ObjectiveTo compare the surgical effects of totally thoracoscopic and thoracoscopic-assisted small incision for left atrial appendage clipping. Methods The clinical data of patients who underwent left atrial appendage clipping surgery via totally thoracoscopy or thoracoscopic-assisted minimally invasive small incision from November 2018 to March 2022 in Beijing Tiantan Hospital were retrospectively analyzed. According to the surgical approach, they were divided into a totally thoracoscopic group and a small incision group. The clinical results were compared between the two groups. ResultsA totoal of 41 patients were enrolled, including 30 males and 11 females, with an average age of 66.6±6.1 years. There were 23 patients in the totally thoracoscopic group and 18 patients in the small incision group. The CHA2DS2-VASc score was 4.5±1.1 points, and HAS-BLED score was 3.7±1.5 points. No death occured in the whole group. There was no statistical difference between the two groups in terms of operation time, chest complications, successful rate of closure of the left atrial appendage, residual length of the left atrial appendage, or displacement of the atrial appendage clip (P>0.05). The total drainage volume in the totally thoracoscopic group was less than that in the small incision group, and the difference was statistically significant (P=0.031). The median follow-up time was 10 (1-30) months, during which there was 1 patient of stroke and 1 patient of left atrial thrombus in both groups. ConclusionTotally thoracoscopic left atrial appendage clipping is less invasive than thoracoscopic-assisted minimally invasive small incision surgery and does not increase the risk of surgical complications.
Objective To assess the quality of current domestic literature about enzyme-linked immunosorbent assay (ELISA) for invasive aspergillosis diagnosis by detecting Aspergillus galactomannan (GM) antigen, and to analyze the sources of bias and variability, as well as the diagnostic ability of different thresholds. Methods Both computer-based online search and manual retrieval were employed to identify relevant articles. The statistical information and quality of science were assessed and classified. The data were analyzed using Meta Disc 1.4 software. The best cutoff value for defining a positive test result was selected by summarizing the following statistical indicators as sensitivity, specificity, likelihood ratio (LR) and summary receiver operating characteristic curve (SROC curve), and by calculating the area under the curve (AUC) as well. Results A total of 20 studies among 2658 literatures were included in accordance with the inclusion criteria, and were divided into different groups based on different cutoff values. Though heterogeneity tests showed no threshold effect, and there were other reasons of heterogeneity. So the data were analyzed by random effects model. The results showed that, compared with other groups, the one with cutoff value set at 0.7 (AUC=0.9456, Q= 0.884 6) showed the best accuracy in diagnosing. Conclusion ELISA detection of Aspergillus GM antigen with cutoff value set at 0.7 has important significance in the early diagnosis of invasive aspergillosis, and it can be conducive to reduce mortality in patients at high risk for Aspergillus infection.
Objectives To evaluate the quality of ophthalmic clinical practice guidelines in China by using the AGREE Ⅱ instrument. Methods CBM, CNKI, VIP, and WanFang Data databases were electronically searched to collect Chinese guidelines for ophthalmology from inception to December 2017. Three reviewers independently evaluated the included guidelines using the AGREE Ⅱ instrument. Results A total of 60 Chinese clinical guidelines for ophthalmology were included. The average scores of the six domains including scope and purpose, stakeholder involvement, rigorism of development, clarity of presentation, applicability and editorial independence were 66.4%, 24.6%, 13.5%, 67.4%, 14.5%, and 19.3%, respectively. The guidelines published from 2013 to 2017 scored higher than those published previously in all areas except for domain 4 clarity of presentation. Conclusions The quality of current ophthalmic clinical practice guidelines in China is low, and there is still a big gap between them and the international guidelines. Guidelines developers should place more emphasis on developing regulations to improve stakeholder involvement, rigorism of development, applicability and editorial independence.
ObjectiveTo explore the safety and feasibility of uni-portal video-assisted thoracic surgery (VATS) for the treatment of bronchopulmonary sequestration (BPS). MethodsThe clinical data of BPS patients with surgical resection in Shanghai Pulmonary Hospital from February 2010 to June 2021 were reviewed. The patients were divided into a VATS group and a thoracotomy group according to the operation method. The operation time, intraoperative blood loss, hospital stay and postoperative complication rate were compared between the two groups. The VATS group was subdivided into a uni-portal VATS group and a multi-portal VATS group for subgroup analysis. ResultsFinally 131 patients were enrolled, including 62 males and 69 females with an average age of 39.3±13.2 years. There were 103 patients in the VATS group and 28 patients in the thoracotomy group. A total of 104 patients were diagnosed with left lower BPS, 26 with right lower BPS and 1 with bilateral lower BPS. The main symptom was cough (88 patients, 67.2%). There were 119 patients diagnosed by thoracic enhanced CT before operation. Compared with the thoracotomy group, the operation time was not statistically different (P=0.717), but the blood loss was less, the rate of postoperative complication was lower and hospital stay was shorter in the VATS group (P＜0.05). The rate of conversion to open surgery in the uni-portal VATS group and multi-portal VATS group was 11.8% and 13.5%, respectively. Meanwhile, patients in the uni-portal VATS group had shorter operation time and postoperative hospital stay, less blood loss and lower postoperative complication rate than those in the multi-portal VATS group (P＜0.05). Conclusion In order to improve the rate of diagnosis, the lung enhanced CT scan should be selected as an optimal noninvasive method in adult suspected patients (especially those with solid cystic and solid lesions in the lower lobe). Uni-portal VATS is a safe and feasible method for BPS which can be widely promoted.