ObjectiveTo investigate the clinical, radiographic characteristics and differential diagnosis of pulmonary Langerhans cell histiocytosis (PLCH) mimicking metastasis of cancer in radiography. MethodsClinical data of 2 patients with PLCH manifesting as metastatic cancer on HRCT and PET/CT were retrospectively analyzed. Patients reported as PLCH on WanFang Database, China Knowledge Resource Integrated Database and Pubmed were reviewed to screen misdiagnosis literature and further analyzed the clinical and radiographic characteristics. ResultsTwo cases both presented with cough and sputum. 18F-FDG PET/CT showed increased 18F-FDG up-take in both nodules in the lungs. One patient presented with multiple nodules, diffuse multiple cystic changes in lungs and osteoclasia in the right 4th rib on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of rib biopsy. The other patient presented with diffuse multiple nodules on HRCT who was diagnosed by a video-assisted thoracoscopic biopsy of lung biopsy. The pathological characteristics of both biopsy specimen demonstrated infiltration by Langerhans cells (LC) and eosinophils. The LC were positive for CD1a. Literature review found seven PLCH cases who were misdignosed as depression, eosinophilic pneumonia, interstitial lung disease involvement of autoimmune disorders and malignant tumor. ConclusionWhen clinician faced with a patient suspected as metastatic cancer by HRCT and PET/CT, it is reasonable to consider PLCH as a differential diagnosis and obtain the pathological information as soon as possible so that better prognosis can be achieved through early intervention.
Objective To evaluate the diagnosis value of temporal Done high-resolution computed tornography (HRCT) in cholesteatoma. Methods There were 30 causes that had received the mastoid surgery because of cholesteatoma. Each patient’s mastoid plain films (Schuller’s and Mayer’s ) and HRCT had been taken and compared with each other and surgical findings and evaluated with health economic evaluation methods. Results The sensitivity rate in diagnosing cholesteatoma with HRCF was much higher than that with mastoid film (Plt;0.005). The more important benefit with HRCT was that it can afford the detail information in ear such as the ossicular chain, facial nerve canal, tympanic sinus, etc. which were basis for otologist in surgery to remove the focus thoroughly and reconstruct the middle ear function at the same time. In the view of health economic evaluation, HRCT is also much better than mastoid X-ray film. Conclusion HRCT should replace masloid Schuller’s and Mayer’s film in diagnosis cholesteatoma and HRCT should use as ordinary examination in chronic otitis media.
Objectives The aim of the review was to assess the effectiveness of anti-reflux therapy for patients with hoarseness, in the absence of other identifiable causes, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. This was assessed by evaluation of prospective randomised controlled studies that were identified by a systematic review of the literature. Both medical and surgical treatments were evaluated. Method The Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1974 to 2005) and conference proceedings were searched with prespecified terms. The date of the last search was September 2005.Randomised controlled trials recruiting patients with hoarseness in the absence of other identifiable causes, such as malignancy, cord palsy or nodules, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. Data collection and analysis?Three reviewers examined the search results and identified studies before deciding which would be included in the review. Results 302 potential studies were identified by the search strategy. No trials were identified which met our inclusion criteria. Six randomised controlled trials were identified in which some, but not all patients presented with hoarseness, and were treated with proton pump inhibition. As we could not determine with certainty whether all these patients had hoarseness among the other laryngeal symptoms, these were excluded. However, these studies suggest a significant placebo response, which is comparable to the benefit derived from anti-reflux therapy in some studies. As no trials met our criteria, we are unable to reach any firm conclusions regarding the effectiveness of anti-reflux treatment for hoarseness. Conclusions There is a need for high quality randomised controlled trials to evaluate the effectiveness of anti-reflux therapy for patients with hoarseness which may be due to laryngopharyngeal and gastro-oesophageal reflux.
ObjectivesTo systematically review the efficacy of Chinese herbal medicine (CHM) combined with chemotherapy for ovarian cancer.MethodsCNKI, VIP, WanFang Data and PubMed databases were searched to collect randomized controlled trials on the CHM combined with chemotherapy for ovarian cancer from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and evaluated the risk bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsThirteen studies were included. Meta-analysis showed that, CHM combined with chemotherapy group was superior to the chemotherapy alone group in effective rate of TCM syndrome (RR=1.72, 95%CI 1.46 to 2.03, P<0.00.000 1), effective rate of tumor change (RR=1.40, 95%CI 1.21 to 1.63,P<0.000 01), physical condition score (MD=9.19, 95%CI 5.89 to 12.48,P<0.000 01), tumor markers (MD=–18.00, 95%CI –20.62 to –1.538,P<0.000 01), leukocyte reduction (RR=0.67, 95%CI 0.58 to 0.77,P<0.000 01), granulocy tedepletion (RR=0.67, 95%CI 0.55 to 0.81,P<0.000 1), thrombocytopenia (RR=0.55, 95%CI 0.45 to 0.69,P<0.000 01), and digestive tract reaction (RR=0.66, 95%CI 0.50 to 0.87,P=0.004).ConclusionsThe current evidence shows that CHM combined with chemotherapy is superior to chemotherapy alone in the treatment of ovarian cancer. Due to limited quality and quantity of included studies, the above conclusions are required to be verified by more high-quality studies.
Objective To assess the efficacy and safety of fibfinogen-depleting agents (snake venom extracts) in the treatment of acute ischemic stroke. Method A systematic review of all the relevant randomized controlled trails (RCTs) was performed. RCTs were identified from the Cochrane Stroke Group’s Specialized Trials Register, additional electronic and handsearching, and personal contract with pharmaceutical companies. We included all completed and unconfounded truly or quasi-randomized trials in patients with ischemic stroke comparing fibrinogen depleting agents for analysis. Results Ten completed and one ongoing RCTs have been identified so far. Up to 1998, only three trials using ancrod (182 patients) met the inclusion criteria. Ancrod was associated with a significant reduction in early deaths (5.6% vs. 16%; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13 to 0.85; 2P=0.02) suggesting that treatment of 100 patients would avoid about 10 early deaths. The frequency of asymptomatic intracranial hemorrhage shown by computed tomography was similar between ancrod-treated and control groups (7.6% vs. 9.6%; OR 0.78; 95%CI 0.26 to 2.33; 2P=0.65). No major intracranial or extracranial hemorrhages or recurrent ischemic strokes occurred in the ancord-allocated patients. There were nonsignificant trends in favor of ancrod in death from any cause (OR 0.57; 95%CI 0.27 to 1.23; 2P=0.15) and death or disability (OR 0.52; 95%CI 0.26 to 1.03; 2P=0.06) at the end of trial follow-up. Up to 2000, other two trials published results. This review will be updated with new trial results soon, which will provide more data. Conclusions There were too few patients and outcome events to draw reliable conclusions from the present data. Although ancrod-like agents appeared promising, their routine use cannot be recommended at the moment. Future trials should test simpler fixed-dose regimens to allow better generalizability.
Objective To assess the efficacy and safety of glimepiride for type 2 diabetes mellitus (T2DM). Methods We searched the literature from PubMed, Ovid (All EBM Reviews), CNKI, Wanfang, VIP, CBM and other databases. Evaluating the quality of the study according to Cochrane systematic reviews, Meta-analysis was performed for the results of homogeneous studies by The Cochrane Collaboration’s software RevMan 5.0, and the heterogeneous data conducted a descriptive qualitative analysis. Results Six RCTs included in the analysis and Meta-analysis was not performed due to the insufficient data (for the median or standard deviation). Six RCTs are multi-center, randomized, double-blind, placebo-controlled trials. The results showed that glimepiride groups to reduce glycosylated hemoglobin, lower fasting and postprandial blood glucose, postprandial plasma insulin enhance the efficacy were statistically significant differences (Plt;0.05) compared to placebo groups. Four studies informed the impact of fasting plasma insulin (FI) and 3 studies showed that the glimepiride groups improving the fasting plasma insulin (FI) were statistically significant differences (Plt;0.05), but 1 study showed the two groups had no significant difference (Pgt;0.05). All studies showed minor adverse reactions of glimepiride. Conclusion Glimepiride can reduce the glycosylated hemoglobin, lower the fasting and postprandial blood glucose, improve fasting and postprandial plasma insulin for type 2 diabetes patients, and have minor adverse reactions. In a word, glimepiride is an effective and security sulfonylureas drug.
ObjectivesTo systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.MethodsA systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.ConclusionsTXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.
ObjectivesTo investigate the status of clinical trial registrations (CTRs), ethical reviews (ERs) and informed consent forms (ICFs) of randomized controlled trials (RCTs), which were published in the top 20 journals included by Chinese Science Citation Database (CSCD), and evaluate the methodological quality of RCTs.MethodsWe selected top 20 high impact factor Chinese medical journals indexed by CSCD, the RCTs published between 2016 and 2017 were searched. The CTR, ER and ICFs for all RCTs were analyzed.ResultsA total of 395 RCTs were included for data analysis. Nineteen RCTs (4.8%) reported the information of registration. For the 4 traditional Chinese medicine journals, only 4 (1.9%) of 207 RCTs reported the registered information. For the 16 western medical journals, only 15 (8%) of 188 RCTs reported the registered information. There were 185 RCTs (46.8%) which reported the information of ethical review. Among them, 66 RCTs (31.9%) were published in traditional Chinese medical journals and 119 RCTs (63.3%) were published in western medical journals. There were 253 RCTs (64.1%) which reported the information of informed consent. Among them, 154 RCTs (74.4%) were published in Chinese medical journals and 199 RCTs (52.7%) were in western medical journals. In terms of methodology, approximately 299 RCTs (75.7%) reported the type of randomization where 60 RCTs (15.2%) reported the information of allocation concealment and 38 RCTs (59.6%) reported blinding.ConclusionsThe proportion of RCTs registration, ethical review and informed consent is still low and the methodological quality of the studies require to be improved. Therefore, it is necessary to strengthen the training of clinical trial methodology.
Objictive To evaluate the efficacy of decompression with and without fusion in the treatment of degenerative lumbar disease. Methods We searched the Cochrane Library (Issue 1, 2006), MEDLINE (1966 to April, 2006), EMBASE (1984 to April, 2006), the China Biological Medicine Database (to Dec., 2005), VIP (1989 to April, 2006) and hand-searched several related journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) involving the comparison of the outcomes between decompression with and without fusion in the treatment of degenerative lumbar disease. The quality of the included trials was assessed. RevMan 4.2.8 software was used for statistical analysis. Results Seven studies involving 412 patients were included. The results of meta-analysis indicated that no statistically significant differences were observed between the two operative procedures in the cumulative clinical outcome (OR1.83, 95%CI 0.92, 3.41), incidence of postoperative leg pain (OR 1.04, 95%CI 0.48, 2.25), incidence of perioperative complications (OR 1.15, 95%CI 0.51, 2.60), incidence of re-operation (OR 0.68, 95%CI 0.30, 1.56) or pre and postoperative pain scores [Pre-op WMD 0.12, 95%CI (-0.44,0.68); Post-op WMD 0.08, 95%CI (-1.08,1.25)]. The only statistical significance was observed in the incidence of postoperative back pain (OR 0.25, 95%CI 0.14, 0.46). Four studies described the length of operation, the intraoperative blood loss, the duration of external fixation postoperative and the total cost in hospital, which revealed that decompression alone was superior to decompression plus fusion. Three studies described the relationships between the clinical outcome and the changes in segmental range of motion/disc height pre- and post-operatively, as well as the flexion-extension radiographs, which revealed that decompression plus fusion was superior to decompression alone. Conclusions There are no significant differences between the two procedures in clinical outcomes, incidences of postoperative leg pain, re-operation and complications. Decompression with fusion leads to fewer patients suffering from postoperative lumbago than that of decompression alone. There is insufficient evidence to demonstrate that the radiographs may predict the clinical outcomes. More high quality, large-scale randomized controlled trials are required.