ObjectiveTo evaluate the effectiveness and safety of prophylactic ondansetron for the prevention of postoperative shivering. MethodsAccording to the Cochrane Handbook, we searched such databases as Cochrane Library, PubMed, OVID, EMbase, CNKI, CBM, and VIP (From January 1999 to September 2013) to collect the literature about ondansetron for the prevention of postoperative shivering. According to the predefined inclusion and exclusion criteria, we screened randomized controlled trials (RCTs). The included studies were evaluated and analyzed by meta-analysis with RevMan 5.0 software. ResultsNine RCTs involving 655 patients were included. The results of meta-analysis showed that there was a significant difference in incidence of postoperative shivering between group ondansetron and the controls [RR=0.32, 95%CI (0.24, 0.42), P<0.05]. There was a significant difference in incidence of postoperative nausea and vomiting between the ondansetron group and the control group [RR=0.30, 95%CI (0.14, 0.63), P<0.05]. There was no significant difference in the 1 min and 5 min neonate born Apgar score between the ondansetron group and the control group [WMD=0.03, 95%CI (-0.02, 0.09), P=0.26; WMD=-0.02, 95%CI (-0.12, 0.08), P=0.68]. ConclusionIntravenous ondansetron before surgery can significantly reduce postoperative shivering without any increment of adverse effects.
ObjectiveTo evaluate the effectiveness and safety of the additional catheter-directed thrombolysis (CDT) and conventional treatment (CT) for treatment primary deep vein thrombosis. MethodsDatabases such as CNKI, WanFang Data, Pubmed, EMBASE.com, Medline, CBM, CSJD, CJFD, and the Cochrane Library were electronically searched from the date of their establishment to 30 June, 2013, and the relevant literatures and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of additional CDT versus CT for primary deep vein thrombosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and accessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability. ResultsTwo RCTs including 3 literatures contain 224 patients reporting data on safety and efficacy of CDT versus CT were included. There were no publication bias (Begg'S test, Z=1.02. P > 0.05;Egger'S test, t=0.98, P > 0.05). The results of meta-analysis showed that:in 6 months after surgery iliofemoral vein patency rate of CDT group was higher than that of CT group (OR=3.62, 95% CI:1.51-8.64, P=0.004), in 6 months after surgery CDT group with a lower rate than CT group of the iliofemoral vein occlusion and (or)venous reflux rate (OR=0.24, 95% CI:0.11-0.53, P=0.000), and the incidence rate of PTS in 24 months after surgery in CTD group was less than that of CT group (OR=0.55, 95% CI:0.31-0.96, P=0.040). There were no statistically significant of the major complications after surgery between CDT group and CT group (OR=1.34, 95% CI:0.12-15.69, P=0.810). But the incidence rates of minor complications and total complications after surgery in CT group were lower than those of CDT group (OR=13.67, 95% CI:4.08-45.83, P < 0.00 01 and OR=11.67, 95% CI:4.40-30.99, P < 0.000 01). ConclusionsCDT is a effective and positive way to treat early deep venous thrombosis especially in terms of the patency of vascular and prevent the occlusion and PTS. Due to the limitation of the included studies, large sample size, multicenter, and high quality studies are needed to verify the above conclusion, such as the ATTRACT Study. The intracavitary therapy could be applied to clinic combining individual conditions of patients.
ObjectiveTo investigate the distribution of bacteria detected from blood culture of pediatric patients and to observe the blood culture contamination rate. MethodsA total of 6 530 blood samples, collected from January 2011 to December 2012 were detected by BacT/Alert 3D automated blood culture system. We found out the contamination bacteria according to clinical data, laboratory data and microbiology knowledge. ResultsA total of 314 bacteria strains were isolated from 6 530 blood samples, and the positive rate was 4.8%, 228 of which were gram-positive bacteria. The isolates were mainly coagulase-negative staphylococci (43.9%), followed by Staphylococcus aureus (2.9%). In addition, 86 cases were gram-negative bacteria, the majority of which were Escherichia coli (9.6%), followed by Klebsiella pneumonia (8.3%). The overall blood culture contamination rate was 49.7% (156 bacteria were identified). The top two were coagulase-negative staphylococci (31.2%), followed by Bacillus sp. (6.4%). ConclusionThe contamination rate is high in children's blood culture, and coagulase-negative staphylococci are the main bacteria. It's necessary to use clinical data and laboratory data to determine its clinical significance, and avoid unnecessary use of antibiotics.
Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
ObjectiveTo evaluate the efficacy and safety of endovascular implantation of bare-metal stent (BMS) and endovascular implantation of drug-eluting stent (DES) in treatment of infrapopliteal arterial occlusive disease by using Meta-analysis. MethodsRandomized controlled trial about endovascular implantation of BMS and endovascular implantation of DES in treatment of infrapopliteal arterial occlusive disease were searched in domestic and international databases, literature screening in accordance with inclusion criteria and exclusion criteria was taken firstly, and then quality assessment was performed. Comparison of 1-year restenosis rate, 1-year patency rate, incidence of limb salvage, mortality, and 1-year target lesion revascularization rate after operation between BMS group and DES group were performed by using RevMan 5.2 software for Meta-analysis. ResultsSix literatures included 572 cases who suffered from infrapopliteal arterial occlusive disease were included at all, including 302 cases in DES group and 270 cases in BMS group. The results of Meta-analysis showed that, compared with BMS group, 1-year patency rate after operation in DES group was higher (OR=1.64, 95% CI:1.35-1.98, P < 0.000 1), but 1-year restenosis rate (OR=0.19, 95% CI:0.12-0.30, P < 0.000 1) and 1-year target lesion revascularization rate after operation (OR=0.09, 95% CI:0.02-0.32, P=0.000 2) were both lower. There were no significance difference between the BMS group and DES group on incidence of postoperative limb salvage (OR=1.29, 95% CI:0.58-2.86, P=0.530 0) and postoperative mortality (OR=0.98, 95% CI:0.58-1.65, P=0.940 0). ConclusionsCompared with endovascular implantation of BMS, endovascular implantation of DES can increase the 1-year patency rate and reduce 1-year restenosis rate or 1-year target lesion revascularization rate after operation for infrapopliteal arterial occlusive disease.
ObjectiveTo assess the efficacy and safety of low-(10 mg) and high-dose (20 mg) of recombinant tissue typeplasminogen activator (rt-PA) catheter-directed thrombolysis for lower limb ischemia by using meta-analysis. MethodsThe literatures of randomized clinical trials (RCT) concerning low-versus high-dose rt-PA catheter-directed thrombolysis for lower limb ischemia study were searched using the national and international electronic databases.The literatures were screened and quality evaluated according to the inclusion and exclusion criteria, and analyzed by using the Cochrane Center the RevMan 5.2 software. ResultsA total of 4 RCT studies, with a total of 360 patients (192 patients in low dose group and 168 patients in high-dose group) were included.No statistical difference were noted in low-versus high-dose group with regard to ankle-brachial index (RR=0.20, 95%CI=-0.43-0.02, P=0.07), 30 days amputation-free survival (RR=1.00, 95%CI=0.94-1.08, P=0.91), 6 months the probability of restenosis (RR=1.00, 95%CI=0.60-1.67, P=1.00), and the incidence of groin hematoma (< 5 cm, RR=1.24, 95%CI=0.56-2.77, P=0.59).But the incidence of bleeding and the incidence of stress ulcer in low-dose group were lower than those in high-dose group (RR=2.38, 95%CI=1.10-5.15, P=0.03;RR=2.49, 95%CI=1.21-5.13, P=0.01). ConclusionTwo doses of rt-PA treatment of limb ischemia similar efficacy, but the incidence of low-dose regimen of complications is significantly lower than the high dose regimen.
ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.