ObjectiveTo systematically review the short term and long term efficacy of early surgery for infective endocarditis (IE) patients. MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases for cohort studies concerning the efficacy of early surgery for IE patients from inception to October 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsSixteen cohort studies including 8 141 patients were included. The results of meta-analysis showed that early surgery could reduce the short term mortality (OR=0.57, 95%CI 0.42 to 0.77, P=0.000 4) and long term mortality (OR=0.57, 95%CI 0.43 to 0.77, P=0.000 7) in IE patients. Subgroup analysis showed that early surgery could significantly reduce the short term mortality and long term mortality in patients with native valve endocarditis (NVE). ConclusionEarly surgery can reduce IE patients' short term mortality and long term mortality. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the association between acid suppressive drug use and fracture risk in children and adolescents. MethodsThe PubMed, Web of Science, EMbase, Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect observational studies on the association between acid suppressive drug use and fracture risk in children and adolescents from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using R4.1.2 software. ResultsA total of 6 studies involving 1 886 423 children and adolescents were included. Meta-analysis results showed that the use of proton pump inhibitors (PPIs) increased the risk of fracture (RR=1.19, 95%CI 1.10 to 1.29, P<0.01), whereas the use of histamine H2 receptor antagonists (H2RAs) did not increase the risk of fracture (P>0.05). Subgroup analysis showed that PPIs use increased risk of fracture in the lower limb and other sites (P<0.05). ConclusionCurrent evidence shows that PPIs can increase fracture risk in children and adolescents, but no association has been found between the use of H2RAs and increased fracture risk in this group. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the correlation between type 2 diabetes mellitus (T2DM) and the risk of kidney cancer. MethodsPubMed, EMbase, Web of Science, CBM, VIP and CNKI databases were electronically searched to collect cohort studies on the association between T2DM and kidney cancer from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis then performed by using Stata 15.0 software. ResultsA total of 17 cohort studies involving 2 003 165 T2DM patients were included. The results of meta-analysis showed that patients with T2DM had a higher kidney cancer risk than controls (RR=1.51, 95%CI 1.39 to 1.64, P<0.001). Subgroup analysis showed that the incidence of kidney cancer in T2DM patients was higher in different gender, region, population, follow-up time, diabetes assessment method and other subgroups. ConclusionsCurrent evidence shows that T2DM is a risk factor for kidney cancer.
Objective To systematically review the effectiveness of thoracoscopy surgery and thoracotomy for thymoma. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) and cohort studies about thoracoscopy surgery versus thoracotomy for thymoma from inception to April 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs and 8 cohort studies involving 1 093 patients were included. The results of meta-analysis showed that, compared with thoracotomy, the thoracoscopy surgery could shorten operative time (MD= –22.2, 95%CI –32.92 to –12.52, P < 0.000 01), duration of ICU stay (MD= –0.76, 95%CI –0.21 to –0.30, P < 0.000 01), duration of hospital stay (MD= –3.71, 95%CI –4.47 to –2.96, P < 0.000 01) and duration of pleural drainage (MD= –1.80, 95%CI –2.42 to –1.18, P < 0.000 01), reduce volume of intraoperative blood loss (MD= –43.27, 95%CI –50.94 to –35.60, P < 0.000 01), and decrease the incidence of postoperative complications (OR=0.19, 95%CI 0.11 to 0.34, P < 0.000 01), but there was no significant difference in recurrence rate between two groups (OR=0.81, 95%CI 0.31 to 2.11, P=0.67). Conclusions Current evidence shows that, compared with thoracotomy, the thoracoscopy surgery for thymoma has shorter operative time, duration of ICU stay, duration of hospital stay, and duration of pleural drainage, as well as less blood loss and postoperative complications. Due to the limited quality of included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the efficacy and safety of totally laparoscopic total gastrectomy (TLTG) versus laparoscopic-assisted total gastrectomy (LATG) for patients with gastric cancer. Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI were searched to collect cohort studies about TLTG vs. LATG for gastric cancer from inception to February 28th 2017. 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. Results A total of six cohort studies were included, of which 407 cases were in the TLTG group, and 315 cases were in the LATG group. The results of meta-analysis showed that compared with LATG group, patients in TLTG group had shorter operation time (MD=–8.97, 95%CI –16.21 to –1.73, P=0.02), and initial postoperative feeding time (MD=–0.30, 95%CI –0.57 to –0.03, P=0.03). However, the anastomic time, bleeding volume, the number of dissected lymph nodes, proximal resection margin, initial flatus time, postoperative hospital stay, overall postoperative complications, anastomotic fistula, and anastomotic stenosis were similar between two groups (all P values>0.05)． Conclusions Compared with LATG, TLTG has shorter operation and recovery time for patients with gastric cancer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the association between maternal folate supplementation during pregnancy and the risk of autism spectrum disorder (ASD) in the offspring.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, Scopus, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect case-control and cohort studies on the association between maternal folate supplementation during pregnancy and the risk of ASD in the offspring from inception to December 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 and Stata 14.0 software.ResultsA total of 17 studies involving 10 812 cases and 876 241 controls were included. The results of meta-analysis showed that there was no significant association between maternal folate supplementation during pregnancy and the risk of ASD in the offspring in the total population. The subgroup analysis revealed that maternal folate supplementation during pregnancy was statistically associated with a reduced risk of ASD in the offspring in the Asian population (OR=0.71, 95%CI 0.53 to 0.96, P=0.03). However, there were no statistical correlations in European and American populations.ConclusionsCurrent evidence shows that maternal folate supplementation during pregnancy may reduce the risk of ASD in the offspring in the Asian population. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. 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 and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo systematically review the relationship between Glasgow prognostic score (GPS) and prognosis of gastric cancer (GC) patients. MethodsPubMed, Web of Science, The Cochrane Library, CNKI, CBM and VIP databases were electronically searched to collect cohort studies on the relationship between GPS and prognosis of GC patients from inception to April, 2022. 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 and Stata 16.0 software. ResultsA total of 9 cohort studies involving 2 395 patients were included. The results of meta-analysis showed that GPS was significantly associated with poor overall survival of GC patients (HR=2.01, 95%CI 1.55 to 2.61, P<0.000 01). It also was associated with deeper depth of tumor, positive lymph node metastasis, more advanced TNM stages, positive distant metastasis and older age. ConclusionCurrent evidence shows that GPS is associated with survival prognosis and clinical pathological features of GC patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the safety of harmonic scalpel and conventional resection in superficial parotidectomy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) or cohort studies of harmonic scalpel and conventional resection in superficial parotidectomy from the inception of the database to December, 2018. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies involving 671 post-cesarean section patients (361 patients in harmonic scalpel group and 310 patients in conventional resection group) were included. The results of meta-analysis showed that: compared with conventional resection, harmonic scalpel had shorter operative time (MD=−23.82, 95%CI −31.20 to −16.44, P<0.000 01), less postoperative drain output (MD=−26.25, 95%CI −38.95 to −13.55, P<0.000 1), less intraoperative blood loss (MD=−23.78, 95%CI −28.64 to −18.91, P<0.000 01), shorter duration of hospital stay (MD=−1.19, 95%CI −2.14 to −0.23, P=0.02), and lower temporary facial nerve palsy rate (OR=0.27, 95%CI 0.14 to 0.50, P<0.000 1). However, there was no significant difference in the incidence of parotid gland leakage between two groups (OR=0.42, 95%CI 0.16 to 1.06, P=0.07).ConclusionsThe current evidence demonstrates that, compared to conventional resection, harmonic scalpel resection is safer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.