Folate as adjunct therapy to SSRI/SNRI for major depressive disorder: Systematic review & meta-analysis

ObjectiveEvaluate depression scores, response, and remission rates in patients with major depression receiving adjunct therapy with folate (L-Methylfolate or folic acid) compared to selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor (SSRI or SNRI) monotherapy.MethodsAcademic Search Premier, CINAHL Complete, Cochrane Database of Systematic Reviews, Medline with Full Text, PsychInfo, PubMed, ClinicalTrials.org, and Google Scholar were searched utilizing specific key words. Identified studies were independently screened for inclusion by two reviewers, were assessed for risk of bias using the Revised Cochrane risk-of-bias tool (RoB2), then meta-analyzed using a random effects model with Review Manager (5.4) software.ResultsThe initial search revealed 293 articles with 6 randomized control trials ultimately meeting inclusion criteria. In patients with depression, analysis of 5 studies revealed a significantly lower Hamilton Depression Rating Scale (HAM-D) score in individuals treated with adjunct therapy with l-Methylfolate/folic acid [Mean Difference (MD): -2.16 (95 % CI -3.62 to -0.69), p = 0.004], as well a combined HAM-D and Beck Depression Inventory-II (BDI-II) scores [standardized mean difference (SMD): -0.61 (95 % Confidence Interval {CI} -0.97 to -0.24), p = 0.002]. This adjunct therapy also yielded an improved response rate [Risk Ratio (RR): 1.36 (95 % CI: 1.16–1.59) P = 0.0001], increase in remission rate [RR: 1.39 (95 % CI: 1.00–1.92) P = 0.05], and reduction in depression scores after varying durations of treatment, 4 week: [SMD = -0.38 (95 % CI: –0.55 to -0.22) P ≤ 0.00001]; 6 week: [SMD = –0.94 (95 % CI: –1.85 to -0.03) P = 0.04]; ≥ 8 week: [SMD= -0.57 (95 % CI: -0.91 to -0.23) P = 0.0009].ConclusionAdjunct therapy with l-Methylfolate or folic acid improves depression scale scores, patient response, and remission rates.     

来氟米特与环磷酰胺治疗IgA肾病的Meta分析

目的系统评价来氟米特(LEF)与环磷酰胺(CTX)治疗IgA肾病的有效性和安全性。方法电子检索The Cochrane Library、PubMed、Embase和中国知网全文数据库、中文科技期刊维普数据库检索来氟米特联合糖皮质激素与环磷酰胺联合糖皮质激素治疗IgA肾病的随机对照试验(RCT),检索文献截止时间为2013年7月,根据纳入和排除标准选择文献,进行数据提取和质量评估,使用Revman 5.1软件进行Meta分析。观察指标为:有效性指标包括:完全缓解率、有效率、24 h尿蛋白、血清白蛋白、血肌酐、安全性指标:不良反应发生率包括:白细胞减少的发生率、消化道反应发生率、肝功能异常发生率、感染发生率。结果共收集国内6个随机对照研究,纳入347例患者,结果显示,LEF与CTX对比,尿蛋白下降有统计学差异,[SMD=-0.41,95%CI(-0.65,-0.18),P=0.006],血清白蛋白升高有统计学差异[SMD=0.43,95%CI(0.20,0.67),P=0.003]。白细胞减少的发生率、消化道反应发生率更低[RR=0.11,95%CI(0.04,0.37),P=0.003]、[RR=0.23,95%CI(0.12,0.45),P=0.0001]。完全缓解率、有效率、血清肌酐、肝功能异常发生率、感染发生率无显著差异。结论对于中国患者,LEF与CTX治疗IgA肾病疗效无显著差异,LEF与CTX对比,治疗效果相似,但LEF的不良反应明显少于CTX,其安全性较好。     

The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials

BackgroundTranexamic acid shows some treatment efficacy for traumatic brain injury. This systematic review and meta-analysis is conducted to investigate the efficacy of tranexamic acid for traumatic brain injury.MethodsThe databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of tranexamic acid for traumatic brain injury.ResultsThis meta-analysis has included six RCTs. Compared with placebo group in patients with traumatic brain injury, tranexamic acid results in remarkably reduced mortality (risk ratio (RR) = 0.91; 95% confidence interval (CI) = 0.85 to 0.97; P = 0.004) and growth of hemorrhagic mass (RR = 0.78; 95% CI = 0.61 to 0.99; P = 0.04), but has no important impact on neurosurgery (RR = 0.99; 95% CI = 0.85 to 1.15; P = 0.92), extracranial surgery (RR = 1.00; 95% CI = 0.97 to 1.04; P = 0.99), unfavorable outcome (Glasgow Outcome Scale, GOS) (RR = 0.72; 95% CI = 0.47–1.11; P = 0.14), pulmonary embolism (RR = 1.86; 95% CI = 0.42–8.29; P = 0.42), and deep venous thrombosis (RR = 0.97; 95% CI = 0.64–1.47; P = 0.88).ConclusionsTranexamic acid is associated with substantially reduced mortality and growth of hemorrhagic mass in patients with traumatic brain injury, but the need of neurosurgery and extracranial surgery, as well as the risk of unfavorable outcome (GOS) are similar between tranexamic acid and placebo.     

出院准备服务对老年慢性病患者干预效果的系统评价

目的系统评价出院准备服务对老年慢性病患者的干预效果。方法计算机检索CNKI、WanFang Data、VIP、Web of Science、The Cochrane Library、PubMed和EMbase数据库,搜集关于老年慢性病患者出院准备服务的随机对照试验(RCT),检索时限均从2000年1月至2019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,采用RevMan 5.3软件进行Meta分析。结果共纳入7个RCT,包括884例患者。Meta分析结果显示:实施出院准备服务后,老年慢性病患者的急性并发症发生率[RR=0.38,95%CI(0.15,0.98),P=0.04]下降,患者遵医行为[SMD=0.54,95%CI(0.25,0.83),P=0.000 3]、运动能力[SMD=2.65,95%CI(0.25,5.04),P=0.03]、护理满意度[SMD=0.71,95%CI(0.10,1.33),P=0.02]均有提高。但两组因急性并发症导致再入院率[RR=0.25,95%CI(0.06,1.11),P=0.07]、自我护理能力[SMD=2.18,95%CI(-1.02,5.38),P=0.18]、日常生活活动能力(ADL)[SMD=0.56,95%CI(-0.47,1.59),P=0.28]的差异无统计学意义。结论当前证据显示,实施出院准备服务后,老年慢性病患者的急性并发症发生率更少,遵医行为、运动能力、护理满意度得到了提高。但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。     

Administration of dietary antioxidants for patients with inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled clinical trials

ObjectiveAccumulating evidence has been reported regarding the effect of dietary antioxidants on clinical variables in IBD patients, however, findings are controversial. This systematic review and meta-analysis aimed to investigate effect of dietary antioxidants on clinical variables in patients with IBD or its subtypes.MethodsWe searched PubMed, Scopus, and ISI Web of Science from inception to January 2021 using relevant keywords. Data were pooled by using the random-effect model. All statistical analyses were done using STATA version 14.ResultsOur meta-analysis was exclusively done on studies about the effect of curcumin on IBD patients, because limited studies were done on other antioxidants. Curcumin administration resulted in significant increment of clinical remission in patients with IBD (SMD: 0.86%, 95% CI: 0.16, 1.56, p = 0.016), significant remission in clinical symptoms (SMD: −0.96 score, 95% CI: −1.34, −0.57, p < 0.001), and significant increment in endoscopic remission in IBD patients (SMD: 0.51%, 95% CI: 0.16, 0.85, p = 0.004), comparing to control group. Curcumin supplementation also made better clinical response than control group (SMD: 0.74%, 95% CI: 0.22, 1.26, p = 0.005) and also resulted in significant improvement in quality of life of patients with IBD, as compared to control group (SMD: 1.23 score, 95% CI: 0.72, 1.74, p < 0.001).ConclusionsOur meta-analysis showed that curcumin significantly improved clinical and endoscopic remissions in IBD patients. This supplementation also caused significant reduction in clinical symptoms of IBD patients along with better clinical response and the increased quality of life. Further researches with larger sample size and longer period of intervention are required to evaluate efficacy of dietary antioxidants on clinical variables in patients with IBD.     

术后早期经口进食对食管癌患者预后影响的meta分析

目的 采用meta分析评估术后早期经口进食对食管癌患者的影响,评价其安全性和有效性。方法 计算机检索PubMed、Web of Science、Cochrane Library、 EMBSCO、中国知网、万方数据库以及维普数据库建库至2022年6月发表的关于食管癌术后患者早期经口进食的干预性研究。由2名评价人员按照纳排标准独立筛选文献、提取资料、评价文献质量。采用RevMan 5.3软件对提取资料进行Meta分析。结果 共纳入6篇文献,涉及到1306例食管切除术后患者。Meta分析结果显示食管癌切除患者术后早期经口进食组较传统进食组术后首次排气时间（MD=－1.11,95%CI（－1.25,－0.96）,P＜0.00001）、术后首次排便时间（MD=－1.68,95%CI（－2.13,－1.22）,P＜0.00001）、术后肺部并发症发生率（RR=0.76,95%CI（0.58,0.99）,P=0.04）、术后住院时间（MD=－3.40,95%CI（－5.30,－1.49）,P=0.0005）、术后生活质量（MD=4.77,95%CI（2.27,7.26）,P=0.0002）,差异具有统计学意义;术后吻合口瘘发生率（RR=0.88,95%CI（0.55,1.41）,P=0.59）、术后乳糜胸发生率（RR=0.72,95%CI（0.22,2.38）,P=0.59）,差异不具有统计学差异。结论 meta分析结果基本稳定可靠,食管癌术后早期经口进食有助于促进胃肠功能早期恢复、减少术后肺部并发症发生率、不增加术后吻合口瘘和乳糜胸等并发症发生率,具有安全性和有效性。     

雷珠单抗联合激光光凝对糖尿病黄斑水肿疗效的系统评价

目的 系统评价雷珠单抗联合激光光凝对糖尿病黄斑水肿的疗效。 方法 计算机检索PubMed、EMbase、Cochrane Library、CBM、Wang Fang Data和CNKI数据库,搜索雷珠单抗联合激光光凝治疗糖尿病黄斑水肿的相关随机对照研究,检索时限均为从建库至2016年12月。由两位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7个随机对照研究,包含患者518例,眼数为556眼。Meta分析结果显示:联合组在1、3、6月最佳矫正视力的测量值均高于对照组,其差异均有统计学意义[SMD=-0.37,95%CI（0.05,0.69）,P=0.02;SMD=1.17,95%CI（0.56,1.78）,P=0.0002;SMD=2.34,95%CI（0.16,4.51）,P=0.04],且随着时间的增加,联合组的视力恢复的更多,联合组在1、3、6月中央黄斑厚度的测量值较对照组明显减少,其差异均有统计学意义[SMD=-1.34,95%CI（-2.41,-0.28）,P=0.01;SMD=-1.36,95%CI（-2.37,-0.34）,P=0.009;SMD=-1.05,95% CI（-1.34,-0.76）,P<0.00001]。 结论 雷珠单抗联合格栅光凝治疗治疗糖尿病黄斑水肿的效果优于单用雷珠单抗或格栅光凝,不良反应少,未见严重不良反应,值得在糖尿病黄斑水肿的治疗中应用和推广。       

Prevalence and factors associated with headache in patients with systemic lupus erythematosus

Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-beta2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache (P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and beta2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and beta2GP-I antibodies.     

室间隔心肌切除术与化学消融术治疗肥厚型梗阻性心肌病临床效果Meta分析

目的应用Meta分析的方法评价室间隔心肌切除术(SM)与化学消融术(ASA)治疗肥厚型梗阻性心肌病(HOCM)的临床效果。方法计算机检索PubMed,Embase,Cochrane图书馆,CNKI、CBM disc及VIP里的比较SM和ASA治疗HOCM的对照研究。文献检索时间从建库至2013年10月。根据The Newcastle-Ottawa Scale(NOS)量表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用Rev Man 5.2进行异质性检验及Meta分析。结果检出相关文献380篇,根据纳入标准最终入选10篇文献;共入选病例927例。SM组与ASA组在术后住院病死率(OR:0.90;95%CI:0.23³.47)、术后随访期病死率(OR:1.01;95%CI:0.603.47)、术后随访期病死率(OR:1.01;95%CI:0.60¹.70)上未见明显差异(分别P=0.88,P=0.97)。两组患者手术前后左心室流出道压差(LVOTG)的下降和NYHA分级的提高均有意义(P<0.05);与ASA组相比,SM组患者的LVOTG下降(SMD:-0.46;95%CI:-0.6 01.70)上未见明显差异(分别P=0.88,P=0.97)。两组患者手术前后左心室流出道压差(LVOTG)的下降和NYHA分级的提高均有意义(P<0.05);与ASA组相比,SM组患者的LVOTG下降(SMD:-0.46;95%CI:-0.6 0⁰.32)及术后NYHA分级提高(SMD:-0.40;95%CI:-0.620.32)及术后NYHA分级提高(SMD:-0.40;95%CI:-0.62^-0.17)均更为明显,差异有统计学意义(均P<0.01)。SM组在术后右束支传导阻滞(OR:0.08;95%CI:0.03-0.17)均更为明显,差异有统计学意义(均P<0.01)。SM组在术后右束支传导阻滞(OR:0.08;95%CI:0.03⁰.23;P<0.01)、完全性传导阻滞(OR:0.27;95%CI:0.110.23;P<0.01)、完全性传导阻滞(OR:0.27;95%CI:0.11⁰.70;P<0.01)、室性心律失常(OR:0.17;95%CI:0.040.70;P<0.01)、室性心律失常(OR:0.17;95%CI:0.04⁰.75;P=0.02)及安装永久性起搏器(OR:0.22;95%CI:0.130.75;P=0.02)及安装永久性起搏器(OR:0.22;95%CI:0.13⁰.38;P<0.01)的发生率上均较ASA组明显降低。两组患者在术后植入性除颤器的安装率(OR:0.73;95%CI:0.310.38;P<0.01)的发生率上均较ASA组明显降低。两组患者在术后植入性除颤器的安装率(OR:0.73;95%CI:0.31¹.71)上未见统计学差异(P=0.46)。结论 SM仍然是治疗药物难治性HOCM的金标准;ASA作为一种替代治疗,远期结果需要进一步的观察和随访。     

Efficacy and safety of ipragliflozin as add-on to metformin for type 2 diabetes: a meta-analysis of double-blind randomized controlled trials

ABSTRACT

Objectives: To evaluate the efficacy and safety of ipragliflozin as add-on therapy to metformin in patients with type 2 diabetes mellitus.

Methods: Systematic literature searches were performed in several databases across PubMed, the Cochrane Central Register of Controlled Trials, Embase, Medline, ClinicalTrials.gov, PsycINFO, and Web of Science from?inception?to 12 March 2019. After the extraction of data from eligible?studies, randomized controlled trials (RCTs) were assessed for quality and analyzed statistically. Standardized mean difference (SMD) and risk ratio (RR) with 95% CIs were used to evaluate efficacy and safety end-points. Sensitivity analyses and subgroup analyses based on intervention times were also performed.

Results: Five RCTs with 847 patients were included. Compared to metformin alone, ipragliflozin as an adjuvant to metformin reduced glycated hemoglobin (HbA1c) in 12 weeks and 24 weeks, respectively [12 w: SMD ?0.30, 95% CI ?0.51 to ?0.10%, p = 0.004; 24 w: SMD ?0.88, 95% CI ?1.04 to ?0.72%, p < 0.00001; Total: SMD ?0.66, 95% CI ?0.79 to ?0.53%, p < 0.00001]. In addition, ipragliflozin as adjuvant therapy to metformin body weight (Total: SMD ?1.47, 95% CI [?1.80,-1.14], p < 0.00001), waist circumference (Total: SMD ?1.09, 95% CI [?1.62,-0.56], p < 0.00001), and blood pressure (SBP Total: SMD ?3.36, 95% CI [?5.11.-1.61], p = 0.0002; DBP Total: SMD ?2.18, 95% CI [?3.63,-0.74], p = 0.003). Compared to metformin alone, ipragliflozin as an adjuvant to metformin showed significant risks in the skin and subcutaneous tissue disorders and constipation.

Conclusion: Compared to metformin alone, ipragliflozin plus metformin significantly improved glycemic control, reduced body weight, and lowered blood pressure; however, further high-quality trials are required to determine their long-term efficacy and safety.     

Effects of ultrasound-guided techniques for radial arterial catheterization: A meta-analysis of randomized controlled trials

ObjectiveThis study aimed to evaluate whether ultrasound-guided techniques are superior compared to traditional palpation techniques in patients undergoing radial artery catheterization (RAC).MethodsElectronic databases of PubMed, Embase, and the Cochrane Library were systematically searched to identify randomized controlled trials (RCTs). The relative risks (RRs) or weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were used to calculate the pooled effect estimates using the random effects model for categories and continuous data, respectively.ResultsA total of 19 RCTs comprising a total of 3220 individuals were selected for final analysis. The pooled RR suggested that ultrasound-guided techniques were associated with higher incidence of first attempt success than traditional palpation techniques (RR, 1.39; 95% CI, 1.21–1.59; P < 0.001). Moreover, we noted that ultrasound-guided techniques were associated with fewer mean attempts to success (WMD, −0.80 s; 95% CI, −1.35 to −0.25; P = 0.004) and a shorter mean time to success (WMD, −41.18 s; 95% CI, −75.43 to −6.93; P = 0.018) than traditional palpation techniques. Furthermore, individuals using ultrasound-guided techniques had a reduced risk of hematoma (RR, 0.40; 95% CI, 0.22–0.72; P = 0.003).ConclusionsThis study indicated that ultrasound-guided techniques were superior compared to traditional palpation techniques for RAC in terms of efficacy and complications.     

孟鲁司特与硫酸镁联合治疗成人支气管哮喘的meta分析

目的系统评价孟鲁司特与硫酸镁联合治疗哮喘的有效性与安全性。方法计算机检索Pubmed、Cochrane Library、CNKI、VIP等数据库,检索时限均为建库至2016年1月,收集孟鲁司特与硫酸镁联合治疗成人哮喘的随机对照试验（randomized controlled trial,RCT）。由2位研究者按纳入与排除标准选择文献、提取资料、质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入12个RCT,1 992例患者。Meta分析结果显示：与对照组相比,硫酸镁联合孟鲁司特可有效提高哮喘临床体征的缓解率(OR=5.50,95%CI=3.73~8.11,P<0.01);显著性降低咳嗽(SMD=-1.66,95%CI=-1.92~-1.40）,P<0.01)、喘息(SMD=-1.42,95%CI=-1.68~-1.16,P<0.01)、胸闷(SMD=-1.54,95%CI=-1.73~-1.34）,P<0.01)的缓解时间;明显降低哮喘的复发率(OR=0.26,95%CI=0.15~0.43,P<0.01);明显改善肺功能指标呼气峰流速（PEF）(SMD=0.85,95%CI=0.11~1.59,P<0.01)、FEV1%(SMD=7.65,95%CI=2.60~12.71,P<0.01)、FEV1/FVC%(SMD=6.31,95%CI=5.47~7.14,P<0.01);硫酸镁与孟鲁司特联用导致的不良反应相对于对照组更高(OR=4.43,95%CI=1.87~10.49,P<0.01)。临床体征缓解率的漏斗图显示不对称,提示纳入评价的文献存在发表性偏倚。结论硫酸镁联合孟鲁司特可明显改善哮喘患者的临床体征、肺功能、复发率,增加不良反应的发生。受纳入研究数量及质量限制,上述结论尚需要更多高质量、大样本、多中心的RCT加以验证。     

A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain

Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size: (1) patient assessed pain, (2) physician assessed pain, (3) duration of morning stiffness, (4) number of painful and/or tender joints, (5) Ritchie articular index, and (6) nonselective nonsteroidal anti-inflammatory drug consumption. Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity (SMD: -0.26; 95% CI: -0.49 to -0.03, p=0.03), minutes of morning stiffness (SMD: -0.43; 95% CI: -0.72 to -0.15, p=0.003), number of painful and/or tender joints (SMD: -0.29; 95% CI: -0.48 to -0.10, p=0.003), and NSAID consumption (SMD: -0.40; 95% CI: -0.72 to -0.08, p=0.01). Significant effects were not detected for physician assessed pain (SMD: -0.14; 95% CI: -0.49 to 0.22, p=0.45) or Ritchie articular index (SMD: 0.15; 95% CI: -0.19 to 0.49, p=0.40) at 3-4 months. The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.     

Antiphospholipid, anti-beta 2-glycoprotein-I and anti-oxidized-low-density-lipoprotein antibodies in antiphospholipid syndrome

Antiphospholipid antibodies (aPL), anti-beta 2-glycoprotein I (anti-beta 2-GPI) and anti-oxidized-low-density lipoprotein (LDL) antibodies are all implicated in the pathogenesis of antiphospholipid syndrome. To investigate whether different autoantibodies or combinations thereof produced distinct effects related to their antigenic specificities, we examined the frequencies of antiphospholipid syndrome (APS)-related features in the presence of different antibodies [aPL, beta 2-GPI, anti-oxidized low density lipoprotein (LDL)] in 125 patients with APS. Median follow-up was 72 months: 58 patients were diagnosed as primary APS and 67 as APS plus systemic lupus erythematosus (SLE). Anticardiolipin antibodies (aCL), anti-beta 2-GPI and anti-oxidized LDL antibodies were determined by ELISA; lupus anticoagulant (LA) by standard coagulometric methods. Univariate analysis showed that patients positive for anti-beta 2-GPI had a higher risk of recurrent thrombotic events (OR = 3.64, 95% CI, p = 0.01) and pregnancy loss (OR = 2.99, 95% CI, p = 0.004). Patients positive for anti-oxidized LDL antibodies had a 2.24-fold increase in the risk of arterial thrombosis (2.24, 95% CI, p = 0.03) and lower risk of thrombocytopenia (OR = 0.41 95% CI, p = 0.04). Patients positive for aCL antibodies had a higher risk of pregnancy loss (OR = 4.62 95% CI, p = 0.001). When these data were tested by multivariate logistic regression, the association between anti-beta 2-GPI and pregnancy loss and the negative association between anti-oxidized LDL antibodies and thrombocytopenia disappeared.     

肾脏替代治疗启动时机对成人急性肾损伤患者预后影响的Meta分析

目的系统评估启用肾脏替代治疗（RRT）时机对成人急性肾损伤（AKI）患者预后的影响。 方法计算机检索PubMed、The Cochrane Library、Embase数据库从建库至2019年2月发表的关于成人AKI患者启用RRT时机的临床随机对照研究（RCT）。由2位研究者按照纳入及排除标准独立进行文献筛选、资料提取及质量评价,采用Revman 5.3软件进行Meta分析。 结果共纳入11个RCT,包括2 332例AKI患者。Meta分析显示,早期与晚期启动RRT治疗的AKI患者间总病死率[相对危险度（RR）= 0.92,95%置信区间（CI）（0.78,1.09）,Z = 5.53,P = 0.35]、14 d病死率[RR = 0.84,95%CI（0.66,1.07）,Z = 1.40,P = 0.16]、30 d病死率[RR = 0.98,95%CI（0.83,1.10）,Z = 0.40,P = 0.69]、60 d病死率[RR = 0.97,95%CI（0.87,1.07）,Z = 0.67,P = 0.50]、90 d病死率[RR = 1.00,95%CI（0.89,1.12）,Z = 0.01,P = 0.99]、ICU住院时间[标准均数差（SMD）= -0.08,95%CI（-0.18,0.02）,Z = 1.63,P = 0.10]以及总住院时间[SMD = -0.16,95%CI（-0.32,0.00）,Z = 1.96,P = 0.05]的比较,差异均无统计学意义。 结论早期RRT治疗不能改善成人AKI患者的预后。     

Intravenous thiamine for septic shock: A meta-analysis of randomized controlled trials

IntroductionThe efficacy of intravenous thiamine to treat septic shock remains controversial. We conduct a systematic review and meta-analysis to explore the impact of intravenous thiamine on treatment efficacy of septic shock.MethodsWe have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2020 and included randomized controlled trials (RCTs) assessing the effect of intravenous thiamine on septic shock. This meta-analysis was performed using the random-effect model.ResultsFour RCTs were included in the meta-analysis. Overall, compared with control group in patients with septic shock, intravenous thiamine revealed no substantial impact on mortality (odd ratio [OR] = 0.87; 95% confidence interval [CI) = 0.62 to 1.21; P = 0.40), lactate change (standard mean difference [SMD] = 0.04; 95% CI = -0.28 to 0.35; P = 0.82), Sequential Organ Failure Assessment (SOFA) change (SMD = 0.02; 95% CI = -0.18 to 0.21; P = 0.87), intensive care unit (ICU) stay (SMD = -0.02; 95% CI = -0.33 to 0.30; P = 0.90) or renal replacement therapy (OR = 0.47; 95% CI = 0.07 to 3.15; P = 0.43).ConclusionsIntravenous thiamine showed no benefit over placebo in treating patients with septic shock.     

基于电子健康的冠心病患者心脏康复效果的系统评价

目的 系统评价基于电子健康的冠心病患者心脏康复的效果,以期为心血管护理实践提供依据.方法 计算机检索PubMed、Embase、Web of Science、Cochrane、Springer、ScienceDirect、Ovid、EBSCO循证医学数据库、 中国生物医学文献数据库、中国知网、万方、中文科技期刊全文数据...     

胶体液与晶体液对感染性休克患者液体复苏影响的Meta分析

目的 系统评价使用胶体液与晶体液对感染性休克患者液体复苏的影响.方法 通过检索MEDLINE、荷兰医学文摘(Embase)、Cochrane临床试验数据库、中国生物医学文献数据库(CBM)和中国期刊网全文数据库(CNKI)等数据库,收集胶体液与晶体液治疗成年感染性休克患者的随机对照试验(RCT),提取资料和评估方法学质量,采用Cochrane协作网RevMan 5.0软件进行Meta分析.结果 最终纳入9个RCT共1998例感染性休克患者.Meta分析显示,胶体液与晶体液复苏对感染性休克患者28d病死率、平均动脉压(MAP)和心率(HR)的影响差异无统计学意义,其中28d病死率的相对危险度(RR)为0.92,95%可信区间(CI)为0.80～1.05,P=0.21;MAP标准化均数差值(SMD)为1.04,95%CI为-0.44～2.51,P=0.17;HR的SMD为0.51,95%CI为-5.84～6.86,P=0.87.胶体液可以明显提高感染性休克患者的心排血指数(CI),SMD为0.39,95%CI为0.17～0.62,P=0.000 5;进一步亚组分析表明,人血白蛋白可以明显提高感染性休克患者的CI,SMD为0.46,95%CI为0.16～0.75,P=0.002,而人工胶体液无此作用(P=0.07).结论 胶体液可以明显提高感染性休克患者的CI,但对感染性休克患者28 d病死率、MAP、HR无显著影响.     

胶体液与晶体液对感染性休克患者液体复苏影响的Meta分析

目的 系统评价使用胶体液与晶体液对感染性休克患者液体复苏的影响.方法 通过检索MEDLINE、荷兰医学文摘(Embase)、Cochrane临床试验数据库、中国生物医学文献数据库(CBM)和中国期刊网全文数据库(CNKI)等数据库,收集胶体液与晶体液治疗成年感染性休克患者的随机对照试验(RCT),提取资料和评估方法学质量,采用Cochrane协作网RevMan 5.0软件进行Meta分析.结果 最终纳入9个RCT共1998例感染性休克患者.Meta分析显示,胶体液与晶体液复苏对感染性休克患者28d病死率、平均动脉压(MAP)和心率(HR)的影响差异无统计学意义,其中28d病死率的相对危险度(RR)为0.92,95%可信区间(CI)为0.80～1.05,P=0.21;MAP标准化均数差值(SMD)为1.04,95%CI为-0.44～2.51,P=0.17;HR的SMD为0.51,95%CI为-5.84～6.86,P=0.87.胶体液可以明显提高感染性休克患者的心排血指数(CI),SMD为0.39,95%CI为0.17～0.62,P=0.000 5;进一步亚组分析表明,人血白蛋白可以明显提高感染性休克患者的CI,SMD为0.46,95%CI为0.16～0.75,P=0.002,而人工胶体液无此作用(P=0.07).结论 胶体液可以明显提高感染性休克患者的CI,但对感染性休克患者28 d病死率、MAP、HR无显著影响.     

Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-α blockers: A meta-analysis of prospective studies

Abstract

Background. Some studies showed an anti-atherogenic effect of TNF-α blockers on lipid profile, but these data have been challenged.

Objective. To perform a meta-analysis on lipid profile changes induced by TNF-α blocker treatment.

Methods. Prospective studies on rheumatic patients receiving TNF-α blockers and providing before-and-after treatment values of triglycerides (TGs), total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc), and atherogenic index (AI) were included. Standardized mean differences (SMD) in lipid profile were analyzed at short-term (2–12 weeks), middle-term (13–24 weeks), and long-term (25–52 weeks) assessments.

Results. Thirty articles (1707 patients) were included. TNF-α blockers determined an increase in TC at short-term, middle-term, and long-term assessments (SMD: 0.20 mmol/L [95% CI: 0.04, 0.35]; SMD: 0.27 mmol/L [95% CI: 0.08, 0.46]; SMD: 0.22 mmol/L [95% CI: 0.01, 0.43]). HDLc increased only at the short-term assessment (SMD: 0.19 mmol/L [95% CI: 0.10, 0.28]), and TGs achieved a significant increase at the long-term assessment (SMD: 0.19 mmol/L [95% CI: 0.04, 0.34]). LDLc and AI were not affected by TNF-α blocker treatment.

Conclusions. Slight but significant increases in TC occurred without any significant change in LDLc and AI. Changes in HDLc and TGs were not consistent among the different time point assessments. These quantitative changes in lipid profile do not seem to be able to explain cardiovascular risk improvement reported in patients receiving TNF-α blockers. Further studies on other mechanisms are needed to address this issue.