Objectives To assess the effectiveness and safety of lumbar continuous drainage of the cerebrospinal fluid therapy for subarachnoid hemorrhage (SAH). Methods The method of Cochrane systematic review was used to evaluate the randomized controlled trials (RCTs) of lumbar contiunous drainage of the cerebrospinal fluid therapy for SAH. Results We included 7 RCTs involving 390 patients. The methodological quality of all the trials was poor. The poor outcome and adverse event evaluation of the SAH patients at the end of long-term follow-up (at least three months) were not reported in all studies. Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance [RR=0.32, 95%CI (0.15, 0.70)]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm RR=0.15, 95%CI (0.06, 0.33), hydrocephalus RR=0.22, 95%CI (0.10, 0.52), cerebral infarction RR=0.25, 95%CI (0.08, 0.82)]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid therapy including intracranial infection and intracranial hypotension reaction, while the other trials did not report the adverse events. Conclusion With poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid therapy is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidence.
Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2. Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.