One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence ...One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence in science. Also for this reason, the quality of the studies included should be accurately evaluated by standardized tools. The overall results of the metaanalysis depend indeed also on a rigorous evaluation of the studies quality. Among all the possible tools for this complex evaluation, the Newcastle Ottawa Scale(NOS) is one of the most used worldwide, above all for observational studies. In this review, we will discuss the strengths and limitation of the NOS, also on the basis of the branch of science in which it has been applied.展开更多
AIM： To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy （PTNB） under Computed tomography （CT） fuoroscopy guidance for lung ground-glass opacity （GGO）.METHODS： We searched for Eng...AIM： To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy （PTNB） under Computed tomography （CT） fuoroscopy guidance for lung ground-glass opacity （GGO）.METHODS： We searched for English- and Chinese-language studies in PubMed, EMBASE, EBSCO, OVID, and CNKI （China National Knowledge Infrastructure） database. Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software. From the pooled data, we calculated sensitivity （Sen）, specificity （Spe）, positive likelihood ratio （＋LR）, negative likelihood ratio （-LR）, and diagnostic odds ratio （DOR）. Summary receiver operating characteristic （SROC） curves were constructed and incidence of complications was recorded.RESULTS： Four documents included in this present meta-analysis met the criteria for analysis. The pooled Sen, Spe, ＋LR, -LR and DOR with 95%CI were 0.91 （0.86-0.95）, 1.0 （0.91-1.0）, 18.64 （4.83-71.93）, 0.11 （0.05-0.26） and 153.17 （30.78-762.33）, respectively. The area under the SROC curve was 0.98. The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%, respectively.CONCLUSION： CT fuoroscopy-guided PTNB, which has an acceptable incidence of complications, can be used as a primary examination method for lung GGO, with moderate sensitivity and specifcity.展开更多
AIM： To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.METHODS： Ovid Medline, CINAHL, Cochrane Data Base of Systematic Reviews, Pubmed, Sco...AIM： To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.METHODS： Ovid Medline, CINAHL, Cochrane Data Base of Systematic Reviews, Pubmed, Scopus, Proquest, Sciencedirect, Wiley Online Library, WanFang Data, Hong Kong Index to Chinese Periodicals, China Journal Net, Chinese Medical Current Contents, Chinese Biomedical Literature Database, China Academic Journals Full-Text database, Taiwan Electronic Periodical Services and HyRead; reference lists of published studies; origi-nal research studies published in English or Chinese examining the association between type and duration of brassiere-wearing and breast cancer risk. Data were abstracted by a frst reviewer and verifed by a second. Study quality was rated according to predefned criteria. “Fair” or “good” quality studies were included. Results were summarised by meta-analysis whenever adequate material was available.RESULTS： Twelve case-control studies were included in the review. Meta-analysis showed brassiere wearing during sleep was associated with a two times ofincreased odds. CONCLUSION： The present review demonstrates insuffcient evidence to establish a positive association between the duration and type of brassiere wearing and breast cancer. Further research is essential; specifcally, a large-scale epidemiological study of a better design is needed to examine the association between various forms of brassiere exposure in detail and breast cancer risk, with adequate control of confounding variables.展开更多
AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion crit...AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion criteria： Surgical correction of ASD using osteotomy; male or female; 〉 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics （demographic, clinical, radiographic, and instrumentation） with different types of MC.RESULTSThe medical records of 94 operations in 88 subjects were analyzed： Female （68%）, mean age 58.6 （SD, 12.7） years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision （ P 〈 0.001）. The following characteristics had significant （ P ≤ 0.05） association with MC： （1） Preoperative： osteoporosis, smoking, previous spinal operation, sagittal vertical axis （SVA） 〉 100 mm, lumbar lordosis （LL） 〈 34°; （2） postoperative： SVA 〉 75 mm; operative correction： SVA 〉 75 mm, LL 〉 30°, thoracic kyphosis 〉 25°, and pelvic tilt 〉 9°; a fall; pseudarthrosis; and （3） device and surgical technique： use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy （PSO vs SPO） if preoperative SVA 〈 100 mm; lumbar osteotomy location; in-situ rod contouring 〉 60°; and fxation to sacrum/pelvis.CONCLUSIONRisk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insuffcient correction of the sagittal imbalance should be avoided.展开更多
AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrenc...AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.展开更多
AIM:To conduct a systematic review and meta-analysis into the efficacy,safety,and dosage regimens of degarelix for treating prostate cancer(PCa). METHODS:Pub Med,EMBASE,the Cochrane Library,and Web of Science was syst...AIM:To conduct a systematic review and meta-analysis into the efficacy,safety,and dosage regimens of degarelix for treating prostate cancer(PCa). METHODS:Pub Med,EMBASE,the Cochrane Library,and Web of Science was systematically searched to identify randomized controlled trials(RCTs) comparing degarelix(240/80 mg vs 240/160 mg) to the gonadotropin-releasing hormone agonists,goserelin and leuprolide,for the treatment of PCa. Two independent reviewers screened putative studies,assessed the risk of bias,and then extracted pertinent data. Analyses were performed using Review Manager 5.2. RESULTS:Seven papers from six RCTs,involving 1204 patients,were identified. The present meta-analysis showed that treatment with 240/160 mg degarelix is more effective and has fewer adverse events(AEs) relative to conventional 240/80 mg regimen. Degarelix significantly decreased International Prostate Symptom Scores [standardized mean differences(SMD) =-0.32,95%CI:-0.51 to-0.12,P = 0.02] and caused fewer AEs(SMD =-0.28,95%CI:-0.48 to-0.07,P = 0.008) than goserelin. Degarelix suppressed testosterone and prostate-specific antigen significantly faster than leuprolide. CONCLUSION:Degarelix is a useful option in the treatment of advanced PCa. Degarelix 240/160 mgregimen was superior to a 240/80 mg regimen. More rigorously designed RCTs are urgently needed to confirm the efficacy of degarelix.展开更多
AIM： To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of bias.METHODS： Epidemiological prospective or case-control studies were identifed which prov...AIM： To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of bias.METHODS： Epidemiological prospective or case-control studies were identifed which provide estimates of relative risk （RR） and 95%CI for never smokers for one or more of seven different indices of exposure to environmental tobacco smoke （ETS）： The spouse; household; workplace; childhood; travel; social and other; and total. A wide range of study details were entered into a database, and the RRs for each study, including descriptions of the comparisons made, were entered into a linked database. RRs were derived where necessary. Results were entered, where available, for all lung cancer, and for squamous cell cancer and adenocarcinoma. “Most adjusted” results were entered based on results available, adjusted for the greatest number of potential confounding variables. “Least adjusted” results were also entered, with a preference for results adjusted at least for age for prospective studies. A pre-planned series of fxed-effects and random-effects meta-analyses were conducted. Overall analyses and analyses by continent were run for each exposure index,with results for spousal smoking given by sex, and results for childhood exposure given by source of ETS exposure. For spousal exposure, more extensive analyses provide results by various aspects of study design and defnition of the RR. For smoking by the husband （or nearest equivalent）, additional analyses were carried out both for overall risk, and for risk per 10 cigarettes per day smoked by the husband. These adjusted for uncontrolled confounding by four factors （fruit, vegetable and dietary fat consumption, and education）, and corrected for misclassification of smoking status of the wife. For the confounding adjustment, estimates for never smoking women were derived from publications on the relationship of the four factors to both lung cancer risk and at home ETS exposure, and on the correlations between the fa展开更多
AIM： To compare the outcomes of endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD） of colorectal lesions.METHODS： An electronic systematic literature search of four computerized databa...AIM： To compare the outcomes of endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD） of colorectal lesions.METHODS： An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate （including bleeding, perforation and surgery post EMR or ESD rate）. Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.RESULTS： Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group （95%CI： 0.17-0.83, P 〈 0.0001, I2 = 99.7%）. Endoscopic clearance rates were also signifcantly higher in the ESD group （95%CI： -0.06-0.02, P 〈 0.0001, I2 = 92.5%）. The perforation rate was 7% higher in the ESD group than the EMR group （95%CI： 0.05-0.09, P 〉 0.05, I2 = 41.1%） and the rate of recurrence was 50% higher in the EMR group than in the ESD group （95%CI： 0.20-0.79, P 〈 0.001, I2 = 99.5%）. Heterogeneity remained consistent when subgroup analysis of high quality studies was performed （with the exception of piecemeal resection rate）, and overall effect sizes remained unchanged for all outcomes.CONCLUSION： ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may beneft from increased assessment through well-designed comparative studies.展开更多
Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently ...Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently voice their frustrations when the media reports a treatment working on one day, but seemingly the next day reports a study refuting the previous one. Meta-analyses are being used more commonly by researchers to convey an understandable summary of scientific studies to the general public and healthcare providers. As time goes by, we have learned how to improve meta-analytic techniques to reflect more valid results and when it is appropriate to pool or not to pool results from different studies. Retrospective reviews often don’t acknowledge this learning curve and may fail to recommend the most current valid guidelines. This editorial presents an example of how the current use of meta-analysis has shifted in one feld （the therapeutic effects of probiotics） and recommendations on how to correctly interpret the results of such an analysis.展开更多
AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHOD...AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHODS We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “cor-onary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies （RCT） and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction （MI） and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our fnal analysis and performed a systematic review.RESULTSTen studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality （RR： 0.755, 95%CI： 0.66 to 0.864, P = 0.765, I2 = 0.0%）, lower rates of MI （RR： 0.759, 95%CI： 0.615 to 0.937, P = 0.091, I2 = 45.1%）, lower rates of MACCE （RR： 0.731, 95%CI： 0.668 to 0.8, P = 0.453, I2 = 0.0%） and reduced rates of repeat coronary revascularization （RR： 0.691, 95%CI： 0.541 to 0.883, P = 0.0, I2 = 88.3%）.CONCLUSIONCR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.展开更多
AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systema...AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systematic Reviews of Interventions. Fifteen English and three Chinese databases were searched from their respective inceptions until July 2014. Key words used in the search consisted of acupuncture, needles, obesity, overweight, randomised trial and their synonyms. The risk of bias of included studies was assessed. The differences in effect size between acupuncture and control （including sham, no treatment, western medicine and dietary therapy/exercise） groups were compared using Cochrane Collaboration’s RevMan5.3 software.RESULTS： Two thousand six hundred and twenty-one records were identifed; after full-text articles assessed for eligibility, 9 of them met inclusion criteria. Majority of included studies had unclear or high risk of bias across all domains. All included studies had high or unclear risk of bias in randomisation, blinding and outcome data. Meta-analysis showed that acupuncture was more effective for reducing body weight and body mass index than no treatment group. Manual acupuncture was also superior to dietary therapy alone for decreasingbody weight. With dietary therapy as co-intervention, combined acupuncture group achieved lower body mass index than combined sham acupuncture group or dietary therapy alone group at the end of treatment period. No severe adverse events from acupuncture group were reported from all included studies.CONCLUSION： Due to the poor quality of included studies the effectiveness of acupuncture cannot be concluded. Better-designed, large-scale, randomised, sham-controlled clinical trials with long-term follow-up are needed.展开更多
文摘One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence in science. Also for this reason, the quality of the studies included should be accurately evaluated by standardized tools. The overall results of the metaanalysis depend indeed also on a rigorous evaluation of the studies quality. Among all the possible tools for this complex evaluation, the Newcastle Ottawa Scale(NOS) is one of the most used worldwide, above all for observational studies. In this review, we will discuss the strengths and limitation of the NOS, also on the basis of the branch of science in which it has been applied.
文摘AIM： To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy （PTNB） under Computed tomography （CT） fuoroscopy guidance for lung ground-glass opacity （GGO）.METHODS： We searched for English- and Chinese-language studies in PubMed, EMBASE, EBSCO, OVID, and CNKI （China National Knowledge Infrastructure） database. Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software. From the pooled data, we calculated sensitivity （Sen）, specificity （Spe）, positive likelihood ratio （＋LR）, negative likelihood ratio （-LR）, and diagnostic odds ratio （DOR）. Summary receiver operating characteristic （SROC） curves were constructed and incidence of complications was recorded.RESULTS： Four documents included in this present meta-analysis met the criteria for analysis. The pooled Sen, Spe, ＋LR, -LR and DOR with 95%CI were 0.91 （0.86-0.95）, 1.0 （0.91-1.0）, 18.64 （4.83-71.93）, 0.11 （0.05-0.26） and 153.17 （30.78-762.33）, respectively. The area under the SROC curve was 0.98. The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%, respectively.CONCLUSION： CT fuoroscopy-guided PTNB, which has an acceptable incidence of complications, can be used as a primary examination method for lung GGO, with moderate sensitivity and specifcity.
文摘AIM： To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.METHODS： Ovid Medline, CINAHL, Cochrane Data Base of Systematic Reviews, Pubmed, Scopus, Proquest, Sciencedirect, Wiley Online Library, WanFang Data, Hong Kong Index to Chinese Periodicals, China Journal Net, Chinese Medical Current Contents, Chinese Biomedical Literature Database, China Academic Journals Full-Text database, Taiwan Electronic Periodical Services and HyRead; reference lists of published studies; origi-nal research studies published in English or Chinese examining the association between type and duration of brassiere-wearing and breast cancer risk. Data were abstracted by a frst reviewer and verifed by a second. Study quality was rated according to predefned criteria. “Fair” or “good” quality studies were included. Results were summarised by meta-analysis whenever adequate material was available.RESULTS： Twelve case-control studies were included in the review. Meta-analysis showed brassiere wearing during sleep was associated with a two times ofincreased odds. CONCLUSION： The present review demonstrates insuffcient evidence to establish a positive association between the duration and type of brassiere wearing and breast cancer. Further research is essential; specifcally, a large-scale epidemiological study of a better design is needed to examine the association between various forms of brassiere exposure in detail and breast cancer risk, with adequate control of confounding variables.
基金Supported by Medicrea(New York,NY 10013,United States)
文摘AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion criteria： Surgical correction of ASD using osteotomy; male or female; 〉 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics （demographic, clinical, radiographic, and instrumentation） with different types of MC.RESULTSThe medical records of 94 operations in 88 subjects were analyzed： Female （68%）, mean age 58.6 （SD, 12.7） years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision （ P 〈 0.001）. The following characteristics had significant （ P ≤ 0.05） association with MC： （1） Preoperative： osteoporosis, smoking, previous spinal operation, sagittal vertical axis （SVA） 〉 100 mm, lumbar lordosis （LL） 〈 34°; （2） postoperative： SVA 〉 75 mm; operative correction： SVA 〉 75 mm, LL 〉 30°, thoracic kyphosis 〉 25°, and pelvic tilt 〉 9°; a fall; pseudarthrosis; and （3） device and surgical technique： use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy （PSO vs SPO） if preoperative SVA 〈 100 mm; lumbar osteotomy location; in-situ rod contouring 〉 60°; and fxation to sacrum/pelvis.CONCLUSIONRisk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insuffcient correction of the sagittal imbalance should be avoided.
文摘AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.
文摘AIM:To conduct a systematic review and meta-analysis into the efficacy,safety,and dosage regimens of degarelix for treating prostate cancer(PCa). METHODS:Pub Med,EMBASE,the Cochrane Library,and Web of Science was systematically searched to identify randomized controlled trials(RCTs) comparing degarelix(240/80 mg vs 240/160 mg) to the gonadotropin-releasing hormone agonists,goserelin and leuprolide,for the treatment of PCa. Two independent reviewers screened putative studies,assessed the risk of bias,and then extracted pertinent data. Analyses were performed using Review Manager 5.2. RESULTS:Seven papers from six RCTs,involving 1204 patients,were identified. The present meta-analysis showed that treatment with 240/160 mg degarelix is more effective and has fewer adverse events(AEs) relative to conventional 240/80 mg regimen. Degarelix significantly decreased International Prostate Symptom Scores [standardized mean differences(SMD) =-0.32,95%CI:-0.51 to-0.12,P = 0.02] and caused fewer AEs(SMD =-0.28,95%CI:-0.48 to-0.07,P = 0.008) than goserelin. Degarelix suppressed testosterone and prostate-specific antigen significantly faster than leuprolide. CONCLUSION:Degarelix is a useful option in the treatment of advanced PCa. Degarelix 240/160 mgregimen was superior to a 240/80 mg regimen. More rigorously designed RCTs are urgently needed to confirm the efficacy of degarelix.
文摘AIM： To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of bias.METHODS： Epidemiological prospective or case-control studies were identifed which provide estimates of relative risk （RR） and 95%CI for never smokers for one or more of seven different indices of exposure to environmental tobacco smoke （ETS）： The spouse; household; workplace; childhood; travel; social and other; and total. A wide range of study details were entered into a database, and the RRs for each study, including descriptions of the comparisons made, were entered into a linked database. RRs were derived where necessary. Results were entered, where available, for all lung cancer, and for squamous cell cancer and adenocarcinoma. “Most adjusted” results were entered based on results available, adjusted for the greatest number of potential confounding variables. “Least adjusted” results were also entered, with a preference for results adjusted at least for age for prospective studies. A pre-planned series of fxed-effects and random-effects meta-analyses were conducted. Overall analyses and analyses by continent were run for each exposure index,with results for spousal smoking given by sex, and results for childhood exposure given by source of ETS exposure. For spousal exposure, more extensive analyses provide results by various aspects of study design and defnition of the RR. For smoking by the husband （or nearest equivalent）, additional analyses were carried out both for overall risk, and for risk per 10 cigarettes per day smoked by the husband. These adjusted for uncontrolled confounding by four factors （fruit, vegetable and dietary fat consumption, and education）, and corrected for misclassification of smoking status of the wife. For the confounding adjustment, estimates for never smoking women were derived from publications on the relationship of the four factors to both lung cancer risk and at home ETS exposure, and on the correlations between the fa
文摘AIM： To compare the outcomes of endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD） of colorectal lesions.METHODS： An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate （including bleeding, perforation and surgery post EMR or ESD rate）. Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.RESULTS： Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group （95%CI： 0.17-0.83, P 〈 0.0001, I2 = 99.7%）. Endoscopic clearance rates were also signifcantly higher in the ESD group （95%CI： -0.06-0.02, P 〈 0.0001, I2 = 92.5%）. The perforation rate was 7% higher in the ESD group than the EMR group （95%CI： 0.05-0.09, P 〉 0.05, I2 = 41.1%） and the rate of recurrence was 50% higher in the EMR group than in the ESD group （95%CI： 0.20-0.79, P 〈 0.001, I2 = 99.5%）. Heterogeneity remained consistent when subgroup analysis of high quality studies was performed （with the exception of piecemeal resection rate）, and overall effect sizes remained unchanged for all outcomes.CONCLUSION： ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may beneft from increased assessment through well-designed comparative studies.
文摘Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently voice their frustrations when the media reports a treatment working on one day, but seemingly the next day reports a study refuting the previous one. Meta-analyses are being used more commonly by researchers to convey an understandable summary of scientific studies to the general public and healthcare providers. As time goes by, we have learned how to improve meta-analytic techniques to reflect more valid results and when it is appropriate to pool or not to pool results from different studies. Retrospective reviews often don’t acknowledge this learning curve and may fail to recommend the most current valid guidelines. This editorial presents an example of how the current use of meta-analysis has shifted in one feld （the therapeutic effects of probiotics） and recommendations on how to correctly interpret the results of such an analysis.
文摘AIM To investigate the infuence of complete and incomplete revascularization （ICR） in patients with multivessel coro-nary artery disease undergoing coronary artery bypass or percutaneous coronary intervention.METHODS We searched PubMed using the keywords “complete revascularization”, “incomplete revascularization”, “cor-onary artery bypass”, and “percutaneous coronary intervention”. We selected randomized controlled studies （RCT） and observational studies only for review. The main outcomes of interest were mortality, myocardial infarction （MI） and repeat revascularization. We identified further studies by hand searching relevant publications and included those that met with the inclusion criteria in our fnal analysis and performed a systematic review.RESULTSTen studies were identified, including 13327 patients of whom, 8053 received complete revascularization and 5274 received ICR. Relative to ICR, CR was associated with lower mortality （RR： 0.755, 95%CI： 0.66 to 0.864, P = 0.765, I2 = 0.0%）, lower rates of MI （RR： 0.759, 95%CI： 0.615 to 0.937, P = 0.091, I2 = 45.1%）, lower rates of MACCE （RR： 0.731, 95%CI： 0.668 to 0.8, P = 0.453, I2 = 0.0%） and reduced rates of repeat coronary revascularization （RR： 0.691, 95%CI： 0.541 to 0.883, P = 0.0, I2 = 88.3%）.CONCLUSIONCR is associated with lower rates of adverse outcomes. CR can be used as a standard in the choice of any particular revascularization strategy.
文摘AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systematic Reviews of Interventions. Fifteen English and three Chinese databases were searched from their respective inceptions until July 2014. Key words used in the search consisted of acupuncture, needles, obesity, overweight, randomised trial and their synonyms. The risk of bias of included studies was assessed. The differences in effect size between acupuncture and control （including sham, no treatment, western medicine and dietary therapy/exercise） groups were compared using Cochrane Collaboration’s RevMan5.3 software.RESULTS： Two thousand six hundred and twenty-one records were identifed; after full-text articles assessed for eligibility, 9 of them met inclusion criteria. Majority of included studies had unclear or high risk of bias across all domains. All included studies had high or unclear risk of bias in randomisation, blinding and outcome data. Meta-analysis showed that acupuncture was more effective for reducing body weight and body mass index than no treatment group. Manual acupuncture was also superior to dietary therapy alone for decreasingbody weight. With dietary therapy as co-intervention, combined acupuncture group achieved lower body mass index than combined sham acupuncture group or dietary therapy alone group at the end of treatment period. No severe adverse events from acupuncture group were reported from all included studies.CONCLUSION： Due to the poor quality of included studies the effectiveness of acupuncture cannot be concluded. Better-designed, large-scale, randomised, sham-controlled clinical trials with long-term follow-up are needed.
