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.     

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。     

Expression of epithelial cellular adhesion molecule in gastric cancer: A meta-analysis

AIM: To obtain an accurate evaluation of the association between high expression of epithelial cellular adhesion molecule (EpCAM) and gastric cancer (GC) risk. METHODS: Studies that had examined the association between high expression of EpCAM and GC risk were identified by searching electronic databases PubMed, EMBASE, Cochrane library and Chinese Biomedical Literature database. Risk ratios (RRs) together with their 95%CIs were used to assess the association between high expression of EpCAM and GC risk. We selected eligible studies based on inclusion criteria. RevMan 5.3 software was used to calculate the pooled values. RESULTS: A total of 14 studies were included in this meta-analysis. EpCAM-positive cases were significantly associated with tumor size (RR: 1.68, 95%CI: 1.47-1.91, P < 0.00001 fixed-effect), depth of invasion (RR: 1.37, 95%CI: 1.11-1.68, P = 0.003 random-effect), TNM stage (RR: 2.02, 95%CI: 1.35-3.02, P = 0.0007 random-effect), tumor location (RR: 0.80, 95%CI: 0.71-0.91, P = 0.0007 fixed-effect), histologic differentiation (RR: 1.23, 95%CI: 1.13-1.33, P < 0.00001 fixed-effect) and lymph node metastasis (RR: 1.89, 95%CI: 1.28-2.80, P = 0.001 random-effect). However, we did not observe any significant association between the presence of EpCAM with age, gender, distant metastasis, Borrmann type or Lauren classification. Additionally, EpCAM expression was not associated with the overall survival rate. The pooled HR of the overall effect was 1.39 (95%CI: 0.30-6.48, P = 0.67 random-effect). CONCLUSION: Our meta-analysis indicates that EpCAM contributes to GC risk, which acts as a prognostic factor and a marker of poor outcome.     

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.     

Ascorbic acid and low-volume polyethylene glycol for bowel preparation prior to colonoscopy: A meta-analysis

AIM: To evaluate the benefits of low-volume polyethylene glycol (PEG) with ascorbic acid compared to full-dose PEG for colonoscopy preparation. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched (January 2012). Only randomized-controlled trials on adult subjects comparing low-volume PEG (2 L) with ascorbic acid vs full-dose PEG (3 or 4 L) were included. Meta-analysis for the efficacy of low-volume PEG with ascorbic acid and full-dose PEG were analyzed by calculating pooled estimates of number of satisfactory bowel preparations as well as adverse patient events (abdominal pain, nausea, vomiting). Separate analyses were performed for each main outcome by using OR with fixed and random effects models. Heterogeneity was assessed by calculating the I² measure of inconsistency. RevMan 5.1 was utilized for statistical analysis. RESULTS: The initial search identified 242 articles and trials. Nine studies (n = 2911) met the inclusion criteria and were analyzed for this meta-analysis with mean age range from 53.0 to 59.6 years. All studies were randomized controlled trials on adult patients comparing large-volume PEG solutions (3 or 4 L) with low-volume PEG solutions and ascorbic acid. No statistically significant difference was noted between low-volume PEG with ascorbic acid and full-dose PEG for number of satisfactory bowel preparations (OR 1.07, 95%CI: 0.86-1.33, P = 0.56). No statistically significant difference was noted between low-volume PEG with ascorbic acid and full-dose PEG for abdominal pain (OR 1.09, 95%CI: 0.81-1.48, P = 0.56), nausea (OR 0.70, 95%CI: 0.49-1.00, P = 0.05), or vomiting (OR 0.99, 95%CI: 0.78-1.26, P = 0.95). No publication bias was noted. CONCLUSION: Low-volume PEG with the addition of ascorbic acid demonstrates no statistically significant difference to full-dose PEG for satisfactory bowel preparation and side-effects.     

Relationship between apolipoprotein E gene polymorphism and total cholesterol level in patients with kidney diseases

AIM: To evaluate the association between apolipoprotein E (apoE) gene polymorphism and total cholesterol (TC) level in patients with kidney diseases. METHODS: A predefined literature search was performed to collect data from the electronic databases of PubMed, Embase and the Cochrane Library and eligible relevant studies reporting the association of apoE gene polymorphism with TC level in patients with kidney diseases were recruited for meta-analysis. RESULTS: Twenty-one studies were identified for the analysis of association between apoE gene polymorphism and TC level in patients with kidney disease. Subjects with E3E4 had a higher TC than those with E3E3 [weighted mean differences (WMD) = 2.14, P = 0.01] and subjects with E2E3 had a lower TC than those with E3E3 (WMD = -1.93, P = 0.01). Subjects with ε2 had a lower TC than those with ε3 (ε2 vs ε3: WMD = -1.23, P = 0.002; ε2 vs ε4: WMD = -2.77, P ﹤0.0001) and subjects with 3 had a lower TC than those with 4 (WMD = -0.79, P = 0.03). CONCLUSION: Subjects with apoE E3E4 and ε4 had a higher TC level and subjects with apoE E2E3 and ε2 had a higher TC level in patients with kidney disease. However, more well-designed studies should be performed in the future to confirm these findings.     

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.     

Sleep-associated movement disorders and the risk of cardiovascular disease: A systematic review and metaanalysis

AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome(RLS)and periodic limb movements during sleep with CVD,but the results were still contradictory.We performed an extensive literature search on Pub Med,Medline and Web of Science published from inception to December 2014.Additional studies were manually searched from bibliographies of retrieved studies.Meta-analyses were conducted with Stata version 12.0(Stata Corp,College Station,Texas).Pooled odds ratios(ORs)and 95%CIs were calculated to assess the strength of association using the random effects model.Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity.The publication bias was detected using Egger’s test and Begg’s test.RESULTS:A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected.Among these studies,nine are cohort studies;two are case-control studies;and two are cross-sectional studies.The results showed that the summary OR of CVD associated with sleepassociated movement was 1.51(95%CI:1.29-1.77)in a random-effects model.There was significant heterogeneity between individual studies(P for heterogeneity=0.005,I2=57.6%).Further analysis revealed that a large-scale cohort study may account for this heterogeneity.A significant association was also found between RLS and CVD(OR=1.54,95%CI:1.24-1.92).In a fixed-effects model,we determined a significant relationship between sleep-associatedmovement disorders and coronary artery disease(CAD)(OR=1.34,95%CI:1.16-1.54;P for heterogeneity=0.210;I2=30.0%).Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.CONCLUSION:This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.     

微课结合翻转课堂对手术室实习护生学习能力影响的Meta分析

目的 系统评价微课联合翻转课堂教学对手术室实习护生学习能力的影响。方法 检索中国知网、万方、维普、PubMed、Web of Science和Cochrane Library等数据库中与手术室实习护生带教模式相关的文献,检索时限为建库至2022年5月。由2 名研究员根据纳入和排除标准独立进行文献筛选、数据提取并进行质量评价,运用RevMan 5.3软件进行Meta分析。结果 本研究最终纳入9篇文献,共包含研究对象833人。Meta分析结果显示,微课结合翻转课堂教学法可显著提高手术室实习护生的理论成绩[MD=8.48,95%CI(1.61～15.35),P＜0.00001],操作技能成绩[MD=10.24,95%CI(4.26～16.23),P＜0.00001],实习护生对教学方法的满意度[RR=1.16,95%CI(1.10～1.22),P＜0.00001]以及护生的学习能力[RR=1.20,95%CI(1.08～1.33),P＜0.00001]。结论 微课联合翻转课堂教学法可以提高手术室实习护生的理论知识水平、操作技能及护生学习能力,护生认可度高。     

基于加速康复外科护理对手术减肥患者有效性的系统评价与Meta分析

目的 评价加速康复外科护理对手术减肥患者的有效性。方法 计算机检索PubMed、Embase、Web of Sience、The Cochrane library、中国知网、中国生物医学文献、维普、万方数据库的文献,检索时间为建库至2019年12月31日。由2名研究员根据纳入与排除标准筛选文献、提取数据,对纳入文献采用RevMan 5.2软件进行Meta分析。结果 共纳入14篇研究,纳入患者10 044例。Meta分析结果显示,与传统围术期护理比较,加速康复外科护理可明显缩短手术减肥患者住院时长[SMD=-2.33,95%CI(-3.43～-1.24),P＜0.0001];加速康复外科护理并未降低手术减肥患者再次入院率及术后相关并发症发生率[OR=0.83,95%CI(0.68～1.00),P=0.05;OR=0.94,95%CI(0.81～1.10),P=0.44];同时部分文献报道加速康复外科理念的推广可降低减肥手术患者住院费用。结论 现有证据表明,加速康复外科护理可显著缩短手术减肥患者的住院时长,降低患者住院费用,但对术后再入院率及并发症无明显影响。鉴于本次研究证据质量有限,今后还应开展更多高质量的研究。     

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.     

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.     

Statin use and risk of liver cancer: A meta-analysis of 7 studies involving more than 4.7 million patients

AIM: To pool data currently available to determine the association between statin use and the risk of liver cancer. METHODS: A computerized literature search was conducted to identify those relevant studies between January 1966 and March 2013. Stata 11.0 (Stata Corp, College Station, Texas) was used for statistical analyses. Pooled relative risk (RR) estimates with 95%CI were calculated for overall analysis and subgroup analyses, using the random- and fixed-effects models. Heterogeneities between studies were evaluated by Cochran’s Q test and I² statistic. The Begg’s funnel plot and Egger’s regression asymmetry test were used to detect the publication bias. RESULTS: Seven studies were included in our meta-analysis according to the selection criteria, including four cohort studies and three case-control studies. These studies involved 4725593 people and 9785 liver cancer cases. The overall analysis showed that statin use was statistically associated with a significantly reduced risk of liver cancer (random-effects model, RR = 0.61, 95%CI: 0.49-0.76, P < 0.001; fixed-effects model, RR = 0.64, 95%CI: 0.57-0.71, P < 0.001); however, significant heterogeneity was found between studies (Cochran’s Q statistic = 19.13, P = 0.004; I² = 68.6%). All subgroup analyses provided supporting evidence for the results of overall analysis. Begg’s (Z = 0.15, P = 0.881) and Egger’s test (t =-0.44, P = 0.681) showed no significant risk of having a publication bias. CONCLUSION: Statin use was associated with the reduced risk of liver cancer. To clearly clarify this relationship, more high quality studies are required.     

Periodontal disease is associated with increased coronary heart disease risk: A meta-analysis based on 38 case-control studies

AIM: To investigate whether periodontal disease (PD) is associated with increasing coronary heart disease (CHD) risk by performing a meta-analysis. METHODS: Two authors independently searched PubMed and China National Knowledge Infrastructure up to January 10^th, 2013 for relevant case-control studies that investigated the association between PD and CHD. After quality assessment using Newcastle-Ottawa Scale and data extraction by two independent authors, the overall and subgroup meta-analyses were performed and publication bias were examined using the Comprehensive Meta-Analysis V2 software. Potential publication bias was assessed using visual inspection of the funnel plots, Egger linear regression test, and trims and fill method. RESULTS: Finally 38 relevant case-control studies were identified, involving 4950 CHD patients and 5490 controls. Eleven studies were rated low quality and 27 were high quality. Based on random-effects, a significant association was identified between PD and CHD (OR 3.79, 95%CI: 2.23-6.43, P < 0.001, I² = 98.59%), and sensitivity analysis showed that this result was robust. Subgroup analyses according to adjusted/unadjusted ORs, source of control, methodological quality, end point, assessment of PD/CHD, and ethnicity also indicated a significant association. Publication bias was detected, and the estimated OR including the “missing” studies did not substantially differ from our estimate with adjustment for missing studies (OR 4.15, 95%CI: 2.62-6.54, P < 0.001). CONCLUSION: Based on the meta-analysis, PD is probably associated with CHD risk independently and significantly.     

曲美他嗪联合阿托伐他汀治疗冠心病患者的疗效与安全性Meta分析

目的 系统评价曲美他嗪联合阿托伐他汀与单独使用曲美他嗪治疗冠状动脉粥样硬化性心脏病（CHD）患者的临床疗效及安全性。 方法 计算机检索Cochrane Library,PubMed,Embase,Wanfang,CNKI,VIP中关于曲美他嗪联合阿托伐他汀治疗CHD的随机对照试验,检索时限为建库至2017年4月。按纳入与剔除标准筛选文献,提取资料并进行方法学质量评估,并使用RevMan5.3软件进行Meta分析。 结果 最终纳入10项研究,纳入研究对象1166例。结果显示,与单独使用曲美他嗪相比,曲美他嗪联合阿托伐他汀显著降低低密度脂蛋白胆固醇（MD=–0.54,95%CI:–0.69~–0.40,P<0.001）、总胆固醇（MD=–1.17,95%CI:–1.30~–1.03,P<0.001）、三酰甘油（MD=–0.51,95%CI:–0.55~–0.47,P<0.001）、C-反应蛋白（MD=–2.40,95%CI:–3.25~–1.55,P<0.001）,能减少心绞痛发作次数（MD=–1.52,95%CI:–1.68~–1.36,P<0.001）和每次心绞痛持续时间（MD=–1.67,95%CI:–1.89~–1.46,P<0.001）。与单独使用曲美他嗪相比,曲美他嗪联合阿托伐他汀显著升高高密度脂蛋白胆固醇（HDL-C）（MD=0.11,95%CI:0.06~0.15,P<0.001）;而在药物不良反应方面,两组差异无统计学意义。 结论 曲美他嗪联合阿托伐他汀治疗CHD有一定的有效性,且安全性和耐受性良好,但上述结果尚需更多更加严谨的大样本、多中心、随机对照试验进一步证实。       

基于GRADE系统的耳穴疗法治疗癌性疼痛的Meta分析

目的 评价耳穴疗法治疗癌性疼痛的临床治疗效果。 方法 综合检索国内外大型数据库,经过严格筛选后运用Revman 5.3软件对符合标准的随机对照试验(randomized controlled trial, RCT)结果进行Meta分析,采用GRADEprofiler 3.6软件对结果证据质量进行评级。 结果 最终纳入11篇文献,共1 243例患者。分析发现耳穴疗法联合药物在恶心呕吐发生率[RR=0.50,95%CI(0.39,0.63)]、便秘发生率[RR=0.53,95%CI(0.44,0.65)]、疼痛评分[SMD=－0.52,95%CI(-0.74,-0.30)]、药物用量[WMD=-12.03,95%CI(-20.64,-3.41)]方面好于单纯应用药物,在疼痛缓解率[RD=0.12,95%CI(0.07,0.17)]、Kamofsky氏活动状态评分[WMD=0.98,95%CI(-0.46,2.42)]方面,与单纯应用药物差异无统计学意义。证据等级:疼痛缓解率评级为非常低,恶心呕吐发生率评级为低,便秘发生率评级为低,7 d用药量评级为非常低,KPS评分评级为低,疼痛评分评级为低。结论 耳穴疗法联合药物治疗癌性疼痛好于单纯应用药物。该结论的证据质量等级不高,研究结论需谨慎对待,需大样本、高质量的临床试验进一步证实。     

KLF4在胃癌组织中的表达与临床病理特征相关性的Meta分析

目的 系统评价Kruppel样转录因子4(KLF4)在胃癌中的表达与临床病理特征的关系。方法 计算机检索PubMed,Web of Science,EMBASE,万方数据库和中国知网(CNKI)数据库等,检索关于KLF4基因表达与胃癌相关性的病例对照研究。检索时间为建库至2018年5月。根据纳入和排除标准筛选文献,提取数据后,使用Review Manager5.3软件统计分析。结果 最终纳入10个研究,共1 063例样本量。Meta分析结果显示:KLF4的表达在胃癌组织组与正常组织或癌旁组织组间[OR=0.22,95%CI(0.09,0.55),P=0.001]、淋巴结转移组与无淋巴结转移组间[OR=0.38,95%CI(0.28,0.51),P<0.000 01]、高中分化组与低分化组间[OR=2.98,95%CI(1.93,4.61),P<0.000 01],Ⅰ～Ⅱ期与Ⅲ～Ⅳ期间[OR=2.93,95%CI(1.53,5.62),P=0.001]、胃癌浸润浆膜以外组与未及浆膜组间[OR=0.42,95%CI(0.27,0.65),P=0.000 1]差异均有统计学意义。结论KLF4在胃癌中的表达与其发生、淋巴结转移、分化程度、TNM分期及浸润程度密切相关。     

Is positivity for hepatitis C virus antibody predictive of lower risk of death in COVID-19 patients with cirrhosis?

Liver injury has been reported in coronavirus disease 2019 (COVID-19) cases but the impact of pre-existing liver damage and related etiology have not been completely elucidated. Our research interests include the potential reciprocal influence of COVID-19 and pre-existing liver damage related to hepatitis C virus (HCV) infection, in particular. To this end, we have evaluated three cohorts of patients admitted at three Italian hospitals during the coronavirus pandemic; these included 332 patients with COVID-19 and 1527 patients with HCV who were from established real-world antiviral treatment study cohorts (sofosbuvir/velpatasvir), with either liver disease (various severities; n = 1319) or cirrhosis (n = 208). Among the COVID-19 patients, 10 had cirrhosis (3%), including 7 of metabolic origin and 3 of viral origin. Mortality among the COVID-19 patients was 27.1%, with 70% of those with cirrhosis of metabolic etiology having died. Cirrhosis, older age, low white blood cell count and lymphocyte count being identified as risk predictors of death [odds ratio (OR) = 13.7, 95% confidence interval (CI): 2.59-83.01, P = 0.006; OR = 1.05, 95%CI: 1.03-1.08, P = 0.0001; OR = 1.09, 95%CI: 1.36-1.16, P = 0.001; OR = 0.61, 95%CI: 0.39-0.93, P = 0.023, respectively]. In the two cohorts of HCV patients, COVID-19 diagnosis was made in 0.07% of those with liver disease and 1% of those with cirrhosis. Thus, the prevalence of HCV antibodies among COVID-19-infected patients was comparable to that currently reported for the general population in Italy. Amongst the COVID-19 patients, pre-existing metabolic cirrhosis appears to be associated with higher mortality, while HCV antibodies may be suggestive of “protection” against COVID-19.     

PCSK9抑制剂对动脉粥样硬化性心血管疾病有效性及安全性的meta分析

目的 系统评价PCSK9抑制剂对动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease, ASCVD)患者的有效性及安全性。方法 计算机检索PubMed、Embase、Cochrane图书馆和临床试验注册平台Clinical Trails.gov,检索年限从建库至2022年5月。筛选并纳入PCSK9抑制剂治疗ASCVD患者的随机对照试验(randomized controlled trials, RCTs),应用Review Manager 5.4软件对符合标准的RCTs进行meta分析。结果 共纳入10项随机对照试验,共计54 472例患者。有效性分析结果显示：与对照组相比,PCSK9抑制剂可降低ASCVD患者低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)水平49.26%(95%CI:-54.00～-44.52,P<0.01),并显著降低了其他5项血脂水平;PCSK9抑制剂组动脉粥样硬化斑块体积百分比(percent atheroma volume, PAV)降低1.1%...     

Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials

AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis(OA). METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases(MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared tosham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials(281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference(SMD)(95%CI) =-0.39(-0.70--0.08); P = 0.01] but not physical function [self-reported in 3 trials(130 participants/OA knees): SMD(95%CI) =-0.21(-0.55-0.14), P = 0.24; walking performance in 4 trials(130 participants/OA knees): SMD(95%CI) =-0.11(-0.59-0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error(χ2 = 8.37, P = 0.04, I 2 = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency(I2 = 28%) but the treatment effect remained insignificant.CONCLUSION: Meta-analyzed double-blind placebocontrolled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.