ObjectivesTo explore the association between liver dysfunction and premature birth (PTB).MethodsA prospective cohort of HBV-infected or uninfected pregnant women of Han nationality attending antenatal care at Nantong Maternal and Child Health Hospital was recruited from January 1st, 2012 to June 30th, 2016. Liver function tests (LFTs) were monitored through pregnancy. Robust Poisson regression was used to estimate adjusted risk ratios (RRs) on HBV infection and LFT abnormalities.ResultsAmong 35 452 pregnant women (1 073 HBV carriers and 34 379 non-HBV women), 4 266 (12.03%) had at least one instance of abnormal LFT results. One fold upper limit of normal aspartate aminotransferase (AST), two folds upper limit of normal total bilirubin, and four folds upper limit of normal total bile acid rather than HBsAg positivity, were identified as independent risk factors for PTB by Robust Possion regression analysis.ConclusionsAbnormal LFTs among pregnant women is an independent risk factor of PTB. We suggest monitoring the LFTs results of high-risk population throughout pregnancy.
ObjectiveTo systematically review the risk factors of related infections on the totally implantable venous access device (TIVAD) in adult.MethodsPubMed, EMbase, CINAHL, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect case-control studies and cohort studies about the risk factors of TIVAD-related infections in adult from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of one case-control study and 12 retrospective cohort studies involving 9 166 patients were included. The results of meta-analysis showed that: longer catheter utilization-days in the previous months (RR=1.06, 95%CI 1.02 to 1.10, P=0.001), inpatient treatment (RR=2.53, 95%CI 1.68 to 3.81, P<0.000 01), palliative care (RR=2.71, 95%CI 1.77 to 4.15,P<0.000 01), parenteral nutrition (RR=3.89, 95%CI 2.37 to 6.40,P<0.000 01), neutropenia (RR=2.20, 95%CI 1.30 to 3.72,P=0.003) and haematological malignancies (RR=3.54, 95%CI 2.03 to 6.17, P<0.000 01) were associated with increased risk of TIVAD-related infections in adult.ConclusionCurrent evidence shows that the risk factors of TIVAD-related infections include catheter utilization-days in the previous months, inpatient, palliative care, parenteral nutrition, neutropenia and hematological malignancies. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusion.
Objective To compare the risk of bone fractures in proton pump inhibitor users and nonusers, so as to evaluate the effects of proton pump inhibitors on the risk of bone fractures. Methods We searched PubMed, MEDLINE and EMbase databases to March 1st 2011 to identify case-control studies or cohort studies evaluating the risk of fracture in proton pump inhibitor users and nonusers. We conducted systematic review and meta-analysis according to the fracture site, duration of exposure, average daily dose and time of last use. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 5.0.25 software. We also calculated and looked for heterogeneity. Results Eleven studies were identified from ten literatures, including seven case-control studies and four cohort studies. In case-control studies, the risk of total fractures increased by 36% in proton pump inhibitor users as compared with nonusers (OR=1.36, 95%CI 1.20 to 1.55). The risk of hip fracture increased by 39% (OR=1.39, 95%CI 1.13 to 1.71). In cohort studies, the risk of total fractures increased by 59% (OR=1.59, 95%CI 1.47 to 1.73). The risk of non-hip fractures increased by 65% (OR=1.65, 95%CI 1.47 to 1.85). As compared with nonusers, fracture risk increased by 41% in current users and by 38% in past users whose last use was at least 1 year ago. There was no significant difference between the two groups. Conclusion Proton pump inhibitors increase the risk of fracture to a certain degree. The effect does not fade away by discontinuation of PPI use for at least one year. Stricter clinical trials are needed to exclude confounding factors.
ObjectiveTo systematically review the predictive value of ezrin expression in bone and soft tissue sarcomas.MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CNKI, CBM, VIP, and WanFang Data were searched to collect cohort studies about the prognostic value of ezrin expression in bone and soft tissue sarcomas from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsFinally, a total of 17 cohort studies, involving 1 460 patients were included. The results of meta-analysis showed that: the overall survival (HR=1.90, 95%CI 1.70 to 2.13, P<0.000 01), event-free survival (HR=2.42, 95%CI 1.53 to 3.84, P=0.0002), metastasis-free survival (HR=2.09, 95%CI 1.10 to 3.97, P=0.02) in the bone and soft tissue sarcomas patients with ezrin high expression were lower than patients with lower expression. The same results were also observed in subgroup analysis according to histologica type and ethnicity in overall survival.ConclusionEzrin high expression may be used as a predictive maker for poor prognosis in bone and soft tissue sarcomas. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
ObjectiveTo systematically review the association between insomnia and the risk of hypertension. MethodsThe EMbase, PubMed, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect cohort studies on the association between insomnia and hypertension from inception to October 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 13.0 software. ResultsA total of 20 cohort studies involving 607 409 participants were included. The results of meta-analysis showed that insomnia increased the risk of hypertension (RR=1.24, 95%CI 1.15 to 1.34, P<0.000 1). Subgroup analysis showed that insomnia increased the risk of hypertension in North American, European and Oceanian population, but not in Asian population. The difficulty falling asleep, difficulty maintaining sleep and early awakening all increased the risk of hypertension. ConclusionCurrent evidence suggests that insomnia increases the risk of hypertension.
ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.
ObjectiveTo systematically review the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 5 2013), CNKI, CBM and WanFang Data were searched up to May 2013 for collecting cohort studies about the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. According to the inclusion and exclusion criteria, related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 9 studies involving 1 020 patients were included. The results of meta-analysis showed that there was no significant difference in GartlandWerley score between patients with ulnar styloid fracture or not. Statistical significant difference was found in DASH score between the two groups (MD=2.71, 95% CI 0.26 to 5.16, P=0.03), which indicated that patients with ulnar styloid fracture got higher score in DASH score. ConclusionCurrent evidence shows that ulnar styloid fracture may affect the prognosis of patients with distal radius fracture. Due to the quality and quantity limitation of the included studies, the above conclusion needs to be further verified by more high quality studies in future.
ObjectiveTo systematically review the efficacy and safety of 12 antimicrobial drug regimens for the treatment of multidrug-resistant Gram-negative bacterial (MDR-GNB) infections. MethodsThe PubMed, Cochrane Library, Web of Science, Clinical Trials, CNKI, WanFang Data, and Chinese Medical Journal Full-text Database were electronically searched to collect studies related to objectives form inception to February 2023. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Stata software was then used to perform a network meta-analysis. ResultsA total of 64 articles were included. The network meta-analysis results indicated that combination regimens based on carbapenems, β-lactam/combination agents, or tigecycline showed higher clinical antibacterial effectiveness and bacterial clearance rates for resistant bacterial infections. Among all regimens, tigecycline + β-lactam/combination agent, polymyxin + β-lactam/combination agent, and triple-therapy regimens exhibited superior antibacterial effects. Moreover, most combination regimens containing carbapenems had lower mortality risks, with carbapenems combined with aminoglycosides, β-lactam/combination agents, or polymyxins ranking high in clinical or bacteriological efficacy. ConclusionCurrent evidence suggests that combination regimens based on β-lactam/combination agents, carbapenems, and tigecycline may be beneficial for improving the clinical and bacteriological efficacy of treating resistant bacterial infections. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the safety of low molecular weight heparin (LMWH) in pregnancy. MethodsPubMed, EMbase, The Cochrane Library, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the safety of LMWH in pregnancy from inception to March 30th, 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 77 RCTs and 13 cohort studies were included. The results of meta-analysis showed that LMWH increased the incidence of postpartum hemorrhage (RR=1.50, 95%CI 1.00 to 2.25, P=0.05). However, there was no significant difference. The incidence of hematological adverse events was different from the results of RCTs and cohort studies. The results of RCT subgroup analysis showed that LMWH increased ecchymosis at the injection site (RR=1.60, 95%CI 1.24 to 2.08, P=0.000 4). However, the incidence of overall skin system adverse events did not increase significantly. LMWH reduced the incidence of cardiovascular adverse events (RR=0.18, 95%CI 0.07 to 0.46, P=0.000 3). LMWH failed to increase the occurrence of fetal congenital malformations, digestive system, central nervous system, skeletal system, and systemic adverse events. ConclusionsCurrent evidence suggests that LMWH is relatively safe to use during pregnancy. However, whether it increases postpartum hemorrhage and hematological adverse events is unclear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.