ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
ObjectiveTo explore the association between single nucleotide polymorphism (SNP) in the X-ray cross complementary repair gene-1 (XRCC1) rs1799782 locus and thyroid cancer.MethodsStudies investigating the association between SNP in the XRCC1 gene and thyroid cancer susceptibility were retrieved from the PubMed, Embase, Web of Science, CNKI (Chinese National Knowledge Infrastructure), Wanfang, and CBM (China Biology Medicine) databases (published date up to February 15, 2021). Eligible studies were screened according to inclusion/exclusion criteria and principles of quality evaluation. Meta-analysis was performed using Stata 14.0 software. Odds ratios with their corresponding 95% confidence intervals (95%CI) were pooled to assess the association between SNP in the XRCC1 gene rs1799782 locus and thyroid cancer susceptibility.ResultsTwelve articles were eligible for this meta-analysis. Meta-analysis results were shown as follows: No significant association was found between XRCC1 rs1799782 polymorphism and thyroid cancer in overall population [Dominant model: CT+TT vs CC, OR=1.07, 95%CI (0.84, 1.36). Recessive model: TT vs CT+CC, OR=1.48, 95%CI (0.95, 2.31). Allelic model: T vs C, OR=1.15, 95%CI (0.93, 1.43). Codominant model: TT vs CC: OR=1.44, 95%CI (0.83, 2.53); CT vs CC, OR=1.02, 95%CI (0.82, 1.28); TT vs CT, OR=1.40, 95%CI (0.98, 1.99)]. rs1799782 polymorphism was significantly associated with the risk of thyroid cancer in Chinese population [Dominant model: CT+TT vs CC, OR=1.38, 95%CI (1.11, 1.71). Recessive model : TT vs CT+CC, OR=1.97, 95%CI (1.55, 2.50); Allelic model: T vs C, OR=1.40, 95%CI (1.16, 1.68). Codominant model: TT vs CC, OR=2.12, 95%CI (1.66, 2.71); CT vs CC, OR=1.26, 95%CI (1.09, 1.47); TT vs CT, OR=1.70, 95%CI (1.31, 2.21)]. rs1799782 polymorphism was significantly associated with the risk of thyroid cancer in Asian population [Dominant model: CT+TT vs CC, OR=0.64, 95%CI (0.49, 0.83). Codominant model: TT vs CC: OR=0.50, 95%CI (0.33, 0.74); CT vs CC, OR=0.65, 95%CI (0.49, 0.86)].ConclusionsThere is no significant correlation between XRCC1 rs1799782 polymorphism and the risk of thyroid cancer in general population. The XRCC1 rs1799782 polymorphism may be associated with an increased thyroid cancer risk among Chinese, and a tendency for decreased thyroid cancer risk among Asians (Chinese excluded). The XRCC1 rs1799782 polymorphism is not associated with thyroid cancer susceptibility among Caucasians under all genetic models.
Objective To systematically evaluate the effect of arm sling on shoulder subluxation in stroke patients with hemiplegia. METHODS CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, Cochrane Library, OVID, EBM Reviews, Best Practice, ACP Journal Club, and Practice Guidline were searched from establishment to March 2023. The literature on randomized controlled trials of arm sling on gait or balance in post-stroke patients with hemiplegia were included. RevMan 5.4.1 software was used for meta-analysis. Results A total of 13 articles were included, including 691 subjects, 343 in the experimental group, and 348 in the control group. The meta-analysis results showed that patients wearing the boom arm were effective in improving the recovery of upper extremity function [mean difference (MD)=8.12, 95% confidence interval (CI) (2.39, 11.60), P＜0.000 01], relieving pain due to shoulder subluxation [MD=−1.13, 95%CI (−1.70, −0.56), P=0.000 1], and enhancement of patients’ quality of life in daily activities [MD=15.07, 95%CI (3.24, 26.90), P=0.01], all of which were superior to the control group. However, there was no statistically significant difference between the two groups in terms of Apnea-Hypopnea Index [MD=−1.86, 95%CI (−3.79, 0.06), P=0.06], 6 min walking test [MD=−0.51, 95%CI (−18.52, 17.49), P=0.96], 10 meter walk time [MD=0.00, 95%CI (−0.06, 0.06), P=0.91], heart rate [MD=−0.22, 95%CI (−5.10, 4.27), P=0.93], and Berg balance scale [MD=−2.53, 95%CI (−8.17, 3.10), P=0.38]. Conclusion The use of arm sling can effectively improve patients’ quality of life, functional recovery of the upper limbs and reduce pain, providing an evidence-based basis for healthcare professionals to treat patients with proven treatment modalities.
ObjectiveTo evaluate the relationship between four classic inflammatory biomarkers, including C-reactive protein (CRP), white blood cell (WBC), IL (interleukin family), tumor necrosis factor-α (TNF-α), and postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and valve replacement (VR) surgeries.MethodsWe searched PubMed, EMBase, the Cochrane Library, Ovid, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, VIP database and WanFang database from the inception to April 2020. Studies on the relationship between POAF and the above four inflammatory biomarkers were analyzed. Two researchers independently reviewed the literature, extracted data and evaluated the quality of the literature. RevMan 5.3 software was used for meta-analysis.ResultsA total of 47 articles were included, covering 10 711 patients. The levels of preoperative CRP (SMD=0.38, 95%CI 0.14-0.62, Z=3.12, P=0.002) and postoperative CRP (SMD=0.40, 95%CI 0.06-0.74, Z=2.33, P=0.02), IL-6 (SMD=1.34, 95%CI 0.98-1.70, Z=7.26, P<0.001) and TNF-α (SMD=−0.33, 95%CI −0.65-−0.01, Z=2.02, P=0.040) were related to POAF, while preoperative IL-8 (SMD=−0.05, 95%CI −0.28-0.18, Z=0.42, P=0.68) and TNF-α (SMD=−0.43, 95%CI −1.22-0.36, Z=1.07, P=0.28), postoperative WBC (WMD=1.16, 95%CI −0.09-2.42, Z=1.82, P=0.07) and IL-10 (SMD=0.21, 95%CI −0.35-0.77, Z=0.73, P=0.46) were not related to POAF. The relationships between preoperative WBC and IL-10, postoperative IL-8 and POAF were inclusive, which needed further verification. Furthermore, the relationship between postoperative CRP and POAF were not consistent, as they were not significantly correlated in sub-group analysis.ConclusionThe inflammatory substrate before the surgery and inflammatory reaction induced by the operation is related to the occurrence and maintenance of POAF. Compared with preoperative inflammatory status, postoperative inflammatory factors may have a greater predictive value for POAF. Preoperative CRP, postoperative IL-6 and TNF-α levels are reliable biomarkers of POAF.
ObjectiveTo evaluate the effect of airway pressure release ventilation (APRV) on the hospital mortality of patients with acute respiratory distress syndrome (ARDS) by using cumulative meta-analysis. MethodsThe PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) related to the objective from inception to June 30, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A cumulative meta-analysis was then performed by using StataSE 12.0 software. ResultsA total of 9 RCTs involving 533 patients were included. The results of meta-analysis showed that APRV could reduce the hospital mortality of patients with ARDS (RR=0.70, 95%CI 0.54 to 0.91, P<0.01) compared with traditional mechanical ventilation. ConclusionCurrent evidence shows that APRV can reduce the hospital mortality of patients with ARDS. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically review the willingness to use pre-exposure prophylaxis (PrEP) and its influencing factors among men who have sex with men (MSM) in China. Methods We conducted a comprehensive search on various databases, including China National Knowledge Infrastructure, VIP database, Wanfang data, China Biomedical Literature Service System, PubMed, Web of Science, Cochrane Library, and Embase, covering the period from database inception to September 6th, 2023. We focused on studies that publicly reported data on the willingness to use PrEP and its influencing factors among MSM in China. The quality of included studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. RevMan 5.3 software and Stata 13.1 software were used to perform meta-analysis for the willingness to use PrEP and its influencing factors among MSM in China. Results A total of 24 cross-sectional studies with 19 influencing factors and a sample size of 16499 participants were included in the review. The results revealed a PrEP usage intention rate of 60.4% [95% confidence interval (CI) (51.8%, 68.9%)] among the MSM population in China. Factors such as awareness of PrEP [odds ratio (OR)=5.26, 95%CI (1.33, 20.82)], having heard of PrEP [OR=1.84, 95%CI (1.28, 2.64)], age<25 years [OR=1.92, 95%CI (1.34, 2.77)], being a student [OR=1.92, 95%CI (1.17, 3.16)], monthly income of 1000-3000 yuan [OR=1.36, 95%CI (1.12, 1.65)], history of human immunodeficiency virus (HIV) testing [OR=2.05, 95%CI (1.53, 2.74)], history of sexually transmitted infections [OR=1.75, 95%CI (1.27, 2.40)], seeking sexual partners online [OR=1.38, 95%CI (1.19, 1.59)], openness about sexual orientation [OR=1.90, 95%CI (1.27, 2.84)], having a non-local household registration [OR=1.66, 95%CI (1.37, 2.02)], and recommending PrEP to friends [OR=20.14, 95%CI (2.59, 156.91)] were identified as promoting factors for the willingness to use PrEP. Conversely, a homosexual orientation [OR=0.67, 95%CI (0.52, 0.85)] was identified as a barrier to the willingness to use PrEP. Conclusions Chinese MSM have a low intention to use PrEP, and there are many factors affecting the intention to use PrEP in MSM. In the future HIV prevention and control work, measures such as strengthening education and publicity of PrEP, providing a certain degree of support for PrEP costs, strengthening health education on campus, strengthening community organizations and support networks should be taken to promote the willingness of MSM to use PrEP.
ObjectiveTo systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC).MethodsThe PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software.ResultsEleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group.ConclusionThe meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.
Objective To systematically evaluate the diagnostic value of artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps. Methods Pubmed, Embase, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure, Chongqing VIP and Wanfang databases were searched. The diagnostic trials of the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps were comprehensively searched. The search time limit was from January 1, 2000 to October 31, 2022. The included studies were evaluated according to the Quality Assessment of Diagnostic Accuracy Studies-2, and the data were meta-analysed with RevMan 5.3, Meta-Disc 1.4 and Stata 13.0 statistical softwares. Results Finally, 11 articles were included, including 2178 patients. Meta-analysis results of the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps showed that the pooled sensitivity was 0.91, the pooled specificity was 0.88, the pooled positive likelihood ratio was 7.41, the pooled negative likelihood ratio was 0.10, the pooled diagnostic odds ratio was 76.45, and the area under the summary receiver operating characteristic curve was 0.957. Among them, 5 articles reported the diagnosis of small adenomatous polyps (diameter <5 mm) by the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system. The results showed that the pooled sensitivity and the pooled specificity were 0.93 and 0.91, respectively, and the area under the summary receiver operating characteristic curve was 0.971. Five articles reported the accuracy of endoscopic diagnosis for adenomatous polyps of those with insufficient experience. The results showed that the pooled sensitivity and the pooled specificity were 0.84 and 0.76, respectively. The area under the summary receiver operating characteristic curve was 0.848. Compared with the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system, the difference was statistically significant (Z=1.979, P=0.048). Conclusion The artificial intelligence assisted narrow-band imaging endoscopy diagnostic system has a high diagnostic accuracy, which can significantly improve the diagnostic accuracy for colorectal adenomatous polyps of those with insufficient endoscopic experience, and can effectively compensate for the adverse impact of their lack of endoscopic experience.
ObjectivesTo systematically review the efficacy and safety of 3D laparoscopic in the treatment of colorectal cancer.MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched online to collect clinical trials of 3D laparoscopic in the treatment of colorectal cancer from inception to September 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 26 trials, including 4 randomized controlled trials and 22 cohort studies were included. The results of meta-analysis showed that: compared with 2D laparoscopic, 3D laparoscopic had shorter operative time (MD=–16.32, 95%CI –22.61 to –10.03, P<0.000 01), less amount of blood transfusion in operation (MD=–10.80, 95%CI –19.93 to –1.66, P=0.02), more lymph node dissection (MD=0.88, 95%CI 0.30 to 1.45, P=0.003), shorter recovery time of gastrointestinal function (MD=–0.18, 95%CI –0.31 to –0.04, P=0.01), lower incidence of postoperative complication (OR=0.63, 95%CI 0.44 to 0.89, P=0.009), and fewer days in hospital (MD=–0.84, 95%CI –1.40 to –0.28, P=0.003). Additionally, there was no significant difference in hospitalization costs (MD=–0.01, 95%CI –0.23 to 0.21, P=0.94).ConclusionsCurrent evidence shows that, compared with 2D laparoscopy, 3D laparoscopy assisted colorectal cancer surgery has obvious advantages such as less bleeding during operation, shorter operation time, lower incidence of complications after operation, shorter hospitalization time and no increase in hospitalization expenses. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the efficiency of prevention and control strategies of carbapenem-resistant organism (CRO) in medical institutions in China using meta-analysis method. Methods PubMed, Embase, Medline (Ovid), Web of Science, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Database were systematically searched for studies on CRO prevention and control in Chinese medical institutions from the establishment of databases to 2023 for meta-analysis. Results A total of 21 studies were included, consisting of 3 randomized controlled studies and 18 non-randomized controlled studies. The meta-analysis results showed that compared with standard prevention and control measures, strengthened intervention measures (including active screening, information-based transparent supervision mode, comprehensive intervention, and bundled prevention and control strategies) could effectively reduce the CRO infection rate [relative risk (RR)=0.40, 95% confidence interval (CI) (0.25, 0.65), P<0.05]. Proactive screening could effectively reduce the CRO infection rate [RR=0.52, 95%CI (0.30, 0.91), P<0.05] and carbapenem-resistant Enterobacteriaceae (CRE) infection rate [RR=0.47, 95%CI (0.24, 0.93), P<0.05]. Information-based transparent supervision could reduce the CRE infection rate by improving compliance with standard prevention and control measures [RR=0.42, 95%CI (0.28, 0.62), P<0.05]. Conclusions Compared with standard prevention and control measures, strengthened intervention measures can effectively reduce the risk of in-hospital transmission and infection of CRO. In clinical practice, bundled comprehensive intervention can be combined with information-based transparent supervision, and if necessary, proactive screening of CRO in high-risk populations should be carried out.