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Meta-analysis poses a challenge when original study results have been expressed in a non-uniform manner, such as when regression results from some original studies were based on a log-transformed key independent variable while in others no transformation was used. Methods of re-expressing regression coefficients to generate comparable results across studies regardless of data transformation have recently been developed. We examined the relative bias of three re-expression methods using simulations and 15 real data examples where the independent variable had a skewed distribution. Regression coefficients from models with log-transformed independent variables were re-expressed as though they were based on an untransformed variable. We compared the re-expressed coefficients to those from a model fit to the untransformed variable. In the simulated and real data, all three re-expression methods usually gave biased results, and the skewness of the independent variable predicted the amount of bias. How best to synthesize the results of the log-transformed and absolute exposure evidence streams remains an open question and may depend on the scientific discipline, scale of the outcome, and other considerations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) share similar clinical manifestations, including cardiovascular complications, suggesting similar underlying immunopathogenic processes. Aberrant neutrophil activation may play a crucial role in the shared pathologies of KD and MIS-C; however, the associated pathogenic mechanisms and molecular drivers remain unknown. METHODS: We performed a single-cell meta-analysis of neutrophil activation with 103 pediatric single-cell transcriptomic peripheral blood mononuclear cell data across 9 cohorts, including healthy controls, KD, MIS-C, compared with dengue virus infection, juvenile idiopathic arthritis, and pediatric celiac disease. We used a series of computational analyses to investigate the shared neutrophil transcriptional programs of KD and MIS-C that are linked to systemic damage and cardiac pathologies, and suggested Food and Drug Administration-approved drugs to consider as KD and MIS-C treatment. RESULTS: We meta-analyzed 521 950 high-quality cells. We found that blood signatures associated with risks of cardiovascular events are enriched in neutrophils of KD and MIS-C. We revealed the expansion of CD177+ neutrophils harboring hyperactivated effector functions in both KD and MIS-C, but not in healthy controls or in other viral-, inflammatory-, or immune-related pediatric diseases. KD and MIS-C CD177+ neutrophils had highly similar transcriptomes, marked by conserved signatures and pathways related to molecular damage. We found the induction of a shared neutrophil expression program, potentially regulated by SPI1 (Spi-1 proto-oncogene), which confers enhanced effector functions, especially neutrophil degranulation. CD177 and shared neutrophil expression program expressions were associated with acute stages and attenuated during KD intravenous immunoglobulin treatment and MIS-C recovery. Network analysis identified hub genes that correlated with the high activation of CD177+ neutrophils. Disease-gene association analysis revealed that the KD and MIS-C CD177+ neutrophils' shared expression program was associated with the development of coronary and myocardial disorders. Last, we identified and validated TSPO (translocator protein) and S100A12 (S100 calcium-binding protein A12) as main molecular targets, for which the Food and Drug Administration-approved drugs methotrexate, zaleplon, metronidazole, lorazepam, clonazepam, temazepam, and zolpidem, among others, are primary candidates for drug repurposing. CONCLUSIONS: Our findings indicate that CD177+ neutrophils may exert systemic pathological damage contributing to the shared morbidities in KD and MIS-C. We uncovered potential regulatory drivers of CD177+ neutrophil hyperactivation and pathogenicity that may be targeted as a single therapeutic strategy for either KD or MIS-C. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of laser therapy for managing patients with orofacial pain (OFP). In addition, to determine which parameters provide the best treatment effects to reduce pain, improve function, and quality of life in adults with OFP. Systematic review. Searches were conducted in six databases; no date or language restrictions were applied. Studies involving adults with OFP treated with laser therapy were included. The risk of bias (RoB) was performed with the Revised Cochrane RoB-2. A meta-analysis was structured around the OFP type, and outcomes. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessed the overall certainty of the evidence. Eighty-nine studies were included. Most studies (n = 72, 80.9%) were considered to have a high RoB. The results showed that laser therapy was better than placebo in improving pain, maximal mouth open (MMO), protrusion, and tenderness at the final assessment, but with a low or moderate level of evidence. The best lasers and parameters to reduce pain are diode or gallium–aluminum–arsenide (GaAlAs) lasers, a wavelength of 400–800 or 800–1500 nm, and dosage of <25 J/cm2. Laser therapy was better than placebo to improve pain, MMO, protrusion, and tenderness. Also, it was better than occlusal splint to improve pain, but not better than TENS and medication. Laser therapy was found to be good in improving pain, maximal mouth opening, jaw protrusion, and tenderness at the end of the treatment. For patients with all types of temporomandibular disorders (TMDs) (myogenous, arthrogenous, and mixed), the following lasers and parameters are recommended: diode or gallium–aluminum–arsenide (GaAlAs) laser, wavelength of 400–800 or 800–1500 nm, and a dosage <25 J/cm2. For patients with arthrogenous TMDs, the following lasers and parameters are recommended: Diode laser and a wavelength between 400 and 800 nm. For patients with myogenous TMDs, the following lasers and parameters are recommended: diode laser, wavelength between 800 and 1500 nm, and dosage of <25 J/cm2. For patients with mixed TMDs, the following lasers and parameters are recommended: diode, GaAlAs, or infrared laser, a wavelength of 800–1500 nm, a dosage >100 J/cm2, and an application time between 15 and 30 s or >60 seconds. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical therapists use dry needling (DN) and percutaneous needle electrolysis (PNE) to treat musculoskeletal pain. OBJECTIVE: To investigate the efficacy of PNE vs. DN in the treatment of musculoskeletal pain. METHODS: This systematic review and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, Cochrane Library, SCOPUS, and Google Scholar databases were searched for randomized clinical trials measuring pain intensity in various musculoskeletal syndromes using PNE and DN. Pain outcome measures were the visual analog scale or the numerical pain rating scale. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). Standardized mean differences were calculated using random effects models. RESULTS: The meta-analysis of the six included studies showed that the overall effect of PNE vs. DN for pain reduction was statistically significant at - 0.74 (95% confidence interval [CI], - 1.34 to - 0.14) with a large effect size (SMD = - 0.41; 95% CI, - 0.75 to - 0.08), albeit clinically insignificant in the short, medium, and long term. Risk of bias was generally low with moderate-level evidence due to the overall effect heterogeneity and the small sample. CONCLUSIONS: Moderate-quality evidence showed that PNE is slightly more effective than DN in reducing pain. However, because the results were not clinically significant, we cannot recommend the application of PNE over DN. More high-quality studies comparing the two interventions are needed to draw firm conclusions. [ABSTRACT FROM AUTHOR]

BACKGROUND: The benefits of combining supervised exercise in the non-surgical treatment of lumbar spinal stenosis (LSS) is unclear. OBJECTIVE: To compare the effectiveness of non-surgical treatments with and without supervised exercise for pain intensity, symptom severity, functional impairment/disability, walking distance, and quality of life (QOL) in LSS patients. METHODS: Randomized controlled trials (RCTs) evaluating combinations of supervised exercises were searched using four electronic databases up to August 13, 2020. Meta-analysis was conducted for immediate and long-term results. RESULTS: Three studies were identified, including 244 participants. Immediate-term results showed that leg pain intensity (mean distance [MD]: - 0.94, 95% confidence intervals [95% CI]: - 1.60 to - 0.29, p < 0.01) and symptom severity (MD: - 0.29, 95% CI: - 0.50 to - 0.08, p < 0.01) were lower in the study group than in the control group, and walking distance (MD: 415.83, 95% CI: 298.15 to 533.50, p < 0.001) and QOL were higher in the study group. Long-term results showed that functional disability/impairment (MD: - 0.27, 95% CI: - 0.49 to - 0.04, p < 0.05) was lower in the study group than in the control group, and walking distance and QOL were higher in the study group. CONCLUSION: The number of studies on this topic was small and limited. Combinations of non-surgical treatment and supervised exercise may not provide significant benefits. [ABSTRACT FROM AUTHOR]

Introduction: Community treatment orders (CTOs) enable patients to actively engage in mental health services while being supervised in the community outside the hospital setting. However, the efficacy of CTOs remains controversial in terms of mental health services usage or service contacts, emergency visits, and violence. Methods: The databases PsychlNFO, Embase, and Medline were searched on 11 March 2022 by 2 independent reviewers through the Covidence website (www.covidence.org). Randomised or non- randomised case-control studies and pre-post studies were included if they examine the effect of CTOs on service contacts, emergency visits, and violence in individuals with mental illnesses by comparing with control groups or pre-CTO conditions. Conflicts were resolved by consultation of the third independent reviewer. Results: Sixteen studies provided sufficient data in the target outcome measures and were included in analysis. Variability in the risk of bias was high among studies. Meta-analyses were conducted separately for case-control studies and pre-post studies. For service contacts, a total of 11 studies with 66,192 patients reported changes in the number of service contacts under CTOs. In 6 case-control studies, a small non-significant increase in service contacts was observed in those under CTOs (Hedge's g = 0.241, z = 1.535, p = 0.13). In 5 pre-post studies, a large and significant increase in service contacts was noted after CTOs (Hedge's g = 0.830, z = 5.056, p < 0.001). For emergency visits, a total of 6 studies with 930 patients reported changes in the number of emergency visits under CTOs. In 2 case-control studies, a small non-significant increase in emergency visits was noted in those under CTOs (Hedge's g = -0.196, z = -1.567, p = 0.117). In 4 pre-post studies, a small significant decrease in emergency visits was noted after CTOs (Hedge's g = 0.553, z = 3.101, p = 0.002). For violence, a total of 2 pre-post studies reported a moderate significant reduction in violence after CTOs (Hedge's g = 0.482, z = 5.173, p < 0.001). Conclusion: Case-control studies showed inconclusive evidence, but pre-post studies showed significant effects of CTOs in promoting service contacts and reducing emergency visits and violence. Future studies on cost-effectiveness analysis and qualitative analysis for specific populations with various cultures and backgrounds are warranted. [ABSTRACT FROM AUTHOR]

Background: A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma. Methods: We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30–0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence). Conclusions: The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs. [ABSTRACT FROM AUTHOR]

Background: Outcome reporting bias in individual trials can compromise the validity of pooled estimates within systematic reviews. Recent strategies have attempted to address outcome reporting bias, which favours the full reporting of statistically significant outcomes over non-significant outcomes. We examined whether the association between full outcome reporting and statistical significance in surgical trials has changed from 2009 to 2019. Methods: We systematically searched for 350 surgical randomized controlled trials (RCTs) from 2009 and 350 surgical RCTs from 2019. Outcomes were classified as fully reported, partially reported, qualitatively reported or unreported. For each outcome, a contingency table was populated with full outcome reporting (yes/no) and statistical significance (yes/no). We combined odds ratios in random effects meta-analysis to estimate the association between full outcome reporting and statistical significance in 2009 compared with 2019. Results: Twenty-eight percent of outcomes in 2009 were incompletely reported, compared with 30% in 2019. In 2009, significant outcomes were more likely to be fully reported than non-significant outcomes (OR = 2.4, 95% CI 1.7–3.4, I2 = 35%), but the opposite association was seen in 2019 (OR = 0.51, 95% CI 0.34–0.77, I2 = 43%). RCTs from 2019 were less likely to demonstrate outcome reporting bias favouring significant outcomes (OR = 0.21, 95% CI 0.12–0.35, P < 0.001). Conclusion: Outcome reporting bias favouring the full reporting of significant over nonsignificant outcomes was demonstrated in 2009, but the opposite association was seen in 2019. There remains a high prevalence of incomplete outcome reporting. We recommend ongoing adherence to trial protocol guidelines to improve outcome reporting transparency and completeness. [ABSTRACT FROM AUTHOR]

Objective: Meta-analyses of analgesic medicines for low back pain often rescale measures of pain intensity to use mean difference (MD) instead of standardised mean difference for pooled estimates. Although this improves clinical interpretability, it is not clear whether this method is justified. Our study evaluated the justification for this method.Methods: We identified randomised clinical trials of analgesic medicines for adults with low back pain that used two scales with different ranges to measure the same construct of pain intensity. We transformed all data to a 0-100 scale, then compared between-group estimates across pairs of scales with different ranges.Results: Twelve trials were included. Overall, differences in means between pain intensity measures that were rescaled to a common 0-100 scale appeared to be small and randomly distributed. For one study that measured pain intensity on a 0-100 scale and a 0-10 scale; when rescaled to 0-100, the difference in MD between the scales was 0.8 points out of 100. For three studies that measured pain intensity on a 0-10 scale and 0-3 scale; when rescaled to 0-100, the average difference in MD between the scales was 0.2 points out of 100 (range 5.5 points lower to 2.7 points higher). For two studies that measured pain intensity on a 0-100 scale and a 0-3 scale; when rescaled to 0-100, the average difference in MD between the scales was 0.7 points out of 100 (range 6.2 points lower to 12.1 points higher). Finally, for six studies that measured pain intensity on a 0-100 scale and a 0-4 scale; when rescaled to 0-100, the average difference in MD between the scales was 0.7 points (range 5.4 points lower to 8.3 points higher).Conclusion: Rescaling pain intensity measures may be justified in meta-analyses of analgesic medicines for low back pain. Systematic reviewers may consider this method to improve clinical interpretability and enable more data to be included.Study Registration/data Availability: Open Science Framework (osf.io/8rq7f). [ABSTRACT FROM AUTHOR]

Introduction: Proton pump inhibitors (PPIs) are one of the most prescribed classes of drugs worldwide as a first-line treatment of acid-related disorders. Although adverse effects are rare and rapidly reversible after a short exposure, concerns have been recently raised about a greater toxicity on cardiovascular health after a longer exposure, especially when combined with clopidogrel. We aimed to evaluate the safety of long-term PPI use on cardiovascular health in patients with known atheromatous cardiovascular disease. Methods: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases and grey literature in April 2022. Articles published between 2014 and 2022 were considered relevant if they were designed as randomized controlled trials (RCTs) that included post hoc analyses or prospective observational studies and if they investigated clinical cardiovascular outcomes associated with PPI use for 6 months or more in patients suffering from cardiovascular disease requiring antiplatelet agent therapy and/or coronary angioplasty. Statistical analyses were performed using RevMan 5.4 software (Computer program, the Cochrane Collaboration, 2020, London, UK). The risk of bias was assessed using the Cochrane risk-of-bias tool for the RCTs and the Newcastle–Ottawa scale for the observational studies. Results: A total of 10 full-text articles involving 53,302 patients were included. Substantial heterogeneity was found among the 10 included studies. The primary analysis showed no significant differences between the PPI group and the control group for the risks of major adverse cardiovascular events (MACEs), all-cause death (ACD), or target vessel revascularization (TVR) using a random-effects model (OR 1.15, 95% CI 0.98–1.35, p = 0.08, I2 = 73%; OR 1.24, 95% CI 0.94–1.65, p = 0.13, I2 = 63%; and OR 1.19, 95% CI 0.76–1.87, p = 0.45, I2 = 61%, respectively). The primary analysis yielded similar results for the risks of myocardial infarction (MI), stroke, and cardiovascular death (CVD) using a fixed-effects model (OR 0.98, 95% CI 0.88–1.09, p = 0.66, I2 = 0%; OR 1.02, 95% CI 0.90–1.17, p = 0.73, I2 = 0%; and OR 1.04, 95% CI 0.94–1.16, p = 0.44, I2 = 35%, respectively). Likewise, a subgroup analysis based on eight randomized controlled trials failed to identify any association between PPI use and the risks of MACEs, MI, stroke, TVR, ACD, or CVD using a fixed-effects model (overall pooled OR 1.01, 95% CI 0.96–1.06; p = 0.66; I2 = 0%). The pulled data from the two included observational studies (OS) demonstrated a significantly increased risk of MACEs in the PPI group (OR 1.42, 95% CI [1.29–1.57], p <0.001; I2 = 0%). In another subgroup analysis, no evidence of an increased risk of adverse cardiovascular events in the co-therapy PPI/clopidogrel versus clopidogrel alone groups was found with the exception of the risk of ACD (OR 1.50, 95% CI 1.23–1.82, p = 0.001, I2 = 0%). Nevertheless, after performing a sensitivity analysis reaching heterogeneity I2 = 0%, the co-prescription of PPIs and clopidogrel was at increased risk of MACEs (p < 0.001), CVD (p = 0.008), and TVR (p < 0.001) but remained statistically non-significant for the risk of MI (p = 0.11). Conclusions: The overall results of this meta-analysis showed that long-term PPI use was not associated with an increased risk of adverse cardiovascular events. However, inconsistent results were found for combined PPI/clopidogrel therapy. These results should be considered with caution in light of the significant heterogeneity, the limited number of included studies, and the lack of adjustment for potential confounders. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the short-term efficacy and safety of robotic pancreaticoduodenectomy (RPD) versus traditional laparoscopic pancreaticoduodenectomy (LPD), and to provide a reference for clinical research and practice. Methods Chinese and English databases such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP were searched to include the cohort studies comparing the clinical efficacy of robot-assisted laparoscopy and traditional laparoscopy in pancreaticoduodenectomy. The quality of included articles was evaluated based on Cochrane systematic review, and Stata15.1 software was used to perform a meta-analysis of related outcome measures extracted. Results A total of 12 cohort studies were included, with 1630 patients in total, and there were 683 patients in the RPD group and 947 patients in the LPD group. The meta-analysis showed that there were significant differences between the RPD group and the LPD group in postoperative bleeding rate (odds ratio [OR]=0.66, 95% confidence interval [CI]: 0.48-0.91, P < 0.05), rate of conversion to laparotomy (OR=0.41, 95%CI: 0.30-0.56, P < 0.05), estimated intraoperative blood loss (weighted mean difference [WMD]=-0.77, 95%CI: -1.33 to -0.22, P < 0.05), and length of postoperative hospital stay (WMD=-0.45, 95%CI: -0.80 to -0.11, P < 0.05). Country of publication might be one of the sources of heterogeneity in the incidence rate of postoperative complications between subgroups (P < 0.05). Conclusion Compared with traditional LPD, da Vinci RPD can reduce postoperative bleeding rate, intraoperative blood loss and rate of conversion to laparotomy and shorten postoperative hospital stay, and meanwhile, it does not increase the operation time and the incidence rate of postoperative complications. Both surgical procedures are safe and feasible. [ABSTRACT FROM AUTHOR]

Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure (ACLF) using a network Meta-analysis. Methods PubMed, Embase, the Cochrane library, Clinical Trial, CNKI, SinoMed, and Wanfang Data were searched for randomized controlled trials (RCTs) on different artificial liver support systems in the treatment of ACLF. Literature screening, data extraction, and method ological quality assessment were performed according to inclusion and exclusion criteria, and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis. Results A total of 14 RCTs were included, with 1141 patients in total. The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison (all P > 0.05). The probability ranking diagram showed that plasma exchange (PE) showed the best effect in reducing 30-day mortality rate, followed by extracorporeal liver assist device (ELAD), fractionated plasma separation and adsorption with Prometheus system, molecular adsorbent recirculating system (MARS), Biologic-DT liver dialysis device, and PE+MARS. PE showed the best effect in reducing 90-day mortality rate, followed by Prometheus, ELAD, and MARS. Biologic-DT showed the best effect in improving hepatic encephalopathy, followed by MARS, PE+MARS, and ELAD. Patients undergoing ELAD had the lowest risk of bleeding, and compared with standard medical treatment, Biologic-DT might increase the risk of bleeding [risk ratio=1.9×108, 95% confidence interval: (4.6-6.2)×1027]. Conclusion PE might be the best option for reducing 30- and 90-day mortality rates in ACLF patients. Biologic-DT has a better effect in improving hepatic encephalopathy, but it may increase the risk of bleeding. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of transient elastography (TE) in the staging of hepatic fibrosis in patients with autoimmune liver disease (ALD). Methods PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases were searched for English and Chinese articles on TE in the staging of hepatic fibrosis in ALD published from January 2000 to January 2021. Two reviewers independently performed data extraction for the articles included, and QUADAS2 was used for quality assessment. The bivariate mixed effects model in Stata 15.0 software was used to perform the Meta-analysis. Results A total of 11 articles were included, with 1041 patients in total. In the diagnosis of significant hepatic fibrosis (F≥2), TE had a pooled sensitivity of 0.81 (95% CI: 0.75-0.86), a specificity of 0.87(95%CI 0.79-0.92), and an area under the receiver operating characteristic curve (AUC) of 0.91(95%CI 0.88-0.93); in the diagnosis of advanced hepatic fibrosis (F≥3), TE had a pooled sensitivity of 0.81(95%CI 0.74-0.87), a sensitivity of 0.90(95%CI 0.85-0.93), and an AUC of 0.92(95%CI 0.90-0.94); in the diagnosis of early-stage liver cirrhosis (F4), TE had a pooled sensitivity of 0.87(95%CI 0.74-0.93), a specificity of 0.93(95%CI 0.87-0.97), and an AUC of 0.96(95%CI 0.94-0.97). Conclusion TE has a good diagnostic value in evaluating significant liver fibrosis, advanced liver fibrosis, and early-stage liver cirrhosis in patients with ALD, especially with a relatively high diagnostic accuracy for early-stage liver cirrhosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of albumin-bilirubin (ALBI) grade in evaluating liver function changes and prognosis of hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Methods PubMed, the Cochrane Library, EMbase, Web of Science, OVID, CNKI, Wanfang Data, VIP, and CBM databases were searched for studies on ALBI grade for evaluating liver function changes and prognosis of HCC patients undergoing TACE published up to December 2020. After quality assessment and data extraction, RevMan 5.3 was used to perform a meta-analysis of the studies included. The chi-square test was used to evaluate heterogeneity between studies; hazard ratio (HR)/odds ratio (OR) and corresponding 95% confidence interval (CI) were used to evaluate outcome measures; funnel plots were used to assess publication bias. Results A total of 18 articles were included, with 9940 patients in total. The meta-analysis showed that the HCC patients with higher ALBI grades after TACE had a shorter overall survival time than those with lower ALBI grades (2nd vs 1st: HR=1.48, 95%CI: 1.39-1.57, P < 0.000 01; 3rd vs 1st: HR=2.45, 95%CI: 1.92-3.13, P < 0.000 01; 3rd vs 2nd: HR=1.91, 95%CI: 1.71-2.13, P < 0.000 01). The degree of deterioration of ALBI caused by 2 times of TACE was higher than that caused by 1 time of TACE (OR=1.91, 95%CI: 1.27-2.88, P < 0.05); the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 1 time of TACE (OR=3.21, 95%CI: 1.95-5.28, P < 0.05); the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 2 times of TACE (OR=1.70, 95%CI: 1.07-2.70, P < 0.05). In addition, ALBI grade could predict the onset of acute-on-chronic liver failure (ACLF) after TACE (OR=4.57, 95%CI: 2.76-7.57, P < 0.000 01). Conclusion Repeated TACE treatment can cause continuous deterioration of liver function based on ALBI, and ALBI has an important clinical value in predicting prognosis and the risk of ACLF after TACE. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the difference in recurrence-free survival rate, hepatocellular carcinoma (HCC) recurrence rate, all-cause mortality rate, and liver-related mortality rate between hepatitis C-related HCC patients receiving oral direct-acting antiviral (DAA) and those receiving non-DAA (NDAA) treatment regimen. Methods CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, and Cochrane Library were searched for Cohort studies of DAA in the treatment of hepatitis C-related HCC patients published before December 2020, and quality assessment and meta-analysis were performed. Results A total of 10 cohort studies were included in this study, with 3108 patients in total. The meta-analysis showed that compared with NDAA regimen, DAA treatment significantly increased recurrence-free survival rate (risk ratio [RR]=1.38, 95% confidence interval [CI]: 1.10-1.72, P=0.005) and significantly reduced HCC recurrence rate (RR=0.52, 95%CI: 0.42-0.63, P < 0.000 01), all-cause mortality rate (RR=0.42, 95%CI: 0.32-0.55, P < 0.000 01), and liver-related mortality rate (RR=0.37, 95%CI: 0.18-0.76, P=0.007) in hepatitis C-related HCC patients. Conclusion DAA treatment is beneficial and safe for hepatitis C-related HCC patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and efficacy of re - hepatic resection ( rHR ) versus radiofrequency ablation ( RFA ) in the treatment of recurrent hepatocellular carcinoma ( RH CC) in Asia through a meta - analysis. Methods PubMed, CNKI, and Wanfang Data were searched for related studies published up to June 15, 2020. Two reviewers independently searched for the articles and extracted related data, and Rev Man 5. 4. 1 was used to perform the meta - analysis. Results A total of 2 randomized controlled trials and 18 retrospective cohort studies met the inclusion criteria and involved 2903 patients with RHCC from Asian countries. The mortality rate in the perioperative period was 2% in the rHR group and 0 in the RFA group, and the incidence rate of perioperative complications was 22. 4% in the rHR group and 3. 3% in the RF A group. The 1 -, 3 -, and 5 - year overall survival rates were 92 . 3 %, 66. 3 %, and 51. 1 %, respectively, in the rHR group and 91. 4%, 69 . 2%, and 39. 9%, respectively, in the RFA group. The 1 -, 3 -, and 5 - year disease - free survival rates were 67. 9 %, 48. 3 %, and 34. 4 %, respectively, in the rHR group and 57. 5 %, 27. 9%, and 14. 0%, respectively, in the RF A group. The Meta - analysis showed that there was no significant difference in overall survival rate between the two groups ( hazard ratio [HR] = 0. 89, 95 % confidence interval [Cl] : 0. 77 - 1. 02, P = 0. 10 ), while the rHR group had a significantly higher disease - free survival rate than the RFA group ( HR = 0. 79, 95 % CI : 0. 72 - 0. 87, P < 0. 001 ) . Conclusion Current evidence shows that rHR may help to achieve a higher disease - free survival rate than RF A in the treatment of RHCC, while rHR and RFA have a similar overall survival rate. [ABSTRACT FROM AUTHOR]

Background/Aim. A large number of studies have been conducted on the survival rate of ceramic single tooth restorations, but few studies have discussed the influence of the number of restoration surfaces on their survival rate. This study aimed to evaluate the survival rate of ceramic inlay and onlay restorations in posterior teeth with one-surface or multi-surface after a 10-year follow-up. Methods. PubMed, Web of Science, Cochrane Library, Embase, and Wanfang databases were searched for articles published by July 31, 2016. Randomized controlled trials and non-randomized trials were collected and patients with posterior teeth defect were included. Publication bias and sensitivity analysis were also assessed. Results. Five studies comprising 6,720 cases were included in this meta-analysis. The results indicated that the survival rate of ceramic inlay and onlay restorations with two-surface was significantly higher than that of onesurface restorations (within 10 years) [hazard ratio (HR) = 2.11; 95% confidence interval (CI) = 1.33-3.36, p = 0.002], and the survival rate of three-surface restorations was higher than that of two-surface ones (HR = 2.50; 95% CI = 1.36-4.59, p = 0.003). Conclusion. The current meta-analysis shows that the increase in the ceramic inlay and onlay restoration surfaces increases their survival rate within a 10-year period. [ABSTRACT FROM AUTHOR]

Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using "AMSTAR" and "Systematic Reviews" as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of a SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies. [ABSTRACT FROM AUTHOR]

Objective To systematically review the efficacy and safety of endoscopic papillary large balloon dilation( EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation( ESBD) in the treatment of large common bile duct stones( ≥10 mm). Methods Pubmed, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for related articles published up to March 2020.Two reviewers independently performed article screening, data extraction, and quality assessment, and RevMan 5. 3 software was used for statistical analysis. Results A total of 11 studies( 6 randomized controlled trials and 5 non-randomized controlled trials) were included, with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( odds ratio [OR]= 0. 71,95% confidence interval [CI]: 0. 45-1. 12,P = 0. 14),overall stone clearance rate( OR = 1. 39,95% CI: 0. 65-2. 96,P = 0. 39),rate of use of mechanical lithotripsy( OR =1. 19,95% CI: 0. 75-1. 89,P = 0. 46),and incidence rate of early complications( OR = 1. 10,95% CI: 0. 60-2. 03,P = 0. 75); in the5 non-randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( OR = 0. 64,95% CI: 0. 35-1. 15,P = 0. 13),overall stone clearance rate( OR = 0. 46,95% CI: 0. 19-1. 12,P =0. 09),and incidence rate of early complications( OR = 1. 20,95% CI: 0. 65-2. 21,P = 0. 56),but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group( OR = 1. 96,95% CI: 1. 26-3. 05,P = 0. 003). Conclusion EPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones, while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion. [ABSTRACT FROM AUTHOR]

The number of systematic reviews and meta-analyses submitted to nursing and allied health journals continues to grow. Well-conducted and reported syntheses of research are valuable to advancing science. One of the common critiques identified in these manuscripts involves how the authors addressed heterogeneity among the studies in their meta-analyses. Methodologically inappropriate approaches regarding heterogeneity introduce error and bias into analyses and may lead to incorrect findings and conclusions. This article will discuss some of the approaches to take as well as avoid when addressing heterogeneity in meta-analyses, including suggestions for how to choose a fixed-effect or random-effects meta-analysis model and steps to follow to address heterogeneity in meta-analysis results. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect and safety of second-line drugs in the treatment of adult patients with autoimmune hepatitis( AIH) through a Meta-analysis of related articles. Methods PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,CBM,Wanfang Data,and VIP were searched for the articles on second-line drugs for AIH published up to December 31,2019. The Newcastle-Ottawa Scale( NOS) was used to assess the quality of articles,related data were extracted,and Meta-Analyst software was used to perform the Meta-analysis. Results A total of 22 articles were included,with 636 patients in total. The Meta-analysis showed that mycophenolate mofetil( MMF),tacrolimus( TAC),cyclosporine,and budesonide had a pooled response rate of 56. 1%,76. 0%,62. 7%,and 57. 3%,respectively,and their pooled incidence rates of adverse events were 22. 5%,47. 4%,48. 4%,and 33. 0%,respectively.The patients treated with MMF were divided into groups based on intolerance or no response to the first-line treatment,and a comparative analysis of these groups showed a relative risk of 1. 965( 95% confidence interval: 1. 181-3. 269,I2= 0. 665,P = 0. 014). Conclusion Selection of second-line drugs for adult AIH patients should consider response rate and incidence rate of adverse reactions. Both MMF and tacrolimus are good second-line drugs,and TAC may be a better choice for patients with no response to first-line treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of the artery-first approach versus the traditional approach for pancreaticoduodenectomy.Methods PubMed,Embase,Cochrane Library,Wanfang Data,CNKI,and VIP were searched for randomized controlled trials(RCTs) and non-RCTs on the artery-first approach versus the traditional approach for pancreaticoduodenectomy published from January1,2003 to January 31,2020,and the articles were screened according to inclusion and exclusion criteria.RevMan5.3 software was used to perform the meta-analysis.Mean difference and odds ratio(OR) were used to analyze continuous variables and binary variables,95%confidence interval(CI) was calculated for each variable.The fixed effects model was used for unobserved heterogeneity,and the random effects model was used for significant heterogeneity.Funnel plots were used to evaluate the absence or presence of publication bias.Results A total of 18 articles were included.The results of the meta-analysis showed that compared with pancreaticoduodenectomy with the traditional approach,pancreaticoduodenectomy with the artery-first approach reduced pancreatic fistula(OR=0.68,95% CI:0.48-0.94,P<0.05),delayed gastric emptying after surgery(OR=0.51,95% CI:0.35-0.73,P<0.05),postoperative abdominal infection(OR=0.50,95% CI:0.30-0.84,P<0.05),local recurrence(OR=0.36,95% CI:0.20-0.65,P<0.05),and incidence rate of blood transfusion(OR=0.20,95% CI:0.07-0.59,P<0.05) and increased R0 resection rate(OR=3.04,95% CI:1.86-4.99,P<0.05).Symmetric funnel plots were observed for the incidence rates of pancreatic fistula and delayed gastric emptying after surgery,suggesting that publication bias of the articles included had little influence on the results of this study.Conclusion The artery-first approach is as safe and feasible as the traditional approach for pancreaticoduodenectomy,and the artery-first approach is superior to the traditional approach in reducing some important postoperative complications and increasing R0 resection rate.Therefore,the artery-first approach holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and clinical effect of pancreaticoduodenectomy with total mesopancreas excision(TMpE)versus traditional pancreaticoduodenectomy(PD) in the treatment of pancreatic head carcinoma and periampullary cancer.Methods PubMed,Web of Science,Cochrane Library,CBM,CNKI,Wanfang Data,and VIP were searched for the Chinese and English articles on the clinical effect of TMpE and PD in the treatment of pancreatic head carcinoma and periampullary cancer published from January 2007 to February 2020.Quality assessment was performed for the articles included,and Revman 5.3 software was used to perform the Meta-analysis.Results Five retrospective cohort studies were included after screening,with a total of 358 patients,among whom 188 underwent TMpE and 170 underwent PD.The results of the meta-analysis showed that compared with the PD group,the TMpE group had a significant increase in the incidence rate of pancreatic fistula(odds ratio [OR]=1.69,95% confidence interval [CI]:1.03-2.78,P=0.04),while there was no significant difference in the incidence rate of postoperative complications between the two groups(OR=1.51,95% CI:0.76-2.98,P=0.24).In addition,TMpE improved R0 resection rate(OR=2.89,95% CI:1.30-6.43,P=0.009),number of dissected lymph nodes(mean difference [MD]=5.14,95% CI:4.16-6.13,P<0.001),and 1-year survival rate after surgery(OR=2.60,95% CI:1.45-4.69,P=0.001),without increasing the time of operation(MD=7.74,95% CI:-42.84 to 58.33,P=0.76),intraoperative blood loss(MD=-45.89,95% CI:-198.19 to 106.41,P=0.55),and the length of postoperative hospital stay(MD=-4.62,95% CI:-16.60 to 7.36,P=0.45).Conclusion TMpE is safe and feasible in the treatment of pancreatic head carcinoma and periampullary cancer and has the advantages of high R0 resection rate and 1-year survival rate after surgery,and therefore,it may become a preferred treatment method for pancreatic head carcinoma and periampullary cancer. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect and safety of robot-assisted laparoscopic hepatectomy(RALH) versus open hepatectomy(OH) in the treatment of liver diseases.Methods Web of Science,PubMed,Cochrane Library,Embase,CNKI,CBM,VIP,and Wanfang Data were searched for Chinese and English articles on RALH versus OH in the treatment of liver diseases published up to February 2020.The quality of the articles included was assessed,and RevMan 5.1 was used to perform the meta-analysis.Results Seven studies were included,with a total of 754 patients(328 patients in the RALH group and 426 in the OH group).The meta-analysis showed that compared with the OH group,the RALH group had a significantly longer time of operation(mean difference [MD]=59.41,95% confidence interval [CI]:9.74-109.08,P=0.02),significantly higher blood transfusion rate(relative risk [RR]=2.24,95% CI:1.04-4.82,P=0.04) and rate of hepatic portal occlusion(RR=2.27,95% CI:1.37-3.75,P=0.001),a significantly shorter length of hospital stay(MD=-3.87,95% CI:-5.63 to-2.12,P<0.001),and significantly lower overall incidence rate of postoperative complications(RR=0.58,95% CI:0.41-0.81,P=0.001) and incidence rates of major postoperative complications(RR=0.45,95% CI:0.22-0.91,P=0.03).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Conclusion For hepatectomy,RALF can shorten the length of hospital stay and reduce postoperative complications,creating conditions for minimally invasive hepatectomy and rapid recovery. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of vitamin E in the treatment of nonalcoholic fatty liver disease (NAFLD) in children. Methods PubMed, Web of Science, The Cochran Library, Embase, OVID/NEJM, CNKI, and Wanfang Data were searched for the articles on vitamin E in the treatment of NAFLD in children published up to December 2019. The data of 8 parameters were analyzed, i.e., body mass index (BMI), liver enzymes ［alanine aminotransferase (ALT) and aspartate aminotransferase (AST)］, blood lipid levels ［triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)］, and remission rate of hepatic steatosis. RevMan 5.3 was used to perform a Meta-analysis. Continuous variables were analyzed by standardized mean difference (SMD) and 95% confidence interval (CI), and the changes after intervention were analyzed; categorical variables were analyzed by risk difference (RD) and 95%CI. A fixed effects model was used for homogeneous data, and a random effects model was used for heterogeneous data. Funnel plots were used to evaluate publication bias. Results A total of 599 articles were retrieved, among which 9 were included in the Meta-analysis, with 607 subjects in total. Vitamin E significantly improved the level of ALT (SMD = -0.27, 95%CI: -0.48 to -0.06, P=0.01), but it did not improve the levels of BMI (SMD=-0.09, 95%CI: -0.28 to 0.10, P=0.34), AST (SMD=-0.20, 95%CI: -0.42 to 0.02, P=0.07), TG (SMD=-0.19, 95%CI: -0.51 to 0.12, P=0.22), TCHO (SMD=-0.11, 95%CI: -0.31 to 0.08, P=0.24), HDL (SMD=-0.02, 95%CI: -0.27 to 0.23, P=0.88), LDL (SMD= -0.04, 95%CI: -0.27 to 0.19, P=0.72), and the remission rate of hepatic steatosis (RD=0.06, 95%CI: -0.05 to 0.17, P=0.29). Conclusion Vitamin E can significantly improve the level of ALT in children with NAFLD and can be considered as an adjuvant drug for clinical treatment. [ABSTRACT FROM AUTHOR]

Objective: Clinical guidelines for the treatment of septic shock are based on the studies with the best scientific evidence, which are meta-analyses of clinical trials. However, these meta-analyses may have methodological limitations that prevent their conclusions from being extrapolated to routine clinical practice. Therefore, the objective of this study is to determine the quality of these meta-analyses through a systematic review.Methods: In this systematic review, we searched MEDLINE, Scopus and EMBASE from inception to May 2019. We selected meta-analyses from clinical trials that determined the effectiveness of an intervention in reducing the incidence of mortality in patients with septic shock. All items were extracted from the Overview Quality Assessment Questionnaire (OQAQ), which collects information from both systematic reviews and meta-analyses.Results: A total of 34 studies were included. Most elements of the OQAQ were conducted satisfactorily, although 35.3% of meta-analyses did not use a quality assessment of the studies included in other analyses. In 52.9% of meta-analyses, the quality of the studies was high or very high.Conclusions: The methods used to obtain the results should be taken into account when recommending an intervention to treat septic shock if the evidence comes from a meta-analysis of the analyzed characteristics. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between nonalcoholic fatty liver disease( NAFLD) and epicardial adipose tissue( EAT). Methods Databases including PubMed, Embase, Web of Science, Wanfang Data, and CNKI were searched for the articles on the association of thickness and volume of EAT with NAFLD published up to January 1, 2019. Stata12. 0 was used to calculate standardized mean difference( SMD) and 95% confidence interval( CI); the I2 test was used to evaluate heterogeneity between studies, and sensitivity analysis and subgroup analysis were used to explore the source of heterogeneity. Results A total of 13 articles were included, with 4672 subjects in total( 2586 subjects in the normal control group and 2086 subjects in the NAFLD group). The NAFLD group had a significant increase in EAT compared with the normal control group( SMD = 0. 58, 95% CI: 0. 39-0. 77, P < 0. 001). There were significant differences between the NAFLD group and the normal control group in the thickness and volume of EAT( thickness: SMD = 0. 61, 95% CI:0. 40-0. 83, P < 0. 001; volume: SMD = 0. 47, 95% CI: 0. 17-0. 76, P = 0. 002). As for the Asian population, compared with the normal control group, the NAFLD group had a significant increase in EAT( SMD = 0. 37, 95% CI: 0. 06-0. 68, P = 0. 018); as for the European/American population, compared with the normal control group, the NAFLD group had a significant increase in EAT( SMD = 0. 66, 95% CI: 0. 40-0. 92, P < 0. 001). Compared with the normal control group, the NAFLD patients aged ≥50 years had a significant increase in EAT( SMD = 0. 46, 95% CI: 0. 31-0. 62, P < 0. 001); there was a significant difference in EAT between the NAFLD patients aged < 50 years and the normal control group( SMD = 0. 72, 95% CI: 0. 37-1. 06, P < 0. 001). The NAFLD patients with a body mass index( BMI) of ≥30 kg/m2 had significantly thicker EAT than the normal control group( SMD = 0. 79, 95% CI: 0. 43-1. 15, P < 0. 001); the NAFLD patients with a BMI of < 30 kg/m2 also had significantly thicker EAT than the normal control group( SMD = 0. 42, 95% CI: 0. 21-0. 62, P < 0. 001). Compared with the normal control group, the NAFLD patients undergoing radiological examination had a significant increase in EAT( SMD = 0. 44, 95% CI: 0. 26-0. 63, P < 0. 001); compared with the normal control group, the NAFLD patients undergoing liver biopsy also had a significant increase in EAT( SMD = 1. 05, 95% CI: 0. 82-1. 29, P < 0. 001). Publication bias was assessed by funnel plots( symmetric), Begg’s test( P = 0. 583), and the Egger’s test( P = 0. 126), and the results showed high reliability. Conclusion NAFLD is significantly associated with EAT cardiovascular risk factors, which will help NAFLD patients to establish effective strategies for the prevention and control of cardiovascular events. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the clinical effect of epidermal growth factor receptor( EGFR)-targeted agents in the treatment of advanced pancreatic cancer.Methods EMbase, PubMed, Cochrane Library, Clinical Trials, CNKI, Wanfang Data, and VIP were searched for randomized controlled trials(RCTs) of EGFR-targeted therapies for advanced pancreatic cancer. Eligible RCTs were screened out based on quality and related criteria, and RevMan 5.3 and STATA 12.0 were used to perform the meta-analysis.Results A total of 8 RCTs were included, with 2382 patients in total. The results of the meta-analysis showed that compared with the control group,the experimental group had no increases in overall survival time(hazard ratio [HR] =0.86, 95% confidence interval [CI]: 0.74-1.02,P>0.05) and objective response rate(risk ratio [RR] = 1.00, 95% CI: 0.76-1.32,P>0.05), but had significant increases in progression-free survival time(HR =0.78, 95%CI: 0.62-0.98,P<0.05) and disease control rate(RR = 1.22, 95% CI: 1.04-1.43,P<0.05). The subgroup analysis showed that after the source of heterogeneity was identified and the studies with high heterogeneity were excluded, the experimental group had a significant increase in overall survival time(HR =0.85, 95%CI: 0.77-0.94,P< 0.05), and the patients with rash appeared to be more sensitive to the therapies(HR =0.70, 95%CI: 0.54-0.92,P<0.05).Conclusion For patients with advanced pancreatic cancer, EGFR-targeted therapies can effectively prolong overall survival time and improve quality of life. [ABSTRACT FROM AUTHOR]

Objective To systematically review the clinical of artificial liver support system (ALSS) in the treatment of drug-induced liver failure. Methods PubMed, Embase, The Cochrane Library, CMB, CNKI, and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019, and a statistical analysis was performed. Odds ratio (OR) was the effect size for categorical data, and the difference between groups was the effect size for continuous data. The weighted mean difference (WMD) method was used for the pooled analysis of effect size, and 95% confidence interval (CI) was calculated for each effect size. I2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I2＜50% and P＞0.1, otherwise a random effects model was used. Results A total of 16 articles with 945 patients were included, with 520 patients in the ALSS+routine medical treatment (RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group, the ALSS+RMT group had a significantly lower mortality rate of drug-induced liver failure (OR=0.27, 95%CI: 0.20-0.36, P＜0.001), significant improvements in albumin (Alb) (MD=1.21, 95%CI: 0.18-2.25, P=0.02) and prothrombin activity (PTA) (MD=11.84, 95%CI: 6.34-17.35, P＜0.001), and a significant reduction in total bilirubin (TBil) (MD=-104.97, 95%CI: -163.63 to -46.30, P＜0.001). Further analysis of Alb, TBil, and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb (MD=1.74, 95%CI: 1.20-2.27, P＜0.001) and PTA (MD=4.45, 95%CI: 2.80-6.10, P＜0.001) and significantly reduced TBil (MD=-128.41, 95%CI: -217.22 to -39.59, P=0.005). Conclusion Compared with RMT alone, RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of endoscopic sphincterotomy with balloon dilation(ESBD) versus sphincterotomy(EST) alone in the treatment of large common bile duct stones. Methods Foreign databases(including PubMed, Cochrane Central, and Embase) and Chinese databases(including CNKI and Wanfang Data) were searched for randomized controlled trials(RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8, 2019. Related data were extracted and RevMan5.3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included, with 973 patients in the ESBD group and953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate(odds ratio [OR]= 1.53, 95% confidence interval [CI]: 1.03-2.29, P = 0.04), one-time clearance rate(OR= 1.77, 95% CI: 1.06-2.93, P = 0.03), rate of use of mechanical lithotripsy(OR = 0.40, 95% CI: 0.25-0.63, P<0.000 1), bleeding rate(OR = 0.23, 95% CI: 0.11-0.50, P<0.001), incidence rate of cholangitis(OR = 0.31, 95% CI: 0.12-0.78, P = 0.01), incidence rate of early complications(OR = 0.59, 95% CI: 0.42-0.84, P = 0.003), and time of operation(mean difference =-8.89, 95% CI:-17.56 to-0.22, P = 0.04), while there were no significant differences between the two groups in perforation(OR = 0.27, 95% CI: 0.05-1.30, P = 0.10) and pancreatitis after endoscopy(OR = 1.03, 95% CI: 0.66-1.61, P = 0.91). Conclusion In endoscopic treatment of large common bile duct stones, ESBD has several advantages over EST in stone clearance rate, rate of use of mechanical lithotripsy, bleeding rate, incidence rate of cholangitis, and time of operation. [ABSTRACT FROM AUTHOR]

Objective To investigate the short- and long-term effects of radiofrequency ablation (RA) versus minimally invasive hepatectomy (MIH) in the treatment of small hepatocellular carcinoma (SHCC). Methods PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, Wanfang Data, and VIP were searched for Chinese and English articles on RA versus MIH in the treatment of sHCC published up to August 2019. Quality assessment was performed for the articles included, and RevMan 5.1 was used for analysis. Results A total of 7 studies with 737 patients were included after screening, and there were 393 patients in RA group and 344 patients in MIH group. Compared with the MIH group, the RA group had significantly shorter time of operation (mean difference ［MD］=-206.57, 95% confidence interval ［CI］: -387.28 to -25.86, P=0.03) and length of hospital stay (MD=-4.02, 95%CI: -4.94 to -3.10, P＜0.01), as well as a significantly lower overall incidence rate of postoperative complications (odds ratio ［OR］=0.31, 95%CI: 0.20-0.47, P＜0.01). Compared with the RA group, the MIH group had significantly higher 3-year overall survival rate (OR=0.55, 95%CI: 0.36-0.84, P＜0.01), 1-year disease-free survival rate (OR=0.63, 95%CI: 0.41-0.98, P=0.04), and 3-year disease-free survival rate (OR=0.51, 95%CI: 0.34-0.74, P＜0.01), as well as a significantly lower local recurrence rate after surgery (OR=1.87, 95%CI: 1.31-2.68, P＜0.01). Conclusion In the treatment of sHCC, RA has good short-term effect, good safety, and poor long-term effect, while MIH has good long-term effect and poor short-term effect. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy and safety of Kanglaite injection (KLT) combined with transarterial chemoembolization (TACE) in the treatment of advanced liver cancer through a Meta-analysis. Methods CNKI, Wanfang Data, VIP, CBM, PubMed, Cochrane Library, and Embase were searched for clinical studies on KLT combined with TACE in the treatment of advanced liver cancer published up to October 2019. The patients in the experimental group were given KLT combined with TACE, while those in the control group were given TACE alone. Data extraction and quality assessment were performed for the articles included in the analysis, and RevMan 5.3 was used for Meta-analysis. The chi-square test was used to evaluate heterogeneity between studies; odds ratio (OR) and 95% confidence interval (CI) were used to evaluate outcome measures; funnel plots were used to evaluate publication bias. Results A total of 16 articles which met the inclusion criteria were included, with a total of 1131 patients (558 patients in the experimental group and 573 in the control group). Compared with the control group, the experimental group had significant increases in tumor response rate (OR=2.85, 95%CI: 2.17-3.76, P＜0.001), disease control rate (OR=2.58, 95%CI: 1.57-4.24, P＜0.001), and Karnofsky Performance Scale score for quality of life (OR=3.54, 95%CI: 2.48-5.06, P＜0.001), as well as significant improvements in clinical symptoms (OR=3.71, 95%CI: 1.55-8.89, P=0.003) and alpha-fetoprotein level (OR=2.57, 95%CI: 1.41-4.68, P=0.002). In addition, the experimental group had a significantly lower incidence rate of bone marrow suppression than the control group (leukocyte reduction: OR=0.39, 95%CI: 0.23-0.66, P＜0.001; thrombocytopenia:OR=0.22,95%CI: 0.12-0.42, P＜0.001). Conclusion In the treatment of advanced liver cancer, KLT combined with TACE results in a high response rate and good quality of life and can reduce the incidence rate of toxic and side effects including bone marrow suppression due to chemotherapy. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical effect and safety of high-intensity focused ultrasound(HIFU) combined with gemcitabine in the treatment of advanced pancreatic cancer. Methods SCI,Cochrane Library,Embase,PubMed,Wanfang Data,CNKI,CBM,and VIP were searched for randomized controlled trials(RCTs) of HIFU combined with gemcitabine in the treatment of advanced pancreatic cancer,with the assistance of expanded search,and these RCTs were screened according to the inclusion criteria. Review Manager 5. 3 was used to perform the Meta-analysis. A fixed effects model was used for non-heterogeneous data; heterogeneity was explained by subgroup analysis based on intervention methods,and if it could not be explained by subgroup analysis,a random effects model was used. Relative risk(RR) and 95% confidence interval(CI) were used as evaluation indices,and funnel plots were generated based on the outcome measure involved in the highest number of studies. Results A total of 8 RCTs with 474 patients were included. The patients in the experimental group received gemcitabine-based chemotherapy and HIFU,and those in the control group received gemcitabine-based chemotherapy alone. Compared with the control group,the experimental group had significantly better results in 3-,6-,and 12-month survival rates(3-month: RR = 1. 07,95% CI: 1. 00-1. 14,P < 0. 05; 6-month: RR = 2. 19,95% CI: 1. 75-2. 75,P < 0. 05; 12-month: RR =2. 35,95% CI: 1. 07-5. 14,P < 0. 05),tumor control(RR = 1. 64,95% CI: 1. 21-2. 24,P = 0. 002),and pain control(RR = 3. 15,95% CI: 2. 45-4. 05,P < 0. 05). There were no significant differences between the two groups in the incidence rates of leukopenia(RR =1. 05,95% CI: 0. 85-1. 30,P > 0. 05),gastrointestinal reactions(RR = 0. 89,95% CI: 0. 56-1. 42,P > 0. 05),and liver injury(RR = 1. 29,95% CI: 0. 95-1. 75,P > 0. 05). Since the outcome measure of pain control was involved in the highest number of studies,funnel plots were generated and showed no significant risk of bias. Conclusion Compared with gemcitabine alone,HIFU combined with gemcitabine can increase patients’ survival rate and improve their symptoms,with a similar incidence rate of adverse effects. Further studies are needed for this combined therapy. [ABSTRACT FROM AUTHOR]

Purpose: Postmenopausal women are a unique population with high risk for the degeneration of muscle. The aim of the present meta-analysis was to accurately evaluate the effects of vitamin D on muscular strength in postmenopausal women. Methods: A review was conducted using electronic databases, including PubMed, EMBASE, Ovid Medline, CINAHL complete, and the Cochrane Library from inception through 19 March 2019. Included studies were selected by two independent reviewers. The meta-analysis were performed using Review Manager 5.3 software. Results: A total of nine randomized controlled clinical trials were included in this review. Vitamin D interventions led to no changes in the upper limb muscle strength (mean difference -0.16, 95% CI: -1.09 to 0.77), lower body muscle strength (standard mean difference 0.08, 95% CI: -0.11 to 0.26), and back/hip muscle strength (standard mean difference 0.06, 95% CI: -0.05 to 0.17). Conclusion: Pooled results from eight studies indicated that supplementation of vitamin D did not increase muscle strength in postmenopausal women. Apparently, the present review suggests that supplementation of vitamin D alone had no didn’t show any beneficial effects on muscle strength in postmenopausal women. [ABSTRACT FROM AUTHOR]

Prediction facial features from the skull are recurring theme on the forensic literature. The nose has been investigated since it has a significant role in facial recognition and the literature shows that there is not an universal method for nasal prediction. This study aimed to conduct a systematic review to analyze what are the most consistent techniques of nasal reconstruction. Primary studies describing or validating nasal reconstruction techniques in adults and published in journals of Forensic Sciences were included in this review. Tedeschi‐Oliveira's method positioned nasal tip with acceptable accuracy as Gerasimov's method. The Krogman's and Iscan's technique underestimated nasal projection in North Americans. The Prokopec's and Ubelaker's method obtained accuracy in Caucasoid. George's method presented results similar to reference standard in Caucasoid. In a supplementary way, studies are needed to accurately estimate the nasal width. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the clinical effect and safety of robotic versus laparoscopic splenectomy in the treatment of nontraumatic splenic diseases. MethodsAccording to the inclusion and exclusion criteria, PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, Wanfang Data, and VIP were systematically searched for Chinese and English articles on the comparison of robotic splenectomy and laparoscopic splenectomy in the treatment of nontraumatic splenic diseases published up to March 2019. After quality assessment was performed for the articles included, RevMan 5.0 provided by Cochrane Library was used for analysis. Mean difference (MD) and rate difference (RD) were used as the effect indicators for continuous variables and binary variables, and pooled value and 95% confidence interval (CI) were calculated. ResultsA total of 7 studies with 374 patients were included, with 160 patients in the robotic splenectomy group and 214 in the laparoscopic splenectomy group. The results of the meta-analysis showed that compared with laparoscopic splenectomy, robotic splenectomy had significantly lower intraoperative blood loss (MD=-127.14, 95%CI: -199.87 to 54.42, P＜0.01), rate of conversion to laparotomy (RD=-0.06, 95%CI: -0.11 to 0.01, P=0.02), and rate of postoperative complications (RD=-0.10, 95%CI: -0.20 to 0.01, P=0.04). There were no significant differences in time of operation and length of hospital stay between the two surgical procedures (both P＞0.05). ConclusionBased on current evidence, robotic splenectomy has better clinical effect and safety than laparoscopic splenectomy in some aspects in the treatment of nontraumatic splenic diseases, and more multicenter large-sample randomized controlled trials are needed in the future for verification. [ABSTRACT FROM AUTHOR]

ObjectiveTo systematically review the efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of type 1 hepatorenal syndrome (HRS1). MethodsPubMed, EMBASE, Medline, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for comparative studies on norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of HRS1. Quality assessment was performed for articles. Related indicators were extracted, including hepatorenal syndrome (HRS) reversal rate, mortality rate, incidence of adverse events, mean arterial pressure, and renal function, and Review Manager 5.3 was used for data analysis. The chi-square test was used to determine the heterogeneity between studies. Odds ratio (OR) was used for the analysis of dichotomous variables, weighted mean difference (WMD) was used for the analysis of continuous variables, and 95% confidence interval (CI) was calculated for these two types of variables. ResultsA total of 6 randomized controlled trials which met the inclusion criteria were included, with a total sample size of 298 patients (149 patients in the norepinephrine+albumin group and 149 in the terlipressin+albumin group). The meta-analysis showed that there were no significant differences between the two groups in HRS reversal rate (OR=0.95, 95%CI: 0.6-1.49, P=0.81), mortality rate (OR=0.84, 95%CI: 0.51-1.41, P=0.51), incidence rate of adverse events (OR=042, 95%CI: 0.16-1.07, P=0.07), mean arterial pressure (standardized mean difference=0.05, 95%CI: -0.92 to 1.03, P=092), and renal function. ConclusionNorepinephrine combined with albumin has similar efficacy and safety as terlipressin combined with albumin in the treatment of HRS1, and terlipressin can be replaced by norepinephrine in clinical practice when necessary. [ABSTRACT FROM AUTHOR]

ObjectiveTo systematically evaluate the value of contrast-enhanced endoscopic ultrasonography (CE-EUS) in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer. MethodsCNKI, Wanfang Data, CBM, PubMed, Embase, and the Cochrane Library were searched for Chinese and English articles on the value of CE-EUC in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer published up to December 31, 2018. Secondary screening, scoring, and data extraction were performed, and then Meta-Disc1.4 and stata12.0 software were used for meta-analysis. ResultsA total of 20 articles with 1888 patients were included in this study. The meta-analysis showed that in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer, CE-EUS had a pooled sensitivity of 86% (95% confidence interval ［CI］: 83%-89%), a specificity of 93% (95%CI: 92%-95%), a positive likelihood ratio of 12.01 (95%CI: 9.72-14.85), a negative likelihood ratio of 0.16 (95%CI: 0.10-0.26), a diagnostic odds ratio of 76.12 (95%CI: 54.50-106.31), and an area under the summary receiver operating characteristic curve of 0.965 5. No sources of heterogeneity were found in the threshold effect test, the meta-regression analysis, and the sensitivity analysis. After the four articles causing heterogeneity were excluded, the heterogeneity of all included articles was reduced to an acceptable range, and there were no significant changes in the results of the meta-analysis. ConclusionCE-EUS has a good value in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer, and its application in clinical practice can improve the diagnostic rate of pancreatic cancer. [ABSTRACT FROM AUTHOR]

ObjectiveTo systematically evaluate the value of contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) in the diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). MethodsPubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Data were searched for studies on CECT and/or CEMRI in the diagnosis of residual or recurrent lesion after TACE published up to April 2019. After two reviewers independently performed literature screening, data extraction, and assessment of the risk of bias using the QUADAS-2 tool, Stata 12.0 and RevMan 5.3 were used to analyze pooled sensitivity, specificity, and area under the receiver operator characteristic curve (AUC). ResultsA total of 13 studies on CECT and 13 studies on CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE were included, with 934 lesions from 748 patients and 847 lesions from 557 patients, respectively. High heterogeneity was observed in the 13 studies on CECT in the diagnosis of residual or recurrent HCC lesion after TACE (P=0.001, Q=12.56, I2=84.08%), while no significant heterogeneity was observed in the 13 studies on CEMRI (P=0.473, Q=0.11, I2=0). In the diagnosis of residual or recurrent HCC lesion after TACE, CECT had a sensitivity of 72% (95% confidence interval ［CI］: 66%-78%), a specificity of 99% (95% CI: 93%-100%), and an AUC of 0.87 (95% CI: 0.83-0.89), and CEMRI had a sensitivity of 88% (95% CI: 82%-93%), a specificity of 96% (95% CI: 91%-98%), and an AUC of 0.98 (95% CI: 0.96-0.99). CECT had a significantly lower sensitivity than CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE (Z=2.12, P=0.03). ConclusionIn comparison with CECT, CEMRI has an extremely higher diagnostic efficiency in the diagnosis of residual or recurrent HCC lesion after TACE and is thus an effective method for diagnosis. [ABSTRACT FROM AUTHOR]

Multiple treatment comparison meta-analyses are systematic reviews that allow to make direct or indirect comparisons of different interventions from the data collection results of randomized clinical trials, grouping them in a common outcome or conglomerate which is expressed quantitatively. Other names given are network meta-analyses, or mixed treatment comparison meta-analyses or indirect meta-analyses. The use of the comparison of several treatments allows a greater estimation of the intervention effect. This is a guide for the physician to make more accurate decisions and to apply better care criteria to their patients. This literature review should help the reader to perform an organized and adequate critical reading (according to the JAMA recommendations) of the multiple treatment comparison meta-analyses. The article is addressed to authors and editors, and it contains information on how this type of studies should be interpreted and communicated. [ABSTRACT FROM AUTHOR]

Background/Aim. Reslizumab is humanized monoclonal antibody produced by recombinant DNA technology which binds to circulating interleukin-5 (IL-5) and down-regulates the IL-5 signaling pathway. Reslizumab is indicated for the add-on maintenance treatment of patients 18 years and older with severe eosinophilic asthma phenotype whose symptoms were inadequately controlled with inhaled corticosteroids. The aim of this meta-analysis was to assess the efficacy and safety of reslizumab compared to placebo in patients suffering from inadequately controlled, moderateto-severe asthma with elevated blood eosinophil counts. Methods. Our meta-analysis was based on systematic search of literature and selection of high-quality evidence according to pre-set inclusion and exclusion criteria. The effects of reslizumab and placebo were summarized using Review Manager (RevMan) 5.3.5 and heterogeneity was assessed by the Cochrane Q test and I² values. Several types of bias were assessed and publication bias shown by Funnel plot and Egger's regression. Results. The meta-analysis included 5 randomized, placebo-controlled clinical trials. Reslizumab 3.0 mg/kg produced substantial improvements in forced expiratory volume in 1. second (FEV 1) (mean difference 0.15 [0.10, 0.21]) and in forced vital capacity (FVC) (mean difference 0.21 [0.09, 0.32]) over the 15 or 16-week treatment period, substantial decrease versus placebo in Asthma Control Questionnaire (ACQ) score (mean difference -0.28 [-0.41, -0.16]), and substantial increase vs. placebo from baseline in Asthma Quality of Life Questionnaire (AQLQ) total score (mean difference 0.24 [0.06, 0.43]). Also, reslizumab 3.0 mg/kg caused less adverse events versus placebo (OR 0.67 [0.51, 0.88]), especially asthma worsening (OR 0.53 [0.36, 0.77]) or bronchitis (OR 0.42 [0.24, 0.74]). Conclusion. On the basis of published clinical trials reslizumab could be considered as an effective and safe therapeutic option for severe, poorly controlled eosinophilic asthma for the time being. [ABSTRACT FROM AUTHOR]

Background and Objectives: Increased risk of venous thromboembolism is observed in several autoimmune inflammatory disorders. However, data on bullous pemphigoid, one of the most common autoimmune blistering disorders, is limited. This systematic review and meta-analysis was conducted to summarize all available evidence.Methods: Two investigators independently searched published studies indexed in MEDLINE and EMBASE from inception to July 2016 using the terms for bullous pemphigoid and venous thromboembolism. The inclusion criteria were as follows: (1) cohort or case-control study evaluated the association between bullous pemphigoid and risk of venous thromboembolism, (2) effect estimates were provided as odds ratios, relative risk, hazard ratio, standardized incidence ratio with 95% confidence intervals, and (3) subjects without bullous pemphigoid were used as comparators for cohort studies, while subjects without venous thromboembolism were used as comparators for case-control studies. Point estimates and 95% confidence intervals were extracted from each study and were pooled together using the random-effect model, generic inverse variance method of DerSimonian and Laird. Cochran's Q test and the I2 statistic were used to evaluate the statistical heterogeneity.Results: Two retrospective cohort studies, one prospective cohort study, and one case-control study met the eligibility criteria and were included in the meta-analysis. The pooled odds ratio was 2.69 (95% confidence interval, 1.79-4.05). Statistical heterogeneity was high with I2 of 77%.Limitation: Limited accuracy of diagnosis of primary studies and high between-study heterogeneity.Conclusion: This meta-analysis demonstrated that patients with bullous pemphigoid have a significantly increased risk of venous thromboembolism. [ABSTRACT FROM AUTHOR]

Meta-analyses are becoming increasingly popular, especially in the fields of cardiovascular disease prevention and treatment. They are often considered to be a reliable source of evidence for making healthcare decisions. Unfortunately, problems among meta-analyses such as the misapplication and misinterpretation of statistical methods and tests are long-standing and widespread. The purposes of this statement are to review key steps in the development of a metaanalysis and to provide recommendations that will be useful for carrying out meta-analyses and for readers and journal editors, who must interpret the findings and gauge methodological quality. To make the statement practical and accessible, detailed descriptions of statistical methods have been omitted. Based on a survey of cardiovascular metaanalyses, published literature on methodology, expert consultation, and consensus among the writing group, key recommendations are provided. Recommendations reinforce several current practices, including protocol registration; comprehensive search strategies; methods for data extraction and abstraction; methods for identifying, measuring, and dealing with heterogeneity; and statistical methods for pooling results. Other practices should be discontinued, including the use of levels of evidence and evidence hierarchies to gauge the value and impact of different study designs (including meta-analyses) and the use of structured tools to assess the quality of studies to be included in a metaanalysis. We also recommend choosing a pooling model for conventional meta-analyses (fixed effect or random effects) on the basis of clinical and methodological similarities among studies to be included, rather than the results of a test for statistical heterogeneity. [ABSTRACT FROM AUTHOR]

Clinical trials in head and neck cancer (HNC) face multiple challenges including low global incidence, excessive patient comorbidity rate, high treatment-related toxicity and more recently a changing tumor biology landscape. As clinical trials evolve to address new knowledge about HNC biology, the overall pool of eligible patients for each trial becomes smaller, leading to more accrual challenges. These challenges have led to the formation of the Head and Neck Cancer Intergroup (HNCIG) comprised of large HNC international and national cooperative groups and sites with the goal of facilitating the conduct of high quality clinical trials in a timely manner to improve outcomes in HNC. This article describes the objectives, structure, and activities of the HNCIG. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The diagnostic tests for this disease are few and discordant. The objective was to evaluate the diagnostic validity, performance, and accuracy of culture, nail clipping with Periodic Acid-Schiff -PAS- staining (biopsy), and direct potassium hydroxide (KOH) examination for the study of onychomycosis.Methods: A systematic review was conducted via meta-analysis using 5 databases and 21 search strategies. An ex ante protocol was applied with inclusion and exclusion criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, and the sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios, receiver operating characteristic (ROC) curves, and proportion of correctly diagnosed patients were evaluated with the meta-analysis of studies of evaluations of diagnostic and screening tests (Meta-DiSc) and Epidat using a random effects model.Results: The efficiency or accuracy of the three tests is influenced by the methodological quality of the studies. These values are lower for KOH and culture and higher for biopsy in moderate quality studies.Conclusion: The diagnostic tests evaluated in this meta-analysis independently showed acceptable validity, performance, and efficiency, with nail clipping with PAS staining outperforming the other two tests. [ABSTRACT FROM AUTHOR]

Objective: Mortality is frequently used as an outcome in critical care trials, being a patient-orientated variable and robust against information/selection bias. Mortality frequency, however, should be measured at a defined time point of follow-up. Practice of meta-analysis shows that follow-up times of trials in critical care medicine differ substantially. This may have substantial implications on potential pooling of effect estimates. We aimed to describe the current practice of mortality follow-up time definitions in a representative sample of published critical care randomized controlled trials and to analyze the influence of different follow-up times on subsequently pooled effect estimates.Data Sources: Cochrane CENTRAL, EMBASE, MEDLINE, PASCAL Biomed, and PsycINFO.Study Selection: Databases were searched for critical care randomized controlled trials published after 2000. A random sample of 50% was drawn for further review.Data Extraction: Study characteristics were extracted, as well as the number and time points of mortality ascertainment. Additional data were extracted from Kaplan-Meier plots, as available.Data Synthesis: Meta-regression and multilevel mixed-effects linear regression were used to analyze the influence of follow-up time (independent variable) on deviation of pooled risk ratios from study baseline (dependent variable). From 9,246 retrieved references, we included 106 studies representing 63,713 participants. Among these, 45 studies (43%) reported more than one time point, with 24 different time points at all, only three (28, 30, and 90 d) being reported in more than 10% of studies. Limiting meta-analyses to only one predefined time point would reduce the number of eligible studies by at least 60%. No influence of time points on meta-analytic summary effect estimates was found.Conclusions: In a large sample of critical care randomized controlled trials, numerous different mortality time points are reported. Mortality time points did not influence pooled point estimates of the effects. Consequently, it seems possible to pool effect estimates, which in turn will increase the precision of these effect estimates. [ABSTRACT FROM AUTHOR]

• Light therapy has increasingly been used in the treatment of non-seasonal depression. • The quality of existing systematic review/meta-analy reviews is not satisfactory. • Methodological and evidence quality assessment is performed using professional tools. Light therapy has increasingly been used in relieving non-seasonal depression. We aimed to summarize the evidence and evaluate the methodological quality regarding the effectiveness and safety of light therapy for non-seasonal depression from systematic reviews/meta-analyses (SRs/MAs). In this study, five databases were searched from their inceptions to January 24, 2022. SRs/MAs on light therapy treatment for non-seasonal depression were included. Methodological quality assessment was performed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and evidence quality assessment was performed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Six SRs/MAs on light therapy treatment for non-seasonal depression were included. The AMSTAR-2 showed that the methodological level of five included SRs/MAs were evaluated as critically low quality, and one included SRs/MAs were rated as low quality. According to the evaluation results of GRADE, the quality of evidence was mostly unsatisfactory. The results and descriptions in the included SRs/MAs suggest that light therapy is effective as a non-pharmacological intervention for the treatment of non-seasonal depression. However, the generally unsatisfied evidence quality and methodological quality of the SRs/Mas indicate that these results must be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background: Multiple treatments are frequently available for a given condition, and clinicians and patients need a comprehensive, up-to-date synthesis of evidence for all competing treatments. We aimed to quantify the waste of research related to the failure of systematic reviews to provide a complete and up-to-date evidence synthesis over time.Methods: We performed a series of systematic overviews and networks of randomized trials assessing the gap between evidence covered by systematic reviews and available trials of second-line treatments for advanced non-small cell lung cancer. We searched the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, EMBASE, and other resources sequentially by year from 2009 to March 2, 2015. We sequentially compared the amount of evidence missing from systematic reviews to the randomized evidence available for inclusion each year. We constructed cumulative networks of randomized evidence over time and evaluated the proportion of trials, patients, treatments, and treatment comparisons not covered by systematic reviews on December 31 each year from 2009 to 2015.Results: We identified 77 trials (28,636 patients) assessing 47 treatments with 54 comparisons and 29 systematic reviews (13 published after 2013). From 2009 to 2015, the evidence covered by existing systematic reviews was consistently incomplete: 45 % to 70 % of trials; 30 % to 58 % of patients; 40 % to 66 % of treatments; and 38 % to 71 % of comparisons were missing. In the cumulative networks of randomized evidence, 10 % to 17 % of treatment comparisons were partially covered by systematic reviews and 55 % to 85 % were partially or not covered.Conclusions: We illustrate how systematic reviews of a given condition provide a fragmented, out-of-date panorama of the evidence for all treatments. This waste of research might be reduced by the development of live cumulative network meta-analyses. [ABSTRACT FROM AUTHOR]

Background: As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data.Methods: A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to published data; the resulting potential decision errors are deduced from this estimation. The same method is used to assess the impact of an initial calibration.Results: The posterior distributions are summarized as mean ± sd (credible interval). The fitted model exhibits a modest mean expected error (0.24 ± 0.73 (-1.23 1.59) g/dL) and a large variability (mean absolute expected error 1.18 ± 0.92 (0.05 3.36) g/dL). The initial calibration modifies the bias (-0.20 ± 0.87 (-1.99 1.49) g/dL), but the variability remains almost as large (mean absolute expected error 1.05 ± 0.87 (0.04 3.21) g/dL). This entails a potential decision error ("false positive" or "false negative") for about one patient out of seven.Conclusions: The proposed hierarchical model allows the estimation of the variability from published aggregates, and allows the modeling of the consequences of this variability in terms of decision errors. For the device under assessment, these potential decision errors are clinically problematic. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia is an important cause of mortality and morbidity worldwide. Therefore, our aim was to assess the efficacy and safety of outpatient treatment of community-acquired pneumonia. Methods: We systematically reviewed randomized clinical trials evaluating efficacy and safety of outpatient treatment (OPT) compared with inpatient treatment (IPT) of community-acquired pneumonia in patients without added co-morbidity. Relative Risk (RR) and 95 % confidence interval (95 % CI) were calculated. Results: From 4088 reviewed articles, two articles were included for meta-analysis, including 2324 patients. One study was conducted in adults, and the other was carried out in pediatric patients. Treatment setting was not significantly associated with treatment failure (RR 0.84 [95% CI 0.68, 1.02]). Death occurred in 6 of 2324 with no difference between the two groups (RR 0.56 [95 % CI 0.12-2.61]). Finally, no differences were seen in hospital readmission between groups (RR 0.82 [95 % CI 0.52-1.30]). Conclusion: Evidence shows that treatment setting of communityacquired pneumonia is not statistically associated with treatment failure or mortality. [ABSTRACT FROM AUTHOR]