Systematic review and meta-analysis of Statins-Fibrates therapy in diabetic dyslipidemia patients

AIM: To evaluate the efficacy,effect of preventing cardiovascular diseases and safety of statins-fibrates combination therapy in diabetic dyslipidemia patients.METHODS: We searched the databases of MEDLINE,EMBASE,web of knowledge and Cochrane central register of Controlled Trials for literatures about the coadministration of statins and fibrates as the treatment of patients with dyslipidemia and type 2 diabetes mellitus.We included related randomized controlled trials,controlled clinical trials and cross-sectional studies and excluded animal trials and clinical observations.The primary endpoints outcomes were the concentration of plasma total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C).The secondary outcomes were cardiovascular diseases(CVD) and adverse events.RESULTS: Ten studies were included in this metaanalysis.For lipid modifying efficacy,the combination of statins and fibrates therapy had more significant effecton reducing TC [P = 0.004,weighted mean difference(WMD) =-8.19,95%CI:-13.82--2.56] and TG concentration(P 0.001,WMD =-47.29,95%CI:-68.66--25.92) and increasing HDL-C concentration(P 0.00001,WMD = 3.79,95%CI: 2.25-5.33) when compared with statins monotherapy,while the effect of reducing LDL-C concentration(P = 0.50,WMD =-2.52,95%CI:-9.76-4.72) was insignificant.To fibrates monotherapy,the combination therapy was more effective on reducing TC(P 0.00001,WMD =-48.51,95%CI:-57.14--39.89),TG(P 0.00001,WMD =-26.07,95%CI:-30.96--21.18),LDL-C concentration(P 0.00001,WMD =-45.74,95%CI:-53.35--38.13) and increasing HDL-C concentration(P = 0.04,WMD = 1.38,95%CI: 0.04-2.73).For cardiovascular diseases,the coadministration therapy had no significant effect on reducing the incidence of these events when compared with monotherapy(For primary clinical endpoints,P = 0.12,OR = 0.61,95%CI: 0.33-1.14); for secondary clinical endpoints,P = 0.13,OR = 0.66,95%CI: 0.38-1.14).For adverse events happened during the follow-up,both the incidence of hepatic-related(alanine aminotransferase and/or aspartate aminotransferase of patients were ≥ 3 times of upper limit of normal)(P = 0.38,OR = 0.55,95%CI: 0.15-2.06) and muscular-related(myopathy and/or creatine phosphokinase ≥ 3 times of upper limit of normal) adverse events(P = 0.10,OR = 1.62,95%CI: 0.91-2.86) had no significant difference between these two therapies.CONCLUSION: The results showed statins-fibrates combination therapy was more effective on lipid modification and well tolerated but there was no significant effect on preventing cardiovascular diseases.     

完全腹腔镜与腹腔镜远端胃癌根治术疗效的Meta分析

目的：比较完全腹腔镜远端胃癌根治术（TLDG）与腹腔镜辅助远端胃癌根治术（LADG）的有效性及安全性,探讨完全腹腔镜技术在远端胃癌根治术中的应用价值。方法检索 PubMed 公开发表的完全腹腔镜与腹腔镜辅助远端胃癌根治术比较的研究文献。通过采用RevMan 5.0统计软件,合并及比较两者手术时间、淋巴结清扫数目、术中出血、术后首次排气时间、术后并发症及住院时间等指标,选择计算优势比（OR,95%的可信区间）和加权均数差（WMD,95%的可信区间）作为效应尺度来评估两种术式的安全性和有效性。结果6项研究文献被纳入本次Meta分析,其中实施完全腹腔镜远端胃癌根治术656例,腹腔镜辅助远端胃癌根治术988例,共1644例患者。本项Meta分析结果显示,与腹腔镜辅助远端胃癌根治术相比,实施完全腹腔镜远端胃癌根治术的患者术中出血少、术后首次排气时间早、住院时间短（合并WMD分别为-17.79,95%CI -32.57～-3.02,P＝0.02;-0.14,95%CI -0.23～-0.06,P＝0.001;-0.32,95%CI -0.53～-0.12,P＝0.002）,而在手术时间、淋巴结清扫数目、术后并发症的发生率方面,两种术式差异无统计学意义（合并WMD为11.19,95%CI -4.54～26.92,P＝0.16;3.55,95%CI -0.18～7.28,P＝0.06;合并OR为1.27,95%CI 0.86～1.88,P＝0.22）。结论 TLDG是安全可行的,与传统LADG具有相似的手术疗效。然而,在术中出血、术后胃肠道功能恢复方面,TLDG 更具优势,但仍然需要开展大样本的临床对照试验来进一步验证这一结论。     

罗氟司特治疗稳定期慢性阻塞性肺疾病的疗效及其安全性的Meta分析

目的研究罗氟司特对稳定期慢性阻塞性肺疾病（COPD）的疗效及安全性。 方法检索Pubmed、EMBASE、CINAHL、Cochrane clinical trials database、ScienceDirect.gov、中国生物医学文献数据库、万方数据数字化期刊全文数据库、维普数据数字化期刊全文数据库、中国期刊全文数据库等数据库1995年1月至2014年7月的论文,将罗氟司特治疗COPD慢性阻塞性肺疾病Ⅱ/Ⅲ期临床实验的相关文章纳入本研究。观察支气管肺功能、加重风险、健康相关生活质量、不良反应等。用修改后的Jadad量表和Cochrane偏倚风险评估工具对纳入研究质量进行评估。计量资料计算加权均数差（WMD）和95%可信区间（95%CI）,计数资料计算比值比（OR）。用I²进行异质性检验。 结果共纳入7篇文献,包含9项随机对照研究。罗氟司特可分别提高支气管舒张前后的一秒用力呼气容积（WMD=57.56,95%CI：48.03~67.10,Z=11.83;WMD=63.97,95%CI：54.01~73.92,Z=12.60,P均<0.05）、用力肺活量（WMD=86.8,95%CI：66.00~107.60,Z=8.18;WMD=89.63 ml,95%CI：70.50~108.77,Z=9.18,P均<0.05）、最大呼气流速（FEF）25%~75%（WMD=21.26,95%CI：11.50~31.03,Z=4.27;WMD=23.04,95%CI：14.17~31.91,Z=5.09,P均<0.05）,降低COPD的总体加重率（OR=-0.16,95%CI：-0.24~-0.08,Z=3.74,P<0.05）、中度加重率（OR=-0.08,95%CI：-0.15~-0.02,Z=2.43,P=0.02）,延长第一次中重度加重时间（WMD=9.65 min,95%CI：5.31~13.98,Z=4.30,P<0.05）,并可提高过渡期呼吸困难指数评分（WMD=0.3,95%CI：0.16~0.44,Z=4.24,P<0.05）。而对重度加重率（OR=0.00,95%CI：-0.02~0.02,Z=0.40,P=0.69）,第二次中重度加重时间（WMD=28.24,95%CI：-2.13~58.62,Z=1.82,P=0.07）的影响无统计学意义。罗氟司特治疗相关不良反应主要涉及消化系统、神经系统症状,主要出现在治疗的前4周,有自限趋势。 结论罗氟司特有望成为COPD稳定期的新型抗炎治疗药物。     

单孔腹腔镜对比传统腹腔镜手术治疗输卵管妊娠的Meta分析

目的全面评价单孔腹腔镜手术(LESS)治疗输卵管妊娠的安全性、可行性及其他潜在优势。方法检索Pubmed、the Cochrane Library、Web of Science等英文及知网、中国生物医学文献等中文数据库中有关单孔与传统腹腔镜下输卵管妊娠手术治疗的对比研究,对选用的研究进行质量评价,运用Rev Man5.3软件行数据合并分析。结果最终纳入2个随机对照研究(RCT)和14个病例-对照研究,共1 541个患者,Meta分析结果提示,单孔对比多孔腹腔镜手术,延长了手术时间[加权均数差(WMD)=8.54,95%CI(2.43,14.64),P=0.006],但并没有增加总并发症[比值比(OR)=0.68,95%CI(0.27,1.71),P=0.410]及术中失血量[WMD=-0.01,95%CI(-2.51,2.48),P=0.990],也未延长术后肠排气时间[WMD=-0.45,95%CI(-1.72,0.82),P=0.490],且能缩短术后住院时间[WMD=-0.40,95%CI(-0.75,-0.06),P=0.020],减少术后止痛治疗[OR^=0.38,95%CI(0.22,0.67),P=0.000]。结论 LESS治疗输卵管妊娠,是安全、可行的,而且有住院时间短,术后疼痛轻的优点,有望取代传统腹腔镜手术(CLS)。     

依托咪酯-芬太尼类药物在老年胃镜检查应用的Meta分析

目的 Meta分析依托咪酯和丙泊酚分别联合芬太尼类药物用于老年胃镜检查的麻醉效果及安全性。方法计算机检索Cochrane图书馆、Pub Med、Embase、中国生物医学文献数据库(CBM)、中国知网、维普资讯网和万方数据库等建库至2016年发表的关于依托咪酯-芬太尼类药物用于老年无痛胃镜术的随机对照试验(RCT),按照Jadad量表评价纳入研究的质量和提取资料,采用Rev Man 5.3软件进行统计分析。结果 11篇RCT(1 535例患者)纳入分析,依托咪酯组(E组)765例,丙泊酚组(P组)770例。依托咪酯组患者心率(HR)[加权均数差(WMD)=2.25,95%CI(0.93,3.56),P=0.001]和平均动脉压(MAP)[WMD=9.09,95%CI(7.60,10.57),P=0.000]的变化幅度较丙泊酚组小,发生低氧血症[OR^=0.46,95%CI(0.32,0.65),P=0.000]的风险较丙泊酚组低,差异有统计学意义;不良反应的发生方面,依托咪酯组发生呼吸暂停[OR^=0.26,95%CI(0.15,0.48),P=0.000]、注射痛[OR^=0.02,95%CI(0.01,0.05),P=0.000]的风险较丙泊酚组低,发生恶心呕吐[OR^=3.44,95%CI(2.03,5.84),P=0.000]、肌阵挛[OR^=8.14,95%CI(4.18,15.87),P=0.000]的风险较丙泊酚组高,差异有统计学意义。结论依托咪酯联合芬太尼类药物用于老年无痛胃镜术能较好地保持循环系统稳定,是一种安全有效的麻醉方案。     

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.     

神经刺激器定位对周围神经阻滞效果和安全性的影响

目的系统评价神经刺激器引导下的神经阻滞效果和安全性。方法采用Cochrane系统评价方法,计算机检索CochraneLibrary（2008年第1期）、OVID（1950～2008．04）、VIP（1989—2008．04）、CNKI（1979～2008．04）、CBM（1978～2008．04）等数据库。由3名评价者共同评价纳入研究质量,并采用RevMan4．2．9进行Meta分析。结果共纳入20个RCT,包括1287例患者。仅2个研究描述了具体的随机方法、分配隐藏和盲法,其余研究均未完整描述。按定位方法和测量指标进行亚组分析,Meta分析结果显示：①阻滞绝对成功率：神经刺激器定位法成功率高于异感定位法[OR=4．36,95％CI（1．97,9．67）,P=0．0003]和解剖定位法[OR=30．3,95％CI（1．73,532．74）,P=0．02],但低于超声定位法[OR=O．27,95％CI（0．06,1．21）,P=0．09]。②阻滞起效时间：神经刺激器法与异感法相似[WMD=-．78,95％CI（-4．50,0．95）,P=0．20],比动脉搏动法快[WMD=-6．00,95％CI（-11．71,-0．29）,P=0．04],但慢于超声定位法[WMD=8．38,95％CI（0．72,16．04）,P=0．04]。③阻滞相关并发症总发生率：神经刺激器定位法与异感定位法[OR=0．98,95％CI（0．33,2．93）,P=0．97]、解剖定位法[OR=0．06,95％CI（0．00,1．21）,P=0．07]和动脉搏动法[OR=0．65,95％CI（0．10,4．11）,P=0．65]相似,但高于超声定位法[OR=4．87,95％CI（1．68,14．15）,P=0．00430④阻滞实施时间：神经刺激器法与异感法相似[WMD=-0．62,95％CI（-3．09,1．86）,P=0．63],比动脉搏动法短[WMD=-4．00,95％CI（-5．58,-2．42）,P〈0．00001],但长于超声定位法[WMD=1．90,95％CI（0．47,3．33）,P=0．00910⑤患者接受率：神经刺激器法比异感法具有更高的接受率[OR=2．32,95％CI（1．02,5．30）,P=0．05],但与动脉搏动法相似[OR=8．14,95％CI（0．88,75．48）,P=0．0630结论现有研究显示,神经刺激器定位法进行神经阻滞是一种定位准确、阻滞效果好,安全性高,患者易接受的定位方法。但鉴于本系统评价纳入研究存在选择性偏倚和测量性偏倚的中度可能性,以上结论仅供参考。并期待有更多高质量的随机、盲法测定的试验提供质量更可靠的证据。     

谷氨酰胺强化肠外营养支持对重症患者临床结局影响的Meta分析

目的系统评价谷氨酰胺强化肠外营养支持治疗对重症患者免疫营养功能及临床结局的影响。 方法检索Embase、Medline、Cochrane Central Register of Controlled Trials、The Cochrane Database of Systematic Reviews、中国期刊全文数据库、维普中文科技期刊全文数据库、万方数据库及中国生物医学文献数据库自建库至2016年12月期间研究常规肠外营养（常规组）与谷氨酰胺强化肠外营养（干预组）支持治疗对ICU重症患者病死率、感染发生率及住院时间等临床结局影响的随机对照试验。由2名研究者按照纳入及排除标准独立进行文献筛选、提取和质量评估后,使用Review Manager 5.2.0分析软件进行Meta分析。 结果共纳入18项随机对照试验,包括1 708例患者。Meta分析结果显示,应用谷氨酰胺强化的肠外营养,可以显著降低重症患者住院病死率[RR=0.63,95%CI（0.47,0.84）,Z=3.16,P=0.002],但两组间ICU病死率[RR=1.00,95%CI（0.83,1.22）,Z=0.04,P=0.97]、6个月病死率[RR=0.95,95%CI（0.67,1.34）,Z=0.29,P=0.77]比较,差异均无统计学意义;且肺部感染发生率[RR=0.91,95%CI（0.62,1.32）,Z=0.52,P=0.61]、尿路感染发生率[RR=0.79,95%CI（0.37,1.67）,Z=0.62,P=0.54]、菌血症[RR=0.52,95%CI（0.21,1.33）,Z=1.36,P=0.18]、导管相关感染[RR=0.69,95%CI（0.32,1.49）,Z=0.95,P=0.34]及其他感染[RR=0.94,95%CI（0.80,1.10）,Z=0.81,P=0.42]比较,差异亦均无统计学意义;同时,两组患者间住院时间[WMD=-0.26,95%CI（-3.81,3.28）,Z=0.15,P=0.88]及住ICU时间[WMD=-1.04,95%CI（3.95,1.87）,Z=0.70,P=0.48]比较,差异均无统计学意义。 结论使用谷氨酰胺强化的肠外营养支持疗法不能改善重症患者临床结局。     

臭氧联合玻璃酸钠治疗膝关节骨性关节炎的Meta分析

目的对公开发表的臭氧联合玻璃酸钠治疗膝关节骨性关节炎的文献进行Meta分析,评价臭氧联合玻璃酸钠治疗膝关节骨性关节炎的疗效。方法计算机检索美国医学文摘数据库(PubMed,1995²014)、Medline数据库(19952014)、Medline数据库(1995²014)、EMBASE数据库(19952014)、EMBASE数据库(1995²014)、中国生物医学文献数据库(CBM,19952014)、中国生物医学文献数据库(CBM,1995²014)、中国期刊全文数据库(CNKI,19952014)、中国期刊全文数据库(CNKI,1995²014)、万方数据库(19952014)、万方数据库(1995²014)、中文科技期刊全文数据库维普(VIP,19952014)、中文科技期刊全文数据库维普(VIP,1995²014),收集臭氧联合玻璃酸钠治疗膝关节骨性关节炎的随机对照试验。按照事先制定的入选与剔除标准筛选文献。然后逐一评价纳入研究的质量,提取有效数据,采用RevMan5.2.10软件进行Meta分析。结果共纳入33个随机对照试验,共3 544例患者,其中试验组1 814例,对照组1 730例。Meta分析结果显示:臭氧联合玻璃酸钠在治疗膝关节骨性关节炎有效率方面与单独应用玻璃酸钠[OR=4.53,95%CI(3.45,5.94),P<0.000 01]、臭氧[OR=5.47,95%CI(2.27,13.20),P=0.000 2]和常规治疗[OR=5.57,95%CI(3.63,8.55),P<0.000 01]比较,差异均有统计学意义;臭氧联合玻璃酸钠在治疗VAS评分方面与单独应用玻璃酸钠[WMD=-1.63,95%CI(-2.07,-1.19),P<0.000 01]、臭氧[WMD=-1.02,95%CI(-1.26,-0.78),P<0.000 01]和常规治疗[WMD=-1.48,95%CI(-2.84,-0.11),P=0.03]比较,差异均有统计学意义;臭氧联合玻璃酸钠在Lysholm评分方面优于单独应用玻璃酸钠[WMD=8.79,95%CI(2.66,14.93),P=0.005]。结论臭氧联合玻璃酸钠治疗膝关节骨性关节炎疗效显著,改善关节活动度,提高患者的生活质量。由于本Meta分析纳入的研究质量较低,存在偏倚的高度可能,影响了结果的论证强度,期待更多高质量的随机双盲对照试验以提供高质量的证据。     

腹腔镜手术与开腹手术治疗直肠脱垂临床效果比较的Meta分析

目的系统评价腹腔镜手术(LS)与开腹手术(OS)治疗直肠脱垂的有效性及安全性。方法检索2000年1月1日至2014年5月1日公开发表在PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CMB)、维普(VIP)及万方文献数据库的LS与OS治疗直肠脱垂疗效比较的研究文献,并用RevMan 5.2软件进行Meta分析。结果共有11篇文献900例直肠脱垂患者被纳入分析,其中LS组482例,OS组418例。与OS相比,LS手术时间延长(WMD=53.42,95%CI:45.34⁶1.49,Z=12.97,P<0.05)、患者住院时间缩短(WMD=-2.42,95%CI:-3.0761.49,Z=12.97,P<0.05)、患者住院时间缩短(WMD=-2.42,95%CI:-3.07^-1.78,Z=7.37,P<0.05)、便秘发生率明显改善(OR=0.55,95%CI:0.30-1.78,Z=7.37,P<0.05)、便秘发生率明显改善(OR=0.55,95%CI:0.30⁰.99,Z=2.01,P<0.05),而在围手术期并发症发生率、术后复发率及死亡率方面,两种术式的差异无统计学意义(OR=1.05,95%CI:0.550.99,Z=2.01,P<0.05),而在围手术期并发症发生率、术后复发率及死亡率方面,两种术式的差异无统计学意义(OR=1.05,95%CI:0.55¹.98,Z=0.14,P>0.05;OR=0.86,95%CI:0.511.98,Z=0.14,P>0.05;OR=0.86,95%CI:0.51¹.45,Z=0.56,P>0.05;OR=0.48,95%CI:0.201.45,Z=0.56,P>0.05;OR=0.48,95%CI:0.20¹.14,Z=1.66,P>0.05)。结论 LS治疗直肠脱垂的短期和长期疗效均优于OS。     

Association between SHBG (TAAAA)n and AR (CAG)n polymorphisms and PCOS risk: A meta-analysis

AIM: To systematically assess the association between sex hormone-binding globulin (SHBG) (TAAAA)n and androgen receptor (AR) (CAG)n polymorphisms and polycystic ovarian syndrome (PCOS) risk. METHODS: We searched MEDLINE (PubMed), EMBASE and Web of Science database from inception to May 2014. To avoid missing any additional studies, we looked through all the references of relevant articles. Case-control studies concerning the (CAG)n variants in the AR gene or the (TAAAA)n polymorphism in the SHBG gene in PCOS patients were included. Five studies regarding the (TAAAA)n polymorphism in the SHBG gene and 14 studies regarding the (CAG)n polymorphism in the AR gene met our criteria. Odd ratio (OR) and weighted mean difference (WMD) were selected as the effect size measurements to evaluate the influence of the (TAAAA)n polymorphism and (CAG)n variants on PCOS risk. Begg’s test was used for the evaluation of publication bias. RESULTS: With respect to the relationship between the (TAAAA)n polymorphism and PCOS risk, the statistical results showed that there was no significant difference between PCOS patients and controls in the alleles of TAAAA (S: OR = 0.91, 95%CI: 0.78-1.05; L: OR = 1.10, 95%CI: 0.95-1.27). Subgroup analyses of the combination of alleles indicated similar results (short-short: OR = 0.87, 95%CI: 0.66-1.14; short-long: OR = 1.12, 95%CI: 0.86-1.46; long-long: OR = 1.03, 95%CI: 0.72-1.47). As for the relationship between the (CAG)n polymorphism and PCOS risk, we found no association between CAG repeat variants and PCOS risk (WDM = 0.03, 95%CI: -0.13-0.08). Subgroup analyses by race and diagnosis criteria indicated the same results (Asian: WMD = -0.03, 95%CI: -0.14-0.07; Caucasian: WMD = -0.02, 95%CI: -0.24-0.21; the criteria of Rotterdam: WMD = 0.01, 95%CI: -0.01-0.03). CONCLUSION: There is no association between (TAAAA)n polymorphism in SHBG gene, (CAG)n repeat variants in AR gene and PCOS.     

Subclinical hypothyroidism and the metabolic syndrome: A meta-analysis of cross-sectional studies

AIM: To determine the relationship between subclinical hypothyroidism (SCH) and the metabolic syndrome (MS). METHODS: We performed a systematic search of databases [MEDLINE (July 1950 to July 2012), EMBASE (July 1966 to July 2012)] and the references of identified studies. Completely published cross-sectional studies of a general population involving SCH and the MS were included. The pooled odds ratio and weighted mean difference (WMD) for the outcomes were calculated using random-effects models. RESULTS: Six cross-sectional studies with 19546 participants were included. In total, 398 of 1324 participants (30.06%) in the SCH group had the MS compared with 4975 of 18222 participants (27.30%) in the euthyroid group [OR = 1.20; 95%CI: 1.05-1.36; P = 0.004; χ² = 2.53 (P = 0.773); I² = 0%]. Further analysis of the components of the MS showed that SCH was associated with increased body mass index (WMD, 0.32 kg/m²; 95%CI: 0.04-0.61; P = 0.026), systolic blood pressure (WMD, 2.62 mmHg; 95%CI: 1.35-3.89; P < 0.001) and triglyceride (WMD, 0.25 mmol/L; 95%CI: 0.23-0.28; P < 0.001). CONCLUSION: Based on the cross-sectional data, SCH may be associated with an increased risk of the MS, which could be attributed to the increased risk of metabolic components.     

冠状动脉旁路移植术后患者吸气肌训练效果的系统评价

目的:评价吸气肌训练在冠状动脉旁路移植术(coronary artery bypass grafting,CABG)术后患者中的应用效果.方法:检索Web of Science、Cochrane Library、EMBASE、PubMed、CINAHL、中国知网、中国生物医学文献数据库、万方和维普国内外数据库中自建库至...     

内镜黏膜下剥离术与外科手术治疗早期胃癌的有效性及安全性的Meta分析

目的内镜黏膜下剥离术(ESD)与外科手术是早期胃癌(EGC)的常用治疗方法,但其相关风险及获益目前仍存在争议,该研究旨在比较两种治疗方法在治疗EGC的有效性、安全性等方面的差异。方法检索1990年1月-2016年6月发表在Pubmed、CBM、Embase、Cochrane Library、中国知网数据库、维普数据库及万方数据库的有关ESD与外科手术治疗EGC对比研究的所有中英文文献,根据纳入和排除标准对搜索的相关文献进行二次筛选,并对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果总共有12篇文献符合纳入标准,且均为回顾性队列研究,共涉及4 331个研究对象。Meta分析的结果显示:ESD与外科手术相比,复发率[(22/2 586,0.85%)vs(6/1 134,0.53%),P=0.370]及5年生存率[(852/909,93.72%)vs(707/746,94.77%),P=0.340]差异无统计学意义,虽然外科手术在整块切除率方面稍高于ESD组[(99/99,100.00%)vs(95/103,92.23%),P=0.020],但是外科手术组的手术时间[标准化均数差(SMD)=-3.04,95%CI:-3.64~-2.45,P=0.000]及住院时间(SMD=-2.53,95%CI:-3.73~-1.32,P=0.000)比ESD组延长,且术后并发症增多[(45/816,5.50%)vs(101/686,14.72%),P=0.000]。结论对于EGC的治疗,两种治疗方法在复发率及5年生存率方面无明显差异,虽然ESD组在整块切除率上不及外科手术组,但其具有创伤小、手术时间短、术中及术后并发症少、住院时间短且恢复快等显著优势,可作为EGC的首选治疗方法。     

围术期肺康复对肺癌患者术后疗效的Meta分析

目的 使用Meta分析评价围术期常规治疗联合肺康复与仅使用常规治疗对肺癌患者的术后疗效。方法 通过计算机检索PubMed、中国知网（CNKI）、维普科技期刊数据库(VIP)和万方医学网等数据库,检索时间截至2022年1月,纳入肺康复对肺癌患者术后疗效的临床随机对照试验。对所有文献进行筛选、资料提取并依据Cochrane系统进行质量评价,采用RevMan5.4软件、Stata15.0软件进行Meta分析。结果 共纳入15篇文献,共计1448例患者,研究结果显示：较常规治疗相比,联合肺康复治疗能更有效的改善肺癌患者的肺功能状态[第1秒用力呼气容积（WMD=0.58,95%CI：0.36~0.80,P＜0.00001）、用力肺活量（WMD=0.61,95%CI：0.30~0.92,P＝0.00001）、第1秒用力呼气容积占用力肺活量比（WMD=5.63,95%CI：1.48~9.78,P＝0.008）、第1秒用力呼气容积占预计值百分比（WMD=4.39,95%CI：1.22~7.55,P＝0.007）、最大通气量（WMD=7.79,95%CI：2.89~12.68,P＝0.002）],提高6分钟步行距离（WMD=45.46,95%CI：20.43~70.48,P＝0.0004）、缩短住院时间（WMD=-2.17,95%CI：-2.47~-1.87,P＜0.00001）。纳入15篇文献中,9篇提到了术后并发症,经常规治疗联合肺康复的肺癌患者术后发生支气管胸膜瘘（1例）、呼吸衰竭（1例）、肺炎和肺不张（3例）;仅常规治疗的肺癌患者术后发生支气管胸膜瘘（5例）、肺炎和肺不张（5例）、呼吸衰竭（4例）、心力衰竭（1例）、心律失常（1例）、术后疼痛（1例）、呕吐及腹泻（1例）,差异有统计学意义。结论 与常规治疗相比,联合物理治疗肺康复能更有效的改善肺癌患者的术后疗效,其显著改善了肺功能各项指标、6分钟步行距离和住院时间,同时,减少了术后并发症,其临床疗效及安全性得到了证实,在临床上应用价值高。     

生长激素治疗烧伤的随机对照试验的系统评价

目的评价生长激素治疗烧伤的有效性和安全性.方法检索中国生物医学文摘数据库、MEDLINE、EMBASE和Cochrane图书馆,收集所有相关随机对照试验,对其逐个进行质量评价,并进行Meta-分析.结果纳入9个高质量研究,共治疗732例患者.①有助于烧伤创面的愈合[WMD-11.25,95%CI(-14.84,-7.66),P＜0.000 01];②有助于供皮区创面的愈合[WMD-1.87,95%CI(-2.28,-1.47),P＜0.000 01];③有助于缩短住院时间[WMD-8.10,95%CI(-10.40,-5.79),P＜0.000 01];④使用生长激素后,患者静息能量消耗有降低的趋势但尚无统计学意义[WMD-0.04,95%CI(-0.08,0.00),P=0.06];⑤生长激素会引起血糖升高[SMD 0.98,95%CI(0.54,1.42),P＜0.000 01],和血胰岛素升高[SMD 0.86,95% CI(0.43,1.30),P=0.000 1];病死率[OR 1.15,95%CI(0.15,8.53),P=0.9]和脓毒血症的发生方面无差异[OR 1.08,95% CI(0.50,2.34),P=0.8]及呼吸机需求方面无差异[OR1.51,95%CI(0.72,3.16),P=0.3].结论目前资料表明烧伤患者在监测和控制好血糖水平的条件下运用生长激素是安全、有效的.     

地塞米松玻璃体内植入剂对比雷珠单抗治疗糖尿病黄斑水肿的疗效及安全性的荟萃分析

目的:比较地塞米松玻璃体内植入剂(intravitreal dexamethasone implant,IDI)和雷珠单抗治疗糖尿病黄斑水肿(diabetic macular edema,DME)的疗效和安全性,为临床治疗DME用药提供依据。方法:检索PubMed、Cochrane图书馆、Embase、Web of Science、万方数据知识服务平台、中国知网、及重庆维普中文科技期刊全文数据库中这两种药物治疗DME的临床对照试验文献,对纳入文献进行风险评估,提取文献中相关指标,采用RevMan 5.3软件进行数据分析,应用随机或固定效应模型分析异质性,检测发表偏倚。结果:共纳入符合条件的文献5篇,合计593例患者。IDI组和雷珠单抗组黄斑中心凹视网膜厚度(central macular thickness,CMT)治疗后1个月加权均数差(weighted mean difference,WMD)=.107.13;95%置信区间(confidence interval,CI):.149.44~.64.81;P<0.00001;3个月WMD=.58.10;95%CI:.88.39~.27.82;P=0.0002,IDI组患者黄斑水肿(macular edema,ME)减轻程度相比雷珠单抗组更明显,差异有统计学意义。两组患者最佳矫正视力(best corrected visual acuity,BCVA)治疗后1个月[WMD=.0.08;95%CI:.0.23~0.07;P=0.28]和3个月[WMD=.0.09;95%CI:.0.09~0.01;P=0.08]比较,差异无统计学意义。IDI组有增加白内障(OR=4.23,95%CI:1.93~9.26,P=0.0003)和升高眼压(OR=8.55,95%CI:4.63~15.81,P<0.00001)的风险,但具有较少的注射次数。结论:IDI和雷珠单抗均可改善BCVA、降低CMT,二者在视力改善方面没有差异,IDI在减轻ME方面比雷珠单抗有优势,且注射次数少,但IDI增加眼压及发生白内障的风险较雷珠单抗高。     

Treatment strategy for gallstone pancreatitis and the timing of cholecystectomy

AIM:To reviewed the literature and evaluated the scope and timing of the application of endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(ES)and cholecystectomy.METHODS:A pooled odds ratio(OR)and a pooled mean difference with the 95%CI were used to assess the enumeration data of included studies.A pooled weighted mean difference(WMD)and a pooled mean difference with the 95%CI were used to assess the measurement data of included studies.Statistical heterogeneity was tested with theχ2 test.According to forest plots,heterogeneity was not significant,so the fixed effect model was adopted.The significance of the pooled OR was determined by the Z test and statistical significance was considered at P0.05.RESULTS:Data were collected from two studies(353patients,142 in the early cholecystectomy group and211 in the delayed cholecystectomy group)regarding the length of hospital stay[The WMD was-2.87(95%CI:-3.36--2.39,P0.01).Data were collected from four studies(618 patients,211 in the early cholecystectomygroup and 408 in the delayed cholecystectomy group)regarding perioperative complications(OR=0.94,95%CI:0.41-2.12,P0.05).Data were collected from four studies(618 patients,211 in the early cholecystectomy group and 408 in the delayed cholecystectomy group)on the number of patients who underwent ERCP±ES postoperatively(OR=0.80,95%CI:0.45-1.41,P0.05).CONCLUSION:Cholecystectomy offers better protection than ES against further bouts of pancreatitis in patients with gallstone pancreatitis,although ES is an acceptable alternative.     

Weekday vs weekend endoscopy: Is there a true difference in patient outcomes? A meta-analysis

AIM:To evaluate the"weekend effect"on outcomes in patient admitted on the weekend for upper gastrointestinal bleeding(UGIB).METHODS:A comprehensive search was performed(March 2014).Studies comparing weekend and weekday endoscopy in patients with UGIB were included.All studies had at least 2 of 3 primary outcomes which included:mortality,need for surgery,time to endoscopy,endoscopy on admission day,and length of hospital stay.Three authors individually extracted data.Metaanalysis was performed using pooled estimates with odds ratio or mean difference by fixed and random effects models.RESULTS:Eleven studies met the inclusion criteria.Patients admitted with UGIB on the weekend exhibited a statistically significant increase in mortality(OR=1.13;95%CI:1.06-1.20;P0.01),need for surgery(OR=2.46;95%CI:1.51-3.99;P0.01),and time to endoscopy(MD 2.68;95%CI:0.17-5.20;P=0.04)as compared to patients admitted with UGIB on a weekday.Furthermore,patients with UGIB admitted on weekend experienced statistically significant less endoscopy on day of admission(OR=0.72;95%CI:0.62-0.85;P0.01).No difference was noted between the two groups for length of hospital stay(MD-1.29;95%CI:-3.03-0.45;P=0.15).CONCLUSION:A weekend effect seems to be apparent in patients with UGIB with significantly poorer outcomes.