ObjectiveTo systematically review the risk factors of retreatment pulmonary tuberculosis with unfavorable treatment outcome. MethodsWe electronically searched databases including CNKI, VIP, CBM and WanFang Date from inception to November 15th 2015, to collect studies about the risk factors of retreatment pulmonary tuberculosis patients with unfavorable treatment outcome. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 studies were included. The results of meta-analysis showed that significant association was found between retreatment pulmonary tuberculosis cases with unfavorable treatment outcome and such factors as the standard retreatment regimen (OR=4.98, 95%CI 2.95 to 8.39, P < 0.00001), drug-resistance (OR=4.22, 95%CI 1.85 to 9.63, P=0.0006), multi-drug resistance (OR=7.19, 95%CI 2.51 to 20.58, P=0.0002), status of cavitas (OR=1.80, 95%CI 1.20 to 2.71, P=0.005), TB-diabetes mellitus (OR=2.05, 95%CI 1.30 to 3.22, P=0.002) and high sputum smear load >2+(OR=2.07, 95%CI 1.30 to 3.29, P=0.002) in univariate-analysis, respectively. But, in multivariate-analysis, only TB-diabetes mellitus (OR=3.38, 95%CI 1.56 to 7.29, P=0.002) showed significant association with retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. ConclusionCurrent evidence shows that TB-diabetes mellitus, standard retreatment regimen, drug-resistance, multi-drug resistance, status of cavitas and high sputum smear load >2+ are considered to be the risk factors for retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. Especially, for patients with diabetes, the importance of management need to be reinforced to reduce the failure rate in the retreatment of pulmonary tuberculosis. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To analyze pathologic features and surgical procedures for patients with unroofed coronary sinus syndrome (UCSS) associated with endocardial cushion defect (ECD). Methods The clinical data of 44 patients with UCSS and ECD from May 1998 to July 2016 were retrospectively reviewed. There were 18 males and 26 females with a mean age of 10.4±12.1 years (range: 5.0 months to 44.0 years) and mean weight of 25.2±20.9 kg (range 5.2-80.0 kg). According to the Kirklin and Barratt-Boyes classification, 28 patients were categorized into type Ⅰ, 5 typeⅡ , 4 type Ⅲ and 7 type Ⅳ. Among them 25 patients suffered partial ECD, 10 complete ECD, 9 transitional ECD, and 27 were associated with single atrium, 34 involved persistent left superior vena cava (PLSVC), and in 27 of the 34 patients PLSVC directly drained into the left atrium (LA). Among the 44 patients, 1 patient associated with complex anomalies underwent palliative operation, and other cardiac malformations were corrected simultaneously by surgical correction. PLSVC was ligated in 2 patients, and the intracardiac tunnels or baffles to drain PLSVC to right atrium (RA) were reconstructed in 25 patients. The associated cardiac lesions were corrected concomitantly. Results In-hospital death occurred in 2 patients, among whom 1 died of low cardiac output syndrome on postoperative day 8 and the other pulmonary infection on postoperative day 21. Thirty-one were followed up from 1 month to 10 years, and there was no death or severe complications. Conclusion When ECD is associated with PLSVC and a single atrium, UCSS may develop. Repair according to the type of UCSS is effective.
Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.
The study aims to investigate whether there is difference in pre-treatment white matter parameters in treatment-resistant and treatment-responsive schizophrenia. Diffusion tensor imaging (DTI) was acquired from 60 first-episode drug-naïve schizophrenia (39 treatment-responsive and 21 treatment-resistant schizophrenia patients) and 69 age- and gender-matched healthy controls. Imaging data was preprocessed via FSL software, then diffusion parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were extracted. Besides, structural network matrix was constructed based on deterministic fiber tracking. The differences of diffusion parameters and topology attributes between three groups were analyzed using analysis of variance (ANOVA). Compared with healthy controls, treatment-responsive schizophrenia showed altered white matter mainly in anterior thalamus radiation, splenium of corpus callosum, cingulum bundle as well as superior longitudinal fasciculus. While treatment-resistant schizophrenia patients showed white matter abnormalities in anterior thalamus radiation, cingulum bundle, fornix and pontine crossing tract relative to healthy controls. Treatment-resistant schizophrenia showed more severe white matter abnormalities in anterior thalamus radiation compared with treatment-responsive patients. There was no significant difference in white matter network topological attributes among the three groups. The performance of support vector machine (SVM) showed accuracy of 63.37% in separating the two patient subgroups (P = 0.04). In this study, we showed different patterns of white matter alterations in treatment-responsive and treatment-resistant schizophrenia compared with healthy controls before treatment, which may help guiding patient identification, targeted treatment and prognosis improvement at baseline drug-naïve state.
ObjectiveTo systematically review the unfavorable treatment outcome of multidrug-resistant tuberculosis in China. MethodsCNKI, WanFang Data, CBM, PubMed, EMbase, and Web of Science databases were electronically searched to collect studies that reported unfavorable treatment outcomes of multidrug-resistant tuberculosis in China from inception to April 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software. ResultsA total of 11 studies involving 4 465 patients were included. The results of meta-analysis showed that the overall rate of treatment success was 62% (95%CI 55% to 70%), the rate of treatment failure was 19% (95%CI 12% to 26%), the rate of default was 7% (95%CI 4% to 10%), the rate of mortality was 6% (95%CI 4% to 8%) and the rate of unfavorable treatment outcome was 25% (95%CI 19% to 32%). ConclusionsCurrent evidence shows that the treatment failure rate of multidrug-resistant tuberculosis in China is slightly high. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.