Objective To explore the clinical effect of occipital-cervical fusion and its impact on cervical curvature, and preliminarily study the causes of postoperative dysphagia. Methods The data of 24 patients who underwent occipito-cervical fusion in the Fourth People’s Hospital of Zigong between January 2014 and December 2018 were retrospectively analyzed, including 13 males and 11 females, aged 33-82 years, with an average age of (58.3±13.3) years. Among them, there were 14 cases of atlas fractures, 6 cases of atlantoaxial fractures, 1 case of intraspinal canal space-occupying lesion, 2 cases of chronic atlantoaxial dislocation with spinal cord compression, and 1 case of instability caused by inflammatory diseases. Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) score were used to evaluate neurological function and pain of patients preoperatively and postoperatively. Occipito-cervical angle (O-C2) and lower cervical angle (C2-C7) were measured to evaluate the preoperative and postoperative angle changes in patients. The causes of postoperative dysphagia were analyzed. Results All the 24 patients were followed up for 8-50 months (26.3 months on average). The mean JOA score increased from 11.6±1.5 before surgery to 15.4±1.2 at the last follow-up, and the mean VAS score decreased from 6.4±1.1 before surgery to 2.0±0.6 at the last follow-up; the differences between the two time points were statistically significant (P<0.001). The bone graft fusion rate was 95.8% (23/24). The mean O-C2 angle decreased from (16.5±7.6)° before surgery to (14.7±4.5)° at the last follow-up, with no statistical significance (P=0.395). The mean angle of C2-C7 increased from (9.4±5.5)° before surgery to (16.3±3.5)° at the last follow-up, and the difference was statistically significant (P<0.001). Two patients developed postoperative dysphagia, possibly due to fusion in a flexion position. Conclusion Occipito-cervical fusion has reliable efficacy in treating occipito-cervical instability, with a high fusion rate and a low incidence of complications, but it will change the physiological curvature of upper and lower cervical vertebra, and fusion in a flexion position may cause postoperative dysphagia.
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.
Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. 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. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo evaluate the clinical efficacy and safety tolerance of perampanel in the treatment of Chinese adult epilepsy patients. Methods Clinical data of adult epileptic patients treated with perampanel in Department of Neurology, China-Japan Union Hospital of Jilin University from January 2020 to December 2022 were analyzed retrospectively by self-control method, including demographic and clinical characteristics of patients, changes of epileptic seizures before and after perampanel treatment and adverse events during the treatment of perampanel. To evaluate the clinical efficacy and safety of perampanel in Chinese adult epileptic patients. Results A total of 69 adult epileptic patients with complete follow-up data were included. The dosage range of perampanel was 2 ~ 8 mg. The total effective rate was 68.1%, and the seizure-free rate was 17.4%. The most common adverse reactions were mood change and dizziness, the incidence of adverse reactions was 52.2%, and the incidence of serious adverse reactions was 0.0%. In terms of analysis of influencing factors of efficacy, the results showed that single drug therapy or combination therapy, type of combined antiepileptic drug and treatment time of perampanel did not affect the efficacy (P>0.05), while dosage was an important factor affecting the efficacy of perampanel (P<0.05), and there was no significant difference in efficacy between the focal epilepsy group and the general epilepsy group (P>0.05). In terms of the analysis of factors related to the occurrence of adverse reactions, the results showed that the occurrence of adverse reactions was related to the dosage of perampanel (P<0.05), and was independent of whether it was monotherapy, the addition time of perampanel and the type of combined antiepileptic agents (P>0.05). Conclusion Perampanel has good efficacy and safety tolerance in the treatment of epilepsy in Chinese adults. Both monotherapy and additive therapy can effectively control seizures, and has a good effect on different seizure types. The most common adverse events during treatment were mood changes and dizziness, which could be alleviated and tolerated by most patients with prolonged treatment.
Objective To systematically review the efficacy and safety of immune checkpoint inhibitors combined with chemotherapy in the treatment of triple-negative breast cancer. Methods The PubMed, Cochrane Library, Embase, Web of Science, CNKI, WanFang Data and VIP databases were searched for randomised controlled trials (RCTs) of immune checkpoint inhibitors combined with chemotherapy versus chemotherapy alone for triple-negative breast cancer from inception to April 1, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 13 RCTs involving 5 416 patients were included. The results of meta-analysis showed that the pathologic complete response rate (pCR) (OR=2.09, 95%CI 1.37 to 3.19, P<0.01), progression-free survival (PFS) (HR=0.75, 95%CI 0.67 to 0.83, P<0.01) and overall survival (OS) (HR=0.87, 95%CI 0.79 to 0.96, P<0.01) were significantly better than those in the control group. The results of subgroup analysis showed that there were statistically significant differences in PFS (P<0.01) and OS (P=0.02) between PD-L1-positive and PD-L1-negative patients, but there was no statistically significant difference in pCR between PD-L1-positive patients and PD-L1-negative patients (P=0.36). There was a statistically significant difference in pCR between node-positive patients and node-negative patients (P=0.03). There was no statistically significant difference in pCR between patients treated with PD-1 inhibitors and PD-L1 inhibitors (P=0.32); and there was no significant difference in PFS (P=0.19) or OS (P=0.99) between patients treated with PD-1 inhibitors and PD-L1 inhibitors. Compared with those in the control group, the incidences of serious adverse events (RR=1.36, 95%CI 1.09 to 1.70, P<0.01) and immune-related adverse events (RR=2.98, 95%CI 1.66 to 5.35, P<0.01) were higher in the experimental group, and the common immune-related adverse events were hypothyroidism and hyperthyroidism.Conclusion The existing evidence shows that immune checkpoint inhibitors combined with chemotherapy are more effective than chemotherapy alone in the treatment of triple-negative breast cancer, and the combination therapy has a higher incidence of adverse reactions. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
ObjectiveTo compare the early efficacy between Quadrant channel and traditional method in treating lumbar disc herniation. MethodBetween July 2010 and December 2012, 60 patients with lumbar disc herniation were randomly divided into two groups with 30 in each. Quadrant channel and traditional method were used respectively to do the same one single segmental pedicle screw fixation with single pieces of cage bone grafting fusion and internal fixation. Then, we compared the two groups in incision length, operative time, blood loss, incision healing time and postoperative incidence of low back pain between the two groups of patients. ResultsThere were no significant differences between the two groups in terms of operation time, blood loss, and recent curative effect (P>0.05), while Quadrant channel was superior in small skin incision, reduced incidence of low back pain, and shorter postoperative incision healing time (P<0.05). ConclusionsTreatment of lumbar disc herniation using Quadrant channel is minimally invasive with less complications. Mid-and long-term efficacy remains to be further analyzed.
Objective To analyze the clinical application, ADR/AE involved systems and manifestations of the six injections containing Houttuynia cordata which are much complicated in their ingredients and pharmacological actions compared with the Houttuynia cordata Injection, and to assess their safety and efficacy, so as to provide references for further deep research. Methods Such databases as MEDLINE (1998 to December 31, 2010), EMBASE (1998 to December 31, 2010), The Cochrane Library (1998 to December 31, 2010), CNKI (1979 to December 31, 2010), CBM (1978 to December 31, 2010), and VIP (1989 to December 31, 2010) were searched to retrieve the case report, series of cases observation, cross-sectional study, and clinical control study. The studies were included according to the inclusive and exclusive criteria, and the data was abstracted to analyze the reason and regularity of ADR/AE. Meta-analyses for efficacy were conducted when the data was feasible. Results a) About ADR/AE: Among the included 132 studies, 118 cases were reported with the ADR/AE. There were 59 studies about the New Houttuyfonate sodium injection, 93 cases with ADR/AE mainly manifested as pain in injection site (41 cases), rash (19 cases), anaphylactic shock (11 cases) and other infusion or allergic reactions (21 cases). There were 69 studies about the Yu Jin injection, 25 cases with ADR/AE manifested as rash (12 cases), anaphylactic shock (four cases), pain in injection site (three cases), and other infusion or allergic reactions (six cases); and b) The good efficacy of the New Houttuyfonate sodium injection and the Yu Jin injection was reported in one cross-sectional study and one RCT respectively, but the limited data was not enough to properly judge the efficacy. Conclusion There are few of clinical studies about these six injections containing Houttuynia cordata, and the irrational use in clinic is serious. Most of the ADR/AE cases are related to irrational use, such as, non-indication use, and arbitrarily change of administration method. The proof for analyzing and evaluating the safety and efficacy of injections containing Houtturnia cordata is insufficient, so strict clinical trials with large sample size are required to support further research.
Objective To assess the efficacy and safety of Etanercept for Ankylosing spondylitis. Methods We searched The Cochrane Library (Issue 4. 2008), MEDLINE (1966 to September 2008), EMBASE (1974 to September 2008), CBM (1978 to 2008), CNKI (1994 to 2008), VIP (1989 to 2008), and Wanfang (1999 to 2008). The quality of included studies was critically evaluated. Data analyses were performed with The Cochrane Collaboration’s RevMan 5.0 software. Results Seven randomized controlled trials with total of 949 patients met the included criteria. The metaanalysis showed the effective rate of ASAS 20 or ASAS 50 receiving Etanercept was significantly higher than in patients receiving placebo, while no significant differences were noted between the Etanercept and placebo group in other indices. There was no statistical significance among different dosages. Patient Injection-site reaction rate for Etanercept was higher than that for placebo. No significant differences were observed in other adverse effects. Conclusions Etanercept is safe and effective for patients with Ankylosing spondylitis, however, some trials included in the review were of poor quality, so we needed the multi-center, large-scale randomized controlled trials of higher quality and the same course of treatment to confirm this.
Objective To systematically review the efficacy and safety of glucocorticoids for severe COVID-19 and to provide references for the treatment strategy of severe COVID-19 patients. Methods PubMed, EMbase, The Cochrane Library, Web of Science, ClinicalTrials.gov, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) that reported glucocorticoid therapy for severe COVID-19 patients from inception to August 26th, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 7 RCTs involving 6 236 patients were included. The meta-analysis results showed that compared with usual care, glucocorticoids significantly reduced the all-cause mortality of severe COVID-19 (RR=0.84, 95%CI 0.77 to 0.91, P<0.000 1), whereas no significant difference was found in the progression of complex diseases between the two groups (RR=0.84, 95%CI 0.69 to 1.01, P=0.06). Glucocorticoids did not increase adverse effects in severe COVID-19 compared with usual care (general adverse events: RR=1.15, 95%CI 0.66 to 2.03, P=0.62; serious adverse events: RR=1.13, 95%CI 0.54 to 2.38, P=0.75). Conclusion Current evidence suggests that glucocorticoids are effective in treating severe COVID-19 without significantly increasing adverse events. However, due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the conclusion.