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.     

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.     

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.     

清胰汤对重症急性胰腺炎治疗价值的系统评价

目的 用循证医学的方法评价清胰汤辅助治疗重症急性胰腺炎的疗效。 方法 检索1966年到2007年7月间发表的有关清胰汤辅助治疗重症急性胰腺炎疗效的随机对照临床试验。按入选和排除标准，有9项临床试验纳入本研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果等内容独立进行摘录，用RevMan4.2 软件进行分析。 结果 清胰汤灌胃灌肠辅助治疗组的腹痛缓解时间（WMD=-24.72，95%CI: -35.06～-14.37，P＜0.01）、住院天数（WMD=-9.81，95%CI:-16.23～-3.39，P＜0.01）、病死率（OR=0.27，95%CI: 0.15～0.50，P＜0.01）均明显低于对照组，差异有统计学意义，并发症发生数两组尚无统计学差异（OR=0.31，95%CI:0.07～1.42，P=0.13）。 结论 中药清胰汤辅助治疗能显著缩短重症急性胰腺炎患者的腹痛缓解时间、住院天数，明显降低病死率。     

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.     

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。     

持续静脉-静脉血液滤过治疗高脂血症性胰腺炎的系统评价

目的系统评价持续静脉-静脉血液滤过(continuous veno-venous hemoi ltration,CVVH)为主要方式治疗高脂血症性胰腺炎的有效性和安全性。方法计算机检索h e Cochrane Library(2014第2期)、PubMed、EMbase、CBM、CNKI和WanFang Data,查找有关CVVH治疗高脂血症性胰腺炎的随机对照试验(RCT),检索时限截至2014年2月12日。由2位评价员根据纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入7个研究,共360例患者,其中CVVH组183例,常规综合治疗组177例。Meta分析结果显示:与常规治疗比较,CVVH能显著降低患者治疗后血脂水平[WMD=–4.63,95%CI(–5.98,–3.27),P<0.000?01]、IL-6水平[WMD=–29.59,95%CI(–34.30,–24.89),P<0.000?01]及总体病死率[RR=0.39,95%CI(0.18,0.84),P=0.02];其APACHE II评分[WMD=–3.34,95%CI(–5.12,–1.56),P=0.000?2]明显低于常规治疗组。结论与常规治疗相比,CVVH治疗高脂血症性胰腺炎更加有效。但受纳入研究数量和质量所限,上述结论尚需今后开展多中心、大样本的高质量RCT加以验证。     

Robot-assisted vs laparoscopy-assisted gastrectomy for gastric cancer: A meta-analysis based on 3518 subjects

AIM: To compare the short-term clinical outcomes of robot-assisted gastrectomy(RAG) with laparoscopyassisted gastrectomy(LAG) in gastric cancer patients.METHODS: Articles were identified through a literature search of Pubmed, EMBASE, Scopus, Web of Science, Chinese National Knowledge Infrastructure and the Cochrane Library. Weighted mean differences(WMDs) and odds ratios(ORs) were selected as effect sizes for quantitative variables and qualitative variables, respectively. And 95%CIs were also calculated.RESULTS: A total of 13 studies with 3518 patients were included. RAG was associated with longer operative time(WMD = 46.26 min, 95%CI: 31.89-60.63, P 0.00001), less blood loss [WMD =-37.19 m L, 95%CI:-60.16-(-14.23), P = 0.002] and shorter postoperative hospital stay [WMD =-0.65 d, 95%CI:-1.24-(-0.05), P = 0.03] than LAG. No significant difference in the numbers of retrieved lymph nodes was found between the two groups(WMD = 1.46, 95%CI:-0.19-3.10, P = 0.08). There was no significant difference in mortality(OR = 1.55, 95%CI: 0.49-4.94, P = 0.45), overall complications(OR = 1.00, 95%CI: 0.80-1.26, P = 0.98), anastomosis leakage(OR = 1.02, 95%CI: 0.62-1.65, P = 0.95) and anastomosis stenosis rates(OR = 0.54, 95%CI: 0.18-1.57, P = 0.25). CONCLUSION: RAG is effective and safe in the treatment of gastric cancer. RAG is a promising alternative to laparoscopic surgery. Long-term randomized controlled studies with large scale and improved designs are needed to further evaluate the long-term outcomes.     

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。     

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。     

Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions

AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions. METHODS: An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate (including bleeding, perforation and surgery post EMR or ESD rate). Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed. RESULTS: Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group (95%CI: 0.17-0.83, P < 0.0001, I² = 99.7%). Endoscopic clearance rates were also significantly higher in the ESD group (95%CI: -0.06-0.02, P < 0.0001, I² = 92.5%). The perforation rate was 7% higher in the ESD group than the EMR group (95%CI: 0.05-0.09, P > 0.05, I² = 41.1%) and the rate of recurrence was 50% higher in the EMR group than in the ESD group (95%CI: 0.20-0.79, P < 0.001, I² = 99.5%). Heterogeneity remained consistent when subgroup analysis of high quality studies was performed (with the exception of piecemeal resection rate), and overall effect sizes remained unchanged for all outcomes. CONCLUSION: ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may benefit from increased assessment through well-designed comparative studies.     

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。     

急性结石性胆囊炎腹腔镜胆囊切除中转开腹影响因素分析

目的:探讨急性结石性胆囊炎行腹腔镜胆囊切除术过程中转开腹的影响因素。方法:回顾性分析3191例急性结石性胆囊炎行腹腔镜胆囊切除术患者的临床资料,按术中是否中转开腹胆囊切除术分为中转组和非中转组,通过多元回归模式对患者性别、年龄、BMI、既往病史(糖尿病病史、高血压病史及既往腹部外科手术史)、术前实验室检查(WBC、PCT、CRP及INR)、术前胆囊B超特征(胆囊结石数量、胆囊壁厚度)及手术时间等因素进行统计学分析。结果:资料数据经多元logistic回归分析显示,BMI、糖尿病病史、术前白细胞计数、PCT、CRP、结石数量、胆囊壁厚度是影响急性结石性胆囊炎患者行腹腔镜胆囊切除中转开腹的因素(P<0.05);BMI(OR=1.784;95%CI:1.621~1.973;P<0.001)、糖尿病病史(OR=21.79;95%CI:13.49~34.90;P<0.001)、WBC(OR=1.330;95%CI:1.254~1.410;P<0.001)、PCT(OR=1.839;95%CI:1.631~2.079;P=0.004)、CRP(OR=2.025;95%CI:1.019~4.031;P=0.004)升高及胆囊壁增厚(OR=1.680;95%CI:1.520~1.859;P<0.001)为中转开腹的独立危险因素,而结石数量(OR=0.422;95%CI:0.273~0.643;P=0.0005)为中转开腹的保护因素。结论:急性结石性胆囊炎患者实施腹腔镜胆囊切除术时,对BMI超标、术前有糖尿病病史、术前WBC、PCT及CRP较高或B超显示胆囊壁增厚、结石单发的患者,应考虑术中中转开腹手术可能。     

Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature

BACKGROUNDGallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications. AIMTo compare outcomes including length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who undergo cholecystectomy during index admission as compared to those who undergo cholecystectomy thereafter. METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). RESULTSInitial search identified 163 reference articles, of which 45 were selected and reviewed. Eighteen studies (n = 2651) that met the inclusion criteria were included in this analysis. Median age of patients in the late group was 43.8 years while that in the early group was 43.6. Pooled analysis showed late laparoscopic cholecystectomy group was associated with an increased length of stay by 88.96 h (95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled risk difference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group. Pooled analysis showed no risk difference in intraoperative complications [risk difference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [risk difference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy [risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and late cholecystectomy groups. Pooled analysis showed the duration of surgery to be prolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy group as compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorter hospital stay, shorter duration of surgery, while decreasing the risk of biliary complications. Rate of intraoperative, post-operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy was performed early or late.     

延续性健康促进模式对老年痴呆患者生活质量干预效果的Meta分析

目的 系统分析延续性健康促进模式对老年痴呆患者生活质量的干预效果。方法 通过检索中国知网、维普、万方及Pubmed、Elsevier等数据库,全面的查阅延续性健康促进影响老年痴呆患者生活质量的相关文献,并运用RevMan 5.3软件对纳入文献进行meta分析。结果 共纳入8篇随机对照实验(randomized controlled trial,RCT)研究,共545例老年痴呆患者。分析发现延续性健康促进模式能改善老年痴呆患者智能状况[WMD=2.28,95%CI(1.60,2.96),P<0.001] ,日常生活能力[WMD=-4.63 ,95%CI(-6.44,-2.81), P<0.001],健康状况[WMD=-8.15,95%CI(-13.49,-2.82),P=0.003],社会活动能力[WMD=2.32,95%CI(0.89,3.75),P=0.001]。 结论 实施积极有效的延续性健康促进有利于提高老年痴呆患者的社会适应能力,改善生活质量。     

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。     

Alcohol consumption and the risk of Barrett&rsquo;s esophagus: A meta-analysis

AIM: To evaluate the possible association between alcohol consumption and Barrett’s esophagus (BE). METHODS: We performed a systematic literature search of multiple online electronic databases. Inclusion criteria entailed studies about alcohol and BE. Meta-analysis was conducted to evaluate odds ratio (OR) and 95%CIs for the association between alcohol consumption and BE. RESULTS: Twenty studies comprising 4758 patients with BE were included in the meta-analysis. The risk of BE in patients with alcohol consumption was increased compared with control groups (OR = 1.01; 95%CI: 1.00-1.02), especially in case-control and cohort, European and Asian, and hospital studies, but there was a decreased risk of BE associated with alcohol consumption from American studies (OR = 0.86; 95%CI: 0.77-0.96). At the same time, there was no significant association between BE and alcohol consumption in community studies (OR = 0.97; 95%CI: 0.84-1.12) and the type of alcohol (wine, beer and liquor) studies. CONCLUSION: Our meta-analysis found that alcohol consumption was associated with an increased risk of BE, especially for European and Asian drinkers.     

糖尿病患者衰弱危险因素的Meta分析

目的 通过Meta分析明确糖尿病患者衰弱的危险因素,为有效预防糖尿病患者衰弱提供科学依据。方法 计算机检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、Web of Science、Cochrane Library,收集关于糖尿病患者衰弱影响因素的横断面研究、病例对照研究或队列研究,检索时限为自建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入21篇文献,其中14篇横断面研究,4篇队列研究,3篇病例对照研究,糖尿病患者合计6 937例,其中衰弱患者1 562例（22.5%）,涉及影响因素13个。Meta分析结果显示,糖尿病患者衰弱的危险因素为高龄（OR=1.29,95%CI：1.12~1.49）、女性（OR=2.68,95%CI：1.88~3.81）、文化程度较低（OR=2.30,95%CI：1.55~3.42）、糖化血红蛋白水平较高（OR=1.92,95%CI：1.33~2.77）、合并其他疾病（OR=2.35,95%CI：1.49~3.73）、住院次数多（OR=7.28,95%CI：3.56~14.89）、营养状况较差（OR=3.13,95%CI：1.96~4.99）、日常生活活动能力较低（OR=2.74,95%CI：1.98~3.80）和抑郁（OR=1.78,95%CI：1.32~2.41）,而体质量（OR=1.48,95%CI：0.30~7.42）和饮酒（OR=2.12,95%CI：0.67~6.76）与糖尿病患者衰弱无关,运动（OR=0.85,95%CI：0.74~0.97）和25-羟基维生素D₃（OR=0.94,95%CI：0.90~0.98）为糖尿病患者衰弱的保护因素。敏感性分析与发表偏倚结果显示各因素合并结果较稳定,发表偏倚不明显。结论 糖尿病患者的衰弱与多种因素有关,其危险强度由高到低依次为住院次数多、营养状况较差、日常生活活动能力较差、女性、合并其他疾病、文化程度较低、糖化血红蛋白水平较高、抑郁以及高龄。     

那格列奈治疗2型糖尿病有效性与安全性的Meta分析

目的系统评价那格列奈(NATE)与米格列奈(MITI)比较治疗2型糖尿病(T2DM)的有效性和安全性。方法计算机检索PubMed、EMbase、MEDLINE、The Cochrane Library(2013年第3期)、CNKI、VIP和WanFang Data,收集NATE与MITI比较治疗T2DM的随机对照试验(RCT),检索时限为从建库至2013年10月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入8个RCT,共计966例患者。Meta分析结果显示:1 NATE组在降低FPG[WMD=0.07,95%CI(–0.19,0.34),P=0.58]、2hPG[WMD=0.33,95%CI(–0.22,0.87),P=0.24]、HbA1c[WMD=0.11,95%CI(–0.03,0.25),P=0.12]方面与MITI组疗效相似,其差异均无统计学意义。2两组均能显著降低胰岛素抵抗水平、改善B细胞功能及抑制氧化应激。3两组在低血糖[OR=1.49,95%CI(0.85,2.60),P=0.17]和胃肠道不良反应发生率[OR=–0.80,95%CI(0.37,1.75),P=0.58]方面差异均无统计学意义。结论 NATE和MITI在治疗T2DM的有效性和安全性方面差异无统计学意义。受纳入研究数量和质量所限,上述结论尚待开展更多大样本、多中心的高质量研究进行验证。