ObjectiveTo compare the characteristics and functions of the network meta-analysis software and for providing references for users. MethodsPubMed, CNKI, official website of Stata and R, and Google were searched to collect the software and packages that can perform network meta-analysis up to July 2014. After downloading the software, packages, and their user guides, we used the software and packages to calculate a typical example. The characteristics, functions, and computed results were compared and analyzed. ResultsFinally, 11 types of software were included, including programming and non-programming software. They were developed mainly based on Bayesian or Frequentist. Most types of software have the characteristics of easy to operate, easy to master, exactitude calculation, or good graphing; however, there is no software that has the exactitude calculation and good graphing at the same time, which needs two or more kinds of software combined to achieve. ConclusionWe suggest the user to choose the software at least according to personal programming basis and custom; and the user can consider to choose two or more kinds of software combined to finish the objective network meta-analysis. We also suggest to develop a kind of software which is characterized of fully function, easy operation, and free.
ObjectiveTo provide some basic data for studies in the future on the prevention of medical disputes by exploring its patterns and reasons. MethodsFifty-five processed medical disputes cases accepted between 2012 and 2014 were retrospectively analyzed for their patterns and causes. ResultsThe number of males in the medical disputes was higher than that of females (male: 60.0%, female: 40.0%), and patients at the age of 40-70 also led in the disputes (aged 40-50: 20.0%, aged 50-60: 18.2%; aged 60-70: 20.0%). There were more medical disputes in the department of cardiology (20.0%), orthopedics (16.4%), otolaryngology (12.7%), and gynecology (10.9%). ConclusionThere are differences in gender and age of the patients as well as departments in terms of medical disputes. We should try to discover the regular patterns of these disputes. Besides those existing medical indexes, we should establish other warning systems through psychological and sociological status of medical staff and patients for reducing medical disputes, which can surely help the administration of medical quality intervention on medical disputes.
ObjectiveTo compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. MethodsBetween May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree Ⅰ or Ⅱ) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. ResultsPrimary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1±1.6) days] was significantly shorter than that of open group [(7.2±2.1) days] (t=2.593, P=0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53%±20.52% in minimally invasive group, and was 64.21%±30.21% in open group, showing no significant difference (t=0.725, P=0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P<0.05), but no significant difference was found between 2 groups (P>0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P<0.05) except PI (P>0.05), but there was no significant difference between 2 groups (P>0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P<0.05). ConclusionBoth minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.
ObjectiveTo introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. MethodsBetween June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. ResultsThe operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). ConclusionArthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.
After 38 years of development, the procedure of selection and evaluation of the World Health Organization Essential Medicine List (WHO EML) is increasingly scientific and formal. However, peer review for the applications of WHO EML is always required in a short period. It is necessary to build up a set of methods and processes for rapid review. The most important items for the rapid review of WHO EML peer reviewers are: 1) to confirm the requirements and identify the purposes; 2) to establish the research questions and translate the questions into the ‘Participants, Interventions, Comparators, Outcomes, Study design' (PICOS) format; 3) to search and screen available evidence, for which high-level evidence is preferred, such as systematic reviews or meta-analyses, health technology assessment (HTA), clinical guidelines; 4) to extract data, where we extract primary information based on the purposes; 5) to synthesize data by qualitative methods, assess the quality of evidence, and compare the results; 6) to provide the answers to the applications, quality of evidences and strength of recommendations. Our study established a set of methods and processes for the rapid review of WHO EML peer review, and our findings were used to guide the reviewers to fulfill the 19th WHO EML peer review. The methods and processes were feasible and met the necessary requirements in terms of time and quality. Continuous improvement and evaluation in practice are warranted.
ObjectiveTo establish an rabbit model of early steroid-induced avascular necrosis of the femoral head (SANFH) and evaluate its validity with MRI and pathological examination. MethodsTwenty 6-month-old rabbits (weighing, 2-3 kg) were randomly divided into 2 groups (control group and model group), 10 rabbits in each group. Dexamethasone sodium phosphate solution (10 mg/kg) was injected into bilateral gluteus in model group, and the same amount of saline was injected in control group, every 3 days for 14 times. General observation was done after modelling. Osteonecrosis was verified by pathological observation and MRI findings at 6 weeks. ResultsAfter 6 weeks, rabbits did not show obvious changes in control group; increased hair removal, decreased food intake, and slight limp were observed in model group. The MRI results showed normal shape of the bilateral femoral head and no abnormal signals in control group; irregular shape of the bilateral femoral head and a slice of irregular abnormal signals were observed, and necrosis and cystolization of the subchondral bone and sparse changes of trabecular bone were shown in model group. General observation from coronal section of femoral head showed smooth red cartilage surface in control group; on the contrary, the cartilage surface of the femoral head became dull, thin even visible hemorrhage under articular cartilage and necrosis of the femoral head were observed. The histopathological examination indicated that trabecular bone of the femoral head in control group was massive, thick, and close, and osteocytes in the bone lacunae had normal shapes. The osseous trabecular became thinner and broken; karyopyknosis of osteocytes and bone empty lacunae could be obviously seen in model group. The rates of empty lacunae were 8.0%±0.5% in control group and 49.0%±0.3% in model group, showing significant difference (t=21.940, P=0.000). ConclusionEstablishing a model of early SANFH through injecting shortterm, shock, and high dose of dexamethasone, and it can been evaluated effectively with MRI and pathological examination.
ObjectiveCapsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. MethodsWe electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. ResultsWe finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusiona) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.
ObjectiveTo develop reporting guideline for dose-response meta-analysis (DMA), so as to help Chinese authors to understand DMA better and to promote the reporting quality of DMA conducted by them. MethodPubMed, EMbase, The Cochrane Library, CNKI, and WanFang Data were searched from Jan 1st 2011 to Dec 30th 2015 to collect DMA papers published by Chinese authors. The number of these publications by years, whether and what kind of reporting guideline was used, and whether the DMA method claimed in these publications was correct were analysed. Then we drafted a checklist of items for reporting DMA, and organized a discussion meeting with experts from the fields of DMA, evidence-based medicine, clinical epidemiology, and clinicians to collect suggestions for revising the draft reporting guideline for DMA. ResultsOnly 33.73% of the publications clarified it is a DMA on the title and 48.02% of them reported risk of bias. Almost 38.49% of the publications didn't use any reporting guidelines. Fourteen of them claimed an incorrect use of methodology. We primarily took account for 47 potential items related to DMA based on our literature analysis results and existing reporting guidelines for other types of meta-analyses. After the discussion meeting with 6 experts, we revised the items, and finally the G-Dose checklist with 43 items for reporting DMA was developed. ConclusionThere is a lack of attention on reporting guidelines in Chinese authors and evidence suggests these authors may be at risk of incomplete understanding on reporting guidelines. It is strongly recommended to use reporting guidelines for DMA and other types of meta-analyses in Chinese authors.