ObjectiveTo compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. MethodsA retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. ResultsIncision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood lossof group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14-38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z=0.168, P=0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7±0.3) months in group A and (8.6±0.4) months in group B, showing no significant difference (t=0.591, P=0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found. ConclusionBased on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
Objective To compare the short-term curative results between Nissen, Thal and Toupet fundoplications in treatment of gastroesophageal reflux(GER) and to provide the basis for operative procedure. Methods Thirty-three male Japan rabbits were randomly divided into six groups: group reflux(n=7), transabdominal Heller’s esophagomyotomy (TAHE)；group Nissen(n=7)，TAHE and Nissen fundoplication；group Thal(n=7)，TAHE and Thal fundoplication；group Toupet(n=7)，TAHE and Toupet fundoplication； control group (n=5)，ventrotomy. The anti-reflux efficacy of fundoplication was evaluated by intraesophageal pH monitoring and MGV（maximal gastric volume sustained by lower esophageal sphincter）4 weeks postoperatively. Results ① The total number of reflux episodes and the reflux ratio（0.83±0.41,2.20%±1.12%） of group Nissen were significantly lower than those of group Thal (2.20±0.45, 4.32%±0.82%) and group Toupet (1.80±0.45, 4.20%±0.57%), respectively (Plt;0.05). ② MGV of group Nissen (233.00±9.44)ml was significantly larger than those of group Thal （203.40±11.13）ml and group Toupet（197.60±10.99）ml, respectively (Plt;0.05). ③There were no significant difference in total number of reflux episodes, reflux ratio and MGV between group Thal and group Toupet (Pgt;0.05).Conclusion Nissen fundoplication was better than Thal and Toupet fundoplications,Thal and Toupet fundoplications are similar in short-term curative result.
Objective To evalute the cl inical outcomes of two different surgical treatments for arachnoid cysts in sacral canal. Methods From January 2004 to March 2009, 55 cases of arachnoid cysts in the sacral canal were treated by traditonal simple sacral laminectomies with resection of the cysts (group A, 25 cases) and novel CT-guided percutaneous fibrin glue therapy of arachnoid cysts (group B, 30 cases). Of them, there were 23 males and 32 females, aging 15-66 years with an average of 42.6 years; the duration of symptoms was 6 months to 15 years with an average of 3.5 years. L5-S1 was involved in 22 cases, S1,2 in 25 cases, S2,3 in 12 cases, S2 in 8 cases, and presacral in 2 cases. The size of cysts was 1.5 cm × 1.0 cm to 6.0 cm × 2.8 cm. The MRI examination showed that all patients had cysts in the sacral canal. There were no significant difference (P gt; 0.05) in sex, ages, disease duration and cysts size between two groups. Preoperative data and postoperative lumbosacral pain and function improvement were analyzed and compared between two groups. Results All operations were performed successfully. The operative time, blood loss and hospital ization days of group B were significantly less than those of group A (P lt; 0.01). All 55 cases were followed up from 9 to 61 months (mean 23 months). In group A, postoperative cerebrospinal fluid leakage (25 cases), intracranial infection (2 cases), nerve injury (3 cases), and nerve root irritation (8 cases) occurred; in group B, mild meningitis (3 cases) and low grade fever (5 cases) occurred. Except for nerve injury, other compl ications were cured after symptomatic management. During the follow-up, 2 recurrent cases were found in group A and 1 case in group B. Of them, 2 recurrent cases were treated with CT-guided percutaneous fibrin glue therapy of arachnoid cysts, and cysts disappeared. For two groups, there were significant differences in Oswestry functional disabil ity index and visual analogue scale score between preoperation and postoperation (P lt; 0.01), and in the rate of score improvement between two groups (P lt; 0.01). According to the rating scale, the excellent and good rates of pain improvement were 64% in group A and 100% in group B; the excellent and good rates of function improvement were 24% in group A and 97% in group B. Conclusion CT-guided percutaneous fibrin glue therapy for arachnoid cysts in the sacral canal is a mini-invasive, safe, effective, and economical method, it may be better choices for the treatment of arachnoid cysts in the sacral canal.
ObjectiveTo summarize the current comparison of the efficacy of different treatments for recurrent hepatocellular carcinoma.MethodTo search the literatures about the comparative studies on the efficacy of different treatments for recurrent hepatocellular carcinoma in recent years and analyze them.ResultsIn the treatment of recurrent hepatocellular carcinoma, percutaneous arterial chemoembolization combined with radiofrequency ablation could improve the survival rate and tumor-free survival rate to some extent, compared with the single use of percutaneous arterial chemoembolization. In the short term, there was no difference in efficacy between radiofrequency ablation and surgical resection, but the local recurrence rate of radiofrequency ablation was higher than that of surgical resection group. Salvage liver transplantation offered potential opportunity to reduce the risk of recurrence and tended to improve long-term survival outcomes, but liver sources were scarce and costly. ConclusionsAt present, there is no systematic staging scheme and treatment system for recurrent hepatocellular carcinoma. At the same time, most studies are retrospective, and more prospective studies are needed to further explore the treatment of recurrent hepatocellular carcinoma.
Objective To compare and analyze hospital operation and management models between China and foreign countries, in order to provide reference and guidance for the continuous improvement of hospital management in China. Methods The NVivo software was used to conduct a qualitative comparative analysis of domestic and foreign literature on hospital operation and management models in China National Knowledge Infrastructure, Wanfang, Web of Science, and PubMed until December 2022, and a model for the differences in operation and management between Chinese and foreign hospitals was further constructed. Results Finally, 33 Chinese literature and 21 English literature were selected as the raw materials for NVivo qualitative analysis. A comparative analysis of the operation and management models of Chinese and foreign hospitals from four dimensions: structure, process, results, and continuous improvement showed that there were differences in operation and management systems, talents, processes, finance, refinement, and innovation between Chinese and foreign hospitals. Conclusion Hospital operation and management needs to be deeply integrated with business work, improve the construction of hospital operation and management system, strengthen the competence of operation talents, pay attention to resource cost-benefit analysis, attach importance to the two-way integration of business and finance, optimize the adjustment of operation and management structure, and attach importance to the innovation drive of new technology application, in order to promote the scientific, standardized, refined, and informationalized level of hospital operation and management.
ITC (Indirect Treatment Comparison) software and indirect procedure of Stata software are especially used for indirect comparison nowadays, both of which possess the characteristics of friendly concise interface and support for menu operation. ITC software needs the application of other software to yield effect estimation and its confidence interval of direct comparison firstly; while Stata-indirect procedure can complete direct comparison internally and also operate using commands, which simplifies complicated process of indirect comparison. However, both of them only perform "single-pathway" of data transferring and pooling, which is a common deficiency. From the results, their results are of high-degree similarity.
It is a challenge for clinicians and diagnostic systematic reviewers to determine the best test in clinical diagnosis and screening. Meanwhile, it also becomes the new chance and challenge for diagnostic test meta-analysis. Network meta-analysis has been commonly used in intervention systematic reviews, which can compare the effect size of all available interventions and to choose the best intervention. Network meta-analysis of diagnostic test can be defined as comparing all available diagnostic technologies in the same conditions based on the common reference tests. In order to provide the guide for diagnostic systematic reviewers, we aims to introduce four methods of conducting diagnostic test accuracy network meta-analysis, and to explore two ranking methods of network meta-analysis of diagnostic test accuracy.
ObjectivesTo assess the accuracy of different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CNKI and CBM databases were searched to collect the studies on different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease from inception to May 15th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were synthesized by using MetaDisc 1.4, RevMan 5.3 and Stata 12.0 softwares. The pooled sensitivity (Sen), pooled specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (–LR), pooled diagnostic odds ratio (DOR) and the area under curve (AUC) of the summary receiver-operating characteristic curve (SROC) were used to assess the diagnostic value of different types and magnetic field intensity of cardiac magnetic resonance.ResultsTwenty diagnostic studies were included, which involved 1 357 patients. The results of meta-analysis showed that (1) based on patient: compared with the gold standard, the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.87, 95%CI 0.82 to 0.90), (0.88, 95%CI 0.82 to 0.92), (7.33, 95%CI 4.74 to 11.32), (0.15, 95%CI 0.11 to 0.20), (49.53, 95%CI 27.46 to 89.36), (0.93, 95%CI 0.91 to 0.95), 20.00% and 65.00%, respectively. (2) Based on blood vessels: the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.81, 95%CI 0.76 to 0.85), (0.87, 95%CI 0.81 to 0.91), (6.37, 95%CI 4.37 to 9.30), (0.22, 95%CI 0.17 to 0.27), (29.58, 95%CI 18.53 to 47.22), (0.89, 95%CI 0.86 to 0.92), 20.00% and 61.00%, respectively. (3) Subgroup analysis showed that there was no difference in AUROC of different types of cardiac magnetic resonance, but significant difference was found in AUROC of 1.5T and 3.0T magnetic field intensity.ConclusionsCurrent evidence shows that, compared with gold standard, cardiac magnetic resonance can be regarded as an effective and feasible method for preoperative staging of breast cancer.
Indirect comparison refers to a comparison of different healthcare interventions using data from separate studies, and is often used because of a lack of, or insufficient evidence from head-to-head comparative trials. We aimed to summarize the definition, fundamental theory, type, relevant statistical contents, and to clarify some question on how to use indirect comparison, in order to attract more researchers' attention and promote methodological development of indirect comparison.
To assess long-term outcomes of reoperation for recurrent lumbar disc herniation, and to compare results of different methods. Methods There were 95 patients who had reoperation for recurrent lumbar discherniation between February 1998 to February 2003, among whom a total of 89 (93.7%) were followed up and their primary data were reviewed. There were 76 patients, with the mean age of 42 years (range from 23 to 61), who met the inclusion criteria and were included. Among them, there were 55 males and 21 females. All patients had the history of more than one sciatic nervepain. The mean recurrent time was 69 months(range from 8 to 130 months). There were 48 patients in L4,5 and 28 patients in L5, S1, of whom we chose 30 to undergo larger vertebral plate discectomy (or two-side fenestration) and nucleus pulpose discectomy (group A), 24 to undergo the whole vertebral discectomy (group B) and 22 to undergo the whole vertebral discectomy and 360degrees intervertebral fusion(group C). The patients’ cl inical results in the three groups were compared, and the cl inical curative effects were evaluated by using cl inical functional assessment standard. Results Cl inical outcomes were excellent or good in 80.3% of the patients, including 80.0% of group A, 79.2% of group B and 81.8% of group C. There was no significant difference in each group (P gt; 0.05). These three groups were not different in age, pain-free interval and follow-up duration (P gt; 0.05). The mean intraoperative blood losses in the three groups were (110.7 ± 98.8), (278.7 ± 256.3), (350.7 ± 206.1) mL, respectively. The mean surgery time were (65.9 ± 22.8), (111.6 ± 24.3), (127.3 ± 26.7) minutes, respectively, and the mean hospital ization time were (6.7 ± 1.4), (10.2 ± 1.8), (12.2 ± 2.3) days, respectively. Group A was significantly less than group B or C (P lt; 0.05) and there was no significant difference between group B and C. All the patients were followed up for 36 to 96 months with an average of 86 months, and with (87.6 ± 27.0), (84.5 ± 19.8), (83.6 ± 13.5) months of group A, B and C, respectively. At the endof the follow-up, there were more cases of spinal instabil ity at the same level in group B (19 patients) than in group A (1 patient) or group C (no patient) in X-ray, and the difference was significant (P lt; 0.05). Conclusion Reoperation for recurrent lumbar disc herniation is effective. Larger vertebral plate discectomy or tow-side fenestration is recommended for managing recurrent lumbar disc herniation.