The formulation of inclusive criteria is very important for the quality of systematic reviews as well as the reliability of results. However, among the systematic reviews based on randomized controlled trials (RCTs) published in Chinese periodicals, there are differences existing in the definition of inclusive criteria of RCTs, which may lead to the incomplete or inequitable inclusion. In addition, the relatively lower quality of domestic RCTs may also cause the possibility of bias. In this study, sampling analysis is applied to assess the current situation of both the RCTs definition for inclusive criteria of domestic systematic reviews and the types of practically included RCTs, so as to figure out the existing problems.
ObjectiveTo assess the effectiveness of phrenic nerve electrical stimulation (PNES) on extubation outcomes in intensive care unit (ICU) patients undergoing mechanical ventilation using a meta-analysis approach. Methods A comprehensive search was conducted on the Cochrane Library, PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) published from database inception to December 2023, evaluating the effect of PNES on extubation outcomes in ICU patients receiving mechanical ventilation. The control group received standard rehabilitation measures, while the intervention group received PNES in addition to standard rehabilitation. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan5.4 software. Results Nine RCTs were included in the final analysis. The quality assessment indicated that one study was rated as Grade A and eight as Grade B, reflecting relatively high study quality. Meta-analysis results demonstrated that PNES significantly improved extubation success rates [relative risk (RR)=1.33, 95%CI 1.09 - 1.62, P=0.006], maximal inspiratory pressure (MIP) [mean difference (MD)=1.36, 95%CI 0.46 - 2.27, P=0.003], and diaphragmatic thickness fraction (DTF) (MD=7.11, 95%CI 0.53 - 13.69, P=0.03) compared with the control group. PNES also significantly reduced the duration of mechanical ventilation (MD=–2.23, 95%CI –3.07- –1.38, P<0.000 01), re-intubation rates (RR=0.35, 95%CI 0.15 - 0.85, P=0.02), and rapid shallow breathing index (RSBI) (MD=–11.57, 95%CI –18.51 - –4.62, P=0.001). Additionally, PNES shortened ICU length of stay (MD=–4.03, 95%CI –5.95 - –2.11, P<0.000 1), with all differences being statistically significant. Conclusion PNES effectively reduces the duration of mechanical ventilation and ICU length of stay, decreases re-intubation rates and RSBI, and improves extubation success, MIP, and DTF in ICU patients. Future high-quality, large-scale, multi-center RCTs are needed to further validate these findings.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
【Abstract】 Objective To increase the viscosity of chitosan/glycerol phosphate（C/GP）and to improve its preparation technique in order to develop the appl ication range of C/GP. Methods Chitosan was treated by high-pressure vapor steril ization in order to prepare high viscous C/GP（HV-C/GP）and prepare C/GP by standard methods. The rheologic changes of HV-C/GP and C/GP were detected dynamically by the Gemini rheometer. The initial solution viscosity, gelation temperature and gelation time were evaluated after the viscosity of the materials were increased. Two gelation materials were placed into continuous flow thermostated cells under the same condition and harvest them at predetermined time intervals, 1st, 2nd, 5th, 10th and 25th days, then they were dried, weighed and the mass loss rate was calculated. Ultrastructure of the freeze-dried samples was visual ized by the scanning electron microscope. Results The initial viscosity of C/GP was 1.81 Pas and that of HV-C/GP was 17.24 Pas. The latter one increased 10 times as well as the former one. The gelation temperature of C/GP was 37°C and that of HV-C/GP was 34°C. There was no remarkable difference in gelation time between them. The mass loss rate of HV-C/GP at first day was 72.5% and at 25th days was 90.8%, while that of C/GP was 55.4% and 78.2%. Porous network structure was observed by the scanning electron microscope in both of them. The pore diameter of C/GP was 50-100 μm and that of HV-C/GP was 30-50 μm, which was obviously smaller than the former. Conclusion The viscosity of HV-C/GP prepared by improved technique obviously increases and the thermosensitivity has no significant changes. The degradation time of HV-C/GP in vitro lengthens. The micrographs show that the HV-C/GP gels are porous and the pore diameter are smaller than C/GP.
目的 通過Narcotrend指導丙泊酚的靶控濃度來研究帕瑞昔布鈉超前鎮痛對宮腔手術患者術中和術后鎮痛效果的影響。 方法 2012年1月－6月，60例實施宮腔手術的患者隨機分為A、B兩組，每組30例，A組為術前20 min靜脈注射帕瑞昔布鈉組，B組為術前20 min靜脈注射等量生理鹽水組。記錄Narcotrend值D1，患者心率穩定時兩組的靶控濃度、血壓、心率、血氧飽和度（SpO2）及患者術蘇醒后10 min鎮痛效果視覺模擬評分（VAS）、Riker鎮靜、躁動評分（SAS）。 結果 A組患者的瑞芬太尼目標靶控濃度小于B組（P＜0.05），兩組的丙泊酚靶控濃度差異無統計學意義（P＞0.05）。兩組患者血壓、心率均小于術前（P＜0.05），SpO2與術前比較差異無統計學意義（P＞0.05）。術后患者VAS評分A組低于B組（P＜0.05），SAS評分B組高于A組（P＜0.05）。 結論 帕瑞昔布鈉對Narcotrend值無影響，帕瑞昔布鈉能減少宮腔手術患者術中、術后的疼痛及術后的躁動。
Objective To systematically review the efficacy and safety of polyethylene glycol and sodium phosphate in bowel preparation of capsule endoscopy. Methods We searched CNKI, CBM, WanFang Data, PubMed, EMbase, and The Cochrane Library (Issue 6, 2016) up to June 2016, to collect randomized controlled trials (RCTs) about polyethylene glycol and sodium phosphate in bowel preparation of capsule endoscopy. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.0 software. Results A total of six RCTs involving 531 patients were included. The results of meta-analysis showed that: compared with the sodium phosphate solution group, the polyethylene glycol solution group had poor intestinal cleansing effect (OR=0.43, 95%CI 0.21 to 0.88,P=0.02), higher incidence of adverse reaction (OR=3.20, 95%CI 1.13 to 9.06,P=0.03); but shorter gastric retention time (OR=–11.61, 95%CI –13.71 to –9.51,P<0.000 01) and residence time in the small intestine (OR=–4.17, 95%CI –7.74 to –0.60,P=0.02). Conclusion The efficacy of oral polyethylene glycol is poor in cleaning effect and adverse reaction than sodium phosphate solution, but better in the digestive tract residence time for capsule endoscopy. Due to the limited quality and quantity of included studies, the above conclusion is still needed to be proved by more high-quality studies.
Objective To prepare a new sirolimus drug-coated polypropylene (SRL-PP) mesh by grafting he sirolimus onto the surface of the polypropylene (PP) mesh via chemical reaction, and to apply the new mesh to animal experiment to explore its anti-adhesion properties.MethodsThe sirolimus was grafted onto the surface of the mesh by chemical reaction to prepare the SRL-PP mesh, which was compared with the PP mesh and the polyethylene glycol modified polypropylene (PEG-PP) mesh. The three groups of meshes were respectively characterized (infrared spectroscopy test, contact angle measurement), and their tensile property was measured. These meshes were implanted into the abdominal cavity of the rats respectively. The anti-adhesion properties of the new sirolimus drug-coated mesh was studied by intraperitoneal adhesion and histopathological change in rats.ResultsThe results of infrared spectrum analysis showed that there was a new absorption peak at the wavelength 1 643 cm–1 (amide group) of SRL-PP mesh, suggesting that sirolimus drug was successfully uploaded onto the surface of the mesh; the SRL-PP mesh was excellent in hydrophilicity, which provided a favorable condition for the growth of peritoneal mesothelial cells. There was no significant difference in mechanical properties between SRL-PP mesh and PP mesh or PEG-PP mesh, which provided a good mechanical guarantee for clinical application. The degree of abdominal adhesion in SRL-PP mesh group (1.00±0.58) was significantly lower than that in PP mesh group (5.17±0.69) and PEG-PP mesh group (4.00±0.58), and the tD value between SRL-PP mesh group and PP mesh group was 2.76 (P<0.05). The number of inflammatory cells and the expression of inflammatory cytokines in the adhesion tissue in SRL-PP mesh group were significantly lower than those in PP mesh group and PEG-PP mesh group.ConclusionsThe sirolimus is successfully loaded onto the surface in the PP mesh by chemical reaction. Animal experiment shows that the sirolimus drug-coated mesh can significantly reduce the abdominal adhesion of the rats, which provides a basis for clinical trial and application.
Objective To assess the effectiveness and safety of nedaplatin combined with 5-fluorouracil (5-Fu) for advanced esophageal cancer. Methods Such databases as PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data were searched from the date of their establishment to May 4th, 2012 to collect the randomized controlled trials (RCTs) about nedaplatin combined with 5-Fu versus cisplatin combined with 5-Fu for advanced esophageal cancer. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. Results A total of 15 RCTs invloving 863 patients were included. The results of meta-analysis suggested that, compared with cisplatin combined with 5-Fu, nedaplatin combined with 5-Fu could improve short-term effects (RR=1.31, 95%CI 1.14 to 1.52, P=0.000 2) and reduce gastrointestinal reaction and renal function impairment, but it was associated with aggravated myelosuppression, increase of thrombocytopenia and leukopenia, and decrease of hemoglobin. There were no significant differences between the two groups in liver function impairment, diarrhea and peripheral neurovirulence. Conclusion Nedaplatin combined with 5-fluorouracil can increase short-term effects and reduce gastrointestinal reaction and renal function impairment. However, nedaplatin is associated with aggravated myelosuppression, so it should be applied in clinic with cautious. Nedaplatin combined with 5-fluorouracil can be used as a replacement chemotherapy regimen for advanced esophageal cancer, but the evidence about long-term effects and safety is still required. For the quality and quantity limitation of the included studies which decreases the level of evidence, so the conclusion of this systematic review only provides some references for clinical practice and research.
Objective To access the protective effects of glucosamine hydrochloride capsules (OTL) on articular cartilage in osteoarthritis of rabbit. Methods Thirty-six New Zealand white rabbits were divided randomly into three groups (n=12): sham group (group A), anterior cruciate l igament transection (ACLT)/normal sal ine group (group B), and ACLT/ OTL group (group C). Rabbits in groups B, C received ACLT on the right knee. Rabbits in group A were not given ACLT ascontrol. Group C received a daily administration of OTL at a dose of 150 mg/kg of body weight for 12 weeks; in contrast, group B received normal sal ine at the same dose. All rabbits were sacrificed after 12 weeks. The right femoral condyle were removed and observed at pathologic changes with HE staining and graded by Mankin’s scale, the expression level of transforming growth factor β1 (TGF-β1) and interleukin 1β (IL-1β) were detected by immunohistochemical staining. Results All rabbits survived at the end of experiment and incision healed well. The gross observation showed that joint synovia increased and articular surface was smooth and integrity in group A; that ulcer was observed on the articular surface of group B; and that articular surface was smooth and integrity in group C. There were sigificant differences in articular cartilage scores between 3 groups (P lt; 0.05). The histological observation showed that the articular cartilage had normal structure and the cells arranged regularly in group A; that the articular cartilage became thin and the cells arranged irregularly in group B; and that the cells arranged with a clear layer and had regular shape in group C. The Mankin scores were 1.04 ± 0.13, 7.97 ± 0.12, and 2.81 ± 0.36 in groups A, B, and C, respectively; showing significant difference between 3 groups (P lt; 0.05). The result of immunohistochemistry showed that the expressions of TGF-β1 were 50.62 ± 1.51, 24.81 ± 1.28, and 41.57 ± 1.69 and the expressions of IL-1β were 13.12 ± 1.21, 62.53 ±2.37, and 30.67 ± 1.28; showing significant differences between 3 groups (P lt; 0.05). Conclusion A daily administration ofOTL at a dose of 150 mg/kg for 12 weeks can partially decrease the expression levels of IL-1β and increase the expression levels of TGF-β1, which delays the development of osteoarthritis.