后微小淋巴结转移具有较高的应用价值。     

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis

BACKGROUNDPrevious studies had shown endoscopic retrograde appendicitis therapy (ERAT) is an effective treatment for acute appendicitis. However, different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy (LA).AIMTo compare the effectiveness of ERAT with LA. METHODSRandomized controlled trials (RCTs) and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed, Cochrane Library, Web of Science, Embase database, China National Knowledge Infrastructure (CNKI), the WanFang Database, and Chinese Scientific Journals Database (VIP) from the establishment date to March 1 2021. Heterogeneity was assessed using the I-squared statistic. Pooled odds ratios (OR), weighted mean difference (WMD), and standard mean difference (SMD), with 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Sensitivity analysis was also performed. Publication bias was tested by Egger''s test, and Begg’s test. The quality of included RCT were evaluated by the Jadad scale, while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies. All statistical analysis was performed using Stata 15.1 statistical software. All statistical analysis was performed using Stata 15.1 statistical software. This study is registered with PROSPERO, CRD42021243955. RESULTSAfter screening, 10 RCTs and 2 case-control studies were included in the current systematic review. Firstly, the length of hospitalizations [WMD = -1.15, 95%CI: -1.99, -0.31; P = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); P = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); P < 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); P < 0.001; P < 0.001] in ERAT group was significantly lower than LA group. Thirdly, ERAT group had a lower incidence of intestinal obstruction than LA group. [OR = 0.19, 95%CI: (0.05, 0.79); P = 0.020]. Moreover, the quality of 10 RCTs were low with 0-3 Jadad scores, while the methodological quality of two case-control studies were fair with a score of 2 (each). CONCLUSIONCompared with LA, ERAT reduces operation time, the level of postoperative inflammation, and results in fewer complications and shorter recovery time, with preserving the appendix and its immune and biological functions.     

同时性结直肠癌肝转移瘤消融治疗后辅助化疗起始时间对患者预后的影响

目的本研究以探究微波消融（MWA）治疗后辅助化疗（AC）起始时间对同时性结直肠癌肝转移瘤（CRLM）患者肝内无复发生存（RFS）及肝损害的影响。 方法回顾性分析2013年10月至2019年1月在中山大学附属第六医院确诊为同时性CRLM且行超声引导下经皮MWA治疗联合AC治疗的患者。本研究共纳入患者144例,其中G1组98例,G2组46例。中位肝内RFS为22.2个月。根据MWA术后AC开始时间,将患者分为≤4周（G1）和4~8周（G2）2组。比较G1组和G2组消融后及第1次AC前后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平的变化。采用Kaplan-Meier法和Log-rank检验计算并比较两组患者的肝内RFS。采用Cox比例风险模型对肝内RFS的危险因素进行单因素和多因素回归分析。 结果G1组肝内RFS较G2组显著延长（中位肝内RFS,40.6个月 vs 12.6个月,Log-rank P=0.007）。采用Cox比例风险模型分析结果发现,辅助化疗开始时间间隔为4~8周（HR=1.917,95%CI：1.104~3.327,P=0.021）和肝转移瘤个数（HR=1.292,95%CI：1.096~1.524,P=0.002）是肝内RFS时间短的独立影响因素。G1组和G2组第1次AC前、后ALT、AST水平,差异均无统计学意义（P均>0.05）。 结论对于同时性CRLM患者,在MWA治疗后早期开始AC（≤4周）有助于延长术后肝内RFS时间。     

Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion

BACKGROUNDFor advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.AIMTo evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.METHODSA total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.RESULTSThere were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103–0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024–6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102–0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334–9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163–0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion. CONCLUSIONCurative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.     

Risk factors for postoperative delayed gastric emptying in ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BACKGROUNDCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has shown promising results in improving the survival of ovarian cancer patients. Although the safety profiles of CRS-HIPEC exist, more attention should be paid to gastrointestinal complications, as the procedure involves a considerable proportion of bowel resection and anastomosis.AIMTo identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODSA cross-sectional study was conducted. According to the inclusion and exclusion criteria, we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRS-HIPEC in Beijing Shijitan Hospital of Capital Medical University. Risk factors for delayed gastric emptying were analyzed using univariate analysis. All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTSAmong the 77 included patients, 36.4% (28/77) had delayed gastric emptying after CRS-HIPEC. The median age and body mass index of all patients were 59 years and 22.83 kg/m², respectively. Preoperative chemotherapy was administered in 55 patients (71%). Sixty-two patients (81%) had a history of at least one previous pelvic surgery. The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL, respectively. Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence. The median peritoneal cancer index was 16. The risk factors for delayed gastric emptying from the univariate analysis were body mass index < 23 kg/m² (X² = 5.059, P = 0.025), history of pelvic surgery (X² = 4.498, P = 0.034), history of chemotherapy (X² = 4.334, P = 0.037), operation time ≥ 7 h (X² = 4.827, P = 0.047), and intraoperative hemorrhage ≥ 800 mL (X² = 7.112, P = 0.008). Multivariable analysis revealed that age ≥ 70 years (HR = 7.127; 95%CI 1.122-45.264; P = 0.037) and intraoperative hemorrhage ≥ 800 mL (HR = 3.416; 95%CI 1.067-10.939; P = 0.039) were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.CONCLUSIONPostoperative gastrointestinal management, including prolonged nasogastric intubation, should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.     

Risk of incident bleeding after acute kidney injury: A retrospective cohort study

PurposeEnd-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding.MethodsSingle-center retrospective cohort study, excluding readmissions, admissions <24 h, ESKD or kidney transplants. The primary outcome was the development of incident bleeding analyzed by multivariate time-dependent Cox models.ResultsIn 1001 patients, bleeding occurred in 48% of AKI and 57% of non-AKI patients (p = .007). To identify predictors of incident bleeding, we excluded patients who bled before ICU (n = 488). In bleeding-free patients (n = 513), we observed a trend toward higher risks of bleeding in AKI (22% vs. 16%, p = .06), and a higher risk of bleeding in AKI-requiring dialysis (38% vs. 17%, p = .01). Cirrhosis, AKI-requiring dialysis, anticoagulation, and coronary artery disease were associated with bleeding (HR 3.67, 95%CI:1.33–10.25; HR 2.82, 95%CI:1.26–6.32; HR 2.34, 95%CI:1.45–3.80; and HR 1.84, 95%CI:1.06–3.20, respectively), while SOFA score and sepsis had a protective association (HR 0.92 95%CI:0.84–0.99 and HR 0.55, 95%CI:0.34–0.91, respectively). Incident bleeding was not associated with mortality.ConclusionsAKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.     

MRI增强早期及晚期全肿瘤直方图分析诊断肿块型乳腺癌新辅助化疗后残余癌

目的 探讨MR增强早期及晚期全肿瘤直方图分析诊断肿块型乳腺癌新辅助化疗（NAC）后残余癌的价值。方法 选取肿块型乳腺癌患者52例，于NAC后行MR增强扫描，在增强早期减影图像上确定是否存在残余强化灶，并勾画全肿瘤ROI。根据病理结果，将原肿瘤部位存在强化灶者分为残余癌组（n=29）和非残余癌组（n=9），比较2组间直方图参数，分析残余癌的影响因素，以ROC曲线分析直方图参数诊断残余癌的效能。结果 残余癌组与非残余癌组间残余强化灶体积、增强早期信号强度最大值（Mx）、增强晚期峰度值差异均有统计学意义（P均<0.05）。Logistic回归分析结果显示，增强晚期峰度值是残余癌的独立影响因素。将增强晚期峰度值（界值为2.25）作为影像学诊断残余癌的标准，其诊断特异度为76.19%（16/21），敏感度90.32%（28/31），准确率84.62%（44/52）。结论 MR增强早期及晚期全肿瘤直方图分析能够反映肿块型乳腺癌病灶内部信号分布；增强晚期峰度值可用于诊断NAC后残余癌。     

Genetic mutations associated with sensitivity to neoadjuvant chemotherapy in metastatic colon cancer: A case report and review of literature

BACKGROUNDColorectal liver metastases (CLM) occur in 15%-30% of patients with colorectal cancer (CRC). Advancements in next generation sequencing (NGS) can provide more precise prognoses for cancer patients and help guide clinical treatment. However, the genetic variants that predict high sensitivity to neoadjuvant chemotherapy remain unclear, especially in patients with CLM. The aim of this study was to identify the relevant genetic variants in a single CLM patient and to summarize the current evidence on mutations and single nucleotide polymorphisms (SNPs) that objectively predict sensitivity to neoadjuvant chemotherapy.CASE SUMMARYA 76-year-old male patient, who was diagnosed as stage IV colon cancer with liver metastases, was found to have APC/TP53/KRAS mutations. He showed a good therapeutic response to 12 courses of oxaliplatin regimens combined with Bevacizumab. Genetic analysis of the patient identified 5 genes with 7 detected SNPs that may be related to a better response to chemotherapy drugs. In addition, a critical literature review was performed based on a standardized appraisal form after selecting the articles. Ultimately, 21 eligible studies were appraised to assess the association between gene mutations and good prognosis. Mutations in KRAS, TP53, SMAD4, and APC were identified as being associated with a poor response to chemotherapy drugs, whereas mutations of CREBBP and POLD1 were associated with longer overall survival.CONCLUSIONNGS can identify precise predictors of response to neoadjuvant chemotherapy, leading to improved outcomes for CRC patients.     

Clinical significance of breast cancer susceptibility gene 1 expression in resected non-small cell lung cancer: A meta-analysis

BACKGROUNDThe clinical significance of breast cancer susceptibility gene 1 (BRCA1) in non-small cell lung cancer (NSCLC) patients undergoing surgery remains unclear up to now.AIMTo explore the relation of BRCA1 expression with clinicopathological characteristics and survival in patients with resected NSCLC. METHODSEMBASE, PubMed, Web of Science, and The Cochrane Library databases were searched to identify the relevant articles. To assess the correlation between the expression of BRCA1 and clinicopathological characteristics and prognosis of patients with resected NSCLC patients, the combined relative risks or hazard ratios (HRs) with their corresponding 95% confidence intervals [CIs] were estimated. RESULTSTotally, 11 articles involving 1041 patients were included in the meta-analysis. The results indicated that the expression of BRCA1 was significantly correlated with prognosis of resected NSCLC. Positive BRCA1 expression signified a shorter overall survival (HR = 1.60, 95%CI: 1.25-2.05; P < 0.001) and disease-free survival (HR = 1.78, 95%CI: 1.42-2.23; P < 0.001). However, no significant association of BRCA1 expression with any clinicopathological parameters was observed.CONCLUSIONBRCA1 expression indicates a poor prognosis in resected NSCLC patients. BRCA1 might serve as an independent biomarker to predict clinical outcomes and help to customize optimal adjuvant chemotherapy for NSCLC patients who had received surgical therapy.     

Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection

BACKGROUNDControversy exists about the benefit of additional surgery after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).AIMTo examine risk factors for overall survival (OS) after additional surgery in patients with EGC who initially underwent ESD.METHODSThis was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019. OS was the primary outcome. Lymph node metastasis and residual tumor were secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis. RESULTSForty-two patients were evaluated, including 35 (83.3%) males and 7(16.7%) females. The mean age was 62 (range, 32-82) years. Male sex [hazard ratio (HR) = 21.906, 95% confidence interval (CI): 3.762-229.250; P = 0.039), T1b invasion (HR = 3.965, 95%CI: 1.109-17.432; P = 0.047), undifferentiated tumor (HR = 9.455, 95%CI: 0.946-29.482; P = 0.049), lymph node metastasis (HR = 2.126, 95%CI: 0.002-13.266; P = 0.031), and residual tumor (HR = 4.275, 95%CI: 1.049-27.420; P = 0.043) were independently associated with OS. The follow-up duration was 4-81 mo (median: 50.7 mo). OS was 77.0 ± 12.1 mo (95%CI: 53.3-100.7 mo). The 3-year and 5-year OS rates were 94.1% and 85%, respectively.CONCLUSIONMale sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor are independently associated with OS in patients with EGC who underwent additional surgery after ESD.     

The Beneficial Effects of Mind-Body Exercises for People With Mild Cognitive Impairment: a Systematic Review With Meta-analysis

ObjectiveTo objectively evaluate the most common forms of mind-body exercise (MBE) (tai chi, yoga, qigong) on cognitive function among people with mild cognitive impairment (MCI).Data SourcesWe searched 6 electronic databases (Scopus, PubMed, PsycINFO, WanFang, Web of Science, CNKI) from inception until September 2018.Study SelectionNine randomized controlled trials and 3 nonrandomized controlled trials were included for meta-analysis.Data ExtractionTwo researchers independently performed the literature searches, study selection, data extraction, and methodological quality assessment using the revised Physiotherapy Evidence Database (PEDro) scale.Data SynthesisThe pooled effect size (standardized mean difference [SMD]) was calculated while random-effect model was selected. Overall results of the meta-analysis (N=1298 people with MCI) indicated that MBE significantly improved attention (SMD=0.39, 95% confidence interval [CI] 0.07-0.71, P=.02, I²=31.6%, n=245), short-term memory (SMD=0.74, 95% CI 0.57-0.90, P<.001, I²=0%, n=861), executive function (SMD=-0.42, 95% CI -0.63 to -0.21, P<.001, I²=38.54%, n=701), visual-spatial/executive function (SMD=0.35, 95% CI 0.07-0.64, P<.05, I²=0%, n=285), and global cognitive function (SMD=0.36, 95% CI 0.2-0.52, P<.001, I²=15.12%, n=902). However, the significant positive effect on cognitive processing speed was not observed following MBE interventions (SMD=0.31, 95% CI -0.01 to 0.63, P=.054, I²=28.66%, n=233).ConclusionsStudy findings of this meta-analysis suggest that MBE have the potential to improve various cognitive functions in people with MCI.     

Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials

AimPresent review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients.MethodWe searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3.Results20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = –2.00, 95 % Confidence Interval (CI) = –3.21 to –0.79), massage (4 RCTs, SMD= –1.84, 95 % CI= –2.77 to –0.91), hypnosis (2 RCTs, SMD= −1.06, 95 % CI= −2.90 to 0.78), relaxation (2 RCTs, SMD= −0.77, 95 %CI= −1.52 to −0.02), transcranial direct current stimulation (1 RCT, SMD= −1.92, 95 %CI= −2.54 to −1.30), and therapeutic touch practices (1 RCT, SMD=−0.45 95 %CI= −0.86 to −0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues.ConclusionDue to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.     

VR exergame interventions among older adults living in long-term care facilities: A systematic review with Meta-analysis

BackgroundTo improve the motivation toward exercise in older adults, exergames have shifted from entertainment to rehabilitation.ObjectivesTo review the training focus of exergames and analyze the effectiveness of exergame training on physical, psychological, or cognitive outcomes among older adults in long-term care facilities (LTCFs).MethodsThis review followed the PRISMA guidelines. By searching 7 electronic databases up to April 30, 2022, studies were included if they 1) involved adults ≥65 years old residing in LTCFs, 2) were randomized controlled trials (RCTs) with virtual reality-based exergames as the intervention, 3) compared the effects of exergames to usual care or conventional exercises, and 4) reported physical, psychological, or cognitive outcomes. The Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to evaluate the methodological quality of studies and levels of evidence for outcomes. The meta-analysis was conducted with Review Manager 5.4. Results are presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA total of 12 RCTs were included in the systematic review and meta-analysis. For overall methodological quality, 10 studies showed some concerns and 2 studies showed high risk. Levels of evidence for outcomes were assessed as low (n = 8) and very low (n = 4). The studies involved a total of 482 older adults. Most studies implemented balance exercise as the exergame intervention. Older adults who completed exergame interventions showed improvements in cognitive outcomes (SMD 0.90, 95%CI 0.61–1.19, p<0.001) and in balance self-efficacy (SMD 1.04, 95%CI 0.47–1.61, p<0.001) as compared with those in usual care. They also showed improvements in balance (SMD 0.49, 95%CI 0.20–0.78, p<0.001) as compared with those in conventional exercise programs. Overall, exergames had a positive effect on balance (SMD 0.62, 95%CI 0.29–0.95, p<0.001).ConclusionThis review revealed that exergames can improve the balance ability of older adults in LTCFs.     

Systematic review and meta-analysis of Chinese herbal medicine as adjuvant treatment in advanced non-small cell lung cancer patients

IntroductionWhether combining Chinese herbal medicines (CHMs) and chemotherapy to treat patients with advanced non-small-cell lung cancer (NSCLC) has clinical benefits has yet to be confirmed. A meta-analysis was performed to address the efficacy of CHM in patients with advanced NSCLC.MethodsSeven databases, including PubMed, MEDLINE, Cochrane Library, Embase, CINAHL Plus with Full Text (EBSCO), WANFANG DATA and the Chinese National Knowledge Infrastructure (CNKI), were systematically searched for available literature through March10, 2020. A meta-analysis was conducted to generate combined risk ratios(RRs) with 95 % confidence intervals (CIs) for objective response rates (ORRs), disease control rates (DCRs), and 1-year overall survival (OS) rates, and a random-effects model was used to estimate the standardized mean differences (SMDs) with 95 % CI for quality or life (QOL), median survival time (mST) and progression-free survival (PFS).ResultsReports of 14 randomized controlled trials involving 1451 patients were included in the analysis. Among them, 739 patients received CHMs, and 712 patients received chemotherapy alone. The ORR (RR = 1.37, 95 % CI [1.20‐1.58], p = .000), DCR (RR = 1.13, 95 % CI [1.07‐1.21], p = 0.000), QOL (SMD = 1.47; 95 % CI [0.30–2.64]; p = 0.014), mST (SMD = 1.62; 95 % CI [1.15‐2.08];p = .000), and 1-year OS rate (RR = 1.24, 95 % CI [1.05‐1.47], p = 0.01) were higher in patients with NSCLC who received CHMs than in those who received only chemotherapy. However, the CHM group was not found to have a higher median PFS (SMD = 1.27, 95 % CI [-0.22‐2.78], p = .095) than the chemotherapy group. Publication bias for ORR and DCR was indicated by funnel plot. For the efficacy endpoint, no evidence of a lack of robustness was found, according to the sensitivity analysis. These results must be interpreted with caution due to differences in the designs of the trials and patients’ characteristics, and also due to the presence of missing data.ConclusionsOur study found that higher ORR, DCR, QOL, mST and 1-year OS rate were associated with CHM use as an adjuvant to chemotherapy. Although these results require further confirmation, CHMs apparently have potential therapeutic value for patients with advanced NSCLC.     

The effect of virtual reality training on the daily participation of patients: A meta-analysis

BackgroundVirtual reality (VR) training are regarded as promising new tools for rehabilitation, but the effect on patients' daily participation is controversial. This study aimed to evaluate the effect of virtual reality (VR) training on different types of patients' daily participation through a meta-analysis.MethodsThe PubMed, Cochrane central register of controlled trials, Embase, and web science databases were searched for studies published through September 2020. Thirty-five randomized controlled trials of virtual reality (VR) training compared with conventional treatment, Other electronic rehabilitation systems, usual care for various types of patients were included. All of the studies were available in English. Standardized mean differences (SMD), 95 % confidence intervals (CI), publication bias, and heterogeneity were calculated.ResultsThe Virtual reality (VR) training group is better than the control group in daily participation improvement on all types of patients. There was a small, significant effect(p＜0.001; SMD = 0.25[95 %CI,0.14 to 0.36], I² = 0.00 %). Observing only the type of Stroke, the VR training group is still better than the control group in improving patients' daily participation (p＜0.001, SMD = 0.24[95 %CI, 0.11 to 0.37], I2 = 0.00 %). Using the cumulative Meta-analysis method to observe the included literature according to the timeline, Using the cumulative Meta-analysis method to observe the included literature according to the timeline, and it has only achieved positive results since 2015 (Nam-YoNg Lee 2015, p = 0.048, SMD = 0.22[95 %CI,0.00 to 0.44]). The heterogeneity of the studies was not detected, but there is obvious publication bias.ConclusionsBecause of controversy over obvious publication bias, we need to be cautious about the conclusion that VR is better than the control group in promoting the patient's daily participation.     

激光汽化术与前列腺电切术治疗良性前列腺增生疗效的Meta分析

目的系统评价经尿道980nm激光汽化术与前列腺电切术(TURP)治疗良性前列腺增生(BPH)的疗效。方法收集国内外关于经尿道980nm激光汽化术与TURP治疗BPH的文献,采用Revman5.3软件进行Meta分析。结果筛选后共6篇文献符合纳入标准,总计839例,其中包括980nm激光治疗组450例和TURP组389例。Meta结果显示:和TURP组相比,980nm激光组手术时间差异无统计学意义[标准化均数差(SMD)=0.11,95%CI(-0.52,0.74),P0.05],住院时间较短[SMD=-1.95,95%CI(-3.42,-0.48),P0.05]及术后尿管留置时间较短[SMD=-2.64,95%CI(-3.92,-1.36),P0.05]。980 nm激光组和TURP组在术后国际前列腺症状评分(IPSS)差异无统计学意义[加权均数差(WMD)=0.12,95%CI(-0.27,0.51),P0.05],术后生活质量评分(QOL)评分差异无统计学意义[SMD=0.00,95%CI(-0.57,0.57),P0.05],术后最大尿流率(Qmax)差异无统计学意义[SMD=0.06,95%CI(-0.26,0.37),P0.05]。结论 980nm激光治疗良性BPH与经典的TURP术式相比,在住院时间和术后尿管留置时间方面有优势,远期效果无明显差异。     

Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older adults

BackgroundMigraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine.MethodsThis retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD.ResultsAmong patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07–1.35) for ischemic stroke and 1.02 (95%CI, 0.93–1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20–1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67–0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17–1.39) and 0.99 (0.93–1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07–1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72–0.95]), each versus those without migraine.ConclusionsOlder adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01338-z.     

Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice

BACKGROUNDMalignant obstructive jaundice is mainly caused by cholangiocarcinoma. Only a few patients are indicated for surgical resection, and the 3-year survival rate is < 50%. For patients who are not eligible for surgery, biliary stent placement can relieve biliary obstruction and improve liver function and quality of life. However, restenosis after biliary stents has a poor prognosis and is a clinical challenge. Biliary stent combined with iodine-125 (¹²⁵I) seed implantation can prolong stent patency and improve survival.AIMTo evaluate the safety and efficacy of biliary stent combined with ¹²⁵I seed strand implantation in malignant obstructive jaundice. METHODSWe enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with ¹²⁵I seed strand treatment (combined) group (n = 32) and biliary stent (control) group (n = 35). All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers. Twelve patients underwent pathological examination before surgery. All patients were followed up by telephone or clinical visit. Postoperative liver function improvement, postoperative complications, stent patency time, and survival time were compared between the two groups. Prognostic risk factors were evaluated. RESULTSTechnical success was achieved in all patients in both groups. Postoperative liver function improved significantly in all patients (total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase decreased significantly in all patients, the P values were less than 0.05). There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin (P = 0.147), direct bilirubin (P = 0.448), alanine aminotransferase (P = 0.120), and aspartate aminotransferase (P = 0.387) between the two groups. The median stent patency time of the combined group was 9.0 ± 1.4 mo [95% confidence interval (CI): 6.3-11.8 mo], which was significantly longer than the that of the control group (6.0 ± 0.3 mo, 95%CI: 5.5-6.5 mo, P = 0.000). The median survival time of the combined group was 11.0 ± 1.4 mo (95%CI: 8.2-13.7 mo), which was significantly longer than that of the control group (7.0 ± 0.3 mo, 95%CI: 6.4-7.6 mo, P = 0.000). Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSIONBiliary stent combined with ¹²⁵I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.