Objective To investigate confidence interval estimation for the amount of heterogeneity in meta-analysis. Methods On the basis of BT’s method, the approximate Q-statistic distribution following linear transformation of Chi-square was applied to improve the accuracy of Q-statistic distribution, and to obtain the confidence interval for the amount of heterogeneity in meta-analysis. Results In case, the Q1 distribution obtained 95%CI 0.07 to 2.20, while the Q2 distribution obtained 95%CI 0.00 to 1.41; The proposed method Q2 narrowed down the range of confidence interval. Conclusion On account of improving the accuracy of Q-statistic distribution, the proposed method effectively strengthens the coverage probabilities of the confidence interval for the amount of heterogeneity. And the proposed method can also improve the precision of the confidence interval estimation for the amount of heterogeneity.
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 correlation between HDL-C level and lung cancer.
MethodsSuch databases as PubMed, EBSCO, ISI Web of Science, The Cochrane Library (Issue 8, 2015), VIP, and CNKI Data were electronically searched from inception to September 23th, 2015 to collect studies about the correlation between HDL level and lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software.
ResultsFifteen studies involving 2 015 lung cancer patients and 15 505 controls were finally included. The results of meta-analysis showed that the total HDL-C level in the lung cancer group was lower than that in the control group (SMD=-0.68, 95%CI-0.97 to -0.40, P=0.000). Further subgroup analysis showed that the incidence of lung cancer of different clinical classification (SMDⅠ~Ⅱ=-0.65, 95%CI -1.07 to -0.23, P=0.002; SMDⅢ~Ⅳ=-0.61, 95%CI -0.73 to -0.50, P=0.000), different pathological types (the small cell lung cancer excluded) (SMDAC=-0.76, 95%CI -1.13 to -0.38, P=0.000; SMDSC=-1.51, 95%CI -2.47 to -0.56, P=0.010; SMDSCLC=-1.19, 95%CI -1.42 to -0.95, P=0.000), different quality scores (SMD≥6 score=-0.60, 95%CI -0.89 to -0.29, P=0.000; SMD< 6 score=-0.77, 95%CI -1.48 to -0.0, P=0.015), the number of different studies (SMD≥100 cases=-0.48, 95%CI -0.80 to -0.15, P=0.004; SMD< 100 cases=-0.80, 95%CI -1.33 to -0.27, P=0.003), smoking (SMD=-1.47, 95%CI -2.51 to -0.43, P=0.006) and Asia (SMD=-0.92, 95%CI -1.21 to -0.63, P=0.000) was correlated with the level of HDL-C.
ConclusionThe level of HDL-C is related to the incidence of lung cancer, and low HDL-C level may increase the risk of lung cancer. In view of the limitations of the studies, the above conclusions need a great many large samples and adjust the smoking status of the prospective cohort study at home and abroad to verify.
ObjectiveTo systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). MethodsPubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. ResultsA total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. ConclusionsThe current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.
ObjectiveTo systematically review the associations of cognitive frailty with mortality and hospitalization in the elderly. MethodsThe VIP, PubMed, CNKI, WanFang Data, CBM, Embase, Cochrane Library and Web of Science databases were electronically searched to collect cohort studies on the association of cognitive frailty with mortality or hospitalization in the elderly from inception to May, 2023. Two reviewers independently screened the literature, extracted data and assessed risk of bias of the included studies. Meta-analysis was performed by R 4.2.2 software. ResultsA total of 19 cohort studies involving 63 624 elderly were included. The results of meta-analysis showed that compared with healthy elder, the elder with cognitive frailty had a higher mortality (OR=2.75, 95%CI 2.10 to 3.59, P<0.01) and hospitalization (OR=1.67, 95%CI 1.40 to 2.00, P<0.01). Subgroup analysis showed that cognitive frailty was related to the risk of death in different status of frailty and cognitive function, different assessment tools, different countries of development, different follow-up time and research sites. At the same time, different status of frailty and cognitive function and different levels of development of countries were related to the risk of hospitalization. ConclusionCurrent evidence shows that cognitive frailty can increase the risk of hospitalization and mortality in the elderly. It is suggested that early screening and intervention of cognitive frailty should be carried out to effectively reduce the risk of adverse consequences, so as to achieve healthy aging.
Objective To evaluate the efficacy and safety of saxagliptin in type 2 diabetes patients. Methods The following databases as The Cochrane Library (Issue 2, 2011), PubMed (1978 to May 2011), EMbase (1974 to May 2011), CNKI (1978 to May 2011), VIP (1989 to May 2011) and CBM (1978 to May 2011) were searched. The quality of included randomized controlled trials (RCTs) was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using RevMan 5.0. Results A total of 7 RCTs were included. The results of meta-analyses showed that HbA1c was significantly reduced in the saxagliptin group than that in placebo group (MD= –0.69, 95%CI –0.78 to –0.60, Plt;0.000 01). There was no significant difference in the incident rate of adverse reaction between two groups (RR=1.02, 95%CI 0.98 to 1.06, P=0.26). Conclusion Saxagliptin is effective and safe for type 2 diabetes. But its long-term efficacy and safety still need to be confirmed by performing more high quality, large sample RCTs with long-term follow-up.
Objective To evaluate the clinical application of the different operative approaches of the laparoscopicrepair of inguinal hernia and provide a more rational and scientific choice for the surgeon. Methods The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook. Results Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention） 〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕. Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.
ObjectiveTo systematically review the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features.
MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2014), PubMed, EMbase, Ovid, CNKI, VIP, CBM and WanFang Data from inception to February 2014, to collect the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was conducted using RevMan 5.2 software.
ResultsA total of 5 case-control studies involving 637 patients were included, of which, 388 cases in the cervical cancer group, 130 cases in the cervical intraepithelial neoplasia (CIN) group, and 119 cases in the normal cervical tissue group. The results of meta-analysis showed that, a) as for Beclin1 expression, significant differences were found in cervical cancer vs. normal cervical tissues (OR=0.07, 95%CI 0.02 to 0.25, P < 0.000 1), cervical cancer vs. CIN (OR=0.37, 95%CI 0.23 to 0.59, P < 0.000 1), CIN vs. normal cervical tissues (OR=0.23, 95%CI 0.06 to 0.88, P=0.03), and cervical cancer tissues with vs. without lymph node metastasis (OR=0.29, 95%CI 0.17 to 0.49, P < 0.000 01). However, no significant difference was found in medium/low differentiation vs. well differentiation (OR=0.50, 95%CI 0.16 to 1.56, P=0.23), tumour diameter no less than vs. less than 4 cm (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), myometrial invasion depth no less than vs. less than 1/2, and FIGO Ⅰ vs. Ⅱ (OR=0.70, 95%CI 0.44 to 1.10, P=0.12).
ConclusionBeclin1 protein expression is notably associated to cervical cancer. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be further verified by performing more high quality studies.
ObjectivesTo systematically review the application of evidence-based medicine (EBM) combined with problem-based learning (PBL) method in clinical teaching.MethodsDatabases including WanFang Data, CNKI, VIP, CBM, PubMed and EMbase were searched to identify eligible randomized controlled trials that compared EBM plus PBL with traditional lecture based learning (LBL) method in clinical teaching from inception to March 28th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Statistical analysis was performed using Stata 14.0 software.ResultsA total of 33 randomized controlled trials with 2 855 students were included. The results showed that students in EBM combined with PBL group obtained better scores of specialized theory (WMD=6.87, 95%CI 5.08 to 8.66, P<0.001), skills examination (WMD=10.57, 95%CI 8.98 to 12.16, P<0.001) and case analysis (WMD=9.79, 95%CI 4.71 to 14.88, P<0.001), comparing with those in LBL group. Besides, EBM combined with PBL method improved students’ overall ability including independent learning capability, clinical thinking ability, problem-solving capability, literature exploring capacity, communication and presentation skills and team-work ability.ConclusionsApplication of EBM combined with PBL method can improve clinical teaching quality.
ObjectiveTo systematically review the risk of hemorrhage in pregnant cerebral arteriovenous malformation (CAVM) patients. MethodsThe Web of Science, PubMed, Cochrane Library, WanFang Data, VIP and CNKI databases were electronically searched to collect clinical studies related to hemorrhage in pregnant CAVM patients from inception to June, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 13.1 and R 4.0.4 software. ResultsA total of 13 studies involving 2 273 patients were included. The results of meta-analysis showed that the pooled incidence of hemorrhage in pregnant CAVM patients was 0.18 (95%CI 0.12 to 0.24). The subgroup analyses were carried out based on world regions and the study duration, with the higher pooled incidence of 0.37 (95%CI 0.05 to 0.80) in Europe and 10 to 20 years of study duration of 0.37 (95%CI 0.17 to 0.57). Conclusion?Current evidence shows that the incidence of hemorrhage in pregnant CAVM patients is about 18%. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
