Objective To evaluate the diagnosis value of temporal Done high-resolution computed tornography (HRCT) in cholesteatoma. Methods There were 30 causes that had received the mastoid surgery because of cholesteatoma. Each patient’s mastoid plain films (Schuller’s and Mayer’s ) and HRCT had been taken and compared with each other and surgical findings and evaluated with health economic evaluation methods. Results The sensitivity rate in diagnosing cholesteatoma with HRCF was much higher than that with mastoid film (Plt;0.005). The more important benefit with HRCT was that it can afford the detail information in ear such as the ossicular chain, facial nerve canal, tympanic sinus, etc. which were basis for otologist in surgery to remove the focus thoroughly and reconstruct the middle ear function at the same time. In the view of health economic evaluation, HRCT is also much better than mastoid X-ray film. Conclusion HRCT should replace masloid Schuller’s and Mayer’s film in diagnosis cholesteatoma and HRCT should use as ordinary examination in chronic otitis media.
ObjectiveTo investigate the clinical, radiographic characteristics and differential diagnosis of pulmonary Langerhans cell histiocytosis (PLCH) mimicking metastasis of cancer in radiography. MethodsClinical data of 2 patients with PLCH manifesting as metastatic cancer on HRCT and PET/CT were retrospectively analyzed. Patients reported as PLCH on WanFang Database, China Knowledge Resource Integrated Database and Pubmed were reviewed to screen misdiagnosis literature and further analyzed the clinical and radiographic characteristics. ResultsTwo cases both presented with cough and sputum. 18F-FDG PET/CT showed increased 18F-FDG up-take in both nodules in the lungs. One patient presented with multiple nodules, diffuse multiple cystic changes in lungs and osteoclasia in the right 4th rib on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of rib biopsy. The other patient presented with diffuse multiple nodules on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of lung biopsy. The pathological characteristics of both biopsy specimen demonstrated infiltration by Langerhans cells (LC) and eosinophils. The LC were positive for CD1a. Literature review found seven PLCH cases who were misdignosed as depression, eosinophilic pneumonia, interstitial lung disease involvement of autoimmune disorders and malignant tumor. ConclusionWhen clinician faced with a patient suspected as metastatic cancer by HRCT and PET/CT, it is reasonable to consider PLCH as a differential diagnosis and obtain the pathological information as soon as possible so that better prognosis can be achieved through early intervention.
ObjectivesTo systematically review the efficacy and safety of sufentanil versus fentanyl used in patient-controlled intravenous analgesia (PCIA) after cesarean section.MethodsAn online search of computerized searches of the database of MEDLINE (OVID), Web of Science, The Cochrane Central Register of Controlled Trials, PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed were conducted. Randomized controlled trials published since the inceptions of these databases until April 1st 2018, involving the comparison of sufentanil versus fentanyl for PCIA after cesarean section were included. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 19 studies were included. The results of meta-analysis showed that, compared with the fentanyl group, the sufentanil group had statistically significant lower VAS scores at 4-hour (MD=–0.99, 95%CI –1.03 to –0.95, P<0.001), 8-hour (MD=–0.30, 95%CI –0.40 to –0.21, P<0.001), 12-hour (MD=–0.54, 95%CI –0.62 to –0.46, P<0.001) and 24-hour (MD=–0.35, 95%CI –0.41 to –0.28, P<0.001); statistically significant higher Ramsay scores at 4-hour (MD=0.72, 95%CI 0.66 to 0.78, P<0.001), 8-hour (MD=0.93, 95%CI 0.86 to 1.00, P<0.001), 12-hour (MD=0.98, 95%CI 0.91 to 1.05, P<0.001), 24-hour (MD=0.07, 95%CI 0.03 to 0.11, P=0.000 5), 48-hour (MD=0.05, 95%CI 0.03 to 0.08, P<0.000 1). As for the adverse reactions, sufentanil group had lower risks of having nausea and vomiting (RR=0.25, 95%CI 0.19 to 0.31, P<0.001), pruritus (RR=0.41, 95%CI 0.30 to 0.57, P<0.001), dizziness (RR=0.27, 95%CI 0.17 to 0.44, P<0.001) and urinary retention (RR=0.35, 95%CI (0.15, 0.82), P=0.02).ConclusionsThe current evidence shows that, sufentanil has better analgesia and sedative effects, and less risks of adverse reactions for safer clinical use.
ObjectivesTo systematically review the efficacy of Chinese herbal medicine (CHM) combined with chemotherapy for ovarian cancer.MethodsCNKI, VIP, WanFang Data and PubMed databases were searched to collect randomized controlled trials on the CHM combined with chemotherapy for ovarian cancer from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and evaluated the risk bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsThirteen studies were included. Meta-analysis showed that, CHM combined with chemotherapy group was superior to the chemotherapy alone group in effective rate of TCM syndrome (RR=1.72, 95%CI 1.46 to 2.03, P<0.00.000 1), effective rate of tumor change (RR=1.40, 95%CI 1.21 to 1.63,P<0.000 01), physical condition score (MD=9.19, 95%CI 5.89 to 12.48,P<0.000 01), tumor markers (MD=–18.00, 95%CI –20.62 to –1.538,P<0.000 01), leukocyte reduction (RR=0.67, 95%CI 0.58 to 0.77,P<0.000 01), granulocy tedepletion (RR=0.67, 95%CI 0.55 to 0.81,P<0.000 1), thrombocytopenia (RR=0.55, 95%CI 0.45 to 0.69,P<0.000 01), and digestive tract reaction (RR=0.66, 95%CI 0.50 to 0.87,P=0.004).ConclusionsThe current evidence shows that CHM combined with chemotherapy is superior to chemotherapy alone in the treatment of ovarian cancer. Due to limited quality and quantity of included studies, the above conclusions are required to be verified by more high-quality studies.
ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
治疗经前期综合症妇女的临床证据显示:①溴隐停(只对乳房症状):RCT所提供的有限证据提示,溴隐停的副作用虽然较常见,但与安慰剂相比对乳房胀痛的缓解更有效.②认知行为治疗:RCT发现,认知行为治疗较对照组能显著缓解经前期症状,但有关疗效大小的证据不足.③达那唑:RCT发现,达那唑较安慰剂能显著缓解经前期症状,但长期持续使用可能导致男性化等严重的副作用.④利尿剂:RCT发现,螺内酯较安慰剂能显著缓解乳房胀痛、水肿等症状.2个RCT发现,甲苯喹唑酮或氯化铵与安慰剂相比,能降低经前期水肿和抑制体重增加.⑤体育锻炼:1个RCT发现,有氧运动较安慰剂更能显著改善经前期症状.另1个RCT发现,高强度的有氧运动比低强度的有氧运动能更有效地缓解症状.⑥促黄体生成素释放激素类似物:RCT发现,促黄体生成素释放激素类似物(过去称GnRH类似物)较安慰剂能显著缓解经前期症状.RCT发现,促黄体生成素释放激素类似物+孕激素+雌激素(反向添加治疗)缓解症状的评分低于单用促黄体生成素释放激素类似物,但其评分优于安慰剂组.1个小样本RCT发现,促黄体生成素释放激素类似物+7-甲异炔诺酮缓解症状评分与单用促黄体生成素释放激素类似物相当.因为持续使用促黄体生成素释放激素类似物超过6个月将带来骨质疏松的危险,所以其长期使用受限.⑦子宫切除术伴或不伴双卵巢切除术:缺乏相关RCT.但观察性研究发现,子宫切除术伴双卵巢切除术具有治愈效果.只行子宫切除术也可缓解症状,但由于缺乏对照,导致证据强度有限.该疗法的危险主要是由手术造成的.双卵巢切除术后的不育也是不可逆的.⑧非选择5-羟色胺重摄取抑制剂--抗抑郁药/抗焦虑药:RCT发现,非选择性5-羟色胺重摄取抑制剂,包括抗抑郁药和抗焦虑药,较安慰剂能显著改善经前期综合症的至少一个症状,但部分妇女因副作用而中断治疗.有关β-阻滞剂和锂剂效果的RCT样本量太小,证据不足.⑨非甾体类抗炎药:一些RCT发现,前列腺素抑制剂较安慰剂能显著改善部分经前期症状,但不能缓解经前期乳房胀痛.⑩雌激素:一些小样本RCT的有限证据提示,雌激素较安慰剂能有效地改善症状,但有效程度尚不明确.(11)口服避孕药:RCT发现,口服避孕药较安慰剂改善经前期症状的证据不足.(12)孕酮:1个系统评价发现,孕酮可以小幅度缓解经前期综合症的所有症状且不增加由于副作用导致的治疗中断,其缓解程度与安慰剂有明显差异,但缓解的程度还达不到理想的临床疗效.目前尚不清楚给药的时间和途径对孕酮的作用是否有影响.(13)孕激素(人工合成):1个小样本RCT比较了孕激素和安慰剂的疗效,但证据不足.(14)Vit B6:1个纳入低质量RCT的系统评价发现,证实Vit B6疗效的证据不足.在这篇系统评价中,一些质量不高的RCT提示Vit B6较安慰剂能有效缓解症状,但另一些方法学质量不高的RCT发现,证实Vit B6效果的证据互有矛盾.(15)选择性5-羟色胺重摄取抑制剂:1篇系统评价和其后的RCT发现,选择性5-羟色胺重摄取抑制剂较安慰剂能显著缓解经前期症状,但也更易出现副反应.(16)7-甲异炔诺酮(替勃龙):1个小样本RCT的有限证据提示,替勃龙较安慰剂(复合维生素)更能缓解经前期症状.(17)其他治疗,如按摩疗法、饮食补充、子宫内膜切除术、月见草油、腹腔镜下行双卵巢切除术、反射论、放松疗法等的疗效证据不足.
ObjectiveTo systematically review the efficacy and safety of prostacyclin for patients with pulmonary arterial hypertension (PAH).MethodsWe searched PubMed, EMbase, The Cochrane Library, WanFang Data, CBM and CNKI databases for randomized controlled trials (RCTs) compared prostacyclin with placebo from inception to April 2018. Two reviewers independently screened literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software.ResultsEleven RCTs including 2 549 participants were included. The results of meta-analysis showed that, compared with placebo group, prostacyclin group was superior to the placebo group in 6-min walk distance (MD=31.10, 95%CI 16.89 to 45.30, P<0.001), mortality (RR=0.62, 95%CI 0.41 to 0.94,P=0.03), Brog score (MD=–0.88, 95%CI –1.28 to –0.49, P<0.001), mean pulmonary arterial pressure (MD=–3.31, 95%CI –4.34 to –2.29,P<0.001) and cardiac index (MD=0.32, 95%CI 0.14 to 0.51,P<0.001). However, there were no differences between two groups in reducing delaying time to clinical deterioration (RR=1.27, 95%CI 0.99 to 1.63,P=0.06), tolerability (RR=0.74, 95%CI 0.42 to 1.31, P=0.30) and pulmonary vascular resistance (MD=–4.35, 95%CI –8.85 to 0.15, P=0.06).ConclusionsCurrent evidence reveals that prostacyclin therapy appears to be superior to the placebo in reducing the mortality, improving excise capacity, respiratory and cardiac function, and ameliorating mean pulmonary arterial pressure for pulmonary arterial hypertension. However, the efficacy of prostacyclin in delaying time to clinical deterioration, tolerability and pulmonary vascular resistance for PAH is not clear. Due to the limited quality and quantity of included studies, more high quality RCTs are required for further verification.
The plasminogen activator inhibitor-1 (PAI-1) is a candidate gene for stroke based on PAI-1's crucial role in fibrinolytic system. However, association studies have yielded conflicting results regarding the association between PAI-1 polymorphisms and stroke susceptibility. To further elucidate the putative association, we performed a systematic review and meta-analysis to provide a complete picture of the loci investigated for association of PAI-1 polymorphism with stroke risk and to derive a precise estimation. PubMed, Embase, and China National Knowledge Infrastructure (CNKI) databases were searched until June 2015 to identify eligible studies. Forty data sets from 39 studies with a total of 8336 cases and 14,403 controls were included. The most commonly investigated polymorphism was -675 4G/5G, followed by -844 G/A, 11053 T > G, HindIII C/G, and (CA)n. Overall, our meta-analysis provided evidence for the significant association of PAI-1 4G/5G polymorphism with an increased risk of adult but not pediatric ischemic stroke (adult: 4G/4G vs. 4G/5G + 5G/5G, OR = 1.21, 95 % CI = 1.04-1.42). In the subgroup analysis, significant association was detected in Asians (4G/4G vs. 4G/5G + 5G/5G, OR = 1.45, 95 % CI = 1.14-1.85) but not Caucasians. Moreover, we found that -844 G/A but not 11053 T > G polymorphism was associated with an increased risk of ischemic stroke (-844G/A: A/A vs. G/G: OR = 1.32, 95 % CI = 1.01-1.73). A tendency of PAI-1 4G/5G polymorphism towards a decreased risk of hemorrhagic stroke was observed (4G/4G + 4G/5G vs. 5G/5G, OR = 0.77, 95 % CI = 0.59-1.02, P = 0.066). Future well-designed studies in large well-characterized sample size and presenting results stratified by gender, age, and stroke subtype are warranted.
Objective To assess the effectiveness of statins in treating early diabetic kidney disease (DKD). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1991 to August 2009), EMbase (1991 to August 2009), CBMdisc (1991 to August 2009) and CNKI (1994 to August 2009). We also handsearched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 4.2 software. Results A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins, there were significant reductions in urinary albumin excretion rate (UAER) (WMD= –55.77, 95%CI –74.20 to –37.34, Plt;0.000 01), serum creatinine (Scr) (WMD= –4.34, 95%CI –6.74 to –1.94, P=0.000 4), C reactive protein (CRP) (WMD= –1.48, 95%CI – 2.32 to – 0.63, P=0.006), total cholesterol (TC) (WMD= –1.33, 95%CI –1.75 to –0.91, Plt;0.000 01), and triglyceride (TG) (WMD= –0.72, 95%CI-1.17 to -0.27, P=0.002) in group treatment compared with group control. Funnel-plot displayed a symmetrical figure, indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level of transaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG, statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal protection and no severe adverse effects in treating early DKD. However, due to lack of quality in the included studies, more studies of better quality should be conducted