ObjectiveTo systematically review the postoperative complications between robotic-assisted surgery (RAS) and laparoscopic-assisted surgery (LAS) in children with hirschsprung's disease (HSCR). MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang Data databases were electronically searched to collect non-randomized controlled studies related to the objective from inception to May 10, 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 7 studies involving 901 children were included. The results of meta-analysis showed that the RAS group had a lower incidence of postoperative enterocolitis than the LAS group (OR=0.64, 95%CI 0.42 to 0.98, P=0.04) and a higher rate of complication-free outcomes (OR=2.16, 95%CI 1.26 to 3.72, P<0.01). No statistically significant differences were found between the two groups in intraoperative duration, intraoperative blood loss, postoperative anastomotic complications, fecal soiling, adhesive intestinal obstruction, wound infection, incisional hernia, perianal infection, or urinary retention (P>0.05). ConclusionCurrent evidence shows that RAS significantly reduces the risk of postoperative enterocolitis and improves the rate of complication-free outcomes in children with HSCR but offers no advantages in intraoperative indicators or other complications. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically evaluate the value of CXC chemokine ligand 9 (CXCL9) in the diagnosis of tuberculosis. Methods Literature on the diagnosis of tuberculosis by plasma CXCL9 were collected by searching PubMed, EBSCO, China National Knowledge Infrastructure and Wanfang databases form establishment to September 2022, and then literature screening, data extraction and quality assessment were performed independently by two researchers. Meta-analysis was performed using Review Manager 5.3 and Stata 15 softwares. Results According to the inclusion and exclusion criteria, 10 articles were selected, including 1586 participants from 5 countries and regions. Meta-analysis results showed that the positive rate of CXCL9 was higher in active tuberculosis patients than that in healthy people and latent tuberculosis patients [active tuberculosis patients vs. healthy people: odds ratio (OR)=21.69, 95% confidence interval (CI) (6.52, 72.16), P<0.00001; active tuberculosis patients vs. latent tuberculosis patients: OR=10.12, 95%CI (3.83, 26.76), P<0.00001]. The sensitivity and specificity of plasma CXCL9 in distinguishing active tuberculosis patients from healthy people were 0.84 [95%CI (0.77, 0.90)] and 0.82 [95%CI (0.63, 0.92)], respectively; the sensitivity and specificity of plasma CXCL9 in distinguishing active tuberculosis patients from latent tuberculosis patients were 0.77 [95%CI (0.56, 0.90)] and 0.72 [95%CI (0.40, 0.91)], respectively. Subgroup analysis showed that the infection status of human immunodeficiency virus had some impact on heterogeneity, while other factors had limited impact on heterogeneity. Egger test showed that there was no publication bias (active tuberculosis patients vs. healthy people: P=0.976; active tuberculosis patients vs. latent tuberculosis patients: P=0.606). Conclusion CXCL9 has a high diagnostic value for tuberculosis patients and may be used as a new biomarker to diagnose tuberculosis.
ObjectiveEarly diagnosis of biliary atresia (BA) is crucial for improving patient prognosis. This study aimed to evaluate the accuracy of serum matrix metalloproteinase-7 (MMP-7) and gamma-glutamyl transferase (GGT) in diagnosing BA. MethodsWe conducted a comprehensive search of English-language databases (PubMed, Elsevier, Web of Science) and Chinese-language databases (CNKI, WanFang Data, VIP) for studies published from the inception of these databases up to December 30, 2024. Eligible studies included diagnostic data based on serum MMP-7 and GGT levels from children with BA and non-BA cholestasis. Results Through a systematic review and meta-analysis, a total of 24 publications encompassing 33 studies were included, covering a combined cohort of 6 879 children with cholestasis. The results of the binary diagnostic model analysis revealed that the pooled sensitivity and specificity of serum matrix metalloproteinase-7 (MMP-7) were 93% (95%CI 92 to 94) and 87% (95%CI 85 to 88), respectively. The positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for MMP-7 were 8.63 (95%CI 5.88 to 12.66), 0.09 (95%CI 0.06 to 0.13), and 115.31 (95%CI 69.08 to 192.48), respectively. The area under the receiver operating characteristic curve (AUC) for MMP-7 was 0.9659, indicating excellent diagnostic performance. In comparison, gamma-glutamyl transferase (GGT) demonstrated a pooled sensitivity of 76% (95%CI 73 to 78) and specificity of 80% (95%CI 78 to 82). The corresponding PLR, NLR, and DOR for GGT were 3.50 (95%CI 2.77 to 4.43), 0.30 (95%CI 0.25 to 0.36), and 12.69 (95%CI 9.18 to 17.55), respectively. The AUC for GGT was calculated to be 0.849 4, reflecting moderate diagnostic accuracy. ConclusionSerum MMP-7 demonstrates higher diagnostic accuracy compared to GGT, which may significantly enhance the diagnostic efficiency for biliary atresia. However, due to its heterogeneity, further multicenter, large-sample, prospective studies that adhere strictly to experimental protocols are necessary to validate its diagnostic accuracy.