Recently, the frequency of lung disease appears higher and more precise than previously estimated. Small pulmonary nodules (SPNs) are frequently detected on high-resolution computed tomography (CT) scans. For the reason of high rate of false positives by fine needle aspirate biopsy, small lung nodules often can not be confirmed by monitor or palpation with forceps. How to precisely locate and mark the nodule before the surgery is one of the most important things for video-assisted thoracoscopic surgery (VATS). We reviews the methods of location the pulmonary nodules before the surgery and analyzes the advantages and disadvantages of various methods.
ObjectiveTo observe the expression levels of related cytokines in the vitreous humor of eyes with rhegmatogenous retinal detachment (RRD) associated with lattice degeneration (LD). MethodsA clinical observational study. From May 2022 to February 2023, 43 patients of 43 eyes diagnosed with RRD, with or without accompanying LD, who underwent their first pars plana vitrectomy (PPV) at Zhongda Hospital Southeast University and The Affiliated Eye Hospital of Nanjing Medical University were included in the study. The patients were divided into two groups: RRD with LD (LD group), consisting of 27 patients with 27 eyes, and RRD without LD (Non-LD group), consisting of 16 patients with 16 eyes. Additionally, 6 patients (6 eyes) with idiopathic macular holes and 4 patients (4 eyes) with idiopathic epiretinal membranes during the same period were selected as the control group. Before initiating PPV and without intraocular perfusion, a 0.5 ml sample of undiluted vitreous fluid from the central portion was excised and aspirated. The concentrations of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1 alpha (MIP)-1α, MIP-1β, interferon-γ- inducible protein 10 (IP-10), interleukin-6 (IL-6), IL-8, macrophage migration inhibitory factor (MIF), tumor necrosis factor-alpha-α, interferon-γ, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1, platelet endothelial cell adhesion molecule 1 (PECAM-1), placental growth factor (PLGF) and vascular endothelial growth factor (VEGF) in the vitreous fluid were quantitatively measured using the Luminex high-throughput multiplex assay technology. The comparison of cytokine expression levels between groups was performed using the Kruskal-Wallis rank sum test, with significance levels for post-hoc pairwise comparisons adjusted by DSCF methods. ResultsThe eyes of the patients in the LD group, Non-LD group, and control group showed statistically significant differences (P＜0.05) in the concentrations of IL-6 (H=14.400), IL-8 (H=13.610), MCP-1 (H=12.050), VEGF (H=9.920), MIP-1α (H=6.620), IP-10 (H=7.780), MIF (H=12.920), PECAM-1 (H=9.990), ICAM-1 (H=8.070), and PLGF (H=16.850). Upon pairwise comparison between groups, the vitreous fluid concentrations of IL-6, IL-8, and PLGF in the LD group were found to be significantly higher than those in the Non-LD group (P＜0.05). ConclusionThe expression levels of IL-6, IL-8, and PLGF are elevated in the vitreous fluid of eyes with RRD accompanied by LD.
ObjectiveTo systematically review the efficacy and safety of simvastatin and its different doses in the adjunct therapy of chronic obstructive pulmonary disease (COPD).MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on adjunct therapy of simvastatin in patients with COPD from inception to May 15th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by using Stata 14.0 software.ResultsA total of 22 RCTs involving 2 377 patients were included. The results of meta-analysis showed that treatment with 20 mg simvastatin could improve FEV1%pred, FEV1/FVC, and reduce inflammatory indexes such as CRP, hs-CRP, IL-8 and TNF-α, while 40 mg failed to improve. Simvastatin could reduce COPD score (CAT), but failed to increase the 6-minute walking distance or alleviate acute exacerbation.ConclusionsCurrent evidence shows that treatment with 20 mg simvastatin can improve pulmonary function, reduce inflammatory index and optimize CAT score in COPD patients, but it cannot increase the 6-minute walking distance and reduce the number of acute exacerbations of COPD. Due to the limited quantity and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
In response to the public health emergency and other urgent needs, World Health Organization (WHO) developed the concept and methodology of rapid advice guidelines (RAGs) in 2006. Compared with the standard guideline, striving to minimize the risk of bias, the RAG shortens the time to 1-3 months from more than 2 years. This study introduces the background, definition, application condition and performing methods of RAGs, and uses an example to clarify it, thus to provide a reference for the guideline development of public health emergency and other urgent need in China.
ObjectiveTo evaluate the quality of traditional Chinese medicine (TCM) guidelines, so as to provide evidence for developing similar guidelines. MethodsWe systematically searched TCM guidelines published in domestic medical journals from WanFang Data, VIP, CNKI and CBM. We also searched Google, Amazon.cn and dangdang.com by hand in order to obtain TCM guidelines published in monographs. And we used AGREE II instrument to assess the methodological quality of included guidelines. ResultsA total of 115 guidelines (87 published in domestic medical journals and 28 published in monographs) were included. Scaled domain percentages from highest to lowest were:scope and purpose (41%), stakeholder involvement (28%), clarity of presentation (33%), rigour of development (20%), editorial independence (9%) and applicability (7%). ConclusionThere is still a large gap about methodological quality between TCM guidelines and international guidelines. So the guideline developers should systematically search, evaluate and synthesize the evidence based on structured problems. At the same time, they also need to consider the costs of recommendations, the implementation environment and the patients' preference and values. On this basis, the developer could further increase the transparency and independence during developing TCM guidelines.
目的 探讨经右胸入路胸腔镜下胸导管结扎在乳糜胸治疗中的作用及优势。 方法 回顾性分析南京军区南京总医院心胸外科 2012～2014 年采用胸腔镜手术治疗乳糜胸 18 例患者的临床资料，男 15 例、女 3 例，年龄 56～79（66.56±6.43）岁。所有患者均采用右胸入路胸腔镜辅助下行胸导管结扎，术中若能找到明显破口，则在破口的两端用 Ham-lock 夹闭胸导管，若未能找到明确的胸导管破口，则在第 8、第 9 胸椎附近用 Ham-lock 将胸导管及周围脂肪组织一起夹闭。 结果 全组 18 例患者均完成手术，无中转开胸，手术时间 28～45（35.83±4.58）min，术后胸腔引流时间 2～5（3.33±1.03）d，术后住院时间 5～8（6.11±1.02）d。术后无感染、吻合口瘘等严重并发症，随访 3 个月无复发。 结论 经右胸入路胸腔镜辅助手术结扎胸导管治疗乳糜胸是一种安全、有效的治疗方法，因其微创、住院时间短、手术效果确切等优点，值得在临床上推广。
Objective To evaluate the effectiveness of robot-assisted percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF) in the elderly. Methods The clinical data of 90 elderly patients with OVCF treated in Sichuan Science City Hospital between June 2019 and March 2021 were retrospectively analyzed. The patients were divided into robot-assisted group (40 cases) and C-arm-assisted group (50 cases). The pre- and post-operative Visual Analogue Scale (VAS) score, pre- and post-operative Oswestry Disability Index (ODI) score, intraoperative cement leakage, intraoperative fluoroscopy frequency, operation time, and the loss of hemoglobin were recorded and compared between the two groups. Results The incidence of intraoperative cement leakage (5% vs. 20%), intraoperative fluoroscopy frequency [(18.3±3.2) vs. (41.3±7.8) times], operation time [(28.3±4.6) vs. (43.2±7.3) min] and the loss of hemoglobin [(7.2±2.0) vs. (15.2±4.4) g/L] of the robot-assisted group were less than those of the C-arm-assisted group (P<0.05). There was no statistically significant difference between the two groups in the decrease of VAS score or ODI score (3.63±1.64 vs. 3.40±1.65, P>0.05; 50.70±4.95 vs. 52.10±6.69, P>0.05). Conclusions Robot-assisted PVP for elderly patients with OVCF can significantly reduce the risk of cement leakage, shorten the operation time, reduce the intraoperative fluoroscopy frequency, and reduce the surgical hidden blood loss. It can be used for clinical promotion and application.
Currently there is no tool designed specifically to assess the risk of bias in the design, conduct or analysis of systematic reviews. ROBIS (Risk Of Bias In Systematic reviews), which was developed lately, aims mainly to assess the risk of bias in the conduct and result interpretation of systematic reviews relating to interventions, etiology, diagnosis and prognosis, as well as the relevance of the systematic review questions and the practice questions that their users want to address. This paper aims to introduce the ROBIS tool to Chinese systematic review developers, guideline developers and other researchers to promote the comprehension of it and its application, so as to improve the quality of systematic reviews in China.
With the perspective of evidence-based medicine, this review aims to investigate the effectiveness and safety of off-label drug use of bevacizumab for eye disease, and explore the barriers to further study. And then, suggestions for the supported evidence and clinical use of off-label drug use will be provided based on this case.
ObjectiveTo interpret ROBIS, a new tool to evaluate the risk of bias in systematic reviews, to promote the comprehension of it and its proper application. MethodsWe explained each item of ROBIS tool, used it to evaluate the risk of bias of a selected intervention review whose title was Cyclophosphamide for Primary Nephrotic Syndrome of Children: A Systematic Review, and judged the risk of bias in the review. ResultsThe selected systematic review as a whole was rated as “high risk of bias”, because there existed high risk of bias in domain 2 to 4, namely identification and selection of studies, data collection and study appraisal, synthesis and findings. The risk of bias in domain 1 (study eligibility criteria) was low. The relevance of identified studies and the review’s research question was appropriately considered and the reviewers avoided emphasizing results on the basis of their statistical significance. ConclusionROBIS is a new tool worthy of being recommended to evaluate risk of bias in systematic reviews. Reviewers should use ROBIS items as standards to conduct and produce high quality systematic reviews.