ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.
ObjectivesTo systematically review the efficacy and safety of oral drugs for treating women with uncomplicated lower urinary tract infection.MethodsPubMed, The Cochrane Library, EMbase, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of oral drugs for treating females with uncomplicated lower urinary tract infection from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using " gemtc” packages in R 3.5.1 software.ResultsA total of 38 RCTs were included. The results of network meta-analysis showed that: quinolones (RR=1.24, 95%CI 1.11 to 1.37), furantoin (RR=1.21, 95%CI 1.06 to 1.37), trimethoprim-sulfamethoxazole (TMP-SMZ) (RR=1.20, 95%CI 1.06 to 1.35), fosfomycin (RR=1.17, 95%CI 1.04 to 1.31) and penicillin (RR=1.18, 95%CI 1.05 to 1.33) were superior to non-steroidal anti-inflammatory drugs (NSAIDS) in clinical cure. Quinolones were better than fosfomycin (RR=1.07, 95%CI 1.03 to 1.12), penicillin (RR=1.18, 95%CI 1.13 to 1.23) and cephalosporin (RR=1.13, 95%CI 1.08 to 1.19); furantoin was better than penicillin (RR=1.15, 95%CI 1.08 to 1.21) and cephalosporin (RR=1.10, 95%CI 1.04 to 1.17); TMP-SMZ was better than penicillin (RR=1.15, 95%CI 1.09 to 1.21) and cephalosporin (RR=1.11, 95%CI 1.04 to 1.16); fosfomycin was better than penicillin (RR=1.10, 95%CI 1.04 to 1.16) in bacteriological cure. The adverse effect rates of quinolones were lower than furantoin (RR=0.83, 95%CI 0.70 to 0.98), TMP-SMZ (RR=0.88, 95%CI 0.78 to 0.99) and fosfomycin (RR=0.74, 95%CI 0.59 to 0.93), and which of fosfomycin was higher than penicillin (RR=1.33, 95%CI 1.01 to 1.74) and NSAIDS (RR=1.46, 95%CI 1.11 to 1.92). All differences were statistically significant.ConclusionsCurrent evidence shows that uncomplicated lower urinary tract infection should be recommended to therapy containing quinolones. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusion.
Objective To assess the effectiveness of letrozole in ovulation induction treatment. Methods We searched CBMdisc (1979 to 2009), Wanfang (1994 to 2009), CNKI (1994 to 2009), VIP(1989 to 2009), PubMed (1997 to 2009), PML (1997 to 2009), FMJS(2000 to 2009) and 9 relevant journals to identify randomized controlled trails (RCTs) comparing letrozole with clomiphene citrate in ovulation induction treatment. The quality of the included trials was critically appraised. RevMan 4.2.7 software was used for statistical analyses. Results Ten RCTs involving 3100 patients were included, among which 5 RCTs were graded A, 4 were graded B, and 1 was graded C. Five RCTs showed that endometrial thickness at the time of human chorionic gonadotrophin (HCG) administration in the letrozole group was significantly higher than that in the clomiphene group. One RCT showed that endometrial thickness at the time of HCG administration in the letrozole group was significantly lower than that in the clomiphene group. Three RCTs showed no significant differences between the two groups. Four RCTs showed that the number of dominant follicle at the time of HCG administration in the letrozole group was signficantly lower than that in the clomiphene group. One RCT showed that the number of dominant follicle at the time of HCG administration in the letrozole group was significantly higher than that in the clomiphene group. Two RCTs showed no significant differences between the two groups. Compared with clomiphene citrate, the pregnancy rate in the letrozole monotherapy group was slightly lower at the RR 1.03 and 95%CI 0.82 to 1.29, pregnancy rate in the combination group was higher at RR 1.73 and 95%CI 1.37 to 2.18. The ovulation rate in the letrozole group was higher and no significant differences were found between the two groups at RR 1.23 and 95%CI 0.97 to 1.57. Conclusions There may be differences between letrozole and clomiphene citrate in ovulation induction treatment in terms of endometrial thickness, number of dominant follicle, ovulation rate, and pregnancy rate, but no significant differences. Letrozole can make up for the shortcomings of clinical clomiphene in ovulation induction and serve as an alternative. This conclusion needs to be further confirmed through more well-designed, multi-centered, large-sample RCTs.
ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.
ObjectiveTo systematically review the efficacy of 10 commonly used intrauterine devices (IUD) by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, POPLINE, CNKI, WanFang Data, SinoMed, CMCI, ChiCTR databases and websites were electronically searched to collect randomized clinical trials (RCTs) on efficacy of 10 IUDs from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using WinBUGS 1.4.3 software and Stata 13.0 software.ResultsA total of 67 RCTs involving 59 991 IUD users were included. The results of network meta-analysis indicated that after 1 year of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165 and MLCu375, and its effectiveness ranked second out of ten IUDs (SUCRA=77.1%). YCu200 had a lower pregnancy rate than that of TCu220C, which ranked third (SUCRA=71.5%). After 2 years of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A and OCu165, which had the highest probability to be the most effective intervention (SUCRA=92.1%). YCu200 had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165, GCu200, GammaCu and MLCu375, and its effectiveness ranked second (SUCRA=81.2%).ConclusionsCurrent evidence shows that the risk of pregnancy of GyneFix and YCu200 are lower at 1 and 2 years of use, which suggests they possess superior short-term effectiveness. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the effectiveness and safety of high intensity focused ultrasound (HIFU) in the treatment of pancreatic cancer, so as to provide references for its clinical application. MethodsPubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data were systematically searched up to November 2013 for randomized clinical trials (RCTs) and clinical controlled trials (CCTs) about HIFU in the treatment of pancreatic cancer. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.0. ResultsA total of 23 studies (19 RCTs and 4 CCTs) were included, of which 14 studies reported safety. The results of meta-analysis showed that:survival rates at the 6th month and the 12th month, overall efficacy and clinical benefit rate in the HIFU plus radiation and chemotherapy group were significantly higher than those in groups treated with three dimensional conformal radiation therapy (3D-CRT) (P < 0.05), gemcitabine (GEM) (P < 0.05), GEM plus cisplatin (DDP) (P < 0.05), and GEM plus 5-fluorouracil (5-FU) (P < 0.05). The adverse effects (mainly including skin damage and fever) in the HIFU plus radiation and chemotherapy group was similar to those in the control group with no significant difference (P > 0.05). ConclusionCurrent evidence suggests that HIFU plus radiation and chemotherapy for pancreatic cancer is superior to other therapies with less adverse reaction. However, the poor quality of the included studies reduces the reliability of outcome to some extent. Thus, it is necessary to regulate and unify the criteria of diagnosis and outcome measures in the treatment of pancreatic cancer and improve the quality of study design and implementation in clinical studies, so as to provide high quality evidence for its clinical application.
Objective To systematically evaluate safety and effectiveness of using fast track surgery (FTS) protocol in perioperative management of hepatectomy. Methods The studies were collected by searching the PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP databases by two researchers. The FTS management was used in the FTS group and the traditional perioperative management was used in the traditional group. The meta analysis was performed using the RevMan 5.3 software. Results A total of 28 articles were included in the study, of which 1 632 patients in the FTS group and 1 820 patients in the traditional group; 14 RCTs, 14 CCTs. The results of meta analysis showed: Compared with the traditional group, the FTS not only could reduce the pain of patients during 24 and 48 hours after the surgery [24 h: WMD=–0. 92, 95%CI (–1.05, –0.79), P<0.000 01; 48 h:WMD=–0.73, 95%CI (–0.90, –0.56), P<0.000 01], but also shorten the first postoperative flatus time of patients [WMD=–17.36, 95%CI (–23.16, –11.56), P<0.000 01] and the length of hospital stay [WMD=–2.42, 95%CI (–3.02, –1.63), P<0.000 01] and reduce the hos-pitalization expenses [WMD=–0.52, 95%CI (–0.64, –0.41, P<0.000 01]; While the incidences of pulmonary comp-lications [OR=0.51, 95%CI (0.32, 0.81), P=0.005], total complications [OR=0.57, 95%CI (0.38, 0.87), P=0.008], and nausea and vomiting [OR=0.45, 95%CI (0.31, 0.65), P<0.000 1] were significantly decreased. The RCT group and CCT group showed the same conclusions with the overall study (except incidence of postoperative pulmonary complications between the two groups in the CCT study). Conclusion For patients with elective hepatectomy, it seems feasible to use FTS protocol, which could promote postoperative bowel recovery, shorten length of hospital day, and save medical resources.