This is the seventh paper in the evidence-based medicine glossary series. In this paper, We mainlyintroduced five terms related to meta-analysis——prospective meta-analysis, individual patient data meta-analysis,cumulative meta-analysis, multiple-treatments meta-analysis and meta regression.We also gave some examples to helpreaders better understand and use them.
To analyze the effectiveness of anterior cruciate l igament (ACL) reconstruction with preserving the remnant ACL by allograft l igament. Methods Between January and July in 2008, 97 patients underwent ACL reconstruction with the allograft l igament. On the basis of the ACL’s condition, patients were divided into 2 groups. In the trial group (patients having remnant ACL, n=38), there were 27 males and 11 females with an average age of 24.3 years (range, 16-43 years); of them, 8 cases compl icated by menicus injury and 13 cases by Outbridge I degree cartilage injury; the time from injuryto operation was 3-20 weeks (mean, 8.6 weeks). In the control group (patients having no remnant ACL, n=59), there were 35 males and 24 females with an average age of 27.8 years (range, 18-48 years); of them, 16 cases compl icated by menicus injury and 23 cases by Outbridge I degree cartilage injury; the time from injury to operation was 4-44 weeks (mean, 12.7 weeks). All injuries were caused by sports in 2 groups. All patients had positive anterior drawer test and positive Lackman test. Before operation and 3, 8, 9, 15 months after operation, the function of the knee joint was evaluated by the International Knee Documentation Committee (IKDC) scale and Lysholm score. KT-2000 arthrometer was used to evaluate knee laxity. Results All incisions healed primarily, and no intraarticular infection occurred. Thirty-seven cases and 57 cases were followed up 15 months in the trial group and the control group, respectively. Knee instabil ity disappeared; the patients showed negative anterior drawer test and negative Lackman test. By the evaluation of KT-2000, the joint sl ippage of 2 groups were less than 2 mm at 3 and 6 months after operation, but it was more than 2 mm in 2 cases of the trial group and in 3 cases of the control group at 9 months after operation; and it was no change in the trial group and 2.5-4.0 mm (mean, 3.4 mm) in the control group at 15 months after operation. Both the IKDC scale and Lysholm score were higher in the trial group than in the control group 3 months after operation, but the differences were not significant (P gt; 0.05). Both the IKDC scale and Lysholm score were
Objective The baseline, clinical characteristics, and risk factors were analyzed in the stroke registry program of the Xinjiang Production Constraction Corp’s Hospital aimed to aid the clinical management and stroke prevention. Method A single center prospective method based on Lausanne Stroke Registry was used in this study. Patients generally, past history, living conditions, onset to treatment time, the stroke scale were collected with 1 year follow up. The investigators of follow up were single blinded. Result Eight hundred and ten ischemic stroke patients were included, of which 478 (59.01%) were male, 332 (40.99%) were female. The average age of these patients was 66.50±10.66 years. One year loss rate of follow up was 4.64%. Seven hundred and sixty-nine patients were diagnosis as acute cerebral infarction, 41 patients were TIA. The median time from onset to treatment was 15 hours. Lacunar infarction was the most common type with 334 (43.43%) patients. The average score of the National Institutes of Heath Stroke Scale was 5.55±7.24. The incidence of carotid artery plaque was 82.2%. Conclution Xinjiang region has its own characteristics of stroke with a higher carotid artery plaque rate and thrombolytic therapy ratio. Good stroke registration system could standardize the clinical behavior and promote the continuous improvement of medical quality.
Objective To discuss the feasibility and clinical outcomes of fast-track (FT) surgery for elderly patients (≥70 years) with colorectal carcinoma. Methods Between November 2007 and January 2009, 103 elderly patients were analyzed prospectively, who were divided into FT group and traditional group randomly. All 103 patients had completed the entire study. Postoperative complications and early rehabilitations were studied and compared. In addition, completion of FT courses was recorded. Results ① In early rehabilitation, the time of first ambulation was (1.96±0.89) d and (2.92±1.43) d, oral intaking was (2.41±0.92) d and (3.62±1.40) d, and first flatus was (3.88±1.05) d and (4.52±1.29) d in the FT group and the traditional group, respectively. The early rehabilitation indexes in the FT group were significantly earlier than those in the traditional group (Plt;0.05). ② Postoperative hospital stay was (9.27±1.87) d and (12.75±7.05) d in the FT group and the traditional group, respectively, in the FT group which was shorter than that in the traditional group (Plt;0.05). ③ The mortality rate and readmission rate was 0 on 2 weeks after operation in two groups. ④ The total morbidity rate was 11.76% (6/51) in the FT group, in the traditional group was 28.85% (15/52), there was significant difference between two groups (Plt;0.05), while there was no significant difference in general complications and surgical complications between two groups (Pgt;0.05).Conclusions FT surgery for elderly patients with colorectal carcinoma is feasible and could enhance recovery, cut down morbidity rate and shorten postoperative hospital stay. If the FT courses are more completed, the clinical outcomes could be better.
ObjectiveTo explore the effect of early enteral nutrition (EEN) on immune status of patients in intenseive care unit (ICU). MethodsA prospective control study was conducted from July 2011 to December 2012, and 80 patients after trauma and surgery were admitted to ICU. The Patients were divided into EEN group and normal enteral nutrition (NEN) group randomly. Enteral nutrition in EEN group began within 24 hours after admitted to ICU, while within 48 hours in NEN group. ResultsIn 80 patients, 78(37 in EEN group and 41 in NEN group) completed the end point. The baseline in two groups was consistent (P>0.05). The indicators of lymphocyte, IgA, IgG, IgM and CD4+, CD8+, natural kill cell and pre-albumin values in EEN group were higher than those in NEN group (P<0.05). The incidence of diarrhea (8.1%, 26.8%) and infection of wound (2.7%, 17.1%) in EEN were less than those in NEN group. The hospitalization duration in ICU in EEN group[(7.94±3.72) days] was also shorter than that in NEN group[(10.62±3.14) days]. ConclusionEarly enteral nutrition improves immune function and nutrition status in ICU patients; it also protects gut barrier function and reduces the ICU hospitalization duration.
ObjectiveTo compare the quality of life in the early stage of treatment in patients who accepted renal transplantation with those who still were undergoing long-term hemodialysis. MethodsPatients undergoing long-term hemodialysis in December 2011 and adult patients who planned to accept renal transplantation within 6 months were chosen to be our study subjects. The Medical Outcomes Study 36-item Short Form Health Survey Questionnaire (SF-36) was used for the study. After 6 months of following up, they were assessed with the same questionnaire again. Those hemodialysis patients who accepted renal transplantation within this period were divided into the intervention group. The quality of life between the two groups was compared then. ResultsA total of 124 end-stage renal failure patients were involved in our study, in which 79 patients successfully accepted renal transplantation (intervention group) and the other 45 patients who still underwent hemodialysis (control group). No other complications were observed during this period. There was no significant difference in life quality between the two groups before treatment (P>0.05). Six months after the treatment, SF-36 total score and each of the 8 dimension scores for the intervention group were all significantly higher than those for the control group (P<0.05). ConclusionRenal transplantation recipients have a totally better life quality than those who depend on hemodialysis.
Objective To compare the postoperative anorectal pressure after procedure for prolapse and hemorrhoids (PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in treatment of patients with mixed hemorrhoid of Ⅲ-degree. Methods In total of 112 patients with mixed hemorrhoid of Ⅲ-degree who underwent PPH (n=60) or MMH (n=52) in The First Affiliated Hospital of Xinjiang Medical University between March 2014 to March 2015 were prospectively enrolled, the type of surgery was according to patients’ individual choice. In 6 months after operation, all patients under-went the examination of anorectal manometry which including rectal anal inhibitory reflex, rectal resting pressure, anal resting pressure, maximal anal contractive pressure, and anal canal length of high pressure belt. Results In 6 months after operation, the positive rate of rectal anal inhibitory reflex 〔88.3% (53/60) vs. 61.5% (32/52)〕 , anal resting pressure 〔(56.42± 2.25) mm Hg vs. (46.31±2.58) mm Hg〕, and anal canal length of high pressure belt 〔(3.35±0.12) cm vs. (2.29±0.23) cm〕 of PPH group were all significantly higher than those of MMH group (P＜0.05), but there was no statistical significance between PPH group and MMH group in rectal resting pressure 〔(5.51±1.26) mm Hg vs. (5.39±1.85) mm Hg〕 and maximal anal contractive pressure 〔(156.64±9.78) mm Hg vs. (155.32±8.53) mm Hg〕, P>0.05. Conclusion PPH and MMH are all effective to treat mixed hemorrhoids of Ⅲ-degree, but PPH is more positive in protection of anal function.
ObjectiveTo evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma. MethodsA total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed. ResultsThe number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ2=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ2=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ2=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ2=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N1 in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ2=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05). ConclusionThe cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.
Objective To investigate the clinical effect of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) in the treatment of cesarean scar pregnancy (CSP). Methods A total of 152 patients with CSP diagnosed by B-type ultrasonography were enrolled prospectively in this study from June 2014 to May 2016 in Chengdu Women and Children’s Central Hospital and Suining Central Hospital. Six patients from Chengdu Women and Children’s Central Hospital and 84 from Suining Central Hospital for Volunteered HIFU treatment were regarded as observation group. The other 62 patients from Chengdu Women and Children’s Central Hospital were selected to accept UAE treatment voluntarily were designated as control group. The clinical efficacy and therapeutic safety of the two groups were compared after the treatment. Results Eighty-two patients (91.1%) in the observation group and 32 (51.6%) in the control group had a bleeding volume equal to 100 mL or lower during complete curettage of uterine cavity (P<0.05). The hospitalization expenses of the above two groups were respectively (25 126.51±1 473.49) and (32 928.42 ±1 579.35) yuan (P<0.05). The hospitalization time was (11.03±1.52) and (10.65±1.87) days respectively, and the difference was not statistically significant (P>0.05). There was no significant difference in the normal rate of human chorionic gonadotropin recovery between the observation group and the control group at 14 days after treatment (P>0.05). Eighty-seven patients (96.7%) in the observation group and 51 (82.3%) in the control group had their menstrual recovery to normal level at 2 months after treatment, and the difference was statistically significant (P<0.05). The incidence of postoperative complications was 1.1% and 6.4% in the observation group and the control group, respectively, and the difference was not statistically significant (P>0.05). Conclusions HIFU in the treatment of CSP is safe and effective. Compared with UAE, HIFU requires less cost with fewer complications, which is worth promoting.
Objective To explore the association between 25-hydroxyvitamin D (25OHD) level and risk of the onset of metabolic syndrome (MS) in people in Chengdu. Methods In total, 474 participants were selected randomly by cluster sampling from one urban district and two rural villages in Longquanyi district of Chengdu. The data of sociodemographic information, lifestyle and family history were collected by questionnaires. Binary logistic regression was performed to assess the relationship between baseline 25OHD level and incident of MS, while multiple linear regression was conducted to analyze the relationship between baseline 25OHD level and insulin resistance. Results Four hundred seventy-four people were enrolled in the cohort study, 39 of them developed MS, with the incidences of 20.8 events per 1 000 person years. Among women, low 25OHD status was significantly associated with the risk of developing MS (OR=4.29, 95%CI 1.05 to 29.50, P=0.044) after adjustment for multiple potential confounders. In a multiple linear regression analysis, low 25OHD level of baseline was independently associated with the increased HOMA-IR over a 4-year period among Chengdu individuals (P<0.05) and was independently related to the decreased ISIcomp over a 4-year period in female (P<0.05). Conclusions The current prospective study suggests that low 25OHD level may contribute to increase insulin resistance in Chengdu population. Furthermore, low 25OHD level may increase the risk of MS among women in Chengdu.