增强CT在诊断口腔癌下颌骨侵犯中的价值：基于诊断性试验的系统评价

目的 评价增强CT诊断口腔癌下颌骨侵犯的诊断效能。方法 对PubMed、荷兰医学文摘EMBASE、欧洲灰色文献数据库、中国生物医学文献数据库及重庆维普数据库进行电子检索，检索时间截至2014年1月3日；同时手工检索19种中文口腔医学杂志。两位评价者独立使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用Meta Disc 1.4软件进行Meta分析。结果 共纳入14篇研究，共涉及患者642名，其中7篇研究为前瞻性研究，1篇研究存在低偏倚风险，其余研究的偏倚风险情况不清。Meta分析结果显示：增强CT诊断下颌骨侵犯的合并敏感度（SEN）为0.718 ，95%可信区间（CI）为0.665~0.767，合并特异度（SPE）为0.909，95%CI为0.872~0.938，曲线下面积（AUC）为0.906 1，Q*值为0.837 8；增强CT在诊断口腔癌下颌骨骨髓侵犯时，SEN为0.787（0.643~0.893），SPE为0.904（0.790~0.968），AUC为0.949 6，Q*值为0.890 0。Meta回顾显示层厚较低的增强CT诊断效能较高。结论 增强CT在诊断口腔癌下颌骨侵犯及下颌骨骨髓侵犯时有较高的诊断效能，其SPE较高，适合用于颌骨侵犯的确诊。选择层厚较低的增强CT能够提高诊断效能。     

Meta分析评价全景片在口腔癌下颌骨侵犯中的诊断效能

目的 评价全景片作为筛查口腔癌下颌骨侵犯的诊断效能.方法 根据预先设定的检索式对MEDLINE、荷兰医学文摘、MEDION和中国生物医学文献数据库等7个数据库进行电子检索,检索时间截至2014年10月25日;同时进行手动检索.2位评价者独立使用QUADAS-2评价纳入研究的方法学质量并进行数据提取.运用MetaDisc 1.4软件进行Meta分析.结果 共纳入12篇研究,涉及患者528名.7篇为前瞻性研究,2篇有高偏倚风险,其余偏倚风险情况不清.Meta分析结果显示,增强CT在诊断下颌骨侵犯的合并敏感度为0.761,合并特异度为0.828,曲线下面积为0.884,Q*为0.814.结论 全景片可以作为口腔癌颌骨侵犯的筛查工具,但其在诊断口腔癌颌骨骨髓侵犯的诊断效能需进一步研究.     

磁共振成像对口腔癌下颌骨骨侵犯诊断价值的系统评价

目的 通过系统评价的方法,探讨磁共振（MR）在口腔癌下颌骨骨侵犯诊断中的价值。方法 通过对Medline Medline、荷兰医学文摘（EMBASE）、欧洲灰色文献数据库（SIGLE）、中国生物医学文献数据库等进行相关文献的电子检索。同时手工检索19种中文口腔医学期刊。两位研究者分别独立完成文献纳入排除并提取数据,运用Meta-Disc 1.4对MR在口腔癌下颌骨骨侵犯诊断的敏感度（SEN）和特异度（SPE）及95%可信区间（95%CI）等进行分析。结果 共纳入相关文献研究12篇,其中前瞻性研究5篇,回顾性研究7篇,共涉及患者476名,所有文献偏倚风险均为中度。Meta分析结果显示MR诊断口腔癌下颌骨骨侵犯的SEN为0.779（95%CI：0.719~0.831）,SPE为0.823（95%CI：0.767~0.870）,合并阳性似然比（+LR）为3.442（95%CI：2.181~5.431）,合并阴性似然比（-LR）为0.286（95%CI：0.181~0.451）,合并诊断比值比（DOR）为25.702（95%CI：13.406~49.273）,曲线下面积（AUC）为0.903 9,Q*值为0.835 4。因仅有2篇研究报告了MR在口腔癌下颌骨骨髓侵犯中的诊断效能,报告文献较少,故未行相关Meta分析,2篇研究包含55例患者,其SEN为0.838,SPE为0.722。结论 MR诊断口腔癌的下颌骨骨侵犯有较高的诊断效能,对口腔癌的下颌骨骨侵犯的术前评估有一定临床价值。     

漂白用于治疗正畸后白垩斑效果的系统评价

目的：白垩斑是使用固定托槽矫治器进行正畸治疗常见的并发疾病。本系统评价的目的是检索所有可查到的相关文献,评价牙齿漂白用于治疗或减缓恒牙正畸后白垩斑的效果。材料和方法：在电子数据库中按预先确定的文献检索方法对相关文献进行检索。各种类型的研究,包括随机对照研究或非随机对照研究、前瞻性研究、回顾性研究以及体外研究均可入选。为了获得补充研究,对入选文章的参考文献也进行了手动检索。两位作者独立进行研究选择、数据提取以及偏倚风险评估。结果：共有1项随机对照研究和8项体外研究满足纳入标准。7项研究被认为有高偏倚风险,2项体外研究被评为中偏倚风险。结果表明,漂白可以缩小龋损区与非龋损区的颜色差异,但是该证据的确定性很低。各项研究方法学的高度异质性也妨碍了通过合并估计对结果的有效解释。结论：本系统评价的发现不能支持或否认漂白是处理正畸后白垩斑的有效方法。由于该领域绝大多数是体外研究,缺乏偏倚风险较低的体内研究科学证据,进一步体内预后研究是非常必要的。     

干细胞局部应用对缺损面神经再生效果的系统评价

目的 系统评价干细胞对面神经缺损的修复效果。方法 在Pubmed、Cochrane Library、Web of Science、Embase、Scopus及中国生物医学文献数据库检索关于评价干细胞对动物面神经再生效果的所有原始研究,2名专业人员独立完成文献筛选、数据提取及偏倚风险评估。使用RevMan 5.3软件及随机效应模型进行统计分析,分析结果以均数差（MD）及95%可信区间（CI）的形式呈现。对面神经的功能性评估（胡须运动评分、面瘫评分）及组织学评估（有髓纤维密度、纤维直径、髓鞘厚度、G比值）结果进行Meta分析。结果 从6个数据库共检索出4 614篇文献,15篇被纳入了Meta分析。干细胞组的胡须运动评分、面瘫评分、有髓纤维密度、髓鞘厚度均高于非干细胞组（P<0.05）,G比值小于非干细胞组（P=0.001）,纤维直径二者无统计学差异（P=0.08）。结论 干细胞具有促进面神经再生的潜能。     

慢性牙周炎与高脂血症相关性的Meta分析

目的 采用系统评价的方法评价慢性牙周炎与高脂血症相关性。方法 计算机检索PubMed、Cochrane Library、Embase、中国生物医学文献数据库、中国期刊全文数据库、万方和维普数据库,检索时限从建库到2016年7月,限中、英文,由两位研究者按标准纳入牙周炎与高脂血症相关性的观察性研究论文,进行资料提取及质量评价,采用RevMan 5.3软件进行Meta分析并用GRADE 3.6软件进行证据整体质量等级的评定。结果 一共纳入6个病例对照研究和1个队列研究。Meta分析结果显示,慢性牙周炎患者血清中甘油三酯（TG）的浓度明显高于牙周健康组（MD=50.50,95%可信区间=39.57~61.42,P<0.000 01）,血清总胆固醇（TC）浓度也较牙周健康组明显增（MD=17.54,95%可信区间=10.91~24.18,P<0.000 01）;并且牙周炎患者血清中TG与TC升高的风险分别是牙周健康者的4.73倍（OR=4.73,95%可信区间=2.74~8.17,P<0.000 01）和3.62倍（OR=3.62,95%可信区间=2.18~6.03,P<0.000 01）;而两组在高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）的统计学差异不大。结论 现有证据表明慢性牙周炎与高脂血症是存在相关性的,慢性牙周炎是高脂血症的一个独立危险因素,尤其是对血清中的TC和TG有显著影响。     

增强CT对头颈部鳞癌患者颈部淋巴结包膜外侵犯的诊断效能：系统评价与meta分析

目的: 评价增强CT对头颈部鳞癌患者颈部淋巴结包膜外侵犯的诊断效能。方法: 根据预先设定的检索式,对PubMed、EMBASE、中国生物医学文献数据库（Chinese Biomedical Literature Database）以及CNKI等数据库进行电子检索,并在SciencePaper Online上搜索尚未正式发表的文献,检索时间截至2017年5月15日;同时进行手工检索。2名评价者独立使用QUADAS-2,评价纳入研究的方法学质量并进行数据提取。运用MetaDisc 1.4、STATA 11.0软件进行meta分析。结果: 最终纳入8篇文献,涉及患者639例。8篇均为回顾性研究,1篇有高偏倚风险,其余偏倚风险情况不清。Meta分析结果显示,增强CT在诊断淋巴结包膜外侵犯的合并敏感度为0.67,合并特异度为0.84,曲线下面积为0.83。结论: 增强CT可作为头颈部鳞癌患者颈部淋巴结包膜外侵犯的确诊工具。     

CYP2E1RsaI/PstI位点多态性与口腔癌易感性的Meta分析

目的:运用Meta的分析方法研究CYP2E1 Rsa I/Pst I多态性与口腔癌易感性的相互关系。方法:检索VIP,CNKI和PubMed数据库中有关CYP2E1 Rsa I/Pst I多态性与口腔癌易感性关联研究的文献,以OR值和95%的可信区间为效应指标,应用Rev Man 4.2软件进行Meta分析,并使用STATA 11.0软件对发表偏倚进行检验。结果:纳入12个病例对照研究,共计1259例口腔癌患者和2262例正常对照,Meta分析结果显示,总人群中c1/c2 vs.c1/c1(OR=1.30,95%CI=1.04～1.62),c1/c2+c2/c2 vs.c1/c1(OR=1.32,95%CI=1.07～1.64)。结论:CYP2E1突变基因型c2可能会增加口腔癌发生的风险。     

CYP2E1RsaⅠ/PstⅠ位点多态性与口腔癌易感性的Meta分析

目的:运用Meta的分析方法研究CYP2E1 Rsa Ⅰ/Pst Ⅰ多态性与口腔癌易感性的相互关系.方法:检索VIP,CNKI和PubMed数据库中有关CYP2E1 Rsa Ⅰ/Pst Ⅰ多态性与口腔癌易感性关联研究的文献,以OR值和95％的可信区间为效应指标,应用Rev Man 4.2软件进行Meta分析,并使用STATA 11.0软件对发表偏倚进行检验.结果:纳入12个病例对照研究,共计1259例口腔癌患者和2262例正常对照,Meta分析结果显示,总人群中c1 /c2 vs.c1/c1(OR=1.30,95％CI=1.04～1.62),c1/c2+c2/c2 vs.c1/c1 (0R=1.32,95％CI=1.07-1.64).结论:CYP2E1突变基因型c2可能会增加口腔癌发生的风险.     

初始弓丝材料对正畸治疗初始疼痛影响的系统评价与网状Meta分析

目的 评价不同材料的初始弓丝对正畸治疗初始疼痛的影响。方法 通过7个常用数据库对不同材料的初始弓丝与正畸治疗初始疼痛的文献进行电子检索,检索时间截至2017年10月1日。对纳入文献参照Cochrane推荐的偏倚风险评估表进行方法学质量评价并提取数据。应用R软件3.4.2（调用JAGS 4.3.0）、GeMTC 0.14.3及STATA 11.0软件进行网状Meta分析。 结果 最终纳入5篇文献,涉及330名患者,涉及4种干预措施（多股不锈钢弓丝、普通镍钛弓丝、超弹镍钛弓丝、热激活镍钛弓丝）。5篇文献中,2篇为低偏倚风险,1篇为高偏倚风险,2篇偏倚风险情况不清。初戴固定矫治器后的第1天及第7天,4种弓丝引起患者疼痛的视觉模拟评分（VAS）两两之间均无统计学差异,但是排秩概率分析表明VAS最小的材料最有可能是热激活镍钛弓丝。结论 固定矫治时选用热激活镍钛弓丝作为初始弓丝可能是正畸治疗初始疼痛最轻的。     

Diagnostic value of intraoperative bone marrow assessment for bone margins in patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis

A clear bone margin is essential for complete resection of the bone-involved tumour, but the evaluation of hard tissue takes time and is impractical intraoperatively. Bone marrow assessment remains controversial. The aim of this study was to investigate the diagnostic value of intraoperative bone marrow assessment for bone margins. PubMed and Web of Science were searched for studies published between 1990 and 2017. A systematic review was conducted. After quality assessment, 10 articles with 11 cohorts and 404 patients were identified. Sensitivity, specificity, and other measures were pooled for meta-analysis; the estimates for intraoperative bone marrow assessment were as follows: sensitivity 0.82 (95% confidence interval (CI) 0.62–0.93), specificity 0.99 (95% CI 0.96–1.00), positive likelihood ratio 109.79 (95% CI 22.99–524.34), negative likelihood ratio 0.18 (95% CI 0.08–0.42), and diagnostic odds ratio 241.82 (95% CI 90.33–647.38). Furthermore, sensitivity and specificity at the summary operating point of the summary receiver operating characteristic curve were 0.82 and 0.99, respectively, and the area under the curve was 0.99. Intraoperative bone marrow assessment was investigated by meta-analysis and shown to have a high level of overall accuracy for the diagnosis of bone margins.     

Deep Learning for Detection of Periapical Radiolucent Lesions: A Systematic Review and Meta-analysis of Diagnostic Test Accuracy

IntroductionThe aim of this systematic review and meta-analysis was to investigate the overall accuracy of deep learning models in detecting periapical (PA) radiolucent lesions in dental radiographs, when compared to expert clinicians.MethodsElectronic databases of Medline (via PubMed), Embase (via Ovid), Scopus, Google Scholar, and arXiv were searched. Quality of eligible studies was assessed by using Quality Assessment and Diagnostic Accuracy Tool-2. Quantitative analyses were conducted using hierarchical logistic regression for meta-analyses on diagnostic accuracy. Subgroup analyses on different image modalities (PA radiographs, panoramic radiographs, and cone beam computed tomographic images) and on different deep learning tasks (classification, segmentation, object detection) were conducted. Certainty of evidence was assessed by using Grading of Recommendations Assessment, Development, and Evaluation system.ResultsA total of 932 studies were screened. Eighteen studies were included in the systematic review, out of which 6 studies were selected for quantitative analyses. Six studies had low risk of bias. Twelve studies had risk of bias. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of included studies (all image modalities; all tasks) were 0.925 (95% confidence interval [CI], 0.862–0.960), 0.852 (95% CI, 0.810–0.885), 6.261 (95% CI, 4.717–8.311), 0.087 (95% CI, 0.045–0.168), and 71.692 (95% CI, 29.957-171.565), respectively. No publication bias was detected (Egger's test, P = .82). Grading of Recommendations Assessment, Development and Evaluationshowed a “high” certainty of evidence for the studies included in the meta-analyses.ConclusionCompared to expert clinicians, deep learning showed highly accurate results in detecting PA radiolucent lesions in dental radiographs. Most studies had risk of bias. There was a lack of prospective studies.     

Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis

IntroductionThe purpose of this review was to determine the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in detecting vertical root fractures (VRFs) in root-filled teeth compared with a reference standard (direct visualization).MethodsElectronic searches were performed in Medline, Scopus, Cochrane, and gray literature for English language articles until June 2020. Prospective and retrospective clinical studies using CBCT imaging to diagnose VRFs in root-filled teeth were included. Case reports and in vitro studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias and applicability concerns. Meta-analysis was performed using Stata 16.1 software (StataCorp, College Station, TX) via the MIDAS v.3.0 package and METANDI module. Publication bias was evaluated using Deeks’ funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was performed to evaluate the certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2).ResultsEight articles were included in this systematic review and meta-analysis. Risk of bias assessment showed that 5 articles in the patient selection domain had low risk of bias with low applicability concern. In the index test and reference standard domains, 7 articles had moderate risk of bias with moderate applicability concern. Three articles had high RB in the flow and timing domain. There was no publication bias. CBCT imaging had a pooled sensitivity and specificity of 0.78 (95% confidence interval [CI], 0.64–0.88) and 0.80 (95% CI, 0.63–0.91), respectively, and an accuracy of 0.86 (95% CI, 0.83–0.89). CBCT imaging also had pooled positive and negative likelihood ratios of 4 and 0.2, respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT imaging was used for the diagnosis of VRF.ConclusionsThe overall quality assessment of the included articles showed that in the patient selection domain, the risk of bias was low, and it was moderate in the index test and reference standard domains. Evidence from this systematic review and meta-analysis indicates that CBCT imaging is still not a good tool for diagnosing VRFs in root-filled teeth compared with direct visualization.     

牙周治疗对心血管疾病危险因素控制效果的系统评价

目的 评价牙周治疗对部分心血管疾病危险因素的控制效果。方法 对Cochrane图书馆临床随机对照试验库、PubMed数据库、荷兰医学文摘（EMBASE）数据库和中国生物医学文献数据库进行检索,检索时间为2011年10月13日;同时对纳入文献的参考文献进行进一步检索。由两位评价者分别对纳入文献进行偏倚风险评价。运用Revman 5.1软件进行Meta分析。结果共纳入6篇随机对照试验,涉及患者682例,偏倚风险评价显示1个研究为低偏倚风险,1个研究为中偏倚风险,4个研究为高偏倚风险。Meta分析的结果显示,牙周治疗并不能明显改善患者血清C-反应蛋白、总胆固醇、低密度脂蛋白、甘油三脂的水平（P>0.05）,但在改善患者血清高密度脂蛋白水平方面效果明显[MD=0.05,95%CI（0.00,0.09）,P=0.04]。结论 牙周治疗对改善患者血清高密度脂蛋白水平有较明显的效果,但还需要更多的临床随机对照试验的支持。     

Bone scintigraphy as a diagnostic method in unilateral hyperactivity of the mandibular condyles: a review and meta-analysis of the literature

Bone scan analyses and clinical assessment are used to diagnose unilateral condylar hyperactivity (UCH). This review compares the diagnostic accuracy of planar and SPECT bone scans. Studies diagnosing patients with possible UCH using bone scans, published between 1968 and 2008, were included in this review. Of 15 articles that met the inclusion criteria, 7 presented results in sufficient detail to calculate index test characteristics. Three control studies show that the difference in uptake values of the left and right condylar regions in the normal population does not exceed 10%. The pooled sensitivity of the planar bone scan (n = 130) was 0.71 (95% confidence interval: 0.57-0.82), which was significantly lower (p = 0.04) than that of the bone SPECT technique (n = 88), which was 0.90 (0.79-0.97). The pooled specificity of the SPECT scan was 0.95 (0.82-0.99), which did not significantly differ (p = 0.58) from that of the planar scan (0.92 (0.83-0.97)). Future studies should include a diagnostic analysis of the data, including two-by-two contingency tables, so the accuracy of the diagnostic test may be evaluated. Bone scans are best performed using SPECT, conducting a quantitative analysis by calculating the percentile differences between the left and right condylar regions.     

氟化亚锡牙膏对牙本质敏感症脱敏作用的Meta分析

目的 对有关含氟化亚锡牙膏治疗牙本质敏感症的随机对照试验（RCT）进行Meta分析,评价其治疗牙本质敏感症的疗效。方法依照Cochrane系统评价员手册（5.1.0版本）指导进行分析,包含检索策略、纳入排除标准、数据提取及质量评价。通过计算机检索CNKI、CBM、PubMed、Embase数据库和Cochrane Library,查找有关含氟化亚锡牙膏治疗牙本质敏感症的RCT,检索时间截至2015年1月。由2位研究者独立根据纳入与排除标准进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入6个RCT,包括494例患者（试验组247例,对照组247例）。氟化亚锡脱敏牙膏治疗牙本质敏感的Meta分析结果显示,触压探诊敏感测试（SMD=1.41,95%可信区间为0.74~2.09）及冷空气喷吹测试（SMD=-1.16,95%可信区间为-1.84~-0.48）的差异均有统计学意义（P<0.000 01）,氟化亚锡脱敏牙膏治疗牙本质敏感症的效果较好。结论现有证据表明,氟化亚锡脱敏牙膏治疗牙本质敏感症的效果较好;但纳入研究的语种、地区及质量有一定局限性,且样本量较小,仍需更多高质量、大样本的RCT以进一步验证。     

微创骨皮质切开加速牙移动的临床效果及安全性的Meta分析

目的系统评价颌骨微创骨皮质切开加速牙移动的临床效果及安全性。 方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方、维普资讯等数据库,检索时间限定至2019年2月。由2位研究者独立使用标准化方法从符合纳入标准的文献中提取相关数据并进行质量学评价。根据各研究间的异质性,采用固定或随机效应模型计算效应合并值的加权均数差（WMD）和相应的95%可信区间（95% CI）进行分析。采用Stata 11.0软件对资料进行Meta分析。 结果最终共纳入9篇文献（5篇随机对照临床试验、4篇临床对照试验）,包括171例受试者。Meta分析结果显示：行颌骨微创骨皮质切开后上颌尖牙移动的差异有统计学意义[WMD = 0.36,95% CI（0.19,0.53）];治疗完成时间差异有统计学意义[WMD = -5.41,95% CI（-6.63,-4.18）];切开前后上颌第一磨牙位置差异无统计学意义[（WMD = -0.41,95% CI（-0.88,0.06）];切开前后尖牙根尖吸收风险差异无统计学意义[WMD = -0.20,95% CI（-0.48,0.88）]。 结论颌骨微创骨皮质切开法能加速早期牙移动,缩短治疗时间;上颌第一磨牙近中移位不明显,尖牙根尖吸收风险未增加。