颅脑肿瘤术后并发静脉血栓栓塞症危险因素的Meta分析

目的明确颅脑肿瘤术后患者发生静脉血栓栓塞症(VTE)的危险因素。方法检索中国知网、万方、维普、中国生物医学文献、PubMed、The Cochrane Library、Web of Science、EMbase等数据库建库至2021年11月1日颅脑肿瘤术VTE危险因素的队列研究或病例对照研究。由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.4软件对纳入文献进行Meta分析。结果共纳入14篇文献,合计样本量40 552例,发生VTE1 801例。Meta分析结果显示,年龄＞45岁、术前D-二聚体升高、肥胖、女性、术前日常生活活动能力处于依赖状态、术前呼吸机依赖、术前曾患脓毒血症、高级神经胶质瘤、手术时间＞3.05 h、术后D-二聚体升高、术后下肢运动功能障碍、术后卧床不起、术后并发尿路感染为颅脑肿瘤术后患者发生VTE的危险因素。结论颅脑肿瘤术后VTE发生与多种因素有关。建议构建颅脑肿瘤术后VTE风险预测模型,关注高风险人群,落实规范化静脉血栓风险评估,注重血栓评估过程管控。     

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis

BackgroundThe aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies’ outcomes.MethodsPubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1?2 years, and 3?5 years. A random effects model was used to evaluate outcome changes.ResultsThe search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1?2 year and 3?5 year follow-up, respectively (p < 0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1?2 year and 3?5 year follow-up, respectively (p < 0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3?5 (p < 0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome.ConclusionSurgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5 years post-operatively.     

Pregnancy in the Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle cell Genotypes: A Systematic Review and Meta-Analysis

BackgroundPregnancy is a major concern among women with the sickle cell disease (SCD), and it is associated with increased adverse outcomes. The aim of the present meta-analysis is to report the fetomaternal outcomes in different sickle cell genotypes.MethodsIn this systematic review and meta-analysis, a comprehensive search of databases and search engines such as PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, Science Direct and Google Scholar were performed. Any observational studies that had compared at least one outcome such as maternal outcomes, fetal outcomes, and morbidity between two groups of pregnant women with different types of sickle cell genotypes and pregnant women without SCD were evaluated.ResultsA total number of 9,827 pregnant women with SCD were examined. The results showed that pregnancy in SCD increased the risk of adverse outcomes for the mothers (including postpartum hemorrhage, prematurity, pregnancy-induced hypertension, pre-eclampsia, eclampsia, cesarean section, lower segment cesareansection, maternal death), fetus (including live births, low birth weight, intrauterine growth restriction, APGAR score at 5 min <7, stillbirth, neonatal death, perinatal mortality, acute fetal distress, intrauterine fetal death) and morbidity among the SCD(severe anemia, urinary tract infection, blood transfusion, painful crisis, acute chest syndrome, vaso-occlusive crises).ConclusionAccording to the results of this meta-analysis, pregnancy in the SCD is associated with an increased risk of maternal outcomes, fetal outcomes, and morbidity among SCD patients with different genotypes. Pregnancy in sickle cell hemoglobinopathies needs careful multidisciplinary management and cautious caring so as to decrease maternal and fetal morbidity and mortality.     

系统化护理干预对癌因性疲乏患者影响的Meta分析

目的系统评价系统化护理干预对癌因性疲乏（cancer-related fatigue,CRF）患者的影响。方法以“癌症”、“疲乏”、“系统化护理”等为关键词,计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普数据库（VIP）及万方数据库,检索日期为数据库建立至2012年12月1日;纳入系统化护理干预 CRF患者的随机对照试验（RCT）,由2名评价者独立评价纳入研究的质量并提取资料,并用 RevMan 5．0统计软件进行Meta分析。结果共纳入9篇文献,包括1042例CRF患者,所有研究均采用了随机对照的方法,但未明确是否采用分配隐藏或双盲。Meta分析结果显示,通过护理干预后,系统护理干预组无疲乏及轻度疲乏患者明显多于常规护理组,差异具有统计学意义（RR 合并＝4．72,P ＜0．01,95％CI ＝3．58～6．24）;系统化护理对CRF患者的生活质量的影响,与常规护理比较,差异具有统计学意义（RR 合并＝9．67,P ＝0．003,95％CI ＝3．30～16．04）;经干预后系统化护理组CRF患者的卡氏功能（KPS）评分明显低于常规护理组患者,差异具有统计学意义（RR 合并＝4．22,P＜0．01,95％CI ＝2．06～6．38）。结论针对CRF患者进行护理,系统化护理干预明显优于常规护理模式,可改善CRF患者疲乏状态、生活质量等。     

Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AimThis network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.MethodsWe searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.ResultsFourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.ConclusionEvidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.     

The impact of antiviral therapy for HCV on kidney disease: a systematic review and meta-analysis

BackgroundControversy persists about the role of hepatitis C as a risk factor for developing kidney disease in the general population. Some authors have evaluated the effect of antiviral therapy for HCV on the risk of kidney disease.Study Aims and DesignA systematic review of the published medical literature was performed to assess whether antiviral therapy for HCV has an independent impact on kidney survival in the adult general population. A random effects model was used to generate an overall estimate of the risk of kidney disease after anti-HCV therapy across the published studies. Meta-regression and stratified analysis were also carried out.ResultsFifteen studies were eligible (n = 356, 285 patients) and separate meta-analyses were conducted according to the outcome. Pooling studies based on viral responses (n = 7; 34,763 individual patients) demonstrated a relationship between sustained viral response and lower frequency of kidney disease; the overall estimate for adjusted risk of kidney disease was 2.50 (95% CI, 1.41; 4.41) (p = 0.0016) and between-study heterogeneity was found (p-value by Q test = 0.004). Aggregation of studies comparing treated vs untreated cohorts (n = 8, n = 333,312 patients) revealed an association between anti-HCV therapy and lower risk of kidney disease. The overall estimate for adjusted risk of kidney disease across the eight studies was 0.39 (95% CI, 0.25; 0.612) (p = 0.0001). Meta-regression showed that the effectiveness of antiviral therapy in reducing the frequency of kidney disease diminishes as cirrhosis (p = 0.02) and HBV infection (p = 0.0001) increase among HCV-infected individuals.ConclusionsAntiviral therapy for HCV lowers the risk of kidney disease among HCV-infected individuals. Studies to understand the mechanisms underlying this association are ongoing.     

居家安宁疗护对晚期癌症患者生活质量和情绪影响的Meta分析

目的 系统评价居家安宁疗护对晚期癌症患者生活质量和情绪的影响,为相关研究提供循证依据。 方法 计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、CINAHL、CENTRAL、PubMed、Web of Science、Embase中关于居家安宁疗护对晚期癌症患者的随机对照试验,并追踪参考文献,检索时限为建库至2020年11月13日。由2名研究者独立筛选文献并交叉核对纳入文献质量,按照Cochrane评价手册5.1.0的质量评价方法评价纳入文献质量。采用RevMan 5.3软件进行Meta分析。 结果 共纳入10篇文献,包括1 720例晚期癌症患者。Meta分析结果显示,居家安宁疗护可以改善晚期癌症患者的生活质量[SMD=0.41,95%CI（0.30,0.51）,Z=7.44,P<0.001],减轻抑郁情绪[SMD=-0.29,95%CI（-0.45,-0.14）,Z=3.68,P<0.001],尚不能认为居家安宁疗护能够减轻晚期癌症患者的焦虑情绪[SMD=-0.15,95%CI（-2.12,1.82）,Z=0.15,P=0.880]。 结论 居家安宁疗护能够提高晚期癌症患者的生活质量,减轻患者的抑郁情绪,暂未发现能够减轻患者的焦虑情绪,需高质量、大样本研究进一步探讨居家安宁疗护对患者的影响。     

Regional and Chronological Variation of Chemosensory Dysfunction in COVID-19: a Meta-Analysis

BackgroundOlfactory and gustatory dysfunction are frequently reported in patients with coronavirus disease 2019 (COVID-19). However, the reported prevalence of olfactory and/or gustatory dysfunction varies widely, and the reason for the inter-study differences is unclear. Hence, in this meta-analysis, we performed subgroup analyses to investigate the factors that contribute to the inter-study variability in the prevalence of olfactory and gustatory dysfunction.MethodsOut of 943 citations, we included 55 eligible studies with 13,527 patients with COVID-19 for a meta-analysis. Calculating the data extracted from each study, the weighted summary prevalence of olfactory and gustatory dysfunction was estimated using a Freeman-Tukey transformation with models based on random-effects assumptions. A meta-analysis of variance compared the prevalence of olfactory and gustatory dysfunction according to regional, chronological, demographic, and methodologic factors, respectively.ResultsThe overall pooled prevalence rates of olfactory and gustatory dysfunction were 51.4% and 47.5%, respectively, in the random-effect model. In subgroup analyses, the prevalence rates of olfactory and gustatory dysfunction were significantly different among four geographical regions (both P < 0.001, respectively). Although the prevalence rates of olfactory and gustatory dysfunction did not significantly differ according to the time of enrollment, the subgroup analyses including only studies from the same geographical region (Europe) revealed a significant difference in olfactory dysfunction according to the time of enrollment.ConclusionThe regional and chronological differences in the prevalence rates of olfactory and gustatory dysfunctions partly explain the wide inter-study variability.     

东亚人群Klotho G-395A基因多态性与冠心病的Meta分析

目的 应用Meta分析探讨东亚人群Klotho G-395A基因多态性与冠心病易感性的关系。方法 分别检索中英文数据,获取2013年12月之前发表的有关Klotho G-395A基因多态性与冠心病易感性的病例对照研究,应用Meta分析方法对纳入的研究结果进行定量合并,采用Stata12.0软件进行统计分析,同时进行异质性检验及敏感性分析。结果 共纳入文献6篇,累计病例组1560例,对照组1459例。以显性模型比较做Meta分析,异质性检验显示无统计学意义（P0.2,I²30.8%）,以固定效应模型合并,表明Klotho G-395A基因多态性与冠心病易感性的关系有统计学意义（OR1.24,95%CI：1.06～1.45,P0.009）。按照病例组是否完全行冠状动脉造影做亚组分析,显示两组内部均无明显异质性,均以固定效应模型合并,冠状动脉造影组显示GA/AA基因型个体患冠心病的风险高于GG基因型个体（OR1.38,95%CI：1.12～1.70,P0.003）。非完全冠状动脉造影组则显示GA/AA基因型个体与GG基因型个体之间患冠心病的风险无统计学差异（OR1.07,95%CI：0.84～1.37,P0.587）。分别采取随机效应模型或去除权重最大的研究或去除等位基因差异最大的研究行敏感性分析,所得OR值与总体模型类似,有统计学意义。Begg’s检验提示无明显发表偏倚。结论 Klotho G-395A基因多态性可能与东亚人群冠心病易感性有关。     

Meniett低压脉冲治疗仪治疗梅尼埃病的系统评价

目的：系统评价Meniett低压脉冲治疗仪对治疗梅尼埃病的影响。方法计算机检索Pubmed、Web of Science、Cochrane Library、CNKI及万方数据库,搜索限于建库至2015年12月。按照纳入和排除标准筛选文献,由2位评价员独立进行资料评价、提取、剔除/引用、最后再进行核对,应用review manager 5.2版软件对最后纳入研究进行Meta分析。结果按照纳入标准,最终纳入英文文献14篇,中文文献1篇,共474例病例。符合Meta分析文献13篇,结果显示对平均纯音听阈的影响[MD=3.31,95%CI（1.29,5.33）],眩晕发作频率的影响[MD=6.81,95%CI（4.62,9.01）],AAO-HNS功能评分的影响[MD=0.63,95%CI （-4.13,5.39）]。结论对于传统药物治疗无效的梅尼埃病,Meniett低压脉冲治疗仪是一种微创性、非结构破坏性和安全有效的治疗方法。