ObjectiveTo systematically evaluate the effect of mucin 1 (MUC1) expression on the prognosis and clinicopathologic characteristics of patients with colorectal cancer.MethodsThe cohort studies on the relationship between MUC1 expression and the prognosis of colorectal cancer patients were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CNKI, China Biology Medicine, WanFang, VIP, and other databases from the establishment of the database to December 2020. The two researchers screened the literatures according to the inclusion and exclusion criteria, extracted relevant data, and performed meta analysis using Stata 12.0 software.ResultsA total of 17 eligible studies comprising 2 516 patients with colorectal cancer were included. The results of meta-analysis showed that the overall survival (OS) of patients with high MUC1 expression was worse than that with low MUC1 expression [HR=1.51, 95%CI (1.33, 1.71), P<0.001], but not statistically significant with disease-free survival [HR=1.39, 95%CI (0.41, 4.68), P=0.565]. Subgroup analysis results showed the same results as the overall analysis regardless of analysis method (multivariate or survival curve), different ethnic groups (Asian or Caucasian), and different sample sizes (≥100 or <100). The results of clinicopathologic analysis showed that the high expression of MUC1 was correlated with lymph node metastasis, distant metastasis, depth of invasion, and TNM stage (P<0.05), but not correlated with gender, age, degree of tumor differentiation, and tumor location (P>0.05).ConclusionsHigh expression of MUC1 is closely associated with poor prognosis, lymph node metastasis, distant metastasis, tumor invasion depth, and TNM stage in patients with colorectal cancer, which is expected to be an important reference indicator for disease monitoring and prognosis judgment of colorectal cancer.
ObjectiveTo systematically review the efficacy of different drugs for patients with methamphetamine-induced psychotic disorders by network meta-analysis.MethodsAn electronical search was conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, CBM, WanFang Data and VIP databases from inception to October 2016 to collect randomized controlled trials (RCTs) about different drugs for methamphetamine-induced psychotic disorders. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then RevMan 5.3, R 3.3.2 and JAGS 4.2.0 softwares were used to perform network meta-analysis.ResultsA total of 16 RCTs involving 1 676 patients and 9 kinds of drugs were included. The results of network meta-analysis showed that: compared with the placebo group, olanzapine (OR=28.00, 95%CI 8.10 to 110.00), risperidone (OR=20.00, 95%CI 7.70 to 58.00), quetiapine (OR=30.00, 95%CI 6.60 to 160.00), ziprasidone (OR=28.00, 95%CI 3.70 to 230.00), chlorpromazine (OR=29.00, 95%CI 5.00 to 200.00), aripiprazole (OR=13.00, 95%CI 1.70 to 93.00), haloperidol (OR=19.00, 95%CI 2.10 to 190.00) could significantly improve the psychotic disorders of patients with methamphetamine, respectively, in which quetiapine was the best choice. There were no significant differences between any other pairwise comparisons of these different drugs.ConclusionFor the treatment of psychotic disorders caused by methamphetamine, quetiapine should be of a priority choice, follows by ziprasidone, chlorpromazine, olanzapine, risperidone, aripiprazole or haloperidol in a descending priority. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation, and provide reference data for clinical decision-making. Methods Seven electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wangfang data and Chongqing VIP database) were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated non-surgically from inception to March, 2020. Articles were screened according to inclusion and exclusion criteria, and the total number of patients, number of patients with resorption, and other important data were extracted for analysis. Random effect models were used for meta-analysis, and subgroup analysis, sensitivity analysis, meta-regression analysis, and Egger’s test were performed. Results A total of 15712 articles were identified from these databases, and 48 were eligible for analysis. A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis, 1740 of whom presented resorption. Meta-analysis revealed that the incidence of resorption was 0.60 [95% confidence interval (CI) (0.46, 0.72)]. In subgroup analyses, studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence [0.73, 95%CI (0.60, 0.85)] than those that used qualitative methods [0.51, 95%CI (0.34, 0.69)] (P=0.0252). The pooled incidence gradually increased in randomized controlled trials (RCTs) [0.50, 95%CI (0.15, 0.85)], non-RCT prospective studies [0.59, 95%CI (0.48, 0.70)] and retrospective studies [0.69, 95%CI (0.36, 0.95)], but the difference was not statistically significant (P=0.7523). The pooled incidence varied from 0.58 [95%CI (0.54, 0.71)] to 0.62 [95%CI (0.49, 0.74)] after the sequential omission of each single study. There was no significant change in the pooled incidence [0.62, 95%CI (0.43, 0.79)] when only low-risk RCTs and high-quality non-RCT studies were included, comparing with original meta-analysis results. Meta-regression showed that measurements partially caused heterogeneity (R2=15.34%, P=0.0858). Egger’s test suggested that there was no publication bias (P=0.4622). Conclusions According to current research, there is an overall incidence of resorption of 60% [95%CI (46%, 72%)] among non-surgically treated patients with lumbar disc herniation. The probability of resorption should be fully considered before making a decision on surgery.
Objective To systematically review the efficacy of six cognitive interventions on cognitive function of patients with mild cognitive impairment after stroke. Methods The PubMed, EMbase, Cochrane Library, SinoMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials on the effects of non-drug interventions on the cognitive function of patients with mild cognitive impairment after stroke from inception to March 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Openbugs 3.2.3 and Stata 16.0 software. Results A total of 72 studies involving 4 962 patients were included. The results of network meta-analysis showed that the following five cognitive interventions improved the cognitive function of stroke patients with mild cognitive impairment: cognitive control intervention (SMD=−1.28, 95%CI −1.686 to −0.90, P<0.05) had the most significant effect on the improvement of cognitive function, followed by computer cognitive training (SMD=−1.02, 95%CI −1.51 to −0.53, P<0.05), virtual reality cognitive training (SMD=−1.20, 95%CI −1.78 to −0.62, P<0.05), non-invasive neural regulation (SMD=−1.09, 95%CI −1.58 to −0.60, P<0.05), and cognitive stimulation (SMD=−0.94, 95%CI −1.82 to −0.07, P<0.05). Conclusion Five cognitive interventions are effective in improving cognitive function for stroke patients with mild cognitive impairment, among which cognitive control intervention is the most effective. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectivesThe present network meta-analysis was conducted to evaluate the potential efficacy and safety of various surgical approaches in the treatment of benign prostatic hyperplasia with enlarged prostate.MethodsPubMed, EMbase, The Cochrane Library, Clinicaltrials.gov and CNKI databases were electronically searched to identify eligible studies. Two reviewers independently screened literature, extracted data and evaluated risk of bias and the ADDIS 1.16.8 software was used to conduct meta-analysis.ResultsA total of 23 studies involving 2 849 patients with 5 approaches including open prostatectomy (OP), holmium laser enucleation of the prostate (HoLEP), plasmakinetic/bipolar plasmakinetic enucleation of the prostate (PK/BPEP), transurethral vaporization of the prostate (TUVP), and laparoscopic prostatectomy (LSP) were included. HoLEP, PK/BPEP and OP were superior to the other methods in improving the objective indicators and subjective feelings of patients during both short and medium-term follow-up. However, compared with OP, HoLEP and PK/BPEP were observed to result in a significantly lower hemoglobin level (MD=1.65, 95%CI 0.35 to 4.41; MD=2.62, 95%CI 0.64 to 2.90), longer postoperative irrigation time (MD=4.67, 95%CI 1.29 to 10.66; MD=2.67, 95%CI 1.32 to 6.63), as well as indwelling catheter after operation (MD=1.64, 95%CI 0.48 to 4.15; MD=2.52, 95%CI 0.60 to 3.78). In terms of short-term complications, PK/BPEP (RR=0.45, 95%CI 0.13 to 1.29) was found to be significantly lower than that of OP.ConclusionsHoLEP and PK/BPEP can be probably used as a superior treatment option for large volume benign prostatic hyperplasia because of its better curative effect, higher safety and quick postoperative recovery.
Objective To systematically evaluate the efficacy and safety of palonosetron hydrochloride injection for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with moderately or highly emetogenic chemotherapy. Methods Searched PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biological Medical Database, Wanfang Database and VIP Chinese Science and Technology Journal Database to find domestic and abroad published literatures of palonosetron used to control CINV associated with moderately or highly emetogenic chemotherapy. Two reviewers independently selected literatures, extracted data and assessed quality of the included studies by the Cochrane handbook 5.1. Meta-analysis was performed using RevMan 5.3 software. Results Twenty trials involving 4 919 patients were included. The results of meta-analysis showed statistically significant differences between palonosetron and first-generation 5-hydroxytryptamine3 receptor antagonists (5-HT3RAS) in prevention of acute〔RR=1.09, 95%CI (1.40, 1.14),P=0.000 4〕, delayed 〔RR=1.26, 95%CI (1.15, 1.37),P＜0.000 01〕, and overall phase of CINV 〔RR=1.19, 95%CI (1.10, 1.30),P＜0.000 1〕. Subgroup analyses indicated that there were no statistical significances between palonosetron and granisetron (P=0.09) or ondansetron (P=0.08) in prevention of acute CINV, as well as between palonosetron and first-generation 5-HT3RAS in prophylaxis of moderately CINV (P=0.18), while there was statistical significance in favor of palonosetron in prophylaxis of delayed and overall phase of CINV. Compared with first-generation 5-HT3RAS, there were different in prophylaxis of highly chemotherapy-induced acute〔RR=1.10, 95%CI (1.02, 1.18),P=0.01〕, delayed〔RR=1.20, 95%CI (1.06, 1.36),P=0.005〕, and overall phase〔RR=1.18, 95%CI (1.04,1.33),P=0.008〕of CINV. In terms of safety, such as headache, constipation, diarrhea and dizziness, there were no statistical differences between two groups. Conclusions Palonosetron hydrochloride injection showed efficacy in prophylaxis of moderately or highly CINV, and didn't increase adverse events. Palonosetron hydrochloride injection is more better than first-generation 5-HT3RAS, especially in prevention of highly CINV, and can significantly improve the control rate of acute, delayed, and overall phase of CINV.
Objective To systematically evaluate the efficacy and safety for video-assisted anal fistula therapy in the treatment of complex anal fistula. Methods The databases of CKNI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library and Embase were retrieved from the time of database establishment to may 31 2022. The two researchers independently screened the literatures and evaluated the quality of the literatures that met the inclusion criteria according to the research purpose and quality evaluation criteria. Meta-analysis were performed with the Revman 5.4.1 software. Results A total of 11 articles and 977 patients were included. The results of meta-analysis showed that the video-assisted group were superior to the traditional incision and thread hanging operation group in improved the cure rate [RR=1.14, 95%CI (1.04, 1.24), P<0.05], accelerated wound healing [MD=–10.40, 95%CI (–13.64, –7.17), P<0.05], protected the anal function after surgery [MD=–1.32, 95%CI (–1.85, –0.79), P＜0.05], relieved postoperative 24-hour pain [MD=–1.23, 95%CI (–1.60, –0.86), P＜0.05], shorten the operative time and hospital stay [MD=–9.46, 95%CI (–17.16, –1.75), P<0.05; MD=–3.87, 95%CI (–5.90, –1.84), P<0.05], reduced intraoperative bleeding [MD=–14.24, 95%CI (–17.49, –10.99), P<0.05] and the incidence of postoperative complications [RR=0.39, 95%CI (0.27, 0.56), P<0.05], which difference were statistically significant. However, there was no significant difference in the recurrence rate of 1-year after operation [OR=0.64, 95%CI (0.33, 1.23), P>0.05]. Conclusions Video-assisted anal fistula treatment is a safe and effective sphincter preserving operation for the treatment of complex anal fistula, which is superior to the traditional incision and thread hanging operation. However, due to the limitations and publication bias of the included literature, more prospective, large sample, multi center randomized controlled trial are needed to confirm its long-term efficacy.
Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.
In 2014, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group published guidance in BMJ to evaluate the certainty of the evidence (confidence in evidence, quality of evidence) from network meta-analysis. GRADE working group suggested rating the certainty of direct evidence, indirect evidence, and network evidence, respectively. Recently, GRADE working group has published a series of papers to improve and supplement this approach. This paper introduces the frontiers and advancement of GRADE approach to rate the certainty of evidence from network meta-analysis.
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.