Objective To systematically review the efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) about preoperative oral carbohydrate treatment in patients undergoing elective hip arthroplasty from inception to January, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 10 RCTs were included. The results of meta-analysis showed that: compared with the placebo group, the preoperative oral carbohydrate group had no significant differences in postoperative insulin resistance (SMD=5.14, 95%CI –1.05 to 11.33, P=0.10), length of hospital stay (MD=–0.26, 95%CI –1.11 to 0.58, P=0.54), rate of complications (OR=1.46, 95%CI 0.53 to 4.07, P=0.47), postoperative glucose and insulin level. Conclusion Current evidence shows that preoperative oral carbohydrate can not mediate postoperative insulin resistance. It also does not reduce length of hospital stay, postoperative glucose and insulin level. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objectives To systematically review the efficacy of multimodal nonpharmacological interventions in mild cognitive impairment (MCI). Methods An electronically search was conducted in PubMed, EMbase, The Cochrane Library, PsycINFO, Web of Science, CINAHL, VIP, CBM, WanFang Data and CNKI databases from inception to November 2017 to collect randomized controlled trials (RCTs) on multimodal nonpharmacological interventions for MCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. Results A total of 12 RCTs involving 1 359 patients were included. The results of meta-analysis showed that there were no statistical differences between two groups in MMSE scores (SMD=0.33, 95%CI–0.13 to 0.78, P=0.16). However, the MoCA scores (SMD=0.52, 95%CI 0.38 to 0.67, P<0.000 01) and ADAS-Cog scores (SMD=1.13, 95%CI 0.75 to 1.51, P<0.000 01) in the multimodal nonpharmacological interventions group were better than those in the control group. Additionally, multimodal nonpharmacological interventions produced significant effects on ADL (SMD=–0.64, 95%CI –0.83 to–0.45, P<0.000 01), QOL-AD (MD=3.65, 95%CI 1.03 to 6.27, P=0.006) and depression (SMD=–0.83, 95%CI –1.41 to–0.26, P=0.005). There were no statistical differences between two groups on conversion rate to Alzheimer's disease (RR=0.27, 95%CI 0.06 to 1.26, P=0.10). Conclusions The current evidence shows that multimodal nonpharmacological interventions are feasible for patients with MCI as they have positive effects on overall cognitive abilities, daily living skills, and quality of life and depression. Nevertheless, due to the limited quantity and quality of included studies, more high quality studies are required to verify the conclusion.
Objective To evaluate the radiographic and postoperative function of computer navigation versus traditional methods for total knee arthroplasty through meta-analysis. Methods we searched the specialized trials registered in Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2009), EMbase (1980 to 2009), PubMed (1966 to 2009), NRR (http://www.update-software.com/National/), CCT (http://www.controlled-trials.com), and CBMdisc (1979 to July 2009), and we manually searched some Chinese orthoopaedics journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials of computer navigation and traditional methods for total knee arthroplasty were included. The quality of the included trials was critically assessed. RevMan 4.2.8 software was used for data analysis. Results Eighteen RCTs of computer navigation and traditional methods for total knee arthroplasty were included. A total of 2 349 patients met the inclusion criteria for the review. The results showed that, computer navigation versus traditional methods for the total knee arthroplasty: a) about radiography: there was difference in the precise measurement of lower limbs mechanical axis (WMD= – 0.56, 95%CI – 0.74 to – 0.38, Plt;0.00001), but no obvious difference in measurement of the femoral frontal axis (WMD= – 0.29, 95%CI – 0.58 to 0.00, P=0.05), sagittal axis (WMD= – 1.64, 95%CI – 3.49 to 0.21, P=0.08) and angle of rotation (WMD= – 0.11, 95%CI – 0.87 to 0.66, P=0.79). Obvious difference was not found in the tibial frontal axis (WMD= – 0.31, 95%CI – 0.69 to 0.06, P=0.10), but found in the tibial sagittal axis (WMD= – 0.69, 95%CI – 1.10 to – 0.28, P=0.001). No difference was found in the tibiafemoral angle (WMD= 0.03, 95%CI – 0.78 to 0.84, P=0.95), patella tilt angle (WMD= – 1.45, 95%CI – 3.12 to 0.22, P=0.09) and patella angle of rotation (WMD= – 0.34, 95%CI – 0.71 to 0.02, P=0.06); b) there was obvious difference in operating time (WMD= 13.31, 95%CI 10.00 to 16.63, Plt;0.000 01), but no obvious difference in the complications (RR= 1.65, 95%CI 0.87 to 3.13, P=0.13) and the hemorrhage volume (WMD= – 74.81, 95%CI – 184.71 to 35.09, P=0.18); and c) about the evaluation of postoperative function: the follow-up in all studies was more than 6 months; there was no obvious difference in joint motion (WMD= – 2.17, 95%CI – 5.66 to 1.33, P=0.22), KSS scores (WMD= 6.28, 95%CI – 3.69 to 16.25, P=0.22), and OXFORD scores (WMD= – 0.31, 95%CI – 2.05 to 1.43, P=0.72). Conclusions Compared with traditional methods, computer navigation using for the total knee arthroplasty: a) is much accurate in measurement of the lower limbs mechanical axis and tibial sagittal axis, but is not superior in measurement of the femoral frontal axis, femoral sagittal axis, femoral angle of rotation, tibial frontal axis, tibiafemoral angle, patella tilt angle, and patella angle of rotation; b) may spend a longer operating time if not performed by proficient for it is a kind of new technique realm, but is similar in decreasing complications and hemorrhage volume; and c) is not obvious different in function evaluation after over 6 months follow-up which has to be further studied.
Objective To investigate the effect of local delayed releasing vascular endothelial growth factor (VEGF) on accelerating healing of intestinal anastomotic stoma. Methods An intra-abdominal infection modal of rabbit was established by artificial appendix perforation, and excision and anastomosis of terminal ileum were subsequently performed after 12 h. The animals were divided into four groups (32 for each group) with different reagents on anastomotic surface: control group, fibrin glue group (FG group), VEGF group, and VEGF＋FG group. The incidence of stomal leak, anastomosic bursting pressure, hydroxyproline content, and expression of VEGF in cured stoma tissue were measured respectively on day 3, 5, 7 and 14 after operation. Results The total incidence rate of leakage was lower in FG group and VEGF group than that in control group, but there was no statistical significance （Pgt;0.05）. The incidence rate was significantly lower in FG＋VEGF group than that in control group （Plt;0.05）. On day 14 postoperatively, the bursting pressure of anastomotic stoma, hydroxyproline content, and positive cell expression rate of VEGF protein (except VEGF group) were significantly increased in FG＋VEGF group than those in other three groups （Plt;0.05, Plt;0.01）. Conclusion Local delayed release of VEGF by fibrin glue can improve the healing of intestinal anastomotic stoma and reduce the incidence of stomal leak.
The formulation process of recommendations in evidence-based clinical practice guidelines was often complex and cumbersome. This paper described the evolution of levels of evidence and strength of recommendations in medical research and analyzed existing problems when making recommendations. We also summarized and introduced the method of formulating the final recommendation. At present, there isn’t a perfect and uniform method to guide the formulation of recommendations. But some organizations provided different content frameworks or auxiliary tools to guide formulation of recommendations. Developers of evidence-based clinical practice guidelines can learn from their experiences, combine with their own characteristics of guidelines such as specific target population and specific clinical situations, establish a rational method of recommendations formation.