Objective To employ spinal virtual surgery system (SVSS) for preoperative planning of thoracolumbar pedicle screw fixation, and to establ ish the measurement method for pedicle screw-related parameters. Methods Eight thoracicand lumbar spine specimens (T11-L3) were selected. First of all, SVSS was used for the preoperative planning of pedicle screw and the parameters of both sides of pedicle were measured in every vertebral segment, including angle of axial view (Aa), angle of sagittal view (As), x-direction entrance (XE), total pedicle length of axial view (TLa), total pedicle length of sagittal view (TLs), pedicle height (PH), pedicle width (PW), and pedicle spongy width (PSW). Then the corresponding parameters of the right and left pedicle screws of the specimens were measured actually. Finally, its accuracy was verified by comparing the data by virtual measurement and actual measurement. Results There was no significant difference in the parameters of virtual measurement (Aa, As, TLa, TLs, XE, PW, PSW, and PH) and actual measurement (Aa, As, TLa, XE, PW, PSW, and PH) between the right and left sides (P gt; 0.05). Except XE of the L3 vertebral segment and PSW of T11 and T12 vertebral segments (P lt; 0.05), the differences in other parameters of other segments were not significant (P gt; 0.05). Conclusion After statistical analysis and comparison, the feasibil ity of preoperative planning of thoracolumbar pedicle screw fixation and the accuracy of the measurement of the SVSS is verified.
ObjectiveTo evaluate the quality of the clinical practice guidelines of acupuncture in China, in order to identify the status quo and challenges in the development of guidelines. MethodsWe evaluated the quality of the 5 clinical practice guidelines of acupuncture in China through the guideline appraisal instrument "Appraisal of Guidelines for Research and Evaluation Ⅱ" (AGREE Ⅱ). Four appraisers rated 6 domains of each guideline independently. ResultsFrom the assessment with AGREE Ⅱ, the mean scores of the six domains were as follows: "scope and purpose"55%, "stakeholder involvement" 27%, "rigor of development" 4%, "clarity of presentation" 55%, "applicability" 4%, and "editorial independence" 1%. ConclusionThe quantity of acupuncture guidelines is small and their quality is low due to the lack of methodological issues.
Guideline Development Tool (GRADE pro GDT) is an online tool that addresses the integration of the important data and process of the clinical practice guidelines and diagnostic guidelines. GRADE pro GDT has been updated several times, including the whole style of the web page, details of the information recording, management of the conflict of interests, and the presentation and dissemination of the results. The new version of the tool is much more intellectualized and transparent, which makes the guideline development and rating quality of evidence more standardized and scientific. This paper introduces new aspects of this tool with examples.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews on acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews on acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5th, 2018. The AMSTAR tool was applied for methodological quality assessment of included studies and the GRADE system was applied for evidence quality assessment of included outcomes of systematic reviews. Results A total of 11 systematic reviews were included. The results of assessment using AMSTAR showed that, among the 11 items, most problems occurred in Item 5 " Were there any lists of research articles included and excluded”, followed by Item 1" Was an‘a prior’design provided?”and Item 11" Were potential conflict of interest included?”. GRADE grading results showed that quality of evidence for the outcome measure were" low”or" very low”. Conclusions Current acupuncture treatment of polycystic ovary syndrome has a certain effect, however, the quality of evidence is low. Thus, physicians should apply the evidence to make decision on acupuncture for polycystic ovary syndrome with caution in clinical practice and consider the actual situation, combined with the patient’s value preferences and economic factors.
In recent years, domestic and foreign scholars have carried out extensive research on the prognostic factors of gastric cancer. Among them, non-specific inflammatory markers and nutritional indicators are the most concentrated in gastric cancer. C-reactive protein, as an acute phase protein, has been widely used to diagnose acute and chronic inflammation throughout the body. Prealbumin is a sensitive indicator of nutrition with a shorter half-life, which can quickly reflect the nutritional status of the body. At present, C-reactive protein and prealbumin as sensitive indicators of inflammation and nutrition, have shown certain predictive value in terms of postoperative complications and prognosis of gastric cancer. This article reviews the use of C-reactive protein, prealbumin and their ratios in predicting postoperative complications and prognosis of gastric cancer, aiming to provide a reference for the diagnosis and treatment of patients after gastric cancer.
Patient values and preferences is one of the elements of evidence-based medicine research, which is also an important part that should be considered in the development of evidence-based guidelines in the present and future. However, the research in this field in China has just begun. This article gives a brief introduction of its concepts, methods, influence factors based on the international researches of patient values and preferences and a brief description of the development in China, in order to provide references for the development of evidence-based guidelines based on the consideration of patient values and preferences in the future.
Abstract: Objective To summarize the surgical outcomes and clinical experience of surgical disease for patients having undergone orthotopic heart transplantation. Methods Five cardiac transplant recipients requiring surgical management due to other surgical diseases including acute cholecystitis in 2 patients, acute appendicitis, bilateral mammary hypertrophy and lung tumor in 1 patients, respectively. The mean age of the entire group at the time of reoperation was 44. 6 years (14-60 years) and the average time of operative procedures after transplant was 16. 4 months (4-37 months). Four patients were treated with t riple immunosuppression, including cyclosporine A (CsA ) or tacroimus, mycophenolate mofetil and corticosteroids, respect ively. One patient received double-therapy of CsA and mycophenolate mofetil withearly withdrawal of corticosteroids. All the acute cholecystitis and appendicitis patients underwent open cholecystectomy and appendectomy emergently. Reduction mammaplasty was performed on the bilateral mammary hypert rophy patients. For the lung tumor patient, right upper lobectomy and nodes excision were undertaken radically after the sample proved to be malignancy by the thoracoscopy. Closely surveillance at concentration of CsA or FK506 was performed continueously in o rder to adjust the effect ive blood concentration in a steady way by which acute rejection can be avoided. The pathways which pathogen organisms invading the human body were controlled strictly as well as intension on ant i-infection treatment during perioperative period. Results Four patients discharged to home within 2 weeks. Only one patient needed further treatment in Digestive Department after emergent cholecystectomy due to gastric retention. And shewas discharged after 66 days. No acute reject ions or operative complications such as severe infection or bleeding were found during the perioperative period. The average length of stay was 21. 3 days (8-66 days). During the fo llow -up from 1month to 13months, there was no relapse or allograft disfunction performed on any patients. All of them enjoy quality lives. Conclusions More attention should be paid to regular follow -up after transplantation, by which the emergent surgical diseases can be diagnosed and treated earlier and more effectively. Cardiac transplant recipients who subsequently require surgical intervention do quite well overall. Most of them can obtain excellent surgical outcomes.
The metacor, which is developed based on the classical frequentist theory, is a specified package for performing meta-analysis of correlation coefficients in R software. This package was officially launched in 2011. Based on the DerSimonian-Laird method and Olkin-Pratt method, correlation coefficients can be directly pooled by using this package. The metacor package also can be used to draw the forest plot and is easy to use; however, it still needs to be improved. This paper briefly introduced how to perform a meta-analysis of correlation coefficients using the metacor package in R software through an example.
One important problem in meta-analysis is heterogeneity, the result of bias. When inconsistency occurs, traditional work in meta-analysis is employing a random effect model based on inverse variance method to combine the results. Such a method used the moment-based estimator τ2 measuring the deviation from true value across studies to obtain a conservative result. It however failed to estimate the influence on each study due to bias and this method may at risk of underestimate the standard error which then may leads to biased summarized estimator. Accordingly, Doi proposed a new weighting procedure, QE method, hopefully be a good solution. In this article, we will introduce the QE method with details on the methodology and software, and then make a comparison between QE and random effect model of the results.
【Abstract】Objective To investigate the detection and significance of micrometastasis in lymph nodes of periampullary carcinoma. MethodsThe immunoreactivity of CK19, CK7 and CK18 in 220 lymph nodes from 60 patients who had been carried out radical resection of periampullary carcinoma were revealed by immunohistochemical method. Combining with clinical data and the followup result discussion and analysis were made. All the lymph nodes collected from January 1997 to August 2004 in this hospital were examined to be nonlymphonodus metastasis by histological HE stain. The criterion of positive CK was established and micrometastasis will be diagnosed if CKs revealed to be positive combining with the morphological changes of lymph node tissue through the observation of microscope. ResultsFortythree of 220 lymph nodes of periampullary carcinoma had been micro metastasized. The detection rates of micrometastasis were 19.55%（43/220）， 14.55%（32/220）and 11.36%（25/220） with CK19，CK7 and CK18 antibody, respectively, which meant that CK19 were better than CK18 for detection of micrometastasis. Detection rates of CK7， CK19 were higher in Ⅲ， Ⅳ stage than inⅠ， Ⅱ（P＜0.05）, whereas it had no relationship with gender, age and tumor differentiation degree. The oneyear survival rate for micrometastasis patients was lower than nonmicrometastasis patients’ (P＜0.05). Conclusion Micrometastasis of periampullary carcinoma may be the early stage of tumor metastasia. The CK antibodies are significant levels to detect micrometastasis of periampullary carcinoma and to guide the clinical treatment and prognostic judgment.