ObjectiveTo systematically review the diagnosis value of glycosylated hemoglobin (HbA1c) in diagnosis of gestational diabetes mellitus (GDM).MethodsThe diagnostic studies concerning glycosylated hemoglobin in gestational diabetes were electronically searched in EMbase, PubMed, The Cochrane Library, CNKI, WanFang Data and VIP from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by RevMan 5.3 and Meta-Disc 1.4 software.ResultsA total of 33 studies involving 16 622 persons were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive predictive value, negative predictive value, the pooled DOR of HbA1c were 0.75 (95%CI 0.74 to 0.77), 0.91 (95%CI 0.90 to 0.91), 8.21 (95%CI 5.41 to 12.46), 0.18 (95%CI 0.11 to 0.28), 45.10 (95%CI 29.70 to 68.48), respectively. The AUC of SROC was 0.933 5. Subgroup analysis by different HbA1c measurements indicated that little variations between different measurements in sensitivity and specificity.ConclusionHbA1c in GDM diagnosis has high sensitivity and specificity. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
ObjectiveTo systematically review the prevalence rate of gestational diabetes mellitus in Chinese population.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant literature of the prevalence rate of gestational diabetes in Chinese population from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using R 3.4.1 software.ResultsA total of 27 studies were included involving 183 338 peoples, of whom 23 834 were diagnosed as gestational diabetes mellitus by oral glucose tolerance test (75g). The prevalence rate was 13% (95%CI 10 to 16). The prevalence rate of gestational diabetes mellitus in north area was 13% (95%CI 9 to 19), central area was 11% (95%CI 2 to 39), east area was 15% (95%CI 12 to 19), south area was 12% (95%CI 11 to 14), northwest area was 5% (95%CI 3 to 8) and southwest area was 4% (95%CI 3 to 4). The prevalence rate of gestational diabetes mellitus during January 2005 to December 2012 was 11% (95%CI 7 to 16), during December 2012 to June 2016 was 17% (95%CI 14 to 20). The prevalence of specialist hospitals was 9% (95%CI 6 to 14), and which of comprehensive hospital was 14% (95%CI 11 to 18). The prevalence of gestational diabetes screening at 24 to 28 weeks gestation remained at 13% (95%CI 10 to 17).ConclusionThe prevalence rate of gestational diabetes mellitus is high in China. The prevalence rate of gestational diabetes mellitus in north China, central China and east China is significantly higher than that in southern China, northwest China and southwest China. The prevalence rate during 2012-2016 is significantly higher than that in 2005 to 2012. Improvement of lifestyle and living standard should be considered be closely related with that. The prevalence of comprehensive hospitals is higher than specialist hospitals. It is related to the China’s economic conditions, medical care situations and the medical habits of patients.
Objective To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children. Methods The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded. ResultsAll 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred. ConclusionMetatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.
ObjectiveTo systematically review the risk factors for intravesical recurrence (IVR) after radical nephroureterectomy (RNU) of upper tract urothelial carcinoma (UTUC).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies about the risk factors for IVR after RNU of UTUC from inception to August 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 studies involving 8 614 patients were included. The results of meta-analysis showed that the history of bladder cancer (HR=1.77, 95%CI 1.42 to 2.22, P<0.001), tumor stage (≥T2) (HR=1.41, 95%CI 1.09 to 1.82,P=0.009), ureteral tumor (HR=1.34, 95%CI 1.20 to 1.49, P<0.000 01), tumor multifocality (HR=1.51, 95%CI 1.34 to 1.69,P<0.001), lymphovascular invasion (HR=1.43, 95%CI 1.20 to 1.70,P<0.000 1), laparoscopic surgery (HR=1.52, 95%CI 1.08 to 2.15,P=0.02), positive surgical margins (HR=1.87, 95%CI 1.17 to 2.99, P=0.009), and preoperative ureteroscopy (HR=1.46, 95%CI 1.21 to 1.75, P<0.001) were the risk factors for IVR after RNU.ConclusionsCurrent evidence shows that the risk factors for IVR after RNU include history bladder cancer, tumor stage (≥T2), ureteral tumor, etc. Due to the limited quality of the included studies, more high quality studies are required to verify the above conclusion.