ObjectiveTo systematically review the efficacy of irbesartan combined with amiodarone versus amiodarone alone for paroxysmal atrial fibrillation. MethodsWe electronically searched databases including PubMed, CENTRAL, EMbase, VIP, CNKI and WanFang Data to collect randomized controlled trials (RCTs) about irbesartan combined with amiodarone versus amiodarone alone in the treatment of paroxysmal atrial fibrillation from 2000 to 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of nine studies involving 998 patients were included. The results of meta-analysis showed that:Compared with the amiodarone group, the left atrial diameter was smaller (MD=-1.49, 95% CI -1.82 to -1.15), and the maintenance rates of sinus rhythm were higher (OR=3.02, 95%CI 2.21 to 4.11) in the irbesartan plus amiodarone group after 12 months. ConclusionCurrent evidence indicates that the combination treatment of irbesartan and amiodarone for paroxysmal atrial fibrillation is better than amiodarone alone in delaying the enlargement of left atrial diameter, as well as the maintenance of sinus rhythm. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the curative effect and value of laparoscopic operation in the treatment of acute gangrenous and perforated appendicitis. MethodsThe clinical data of 243 patients with acute gangrenous and perforated appendicitis from February 2011 to February 2014 in our hospital were retrospectively analyzed. Laparoscopic appendectomy was performed in 118 cases (LA group), and open appendectomy was performed in 125 cases (OA group). The operative time, hospital stay, hospital costs, incision bleeding, gastrointestinal function recovery, wound infection, pelvic abscess, and postoperative adhesions of two groups were compared. ResultsThere was no significant difference in the operative time, incision bleeding, and the incidence of pelvic abscess after operation between the LA group and OA group (P>0.05). Compared with the OA group, the recovery time of gastrointestinal function was significantly shortened (P<0.01), eating time was earlier (P<0.01), hospitalization time also shortened significantly (P<0.01), and the incidence of postoperative wound infection and intestinal adhesion were significantly decreased (P<0.01) after operation in LA group. But the cost of hospitalization in LA group increased significantly (P<0.05). ConclusionsThe laparoscopic operation in the treatment of gangrenous and perforated appendicitis are light of pain., recover quickly, shorter of hospital stay, and fewer complications. The increase of hospitalization expenses is the only deficiency.
ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease. MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
The interpretation of the guideline is an important method to learn, understand and apply authoritative guidelines. This is the fourth article of the research group about evidence-based diagnosis clinical practice guidelines. We would analyze the ACR Appropriateness Criteria® Right Lower Quadrant Pain—Suspected Appendicitis from the methodological perspective which was made by American College of Radiology, referring to the standard of AGREE.
ObjectiveTo observe the efficiency of endovenous laser therapy combined with planning sucking operation in the treatment of great saphenous varicose veins. MethodsTotally 48 patients (60 limbs) were treated from May 2011 to May 2014 in general surgery department of our hospital. The main trunk of great saphenous vein was ablated by endovenous laser treatment; and the varicose veins in calf were resected by planning sucking operation. ResultsAll 48 patients (60 limbs) were cured without recurrent during 6-36 months followed-up. The operative time of each side was 18-43 min, the average operative time was 22.6 min; with 1-3 skin incisions. Hospital stay was 5-8 d, the average hospitalization time was 6.7 d. After operation, the varicose veins and the felling of swelling were disappeared, the pigmentation was reduced or disappeared. Local skin numbness showed in 6 cases and recovered in 3-7 months after operation. Felling of burns appeared in 2 cases, and was healed after treatment. Ankle swelling presented in 5 cases, and released in 6-13 d with related treatment. Different degree of subcutaneous bruising appeared without any hematoma, and recovered in 2-4 weeks. Two cases were lost during the followed-up. ConclusionsEndovenous laser therapy combined with planning sucking operation is safe and effective in the treatment of great saphenous varicose. It is worthy of promotion with minimum damage, less pain, fast recovery, no scars, shorter operative time, and shorter hospital stay.
Objective To compare the surgical outcome of surgical treatment for chronic pancreatic head mass pancreatitis combined with pancreatic duct stones. Methods Clinical data of 19 patients diagnosed as chronic pancreatic head mass pancreatitis combined with pancreatic duct stones by pathology in our hospital were analyzed retrospectively and patients were divided into Beger group (n=9) and Frey group (n=10) according to operation type. Results The duration of operation, blood loss, morbidity, ratio of postoperative pancreatic fistula of grade B, ratio of abdominal cavity infection, ratio of gastric emptying dysfunction, total length of hospital stay, and total hospitalization cost in Frey group were less or lower than those in Beger group significantly (P ＜0.05). None of death or pancreatic fistula of grade C happened in both 2 groups, and abdominal pain and jaundice were subsided in all patients. There were 18 patients (94.7%) were followed up for (8.6±2.5) years ( 5-12 years), and just 1 patient of Frey group was not available for followup. The ratios of 5-year pain subsided of 2 groups were both 7/9, there was no significant difference between the 2 groups (P>0.05). During the follow-up period, there was no dead, relapsed, cancerate or reoperation, but 2 patients suffered from diabetes (1 patient of Frey group and 1 patient of Beger group), 2 patients suffered from steatorrhea (1 patient of Frey group and 1 patient of Beger group), and there was no significant difference between the 2 groups in the ratios of diabetes and steatorrhea (P>0.05). Conclusion The effect is equal for Frey surgery and Beger surgery in treatment of chronic pancreatic head mass pancreatitis combined with pancreatic duct stones, but recover of patient who receives Frey surgery is better than that of Beger surgery.
ObjectiveTo investigate the citation status of systematic reviews on imaging diagnosis in clinical practice guidelines (CPGs) and provide reference for the development of Chinese imaging diagnosis guidelines. MethodsWe electronically searched PubMed databases to collect systematic reviews on imaging diagnosis. The date was limited from January 1st 2010 to December 31th 2012. Two reviewers independently screened literature and extracted data. The citation data of included systematic reviews were obtained on the Web of Science. Citation analysis method was used to analyze the citation frequency of systematic reviews on imaging diagnosis in CPGs. Results292 systematic reviews on imaging diagnosis were included, of which 94% (275/292) were indexed by Science Citation Index. The total citation frequency of these systematic reviews was 5413 (medium:20, range:0 to 131). 28% (78/275) were cited by CPGs. Of which, 7% (19/275) were used as the source of the evidence of recommendations in CPGs. ConclusionThe ratio of systematic reviews cited by CPGs is low, the ratio of being the source of evidence of recommendations of systematic reviews in CPGs is lower, and furthermore, the citation is time-delayed.
ObjectiveTo investigate the recommendations on imaging diagnosis in Chinese clinical practice guidelines (CPGs). MethodsWe electronically searched WanFang Data, VIP, CNKI and CBM databases from inception to December 31, 2014. Two reviewers independently screened literature and extracted data. The method of bibliometrics was used to analyze the data (including basic characteristics, strength of recommendation, quality of evidence, etc.). ResultsA total of 341 CPGs formulating the recommendations on diagnosis were included. 48.7% (166/341) guidelines developed the recommendations on imaging diagnosis (a total of 534). 25.7% (137/534) recommendations were with the symbols of quality of evidence and strength of recommendation, and 18.9% (101/534) with special words such as recommend, suggest. 22.3% (119/534) recommendations reported the strength of recommendation. Of which, 38.7% (46/119) were strong and 16.0% (19/119) were weak. However, 23.9% (11/46) strong recommendations were based on low quality of evidence. And 42.1% (8/19) weak recommendations were based on high quality of evidence. ConclusionAmong Chinese CPGs formulating the recommendations on diagnosis, the number of CPGs with recommendations on imaging is about 50%. And the quantity increases by years. The proportions of recommendations on imaging which report the strength of recommendation and/or quality of evidence are low. Meanwhile, the rating systems are uniform. Then the developers do not report the explanation for the strong recommendations based on low quality of evidence or the weak recommendations based on high quality of evidence in guideline.
In order to help Chinese guideline developers, clinicians, health policy makers and other relevant researchers fully understand and make appropriate use of World Health Organization (WHO) guidelines, Chinese GRADE Center and Guidelines Review Committee of World Health Organization (WHO-GRC) have written a series of papers about development methods, review principles and the structure and content of WHO guidelines. This is the third (also last) paper which interpreted Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection and Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection as examples with the process and steps of WHO guideline development.
In order to help Chinese guideline developers, clinicians, health policy makers and other relevant researchers fully understand and make appropriate use of World Health Organization (WHO) guidelines, Chinese GRADE Center and Guidelines Review Committee of World Health Organization (WHO-GRC) have written a series of papers about development methods, review principles and the structure and content of WHO guidelines. This is the second paper of this series introducing the composition, main work and functions of WHO-GRC.