针灸治疗宫颈癌术后尿潴留的研究

为探讨针灸对子宫颈癌术后神经损伤性膀胱功能障碍恢复的作用,选用健康雌性家兔３６只,随机分成造模组（子宫切除术后尿潴留模型）、针灸组（术后电针加艾灸治疗）和对照组,分别进行膀胱内压、排尿阈值、残余尿量、盆神经放电频率测定。结果：３组家兔随着膀胱内注入量的增加膀胱内压力随之增加,造模组明显低于对照组及针灸组（Ｐ〈０．０１,Ｐ〈０．０５）;膀胱排尿阈植造模组明显高于对照组及针灸组（Ｐ〈０．０１,Ｐ〈０．     

宫颈癌根治术后尿潴留预防和管理最佳证据的审查及障碍因素分析

目的 审查宫颈癌根治术后尿潴留预防和管理的最佳证据,分析循证护理实践中的障碍因素,为临床护理工作提供参考。方法 计算机检索最佳证据并总结,确定审查指标、审查方法,针对审查结果进行障碍因素分析。结果 依据12条最佳证据制订13条质量审查指标,障碍因素主要为培训不足、物资缺乏、医务人员意识问题、缺乏规范化管理。结论 临床科室需要结合临床环境、医务人员应用证据的促进因素及阻碍因素、患者意愿及偏好等有针对性地选择证据,同时应用者还需持续对证据进行更新。     

卡孕栓与新斯的明治疗宫颈癌根治术后尿潴留的疗效比较

目的对比卡孕栓与新斯的明治疗宫颈癌根治性子宫全切除术后尿潴留的疗效。方法选取2008年1月～2011年3月宫颈癌根治性子宫全切除术后发生尿潴留的患者52例。随机分为实验组及对照组各26例。实验组舌下含服卡孕栓1mg,对照组经臀部肌注新斯的明1mg,比较两组患者用药60min后的效果。结果实验组效果明显优于对照组,两组差异有统计学意义（P〈0.05）。结论卡孕栓治疗宫颈癌根治术后的尿潴留疗效迅速,效果显著。     

针灸配合推拿治疗肛肠病术后尿潴留效果分析

目的分析针灸配合推拿治疗肛肠病术后尿潴留的效果。方法选取2018-01—2019-04间在南石医院行肛肠病术后发生尿潴留的54例患者,根据不同治疗方法分为2组,每组27例。对照组采用常规治疗措施,针推组联合针灸配合推拿治疗。回顾性分析2组患者的临床资料。结果针推组治疗总有效率高于对照组,自行排尿时间短于对照组,差异均均有统计学意义(P0.05)。结论对肛肠病术后尿潴留患者,在常规治疗的基础上联合针灸配合推拿治疗,可缩短术后自主排尿时间,提高治疗效果。     

膀胱冲洗加酚妥拉明预防宫颈癌根治术后尿潴留的疗效观察

广泛性全子宫切除加盆腔淋巴结清扫术是治疗早期宫颈癌的有效方法,尿潴留是广泛性子宫切除术后最常见的并发症．其发生率为7．5％～44．9％。尽管国内外学者对预防广泛性子宫切除术后尿潴留的发生采取了很多措施,但目前尚未得到满意的解决。本文的研究目的是探讨手术后采用膀胱冲洗加酚妥拉明的应用预防尿潴留的发生。     

针灸治疗痤疮系统评价的再评价

目的:对已发表的针灸治疗痤疮的系统评价进行再评价.方法:计算机检索CNKI、WanFang、VIP等中文数据库及Cochrane Library和PubMed等外文数据库中已发表的针灸治疗痤疮的系统评价,检索时间选为建库至2019年12月31日.由两名研究人员独立进行文献筛选及资料提取,采用AMSTAR2条目、PRIS...     

宫颈癌术后尿潴留患者清洁间歇导尿的居家护理

目的 总结宫颈癌术后尿潴留患者清洁间歇导尿的居家护理措施。方法 对157例宫颈癌术后尿潴留患者,专科护士正确指导患者进行清洁间歇导尿操作,提高患者首次清洁间歇导尿成功率;通过多种健康教育方式,每日微信群规范化随访,适时电话指导,保证患者间歇清洁导尿的规范及导尿日记的正确记录,预防及减少尿路感染的发生;进行有效沟通,采取同伴教育缓解患者焦虑情绪。结果 112例（71.3%）通过规范化的居家护理最终顺利完成清洁间歇导尿,尿潴留治愈;45例（28.7%）患者因多种因素放弃治疗,改为留置尿管。结论 通过完整的、个性化的居家护理可以保证患者清洁间歇导尿的质量和安全,促进患者膀胱功能恢复,提高尿潴留治愈率。     

间歇性自我清洁导尿术在宫颈癌术后尿潴留患者中的应用

目的探讨间歇性自我清洁导尿术在宫颈癌术后尿潴留患者中的应用效果。方法将120例宫颈癌术后尿潴留患者随机分为观察组和对照组各60例,观察组行间歇性自我清洁导尿,对照组予留置导尿。于术后第14天、第21天留取患者中段尿液进行细菌培养,术后第21天评估患者膀胱残余尿量情况。结果术后第14天、第21天两组泌尿系感染发生率比较,差异有统计学意义(均P0.01);术后第21天观察组残余尿量及膀胱功能恢复情况显著优于对照组(均P0.01)。结论间歇性自我清洁导尿术能显著降低宫颈癌术后尿潴留患者泌尿系感染发生率,对促进患者膀胱功能的恢复有积极作用。     

胃癌根治术后静脉化疗效果的系统评价

目的:评价胃癌根治术后接受不同药物、剂量(经静脉)化疗的疗效和安全性。方法:应用国际Cochrane协作网的系统评价方法,研究文献中关于胃癌根治术后接受不同药物、剂量(经静脉)化疗组与单纯根治手术组疗效比较的随机和半随机试验进行了系统评价。结果:17个试验包括2915例病人,经异质性检验,χ2=37.58,P=0.0017,17个试验存在异质性;采用随机效应模型(D鄄L)法进行meta分析,合并效应量OR=0.66,95%可信区间为0.51～0.85,经u检验,P=0.002,说明胃癌根治术后接受不同药物、剂量(经静脉)化疗组的疗效优于单纯根治手术组。17篇文章中有9篇对化疗药物的毒性反应按WHO分度标准进行描述,副作用主要有胃肠道症状、骨髓抑制、心脏毒性、血液毒性等,5例病人死于化疗相关毒性事件。结论:胃癌根治术后接受化疗可能有一定效果,毒性事件发生率较低;在接受根治性切除术后,全身静脉化疗对提高胃癌病人的5年生存率可能有一定的作用。     

A systematic review and meta-analysis of neostigmine for urinary retention after surgeries

BackgroundThe aim of this research is to analyze the efficacy of neostigmine in the treatment of postoperative urinary retention (POUR).MethodsIn this research, we screened multiple databases including PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI). After a systematic search process, data extraction was conducted. Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis, and bias analysis.ResultsAfter searching for articles, 20 eligible trials including 1,850 patients after surgery were extracted. Our results suggested that the neostigmine group had a higher effective rate for urinary retention than the Chinese traditional and physical therapy group (OR =7.47, 95% CI: 4.10–13.59, overall effect P<0.001). Further subgroup analysis showed that neostigmine acupoint injection was better than neostigmine intramuscular injection. Time to first voiding in the neostigmine acupoint injection group was shorter than that in the neostigmine intramuscular injection group (MD =–81.92, 95% CI: –130.13 to –33.70, overall P<0.001, I²=99% with random effects model). Furthermore, neostigmine acupoint injection improved urine excretion (MD =243.40, 95% CI: 201.62–285.18, overall P<0.0001) and reduced the residual urine volume (MD =–41.31, 95% CI: –58.05 to –24.58, overall P<0.001, I²=75% with random effects model). The results of the sensitivity analysis and publication bias showed that this research was robust and had little publication bias.DiscussionOur meta-analysis results suggest that neostigmine can effectively improve the symptoms of POUR and neostigmine acupoint injection may achieve a better therapeutic effect.     

Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

BackgroundThere are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic value of various urine analysis and detection methods in urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods.MethodsThe PubMed, Embase, Cochrane Library, SpringerLink, CNKI, and Wanfang databases were searched from inception to December 2021. Two system assessors independently screened the literature according to the inclusion and exclusion criteria. RevMan version 5.3 (the Cochrane Collaboration) and Meta-DiSc were used to calculate the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic ratio (DOR) of the diagnostic tests and draw summary receiver operating characteristic (SROC) curves.ResultsA total of 14 documents were included according to the inclusion and exclusion criteria. There was a significant statistical difference between the urine sediment microscopy group and the urine normalization group in urine leucocyte detection (OR =2.15, 95% CI: 1.29–3.56, P=0.003, I²=19%, Z=2.95), urine erythrocyte test (OR =1.87, 95% CI: 1.13–3.09, P=0.01, I²=0%, Z=2.45), quantitative determination of urinary protein composition (OR =2.32, 95% CI: 1.27–4.23, P=0.006, I²⁼30%, Z=2.73), and determination of urinary enzymes (OR =1.67, 95% CI: 1.03–2.72, P=0.04, I²⁼0%, Z=2.07).DiscussionWhen examining red and white blood cells in urinary tract infection diagnosis, urine dry chemistry is superior to automated urinalysis in terms of area under the curve (AUC), Sen, Spe, etc. When examining urine bacteria, urine dry chemistry can be recommended for urine bacteria screening, with bacterial culture required for confirmation.     

食管癌术后食管胃吻合口瘘危险因素的系统评价与Meta分析

目的系统评价食管癌术后食管胃吻合口瘘(esophagogastric anastomotic leakage,EGAL)的危险因素,为防治EGAL提供理论基础。方法通过计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、万方、维普、中国知网和中国生物医学文献数据库,收集食管癌术后EGAL危险因素的病例对照研究、队列研究。检索时限均为建库至2020年1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,使用RevMan 5.3软件进行Meta分析。结果共纳入33个研究,其中病例对照研究19个,队列研究14个,纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评分均≥6分。所有研究共包括26636例患者,其中男20283例、女6353例,国内9587例,国外17049例。Meta分析结果显示以下因素可增加食管癌术后EGAL的发生风险(P≤0.05):(1)患者自身因素(18个):年龄、性别、体重指数、吸烟史、吸烟指数(≥400年支)、饮酒史、消化道溃疡、呼吸系统疾病、第一秒用力呼气容积与用力肺活量比值(ratio of forced expiratory volume in one second to forced vital capacity,FEV1/FVC)、慢性阻塞性肺疾病(chronic obstructive pulmoriary disease,COPD)、冠状动脉粥样硬化、外周血管疾病、心律失常、糖尿病、高血压、脑血管疾病史、腹腔干钙化、降主动脉钙化;(2)术前因素(6个):肝功能异常、肾功能不全、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、新辅助放射治疗(放疗)、术前白蛋白<35 g/L、术前白蛋白低;(3)术中因素(7个):胸骨后途径、颈部吻合、胸腔镜手术、手术时间≥4.5 h、管状胃、上段肿瘤、脾切除;(4)术后因素(5个):呼吸衰竭、术后心律失常、使用纤维支气管镜、肺部感染、深静脉血栓。新辅助化学治疗(化疗)可降低术后EGAL的发生风险(P<0.05)。而年龄≥60岁、上消化道炎症、一氧化碳弥散量(diffusing capacity of carbon monoxide,DLCO)占预计值的比值(DLCO%)、胸部手术史、腹部手术史、糖皮质激素药物史、新辅助放射治疗和化学治疗、吻合口包埋、端端吻合、手工吻合、术中出血量等因素与食管癌术后EGAL的发生无明显相关性(P>0.05)。结论当前证据表明,食管癌术后发生EGAL的危险因素有年龄、性别、体重指数、吸烟指数、饮酒史、消化道溃疡、FEV1/FVC、COPD、糖尿病、ASA分级、新辅助放疗、术前白蛋白<35 g/L、颈部吻合、胸腔镜手术、手术时间≥4.5 h、管状胃、上段肿瘤、脾切除、术后呼吸衰竭、术后心律失常等,新辅助化疗可能是其保护因素。受纳入研究质量限制仍需要更多高质量的文献予以佐证。     

Efficacy and safety of acupuncture for the treatment of oligoasthenozoospermia: A systematic review

Oligoasthenozoospermia is a common factor leading to male infertility. Acupuncture has been applied for treating male infertility for several thousand years in China, but clinical evidence of its efficacy and safety in treating oligoasthenozoospermia is yet to be established. This review aimed to systematically assess the evidence on the effect of acupuncture in males with oligoasthenozoospermia. Databases (PubMed, EMBASE, SINOMED, CNKI, Wanfang database and Cochrane Library) were searched to identify related studies published before 30th June 2019. The Cochrane risk of bias tool and Jadad score was adopted to assess the methodological quality of included studies. Twelve randomised controlled trials (RCTs) with 1,088 participants were included in this review. The aim of this study was to perform a meta-analysis, but it was not possible due to considerable clinical heterogeneity among the included studies. According to the narrative analysis, acupuncture or acupuncture combined with another intervention was effective in improving the semen quality based on the included studies. However, this result should be interpreted with caution due to high risk. The methodological quality of most included studies was low. The current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a solid conclusion due to the poor methodological quality. Rigorous full-scale RCTs are needed to validate the therapeutic efficacy and safety of acupuncture in treating oligoasthenozoospermia.     

基于信息-动机-行为模型的宫颈癌术后尿潴留带管出院患者的护理干预

目的探讨基于信息-动机-行为模型的宫颈癌术后尿潴留带管出院患者的护理干预效果。方法将96例宫颈癌根治术后14d首次拔除尿管时确诊的尿潴留患者,按照随机数字表法分为对照组和观察组各48例,对照组按常规进行尿管护理,指导患者进行盆底肌功能锻炼,面对面讲解并示范尿管的护理操作,并进行常规的出院随访;观察组实施基于信息-动机-行为模型的护理干预。比较干预后两组残余尿量、膀胱功能及尿路感染率。结果干预后观察组残余尿量和尿路感染率显著低于对照组,膀胱功能显著优于对照组,差异有统计学意义(P<0.05,P<0.01)。结论基于信息-动机-行为模型对宫颈癌术后尿潴留患者进行护理干预,可以降低其残余尿量和尿路感染率,促进膀胱功能的恢复。     

针刺治疗绝经后骨质疏松症有效性及安全性的系统评价和Meta分析

目的评价针刺治疗绝经后骨质疏松症的有效性及安全性。方法电子检索中文和英文数据库共6个,检索日期截至2017年11月,根据Cochrane Hand book 5.3评价标准和工具评价纳入研究的质量,并用Revman 5.3软件进行Meta分析。结果共纳入10篇文献,包括710例患者,试验组354例,对照组356例。Meta分析显示:①针刺vs常规治疗[RR=1.36,95%CI(1.18,1.57),Z=4.34,P0.0001]、针刺+常规治疗vs常规治疗[RR=1.31,95%CI(1.14,1.50),Z=3.77,P=0.0002],在提高临床有效率上均优于对照组;②针刺vs常规治疗[MD=-2.36,95%CI(-4.20,-0.53),Z=2.53,P=0.01]、针刺+常规治疗vs常规治疗[MD=-1.61,95%CI(-2.06,-1.16),Z=7.01,P0.00001],在改善疼痛评分上均优于对照组。结论与单用常规治疗相比,针刺或针刺联合常规治疗在提高临床治疗有效率、改善疼痛方面疗效更优,适于临床采纳应用。但考虑到纳入文献的局限性,在今后的研究中需要更多高质量、大样本、多中心、方法学设计严谨的随机对照试验,进一步佐证并提升针刺治疗绝经后骨质疏松症有效性和安全性证据强度。     

Lifetime prevalence and adherence rate of cervical cancer screening among women living with HIV: a systematic review and meta-analysis

Introduction

Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We aimed to summarize the lifetime prevalence and adherence rate of cervical cancer screening among WLWH across low- and middle-income countries (LMICs), and high-income countries (HICs).

Methods

We systematically searched PubMed, Web of Science and Embase for studies published between database inception and 2 September 2022, without language or geographical restrictions. Those reporting the lifetime prevalence and/or adherence rate of cervical cancer screening among WLWH were included. Pooled estimates across LMICs and HICs were obtained using DerSimonian–Laird random-effects models. When the number of eligible studies was greater than 10, we further conducted stratified analyses by the World Health Organization (WHO) region, setting (rural vs. urban), investigation year, screening method, type of cervical cancer screening programme, age and education level.

Results

Among the 63 included articles, 26 provided data on lifetime prevalence, 24 on adherence rate and 13 on both. The pooled lifetime prevalence in LMICs was 30.2% (95% confidence interval [CI]: 21.0–41.3), compared to 92.4% in HICs (95% CI: 89.6–94.6). The pooled adherence rate was 20.1% in LMICs (95% CI: 16.4–24.3) and 59.5% in HICs (95% CI: 51.2–67.2).

Discussion

There was a large gap in cervical cancer screening among WLWH between LMICs and HICs. Further analysis found that those in LMICs had higher lifetime prevalence in subgroups with urban settings, with older age and with higher education levels; and those in HICs had higher adherence in subgroups with younger age and with higher education levels.

Conclusions

Cervical cancer screening among WLWH falls considerably short of the WHO's goal. There should be continuous efforts to further increase screening among these women, especially those residing in the rural areas of LMICs and with lower education levels.     

Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications

Objective

This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary incontinence (SUI) by conducting a systematic review.

Materials and Methods

We selected all randomized controlled trials (RCTs) that compared retropubic and transobturator sling placements for treatment of SUI. We estimated pooled odds ratios and 95% confidence intervals for intraoperative and postoperative outcomes and complications.

Results

Six hundred twelve studies that compared retropubic and transobturator approaches to midurethral sling placement were identified, of which 16 were included in our research. Our study was based on results from 2646 women. We performed a subgroup analysis to compare outcomes and complications between the two approaches. The evidence to support the superior approach that leads to better objective/subjective cure rate was insufficient. The transobturator approach was associated with lower risks of bladder perforation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.09-0.32), retropubic/vaginal hematoma (OR 0.32, 95% CI 0.16-0.63), and long-term voiding dysfunction (OR 0.32, 95% CI 0.17-0.61). However, the risk of thigh/groin pain seemed higher in the transobturator group (OR 2.53, 95% CI 1.72-3.72). We found no statistically significant differences in the risks of other complications between the two approaches.

Conclusions

This meta-analysis shows analogical objective and subjective cure rates between the retropubic and transobturator approaches to midurethral sling placement. The transobturator approach was associated with lower risks of several complications. However, good-quality studies with long-term follow-ups are warranted for further research.     

Lifestyle factors and colorectal cancer risk (2): a systematic review and meta-analysis of associations with leisure-time physical activity

Objective  Increased physical activity may decrease the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we performed a systematic review and meta-analysis of prospective observational studies to quantify gender-specific risk associated with increased leisure-time physical activity (LT-PA).
Method  We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. We used random-effects meta-analyses to estimate summary risk ratios (RR) and 95% confidence intervals (95% CI) for uppermost vs lowermost categories of physical activity. To investigate dose–response, we explored risks ratios as a function of cumulative percentiles of physical activity distribution.
Results  Fifteen datasets from 14 articles, including 7873 incident cases, were identified. For colon cancer, there were inverse associations with LT-PA for men (RR: 0.80; 95% CI: 0.67–0.96) and women (0.86; 0.76–0.98). LT-PA did not influence risk of rectal cancer. The dose–response analysis was consistent with linear pattern reductions in risk of colon cancer in both genders. There was evidence of moderate between-study heterogeneity but summary estimates were broadly consistent across potential confounding factors.
Conclusion  Increased LT-PA is associated with a modest reduction in colon but not rectal cancer risk; a risk reduction, which previously may have been overstated. LT-PA only interventions in public health cancer prevention strategies are unlikely to impact substantially on colorectal cancer incidences.