Objective To evaluate the efficacy and safety of whole lung lavage in the treatment of pulmonary alveolar proteinosis ( PAP) .Methods Twelve patients who were diagnosed as PAP from September 2008 to October 2011 in Hunan Occupational Disease Hospital were recruited in the study. The changes of dyspnea symptom, lung-function, arterial blood gas, and chest image were compared before and after whole lung lavage treatment. Meanwhile, the safety of lung lavage was evaluated. Results All patients were relieved from dyspnea. The lung function, hypoxia, hyperventilation, and chest image were all obviously improved. The vital signs in the process of lung lavage were stable without serious complications. Conclusion Whole lung lavage is an effective and safe treatment for PAP.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo systematically review the efficacy and safety of vaccines for the coronavirus disease 2019 (COVID-19) . Methods The CNKI, VIP, WanFang Data, PubMed, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) on the safety and efficacy of COVID-19 vaccines from their inception to June 30th, 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software and Stata 12.0 software. Results A total of 13 RCTs involving 139 015 subjects were included. The results of meta-analysis showed that the sero-antibody conversion rate (RR=37.883, 95%CI 8.086 to 177.491, P<0.001) and infection prevention rate (RR=1.011, 95%CI 1.006 to 1.017, P<0.001) of the vaccine group were higher than those of the placebo group. The incidence of adverse reactions in the vaccine group was higher than that in the placebo group (OR=1.839, 95%CI 1.165 to 2.903, P=0.009), which mainly included pain, redness, swelling, fever, headache and itching (P<0.05). However, the incidence of serious adverse reactions was not significantly different from that of the placebo group. Conclusion The current evidence shows that the efficacy of the COVID-19 vaccines is high. The most prevalent adverse reactions are mild and moderate, and severe adverse reactions are the same as those of the placebo group. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To compare the clinical effects of one-stage anastomosis on patients with middle and lower rectum carcinoma and intestinal obstruction and the ones without intestinal obstruction, and to evaluate the safety and feasibility of patients with middle and lower rectum carcinoma and intestinal obstruction undergoing one-stage anastomosis. Methods The data of patients diagnosed definitely by pathology as middle and lower rectum carcinoma underwent one-stage anastomosis in West China Hospital of Sichuan University between January 2007 and December 2008 was retrospectively analyzed. The clinical effects were compared between intestinal obstruction group and non-intestinal obstruction group. Results During this period, 525 patients were included into intestinal obstruction group (n=87) and non-intestinal obstruction group (n=438). Among the patients included, there were 307 males and 218 females. Ages were from 25 to 85 years, and the average age was 60 years old. According to tumor histology, there were 487 cases of adenocarcinoma, 29 of mucinous adenocarcinoma and 9 of other types. According to the degree of tumor differentiation, there were 140 cases of low differentiation, 372 of middle differentiation and 13 of high differentiation. According to TNM stage, there were 4 cases of stage 0, 93 of stageⅠ, 189 of stage Ⅱ, 202 of stage Ⅲ and 37 of stage Ⅳ. Constituent ratio of gender, distributions of distances from tumor to anus, TNM stages and differentiation degrees of tumor were significantly different between intestinal obstruction group and non-intestinal obstruction group (Plt;0.05); and there was no statistical difference in the age, pathological types， significant internal medical complications and operative types between the two groups (Pgt;0.05). There was no statistical diffe rence in operative duration and intraoperative blood loss between the two groups (Pgt;0.05). There was no statistical difference in postoperative time of first defecation, first out-of-bed activity and first oral feeding, and postoperative hospital stay between the two groups (Pgt;0.05); while time of first aerofluxus was earlier in intestinal obstruction group than that in non-intestinal obstruction group (Plt;0.05). There was no statistical significance in the disease incidence of postoperative complications between the two groups (Pgt;0.05). Conclusions Comparing with patients with non-intestinal obstruction, there is no significant evidence shows that one-stage anastomosis will affect the rehabilitation and increase the risk of complications in patients with middle and lower rectum carcinoma and intestinal obstruction. It is considered that it would be safe and feasible for patients with middle and lower rectum carcinoma and intestinal obstruction to have one-stage anastomosis; however, it is necessary for us to have more researches to evaluate the long-term clinical effect.
Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors. Methods A retrospective investigation of patients with CT-guided percutaneous lung biopsy in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patients’demographics, lung lesions, biopsy procedures, and individual radiological features. Results 281 biopsy procedures were enrolled. The total complication rate was 55. 9% with pneumothorax 32. 4% ( 91/281) , hemoptysis 34. 5% ( 97 /281) , and cutaneous emphysema2. 1% ( 6 /281) , and with no mortality.The pneumothorax rate was correlated with lesion location, lesion depth, and number of pleural passes. The bleeding risk was correlated with lesion size, lesion depth, and age. Prediction models for pneumothorax and bleeding were deduced by logistic regression. The pneumothorax model had a sensitivity of 80. 0% and a specificity of 62. 4% . And the bleeding model had a sensitivity of 67. 4% and a specificity of 88. 8% .Conclusions Lesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factors for bleeding. The prediction models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure. Methods The Cochrane Library, Web of Science, PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 16 randomized controlled trials, including 15 312 patients, involving 5 interventions, namely dapagliflozin, empagliflozin, canagliflozin, sotagliflozin and ertugliflozin were included. Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death, hospitalization for heart failure, all-cause mortality, risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors (P>0.05). Compared with placebo, both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure, hospitalization for heart failure, or compound cardiovascular mortality (P<0.05), while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality, all-cause mortality, and serious adverse events (P<0.05). However, there was no significant difference between them (P>0.05). The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second, except for the combined outcome of heart failure or cardiovascular death. Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure, and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis.MethodsPubMed, EMbase, The Cochrane Library, VIP, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis from inception to June 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 970 patients were included. The results of meta-analysis showed that: there was no statistical difference between iguratimod and methotrexate in ACR20 (RR=1.06, 95%CI 0.91 to 1.23, P=0.49), ACR50 (RR=0.93, 95%CI 0.73 to 1.19, P=0.55), ACR70 (RR=0.92, 95%CI 0.62 to 1.39, P=0.70), morning stiffness time (MD=0.45, 95%CI –0.26 to 1.16, P=0.22), tender joint count (MD=0.07, 95%CI –2.31 to 2.45, P=0.95), swollen joint count (MD=–0.30, 95%CI –1.44 to 0.84, P=0.61), health assessment questionnaire (MD=0.01, 95%CI –0.05 to 0.07, P=0.73) and the rate of adverse effects (RR=0.66, 95%CI 0.41 to 1.07, P=0.09). Meta-analysis of 2 RCTs using double-blind method showed that, iguratimod was superior to methotrexat in the patient (MD=4.11, 95%CI 0.11 to 8.10, P=0.04) and physician (MD=4.81, 95%CI 0.93 to 8.69, P=0.01) global assessment of disease activities.ConclusionsCurrent evidence shows that the efficacy and safety of iguratimod in the treatment of rheumatoid arthritis are similar to methotrexate. And iguratimod is superior in global assessment of disease activities by patients and doctors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
ObjectiveTo investigate the efficacy and safety of recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) for treatment of active rheumatoid arthritis (RA). MethodsThis study included 86 patients with active rheumatoid arthritis treated between September 2011 and January 2013. They were divided into two groups randomly. Forty-three patients in the treatment group received rhTNFR:Fc (25 mg, twice a week) by subcutaneous injection and methotrexate (MTX) (10 mg, orally once a week), and the other 43 patients in the contrast group received MTX (10 mg, orally once a week), hydroxychloroquine (100 mg, orally twice daily), and leflunomide (10 mg, orally once daily). The clinical efficacy of the treatments 12 weeks later were compared between the two groups. American College of Rheumatology (ACR) 20, 50, and 70 evaluation criteria were used for efficacy evaluation. ResultsThe ACR 20, 50 and 70 effective rates in 4, 8 and 12 weeks after the treatment in the treatment group were significantly higher than those in the control group (P<0.05). The seven indicators including the duration of morning stiffness, joint tenderness index, joint swelling index, erythrocyte sedimentation rate, C-reactive protein, platelets and rheumatoid factors within 12 weeks after treatment were significantly improved in both the two groups, and the improvements in the treatment group were more significant (P<0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (P>0.05). ConclusionRhTNFR:Fc is effecive and safe in treating active RA.