非穿透性小梁手术治疗开角型青光眼的Meta分析

目的：对非穿透性小梁手术治疗开角型青光眼的疗效进行Meta分析。方法：检索MEDLINE和中国生物医学文献数据库，获得以往发表的相关论文。根据临床和统计标准进行合并分析，评价非穿透性小梁手术的降压效果。结果：总计有26篇文献纳入Meta分析。无需降压药物治疗而术后眼压控制良好患者的合并百分率：单纯深层巩膜切除术为71．3％[95％CI为56．2％～86．5％]，深层巩膜切除术联合胶原植入物为58．5％[95％CI为47．8％～69．2％]，深层巩膜切除术联合交键透明质酸植入物为62．0%[95％CI为51．0％～73．0％]，粘性小管切除术为69．7％[95%CI为50．5％～88．9％]。非穿透性小梁手术和小梁切除术的合并危险差为2％[95％CI为-8％0～12％]。结论：非穿透性小梁手术是药物难以控制的开角型青光眼的一种很好的治疗措施，治疗成功率超过60％，眼压控制效果和标准小梁切除术近似。但联合植入物的应用并没有显著改善治疗效果的意义。     

非穿透性青光眼手术治疗开角型青光眼有效性的系统评价

目的 评估非穿透性青光眼手术（NPGS）治疗开角型青光眼患者的降眼压（IOP）效果。方法 全面收集评价NPGS治疗原发性/继发性开角型青光眼的随机对照试验,进行系统评价。主要疗效指标包括IOP下降百分比和IOP达标率。应用多功能meta分析软件2.0版的随机效应模型进行汇总分析,计算合并评价量。结果 术后2年,与小梁切除术（TE）相比,深层巩膜切开术（DS）、黏小管切开术（VCO）的降眼压作用均相对较低,IOP下降百分比分别为35.2%（DS）、30.2%（VCO）、45.6%（TE）。术中加用植入物及丝裂霉素C（MMC）均可提高DS的降眼压作用,术后2年的IOP下降百分比分别为41.1%和41.7%。术后4年,DS、VCO、TE的IOP达标率分别为35.4%、22.7%、47.6%;DS加用植入物和MMC的IOP达标率分别为64.6%、52.1%,高于单纯DS。NPGS并发症的发生率较TE低。结论 常用的NPGS（DS和VCO）能有效降低眼压,并发症也比TE少,但是NPGS的降眼压作用要比TE为低。术中加用植入物、MMC可提高DS的降眼压作用。     

Meta analysis of non-penetrating trabecular surgery versus trabeculectomy for the treatment of open angle glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration’s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P<0.00001). There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92, P<0.00001). Difference in the success rate was also found between the two surgeries (Z=3.82, P=0.0001). It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.     

非穿透小梁手术联合羊膜植入临床观察

目的 :探讨非穿透小梁手术联合羊膜植入治疗开角型青光眼的机理及临床效果。方法 :对 2 0例2 4眼开角型青光眼患者行非穿透性小梁手术 ,术中植入羊膜 ,并对术后视力、眼压、滤过泡情况、羊膜植片及手术并发症进行观察。结果 :2 0例、2 4眼术后眼压均控制在 2 1mmHg以下 ,视力提高 12眼 ,不变 12眼 ,所有病例均形成功能性滤过泡 ,术后炎症反应轻 ,并发症少。结论 :非穿透小梁手术联合羊膜植入是一种安全有效的抗青光眼手术。     

Nonpenetrating very deep sclerectomy with reticulated hyaluronic acid implant in glaucoma treatment

BACKGROUND: The purpose of our study was to assess intraocular pressure control (IOP) and postoperative complications in nonpenetrating very deep sclerectomy (NPVDS) with reticulated hyaluronic acid implant (SKGEL) and Mitomycin C (MMC). MATERIAL/METHODS: Fifty eyes from fifty patients with medically uncontrolled glaucoma were randomized to either the NPVDS or NPDS group. The NPVDS procedure was similar to traditional NPDS (control group); however, excision of sclera and exposure of ciliary body were also performed, and only a narrow scleral flap was retained at a distance of 0.5 mm from Schlemm's canal. Mitomycin-C 0.2 mg/ml was applied on and under the superficial flap of the sclera during both NPVDS and NPDS. Follow-up examinations were carried out at 1 week, and then at 1, 3, 6, and 12 months after surgery. Success was defined as IOP <22 mmHg with or without glaucoma medication and laser procedures. RESULTS: The 12-month success rate in the NPVDS group was 96%, not significantly higher than in the control group (88%, p=0.88). There was no statistically significant difference in IOP between the NPVDS (15.9+/-2.5 mmHg) and NPDS (16.3+/-3.6 mmHg) groups (p=0.57). Complications included four cases of hyphema, three of choroidal detachment (myopic eyes), and one of filtering bleb fibrosis in the NPVDS group, and three cases of hyphema, two of choroidal detachment (myopic eyes), and three of filtering bleb fibrosis in the NPDS group. CONCLUSIONS: NPVDS is an effective surgical modality for patients with glaucoma. The safety of NPVDS is comparable to that of NPDS.     

非穿透性小梁切除加羊膜移植治疗开角型青光眼

目的 :探讨非穿透性小梁切除术术中加羊膜移植治疗开角型青光眼的机理及疗效。方法 :为 10例、12眼开角型青光眼行非穿透性小梁切除术联合术中巩膜瓣下植入羊膜 ,术后观察视力、眼压、滤过泡、眼内反应及并发症 ,随访 3～ 5个月。结果 :术后炎症反应轻 ,眼压控制良好 ,术后眼压为 14～ 19mmHg ,术后并发症少。结论 :非穿透性小梁切除术能安全、有效地降低眼压 ,是治疗开角性青光眼有效的手术方法。     

Efficacy and tolerability of one-site versus two-site phaco- trabeculectomy: a meta-analysis of randomized controlled clinical trials

Background Phacotrabeculectomy can be performed using one-site or two-site incisions.This meta-analysis evaluated the efficacy and tolerability of one-site versus two-site phacotrabecuiectomy in the treatment of patients with coexisting cataract and glaucoma.Methods A comprehensive literature search was performed according to the Cochrane Collaboration methodology toidentify randomized controlled clinical trials comparing one-site with two-site phacotrabeculectomy.Studies meeting our predefined criteria were included in the meta-analysis.Efficacy estimates were measured by weighted mean difference （WMD） for the percentage intraocular pressure （IOP） reduction from baseline to end point, relative risk （RR） for the proportion of patients with a best-corrected visual acuity （BCVA） of 0.5 or better after surgery and complete success rates.Tolerability estimates were measured by RR for adverse events.All of outcomes were reported with 95% confidence interval （95% CI）.Data were synthesised by Stata 10.1 for Windows.Results Two-site phacotrabeculectomy was associated with greater reductions in IOP than the one-site procedure （WMD： -5.99, 95% CI： -10.74-1.24, P=0.01）.A greater proportion of patients also achieved a BCVA of 0.5 or better （RR：0.91, 95% CI： 0.74-1.12, P=0.36） and the target IOP without anti-glaucoma medication at the study end point （RR： 0.94,95% CI： 0.83-1.07, P=0.34） after two-site than one-site phacotrabeculectomy, but the differences were not significant.There were no significant differences in adverse events between two surgical procedures.Conclusions Two-site phacotrabeculectomy is superior to one-site phacotrabeculectomy in reducing IOP, but other post-operative effects are similar.One-site and two-site phacotrabeculectomies have similar adverse event rates.     

深层巩膜咬切术后浅前房原因探讨

目的：分析深层巩膜咬切术后浅前房发生的原因。方法：对不同类型青光眼38例43眼深层巩膜咬切术进行回顾性总结与分析。结果：43眼中有28眼发生浅前房，发生率为65.12%，其中脉络膜脱离6眼，咬切口过大9眼，结膜切口渗漏3眼，恶性青光眼2眼，不明原因8眼。结论：深层巩膜咬切术后浅前房发生主要原因为睫状体、脉络膜脱离以及咬切口过大。如手术中避免这些因素，其仍是一种简单易行、行之有效的抗青光眼手术。     

中国2004—2010艾滋病母婴传播率及母婴阻断药物应用状况的系统评价

目的:了解我国2004-2010年艾滋病母婴传播及母婴阻断药物应用状况。方法：全面检索CBM和Pubmed等中英文数据库,检索时间均从建库到2013年5月。对纳入的文献采用参照AHRQ横断面研究评价标准和STROBE声明拟定的四条标准进行质量评价。并将样本量、监测地点和监测年份作为主要异质性来源进行meta回归分析。采用Comprehensive Meta-Analysis V2.0 software 进行meta分析。结果：共检索到文献2356篇,最终纳入51篇进行分析。2004-2010年我国艾滋病母婴传播率依次分别为12.90%（95% CI: 7.48 %- 21.36%）,16.35%（95% CI: 10.41%- 24.73%）,6.45%（95% CI: 3.73 %- 10.93%）,6.25%（95% CI: 2.39%- 15.36%）,5.56%（95% CI: 2.79 %- 10.76%）,3.10%（95% CI: 1.59 %- 5.97%）,2.29%（95% CI: 1.36 %- 3.83%）。2004-2010年,我国艾滋病孕产妇中阻断药物应用率依次分别为70.39%（95% CI: 24.42%-94.59%）,71.99%（95% CI: 61.49%-80.54%）,78.79%（95% CI: 70.19%-85.43%）,86.84%（95% CI: 79.24%-91.94%）,82.71%（95% CI: 76.62%-87.48%）,81.85%（95% CI: 75.55%-86.80%）,86.16%（95% CI: 53.20%-97.15%）。2005-2010年婴儿阻断药物应用率依次分别为80.72%（95%CI: 72.89%-86.70%）,81.84%（95% CI:71.55%-88.98%）,85.43%（95% CI:80.99%-88.97%）,89.75%（95% CI: 81.82%-94.45%）,92.39%（95% CI: 84.97%-96.31%）,90.34%（95% CI: 85.50%-93.68%）。 结论：近年来我国艾滋病母婴传播率呈下降趋势,孕产妇及婴儿阻断药物应用率都有所升高。     

18F-FDG PET和99Tcm-MDP骨扫描对乳腺癌骨转移诊断价值的Meta分析

 目的 应用Meta分析方法评价氟脱氧葡萄糖正电子发射断层扫描（18F-fluorode oxyglucose positron emission tomography,18F-FDG PET）和亚甲基二膦酸盐(technetium-99m methylene diphosphonate,99Tcm-MDP)骨扫描诊断乳腺癌骨转移的诊断价值。方法 检索PubMed（1966—2011.5）、EMBASE（1974—2011.5）、Cochrane 图书馆（1993—2011.5）及中国生物医学文献数据库（CBM,1978—2011.5）、中国期刊全文数据库（CNKI,1994—2011.5）、中文科技期刊数据库（VIP,1989—2011.5）、万方数字化期刊群（1982—2011.5）等数据库,并追溯纳入文献的参考文献,依据纳入排除标准筛选文献,按照QUADAS评价纳入研究的质量并提取数据,利用Meta-disc 1.4和RevMan 5.0进行统计分析,计算合并敏感度、特异度、诊断比值比及其95%可信区间（95%CI）和SROC曲线下面积（AUC）。结果 共纳入6个研究（222例患者/1349个病灶）,Meta分析结果显示：与手术、病理相比,(1)基于患者,18F-FDG PET的合并敏感度、特异度及其95%CI、AUC分别为84.6%（75.5%~91.3%）,93.9%（88.3%~97.3%）,0.965 1;骨扫描的合并敏感度、特异度及其95%CI、AUC分别为80.2%（70.6%~87.8%）,85.5%（78.3%~91.0%）,0.887 8;(2)基于病灶,18F-FDG PET的合并敏感度、特异度及其95%CI、AUC分别为53.7%（48.8%~58.5%）,99.2%（98.5%~99.7%）,0.957 1;骨扫描的合并敏感度、特异度及其95%CI、AUC分别为87.9%（84.4%~90.8%）,96.0%（94.5%~97.2%）,0.944 9。结论 当前证据提示,99Tcm-MDP骨扫描可以作为乳腺癌患者骨转移筛查的首选方法,而当MDP显像呈不典型骨病变且临床怀疑骨转移时,可考虑行PET显像确诊。     

定量CT对骨质疏松症诊断价值的meta分析

目的 对定量CT在骨质疏松症中的诊断价值进行meta分析。方法 按照循证医学诊断meta分析的相关原则,对PubMed、Google学术、中国知网、百度学术中定量CT诊断骨质疏松症的相关文献进行检索,时间与语言不限。对筛选出的文献分别进行双变量混合效应及层次综合受试者工作曲线模型分析,并对其异质性进行分析。结果 共筛选出13篇文献,15组研究,两种分析方法均表明纳入文献的总敏感性为0.84(95% CI: 0.68～0.93),总特异性为0.78(95% CI: 0.66～0.87),SROC曲线下面积为0.88(95% CI: 0.84～0.90),表明该诊断方法具有较高的诊断价值。结论 定量CT骨质疏松症的筛查中具有较高的价值,在疾病的确诊中尚需要结合其他临床资料进行综合诊断。     

板层巩膜切除联合穿透性小梁切除术治疗闭角型青光眼

目的：探讨板层巩膜切除联合穿透性小梁切除术治疗闭角型青光眼的疗效。方法：将诊断为闭角型青光眼的患者分为研究组和对照组。研究组采用板层巩膜切除联合穿透性小梁切除术；对照组采用深层巩膜咬切术。观察二组之间在术后浅前房、脉络膜脱离发生率、术后复发率等方面，并进行统计学处理。结果：二组间在术后浅前房、脉络膜脱离发生率，术后复发率均有显著差异。P＜0．05或P＜0．01。结论：板层巩膜切除联合穿透性小梁切除术治疗闭角型青光眼是一种行之有效的方法。     

替诺福韦酯与恩替卡韦治疗慢性乙型肝炎肾安全性Meta分析

目的:通过系统综述和Meta分析比较替诺福韦酯（TDF）与恩替卡韦（ETV）治疗慢性乙型肝炎（CHB）时,对肾功能包括肾小球滤过率（eGFR）、血肌酐(creatinine)、血磷酸盐（phosphate）的影响。方法:计算机检索PubMed、EMbase、Springer、Cochrane Library、中国期刊全文数据库、万方数据库2018年6月之前的有关TDF和ETV治疗CHB患者相关文献。按照NOS评分标准,评价纳入文章质量,采用Stata12.0进行Meta分析。结果:共纳入相关文献9篇,包括2 346例患者。Meta分析结果显示TDF和ETV在治疗CHB患者24月时,eGFR、血肌酐、血磷的SMD分别为-0.07（95%CI:-0.31~0.16）,-0.15（95%CI:-0.46~0.17）,-0.37（95%CI:-0.66~-0.08）,组间效应24月时eGFR、血肌酐、血磷的影响分别是（t=2.48,P=0.056）,（t=-1.98,P=0.105）,（t=1.41,P=0.252）。结论:TDF和ETV在CHB患者治疗时,均影响肾功能,对eGFR、血肌酐、血磷的影响均无显著性差异。TDF和ETV治疗慢性乙型肝炎患者的肾安全有相似性。     

直肠内超声检查诊断直肠癌准确度的Meta分析

目的评估直肠内超声检查对于直肠癌患者肿瘤侵犯直肠壁和淋巴结转移的的诊断效能。方法利用Meta分析的方法综合评价国内外公开发表的有关于直肠内超声检查诊断直肠癌准确性的文献。结果筛选出符合纳入标准和排除标准的文献11篇研究,964名患者被纳入。分成2个亚组分别做了Meta分析,一组是关于肿瘤直肠壁浸润:总灵敏度是94.6%(95%可信区间:0.920～0.966),总特异度是79.5%(95%可信区间:0.715～0.862),诊断优势比(DOR)是62.878(95%可信区间:9.295～425.330)。另一组为有淋巴转移组:总灵敏度是63.2%(95%可信区间:0.559～0.700),总特异度是84.9%(95%可信区间:0.803～0.887),诊断优势比(DOR)是9.789(95%可信区间:5.807～16.502)。结论在肿瘤直肠壁浸润方面的诊断,直肠内超声检查有较高的准确性,适用于疾病的普查筛选。而对于淋巴转移的诊断,直肠内超声检查的报告应与临床其他常规检查互相结合。     

异体输血对结直肠癌患者预后影响的meta分析

背景 肾移植患者移植前行异体输血(allogeneic blood transfusion,ABT)可以提高移植肾的存活率这一事实激发了医学工作者对一个问题的思考,即ABT对肿瘤患者是否存在不利影响。 目的 评估ABT对行手术治疗的结直肠癌(Colorectal Cancer,CRC)患者远期预后的影响。 方法 计算机检索PubMed、EMbase、The Cochrane Library以及中国生物医学文献数据库中ABT与CRC患者预后相关的研究,并辅以文献追溯法查找相关文献。检索时限均从建库至2014年3月。由2名评价者按纳入与排除标准独立选择文献、提取资料并评价质量后,采用Stata12.0软件进行Meta分析。 结果 最终纳入8个研究,共5479名患者。Meta分析结果显示：与未输血组相比,输血组总生存风险和疾病特异性生存风险分别增加了21%(HR=1.21;95% CI,1.09-1.33;p<0.001)和47%(HR=1.47;95% CI,1.17-1.84;p=0.001),差别有统计学意义;而输血组无病生存风险、局部复发风险和远处转移风险与未输血组的差别无统计学意义。 结论 ABT可以增加CRC手术患者的总生存风险与疾病特异性生存风险,因此积极采取围手术期血液保护策略以降低ABT率具有重要的临床意义。     

Experience with cardiac valve operations in Cape York Peninsula and the Torres Strait Islands, Australia

OBJECTIVE: To describe the outcome of valve surgery, for rheumatic heart disease (RHD) and non-RHD, in residents of Cape York Peninsula and the Torres Strait Islands referred to the Cairns Base Hospital specialist outreach service. DESIGN AND PARTICIPANTS: Retrospective review of medical records on all patients residing in the outreach area who had surgery for valvular heart disease between 1 January 1992 and 31 December 2004. MAIN OUTCOME MEASURES: Operation type and perioperative characteristics; 5- and 10-year survival rates; reoperation rates; complications. RESULTS: Forty-seven patients met the selection criteria; the median age was 40 years (range, 4-76 years); and 39 patients were Indigenous. RHD was the predominant cause of valve dysfunction (30/47 patients). Thirty-seven patients had valve replacements, six had valve repair and four had balloon valvotomy as the initial procedure. There were three bleeding complications, two episodes of operated valve endocarditis, and six embolic complications. There were nine valve-related deaths (six in the first 5 years). At 5 years, all seven patients who had had valve repair or balloon valvotomy were alive. Seven of the 47 patients required reoperation. Survival analysis showed freedom from valve-related deaths to be 83% (95% CI, 66%-92%) at 5 years and 61% (95% CI, 33%-80%) at 10 years. Freedom from reoperation at 5 years was 88% (95% CI, 71%-95%). Among the 30 patients with RHD, freedom from valve-related death was 80% (95% CI, 60%-92%) at 5 years and 52% (95% CI, 21%-75%) at 10 years. In patients with RHD, freedom from reoperation at 5 years was 87% (95% CI, 65%-96%). CONCLUSION: Valvular heart disease results in substantial morbidity and mortality, despite intervention. Efforts need to focus on prevention of rheumatic fever and closer follow-up.     

微穿透性小梁切除术联合羊膜植入治疗开角型青光眼的中远期疗效

目的：研究微穿透性小梁切除术联合羊膜植入术治疗开角型青光眼的中远期疗效及其并发症。方法：对30例（49只眼）开角型青光眼患者行微穿透性小梁切除术联合羊膜植入术,观察术前和术后视力、眼压、视野、滤过泡,并进行统计学分析。结果：随访6~24（15.93±2.35）月。术前及术后24月时眼压分别为（36.84±11.02）mmHg和（18.24±1.34）mmHg(P=0.000),术前及术后使用的抗青光眼药物分别为（2.76±0.69）种和（0.59±0.89）种（P＜0.05）,早中期视野缺损视野指数较术前有改善(P＜0.05),晚期视野缺损没有改善。术后24月70.8%形成功能性滤过泡,末次随访时手术完全成功率75.5%(37/49),质量成功率93.9%(46/49)。手术前后视力比较无统计学差异。无严重并发症发生。结论：微穿透性小梁切除术联合羊膜植入是治疗开角型青光眼安全有效的方法,中远期疗效稳定可靠。     

Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials

CONTEXT: Lowering low-density lipoprotein cholesterol (LDL-C) is known to reduce risk of recurrent coronary heart disease in middle-aged men. However, this effect has been uncertain in elderly people and women. OBJECTIVE: To estimate the risk reduction of coronary heart disease and total mortality associated with statin drug treatment, particularly in elderly individuals and women. DATA SOURCES: Trials published in English-language journals were retrieved by searching MEDLINE (1966-December 1998), bibliographies, and authors' reference files. STUDY SELECTION: Studies in which participants were randomized to statin or control treatment for at least 4 years and clinical disease or death was the primary outcome were included in the meta-analysis (5 of 182 initially identified). DATA EXTRACTION: Information on sample size, study drug duration, type and dosage of statin drug, participant characteristics at baseline, reduction in lipids during intervention, and outcomes was abstracted independently by 2 authors (J.H. and S.V.) using a standardized protocol. Disagreements were resolved by consensus. DATA SYNTHESIS: Data from the 5 trials, with 30 817 participants, were included in this meta-analysis. The mean duration of treatment was 5.4 years. Stati n drug treatment was associated with a20% reduction in total cholesterol, 28% reduction in LDL-C, 13% reduction in triglycerides, and 5% increase in high-density lipoprotein cholesterol. Overall, statin drug treatment reduced risk 31 % in major coronary events (95% confidence interval [CI], 26%-36%) and 21 % in all-cause mortality (95% CI, 14%-28%). The risk reduction in major coronary events was similar between women (29%; 95% Cl, 13 %-42 %) and men (31 %; 95% CI, 26%-35%), and between persons aged at least 65 years (32%; 95% CI, 23%-39%) and persons younger than 65 years (31 %; 95% CI, 24%-36%). CONCLUSIONS: Our meta-analysis indicates that reduction in LDL-C associated with statin drug treatment decreases the risk of coronary heart disease and all-cause mortality. The risk reduction was similar for men and women and for elderly and middle-aged persons.     

Oral anticoagulant therapy in patients with coronary artery disease: a meta-analysis

CONTEXT: Despite years of use in coronary artery disease (CAD) and several studies of its effectiveness, the role of oral anticoagulants (OAs) remains controversial. OBJECTIVE: To determine the effects of long-term OA therapy, stratified by the intensities of anticoagulation and aspirin therapy, on outcomes in patients with CAD. DATA SOURCES: Studies were identified by MEDLINE, EMBASE, and CURRENT CONTENTS searches (1960-July 1999) and by reviewing reference lists and inquiring with experts and pharmaceutical companies. STUDY SELECTION: Studies were included if they were published between 1960 and July 1999, were randomized, had recruited patients with CAD, who had used OA therapy for at least 3 months. Of 43 articles identified, 30 articles (31 trials) were analyzed. DATA EXTRACTION: Information on type, duration, and method of monitoring OA therapy, as well as rates of death, myocardial infarction (MI), thromboembolic complications, stroke, and bleeding were abstracted by 2 independent observers. DATA SYNTHESIS: With high-intensity (international normalized ratio [INR], 2.8-4.8) OAs vs control (16 trials, 10056 patients), clear reductions in mortality (odds reduction [ORed], 22%; 95% confidence interval [CI], 13%-31%), MIs (ORed, 42%; 95% CI, 34%-48%), and thromboembolic complications including stroke (ORed, 63%; 95% CI, 53-71%) were observed, but were associated with a 6.0-fold (95% CI, 4.4- to 8.2-fold) increase in major bleeding. For moderate OAs (INR, 2-3) vs control (4 trials, 1365 patients) the ORed for death was 18% (95% CI, -6% to 37%); for MI, 52% (95% CI, 37%-64%); and for stroke, 53% (95% CI, 19%-73%), but it increased bleeding by 7.7-fold (95% CI, 3.3- to 18-fold). For moderate- to high-intensity OAs (INR, > or =2) vs aspirin (7 trials, 3457 patients), no reduction in death, MI, or stroke was observed, and it was associated with a 2.4-fold (95% CI, 1.6- to 3.6-fold) increase in major bleeding. For moderate- to high-intensity OAs and aspirin vs aspirin alone (3 trials, 480 patients), the ORed for death, MI, or stroke was 56% (95% CI, 17%-77%) and major bleeding increased by 1.9-fold (0.6- to 6.0-fold). For low-intensity OAs (INR, <2.0) and aspirin vs aspirin alone (3 trials, 8435 patients), no significant reduction in death, MI, or stroke was observed, and major bleeding increased by 1.3-fold (95% CI, 1.0- to 1.8-fold). CONCLUSIONS: Among patients with CAD, high-intensity and moderate-intensity OA are effective in reducing MI and stroke but increase the risk of bleeding. In the presence of aspirin, low-intensity OA does not appear to be superior to aspirin alone, while moderate- to high-intensity OA and aspirin vs aspirin alone appears promising and the bleeding risk is modest, but this requires confirmation from ongoing trials.     

Ultrasonography in diagnosing colorectal cancers in patients presenting with abdominal distension

OBJECTIVE: To determine the usefulness of abdominal ultrasonography for diagnosing colorectal cancer in patients presenting with abdominal distension. DESIGN, SETTING AND PARTICIPANTS: A prospective case series of consecutive adult patients with abdominal distension admitted to the National Taiwan University Hospital between January 2001 and July 2004. All participants were examined by abdominal ultrasonography. Those with suspected colorectal tumours on ultrasonography had follow-up colonoscopy, while all other patients had computed tomography scans. MAIN OUTCOME MEASURES: Accuracy of abdominal ultrasonography for diagnosing colorectal cancer in patients with abdominal distension; incidence of colorectal cancer. RESULTS: Of 511 patients eligible for inclusion in our study, 97 (19.0%) were confirmed to have colorectal cancer. For diagnosis of colorectal cancer, ultrasonography had a sensitivity of 92.8% (95% CI, 85.2%-96.8%); a specificity of 98.8% (95% CI, 97.0%-99.6%); a positive predictive value of 94.7% (95% CI, 87.6%-98.0%); a negative predictive value of 98.3% (95% CI 96.4%-99.3%); and an accuracy of 97.7%. CONCLUSION: Ultrasonography is a sensitive tool for diagnosing colorectal cancer in patients presenting with abdominal distension.