Evidence serves as the driving force shifting medical practice from empirical medicine towards evidence-based medicine. In the current era of information explosion, it is challenging for clinical surgeons to extract evidence from the vast pool of primary research literature to address clinical issues. Literature reviews, as a form of synthesized evidence, are particularly crucial for precise and efficient evidence utilization. A new form of review within the framework of evidence-based medicine, systematic reviews, also has widespread application in the surgical domain. With the development of methodological approaches in evidence-based medicine, the types of systematic reviews continue to diversify. This paper outlines and summarizes the common types and methodologies of systematic reviews in the surgical field, aiming to provide a clear framework for surgical practitioners to select evidence for both confirming and innovating clinical practices in specific clinical challenges.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.
Objective To investigate the effect of ABO-incompatible liver transplantation on patients with acute hepatic failure. Methods A retrospective review was undertaken on the clinical data of 3 cases （1 case of Budd-Chiari syndrome, 1 case of liver cancer and 1 case of severe hepatitis B were included） undergoing ABO-incompatible liver transplantation for acute hepatic failure. The patients were given quadruple immunosuppression after operation. Results Postoperative complications including pulmonary infection, central pontine myelionlysis and acute rejection was suffered from by the patient of Budd-Chiari syndrome who was then given a positive deal and had survived for more than 14 months. The patient of liver cancer was aggravated by severe infection who died of multiple organ failure on day 13 after operation. The patient with severe hepatitis B was made more severe by acute renal failure whose kidney function was restored with continuous renal replacement therapy. Conclusion The outcome of ABO-incompatible liver transplantation can be improved with refined peri-transplant management and better immunosuppressive strategies. ABO-incompatible liver transplantation should be viewed as an important option in patients with acute hepatic failure awaiting an emergency procedure.
ObjectivesTo systematically review the efficacy and safety of Shenlingbaizhusan as adjuvant therapy for gastric cancer.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on efficacy and safety of Shenlingbaizhusan as adjuvant therapy for gastric cancer from inception to July 31st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 RCTs involving 1 142 patients were included. The results of meta-analysis showed that: compared with control group, Shenlingbaizhusan could improve the efficiency of gastric cancer patients (RR=1.55, 95%CI 1.31 to 1.84, P<0.000 01) and the living quality of patients (RR=1.70, 95%CI 1.39 to 2.07, P<0.000 01), and reduce the side effects such as nausea, vomiting, diarrhea and the the possibilities of recurrence. However there was no difference between two groups in bone marrow suppression.ConclusionsThe current evidence shows that Shenlingbaizhusan as adjuvant therapy has better curative effect on gastric cancer, which can improve the efficiency of treatment and quality of life, and reduce some adverse reactions of chemotherapy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
ObjectiveTo systematically review the infection and colonization of Mycoplasma genitalium (Mg) in the reproductive tract of pregnant females in China. MethodsPubMed, Web of Science, SinoMed, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on Mg infection in pregnant females in China from inception to October 10, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using R1.1.463 software. ResultsA total of 23 cross-sectional studies were included. The results of meta-analysis showed that the prevalence rate of Mg infection in pregnant females was 4.86% (95%CI 2.84% to 7.38%). The prevalence rates of Mg infection in females with ectopic pregnancy, spontaneous abortion, induced abortions and PROM were 13.01% (95%CI 6.90% to 20.69%), 11.81% (95%CI 3.30% to 24.59%), 6.11% (95%CI 2.70% to 10.77%), and 12.63% (95%CI 9.56% to 16.06%), respectively. ConclusionCurrent evidence shows that the prevalence rate of Mg infection in females with ectopic pregnancy, spontaneous abortion and premature rupture of membranes are higher than those in other pregnant females. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectivesTo investigate the efficacy and safety of Hou Gu Mi Xi (HGMX) in patients with nonorganic gastrointestinal disorders (NOGD) from the aspect of dietary therapy.MethodsA randomized, double-blind, parallel, placebo-controlled trial was performed. Patients with NOGD and spleen qi deficiency (SQD) syndrome were randomly assigned into HGMX or placebo group. Each received 30 g/day HGMX or placebo for one year. The outcomes included SQD scores, body weight, body mass index (BMI), gastrin-17, and adverse events (AEs) between HGMX and placebo groups, or subgroups divided by NOGD type or helicobacter pylori (Hp) infection, at the 0th, 2nd, 4th, 8th, 26th, or 52nd weeks’ follow-up.ResultsThe reduction of SQD scale score was found in the HGMX group compared with the placebo group at 4th week (MD=−9.40, 95%CI −18.53 to −0.27, P=0.044), 8th week (MD=−10.07, 95%CI −19.66 to −0.48, P=0.04), 26th week (MD=−12.45, 95%CI −22.31 to −2.59, P=0.014) and 52th week (MD=−17.25, 95%CI −28.53 to −5.97, P=0.003), respectively. In the subgroup analyses, HGMX showed significant efficacy in Hp-negative patients with the detailed reduction of SQD scale score being (MD=−15.20, 95%CI −28.16 to −2.24, P=0.022), (MD=−17.91, 95%CI −31.22 to −4.59, P=0.009) and (MD=−20.38, 95%CI −35.43 to −5.32, P=0.008) at the 8th, 26th and 52nd week, respectively, and in patients with chronic nonatrophic gastritis with the detailed reduction being (MD=−13.02, 95%CI −24.75 to −1.29, P=0.03), (MD=−12.43, 95%CI −24.36 to −0.5, P=0.041) and (MD=−15.90, 95%CI −30.72 to −1.08, P=0.036) at the 2nd, 26th and 52nd week, respectively, and in patients with functional gastrointestinal disease with the reduction being (MD=−18.22, 95%CI −35.75 to −0.69, P=0.042) at the 52nd week. However, no significant efficacy was found in Hp-positive patient at any time. HGMX was not associated with changes in weight, BMI, or gastrin-17. No AEs were reported in the HGMX group.ConclusionsHGMX improves SQD symptoms in patients with NOGD, especially Hp-negative patients, and has a good safety profile.