Objective To systematically review the methodological quality of guidelines concerning infertility, so as to provide references for clinical practice. Methods Guidelines concerning infertility were electronically retrieved (from inception to Feb. 2013) in PubMed, EMbase, CBM, WanFang Data, CNKI, GIN guideline database guideline development websites (including NGC, NICE, SIGN, NZGG, SOGC, etc.), and medical associtation websites (including IFFS, FIGO, ESHRE, NFOG, RCOG, ASRM, ACOG, etc.). We also searched Chinese guideline websites including the website of the National Health and Family Planning Commission of People’s Republic of China, CGC (China Guideline Clearinghouse), and CPGN (Clinical Practice Guideline Net). Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline development and reporting using the Appraisal of Guidelines for Research and Evaluation (AGREE II). Results a) A total of 16 guidelines concerning infertility were included, with development time ranging from 1998 to 2012. Among 16 guidelines, 10 guidelines were made by the USA, 3 by Britan, 1 by the Europe, and 1 by America and Europe. b) The scores of guidelines according to the domains of AGREE II decreased from “Clarity of presentations, scope and purpose”, “Participants”, “Applicability”, “Rigour of development”, and “Editorial independence”. 16 guidelines were generally low in quality. The levels of recommendations were Level A (5 guidelines), Level B (8 guidelines), and Level C (3 guidelines). c) Four evidence-based guidelines scored the top three in the domain of “Rigour of development”. d) The recommendations of different guidelines were fairly the same. e) No guidelines on infertility have been developed in China. Conclusion a) The guidelines on infertility should be improved in “Rigour of development” and “Applicability” in future. Conficts of interest should be addressed. b) Guidelines are recommended to be developed on the basis of the methods of evidence-based medicine, and best evidence is recommended. c) National organizations such as ASRM should be established in China, so as to develop biomedicine and TCM guidelines based on evidence and regulate the treatment. d) For the general assessment of guidelines, AGREE II should offer threshold criteria of suggestion.
ObjectiveTo observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids. MethodsThe patients with four degree mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2023 to June 2023 were included as the study subjects, then were randomly averagely divided into an observation group (underwent ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation) and a control group (underwent Milligan-Morgan hemorrhoidectomy) by a random number table method. The therapeutic efficacy, total hospitalization time, operation time, intraoperative blood loss, wound healing time, hospitalization costs, postoperative pain score, bleeding score, wound edema score, postoperative complications (anal stenosis, urinary retention, anal incontinence), and recurrence were compared between the two groups. ResultsA total of 100 patients with four degree mixed hemorrhoids treated in this hospital were included, with 50 patients in each group. There were no statistically significant differences in the general information such as the gender, age, disease course, body mass index, hematochezia, and tumor prolapse between the two groups (P>0.05). ① The overall therapeutic efficacy both the observation group and the control group was well (100% versus 96.0%, Fisher exact test, P=0.495). ② The observation group had less total hospitalization time, operation time, intraoperative blood loss, hospitalization costs, and wound healing time as compared with the control group (P<0.05). ③ The differences in the interaction effects of the time-group for the points of postoperative pain, bleeding, and wound edema were not statistically significant (χ2=6.668, P=0.083; χ2=5.500, P=0.139; χ2=6.204, P=0.102). However, the main effects of group (χ2=5.073, P=0.024; χ2=7.107, P=0.008; χ2=8.857, P=0.003) and time (χ2=188.526, P<0.001; χ2=212.472, P<0.001; χ2=185.110, P<0.001) showed statistically significant differences. The points of postoperative pain, bleeding, and wound edema in the observation group were statistically lower than thoes in the control group (χ2=9.323, P=0.002; χ2=18.133, P<0.001; χ2=6.232, P=0.013). ④ The incidences of postoperative urinary retention and anal stenosis in the observation group were lower than those in the control group (P=0.046 and 0.031, respectively), there were no statistically significant differences in the incidences of incontinence and postoperative recurrence between the two groups (P>0.05). ConclusionFrom the preliminary research results of this study, ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation has a better efficacy in treating four degree mixed hemorrhoids, with a smaller wound, faster healing, higher safety, and fewer complications.