ObjectiveTo explore the clinical applicability and safety of nanocarbon in patients with gastric cancer, and evaluate its application value in radical gastrectomy.MethodsCollectted relevant literatures on radical gastrectomy for nanocarbon scales from the time of construction of the library to February 2019, according to search databases included PubMed, Embase, Cochrane Library, China Journal Full-text Database (CNKI), and Wanfang. The data of lymph node detection, detection time, number of lymph node metastases, and postoperative complications were extracted from the two groups. We systematically evaluated it, and analyzed the two groups by using RevMan 5.3 software.ResultsWe searched 88 articles and selected 10 articles, including 5 randomized controlled trials and 5 case-control studies. There were 784 patients in the nanocarbon group and 695 patients in the non-nanocarbon group. Results of meta analysis on the clinical utility and safety of nanocarbon labeled lymph nodes showed that, the number of lymph node detection, lymph node detection time, and number of lymph node metastases in the nanocarbon group and non-nanocarbon group were statistically significant (P<0.05), they were better in the nanocarbon group. There was no significant difference in postoperative complications between the two groups (P>0.05).ConclusionsNanocarbon has a clear trace effect on lymph nodes of gastric cancer. It can reduce the difficulty of the number of lymph node detection, improve the detection rate of lymph nodes, and avoid blindness during traditional lymph node dissection.
ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.
ObjectiveTo compare the efficacy and safety in the treatment of malignant gastric outlet obstruction between gastrojejunostomy (GJ) and self-expandable metallic stent (SEMS) placement.MethodsThe relevant literatures of efficacy and safety of GJ and SEMS placement in the treatment of malignant gastric outlet obstruction were searched in the PubMed, Embase, Cochrane Library, Web of Science, Clinical Trial, VIP, CNKI, Wanfang Data databases. The data were extracted and evaluated by the RevMan 5.3 software.ResultsA total of 12 articles with 1 505 patients were included, of which 620 underwent the GJ (GJ group) and 885 underwent the SEMS placement (SEMS group); 3 RCTs, 9 non-RCTs. The meta-analysis results showed: the length of hospital stay [MD=5.83, 95%CI (4.24, 7.42), P<0.000 01] and time of postoperative recovery diet [MD=3.41, 95%CI (1.79, 5.03), P<0.000 1] of the SEMS group were significantly shorter than those of the GJ group; Although the incidence of complications of the GJ group was significantly higher than that of the SEMS group [OR=1.85, 95%CI (1.27, 2.70), P=0.001], the technical success rate [OR=2.72, 95%CI (1.13, 6.53), P=0.03] and clinical success rate [OR=1.86, 95%CI (1.35, 2.57), P=0.000 2] were higher and the survival time was longer [MD=38.31, 95%CI (28.98, 47.64), P<0.000 01] of the GJ group as compared with the SEMS group.ConclusionsSEMS placement is more effective in recovering dietary capacity, length of hospital stay, and incidence of complications, while GJ is more effective in survival time, technical success rate, and clinical success rate. In clinical practice, we could choose different surgical method according to patient situation.
ObjectiveTo systematically evaluate effect of metformin on prognosis of colorectal cancer patients with type 2 diabetes mellitus (T2DM).MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wangfang, etc. databases for cohort studies over the past 10 years were systematically searched. The relationship between the metformin and the prognosis in the colorectal cancer patients with T2DM was assessed with RevMan 5.3 software.ResultsA total of 12 articles with 13 694 patients were included in this study, of which 9 069 patients treated by the metformin (metformin group) and 4 625 patients treated by the other antidiabetic agent (control group). The results of meta-analysis showed that the metformin group had higher over survival [HR=0.74, 95%CI (0.66, 0.82), P<0.000 01] and cancer-specific survival [HR=0.77, 95%CI (0.69, 0.86), P<0.000 01] as compared with the control group. The sensitivity analysis of the heterogeneity showed that the research results did not be changed when the study which might cause heterogeneity was excluded. ConclusionMetformin treatment could improve prognosis of colorectal cancer patients with T2DM and improve overall survival and cancer-specific survival.
ObjectiveTo compare the diagnostic accuracy, sampling satisfaction, and safety of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) for thyroid nodules.MethodsThe databases of PubMed, Medline, Web of Science, Cochrane Library, Wanfang, CNKI, and CBM were searched to collect the relevant studies on the diagnostic performance, sampling satisfaction, and safety of ultrasound-guided CNB and FNA for thyroid nodules. Revman 5.3 and Stata 15 software were used for meta-analysis.ResultsA total of 24 studies involving 25 388 patients were included. Meta analysis showed that: compared with CNB, FNA had poor diagnostic accuracy ［OR=0.26, 95%CI (0.15, 0.46), P<0.000 01］, poor sampling satisfaction ［OR=0.20, 95%CI (0.12, 0.33), P<0.000 01］, lower incidence of total complications ［OR=0.28, 95%CI (0.16, 0.50), P<0.000 1］, and lower incidence of bleeding after biopsy ［OR=0.62, 95%CI (0.48, 0.81), P=0.000 3］. However, there was no significant difference in the pain score ［WMD=–0.21, 95%CI (–0.57, 0.15), P=0.26］ between the two groups. Subgroup analysis showed that there was no significant difference in the accuracy of biopsy diagnosis of thyroid nodules with diameter less than 10 mm between the two groups ［OR=0.52, 95%CI (0.15, 1.81), P=0.30］, however, the accuracy of CNB in the diagnosis of thyroid nodules with diameter ≥ 10 mm was still better than FNA ［OR=0.26, 95%CI (0.12, 0.56), P=0.000 5］.ConclusionsCompared with FNA, ultrasound-guided CNB has a certain advantages in sampling satisfaction and the diagnosis accuracy of thyroid nodules with diameter ≥ 10 mm. CNB is better than FNA, but will bring higher risk of complication.
Objective To systematically evaluate the related factors that lead to the underestimation of puncture pathology of ductal carcinoma in situ (DCIS), and to reduce the underestimation rate of puncture pathology of DCIS by controlling related factors. Methods A computer search of PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, and Wanfang databases were conducted to retrieve clinical studies that led to underestimation of puncture pathology for DCIS between the establishment of the database and April 1, 2021. After two researchers independently screened the literatures, extracted the data, and evaluated the risk of bias in the included studies, RevMan 5.4 software was used for meta analysis. Results A total of 24 studies including 8 810 patients were included. Results of meta analysis showed that puncture pathology underestimation rate in patients ≥50 years old was lower than that <50 years old [OR=0.82, 95%CI (0.70, 0.96), P=0.020]. Breast imaging reporting and data system (BI-RADS) of DCIS ≤4A class patients had a lower puncture pathology underestimation rate [OR=0.38, 95%CI (0.21, 0.68), P=0.001]. Human epidermal growth factorreceptor 2 (HER2) negative [OR=1.69, 95%CI (1.12, 2.55), P=0.010], no calcification in the mass [OR=1.55, 95%CI (1.10, 2.18), P=0.010], estrogen receptor (ER) positive [OR=0.73, 95%CI (0.60, 0.89), P=0.001], progesterone receptor (PR) positive [OR=0.62, 95%CI (0.44, 0.86), P=0.004], tumor diameter ≤2 cm [OR=2.98, 95%CI (2.18, 4.09), P<0.001], DCIS patients with low/intermediate nuclear grading [OR=0.58, 95%CI (0.50, 0.68), P<0.001], and untouchable masses [OR=0.48, 95%CI (0.28, 0.82), P=0.008] had lower puncture pathology underestimation rate. Conclusions In patients with DCIS, age≥50 years, BI-RADS≤4A class, mass diameter ≤2 cm, non-palpable mass, low nuclear grade (low grade/medium grade DCIS), ER positive, PR positive, HER2 negative, and no calcification can reduce the underestimation rate of puncture pathology. Due to the limitation of the number and quality of included studies, the above conclusions need to be confirmed by the results of high quality cohort studies with large samples.
Objective To explore the value of procalcitonin (PCT) in differential diagnosis of invasive candidiasis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure and Wanfang Data were searched for articles published from the dates of establishment of databases to January 2021. A prospective and retrospective cohort studies and a case-control studies of PCT in differential diagnosis of invasive candidiasis were collected. RevMan 5.3 software QUADAS-2 risk assessment tool was used to evaluate the quality of the literature. Meta-Disc 1.4 software was used to determine whether the original data had threshold effect and heterogeneity. Stata 14.0 software was used to analyze meta, judge publication bias and draw Deeks diagram. Results A total of 9 articles and 943 patients were included. There were 259 cases in candida group and 684 cases in control group. The study showed that the total sensitivity was 0.86 [95% confidence interval (CI) (0.80, 0.91)], specificity was 0.78 [95%CI (0.70, 0.84)], positive likelihood ratio was 3.92 [95%CI (2.77, 5.55)], negative likelihood ratio was 0.18 [95%CI (0.12, 0.27)], the area under receiver operator characteristic curve was 0.90 [95%CI (0.87, 0.92)], diagnostic odds ratio was 19.75 [95%CI (10.71, 36.43)]. The results of heterogeneity test showed that there was heterogeneity caused by non-threshold effect between studies. The results of subgroup analysis showed that the heterogeneity I2 value of PCT<2 ng/mL subgroup decreased significantly, and the result was more stable, with sensitivity. The results show that sensitivity was 0.86 [95%CI (0.79, 0.91)], specificity was 0.72 [95%CI (0.63, 0.80)], the area under receiver operator characteristic curve was 0.87 [95%CI (0.83, 0.89)]. Conclusions Serum PCT in the differential diagnosis of invasive candidiasis has certain accuracy and negative predictive value. However, PCT is only an auxiliary test. The differential diagnosis of invasive candidiasis should be combined with clinical features and other diagnostic indexes.
ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ObjectiveTo systematically evaluate the effects of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists (VKA) on postoperative anticoagulation in patients undergoing transcatheter aortic valve implantation (TAVI) with combined high-risk atrial fibrillation (AF). MethodsAll clinical research literature on NOAC and VKA in TAVI patients with high-risk AF was collected using computer searches of PubMed, EMbase, The Cochrane Library, CNKI, VIP, and SinoMed. The retrieval schedule was from inception to January 2023. The Newcastle-Ottawa Scale (NOS) was utilized to provide an assessment of the quality of the included literature. Meta-analysis was performed by applying RevMan 5.4 software to the studies that met the quality criteria. ResultsA total of 24 592 patients were incorporated in 7 eligible papers for meta-analysis. Patients with NOAC had a significantly lower risk of all-cause mortality compared with TAVI patients with combined high-risk AF who had VKA [RR=0.74, 95%CI (0.58, 0.94), P=0.01]. During the first year of follow-up, no apparent difference in all-cause mortality was observed between the two groups [RR=0.57, 95%CI (0.17, 1.88), P=0.35]. After a year of following up on patients treated with VKA, all-cause mortality was higher in the group treated with NOAC, and the difference was statistically meaningful [RR=0.73, 95%CI (0.57, 0.95), P=0.02]. Patients in both groups had early stroke [RR=0.50, 95%CI (0.19, 1.28), P=0.15], follow-up stroke [RR=1.04, 95%CI (0.88, 1.22), P=0.64] and bleeding [RR=0.94, 95%CI (0.73, 1.21), P=0.61], severe or life-threatening hemorrhage [RR= 0.80, 95%CI (0.49, 1.31), P=0.38], and acute kidney injury [RR=0.51, 95%CI (0.16, 1.59), P=0.24] were all non-statistically significant differences. ConclusionCompared with the application of VKA, postoperative anticoagulation with NOAC in TAVI patients with combined high-risk AF may reduces all-cause mortality in patients and may yield additional benefit especially in long-term anticoagulation.