Objective To explore the serious situation of injection abuse, and its influence to average prescription fee. Methods The subjects of this study were health service settings in rural area of 9 provinces/cities in Midwest of China. The treatment prescription indicators of county and village health service settings were calculated. Results Prescription injection rates of health care facility in rural area of Midwest provinces/cities of China (25.8% to 62.2%,mean: 45.1%) were higher than the standard of WHO (13.4% to 24.1%), and the injection abuse situation was serious. Injection bause caused the increase of prescription fee. Excess usage of injection in health service settings was related to the economic level of the on-site county or village, and also related to the size and load of health service facilities. Conclusion Suggestions are proposed to the government health agency according to the results of the study: enhancing the lawmaking, establishing the related policy and effective measure, training the medical personnel, promoting the mass health education, investigating the effective injection management model in rural area, and reducing the rate of injection.
Objective To systematically review the prognostic and clinicopathological value of FOXM1 expression in non-small cell lung cancer (NSCLC). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and CBM were searched to collect cohort studies about the prognostic value of FOXM1 expression in NSCLC from inception to May 30th 2016. 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. Results A total of 8 cohort studies, involving 781 patients were included. The results of meta-analysis showed that FOXM1 expression was higher in tumor stage Ⅲ to Ⅳ than stageⅠtoⅡ(OR=2.24, 95%CI 1.25 to 4.01,P=0.007). Higher FOXM1 expression group had a shorter overall survival (HR=1.77, 95%CI 1.42 to 2.22,P<0.000 01) and disease-free survival (HR=1.96, 95%CI 1.04 to 3.17,P=0.04) than those of the lower FOXM1 expression group. Conclusion Current evidence shows that FOXM1 expression is associated with NSCLC stage. Furthermore, FOXM1 overexpression may be prognosis biomarker for NSCLC patients. Due to the limited quantity and quality of included studies, the above conclusions are needed to be verified by more high quality studies.
Objective To systematically review the prognostic value of perineural invasion (PNI) for patients with early-stage cervical cancer. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, WanFang Data, CBM and VIP databases to collect case-control studies about prognostic value of PNI in cervical cancer from inception to October, 2016. 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. Results Seven case-control studies from eight articles involving 1 218 patients were included. The results of meta-analysis showed that: (1) On Cox's model multivariate analysis, PNI was not identified as an independent risk factor for disease free survival (DFS) (HR=0.73, 95%CI 0.33 to 1.58,P=0.42) or overall survival (OS) (HR=0.89, 95%CI 0.41 to 1.94,P=0.77) with no significant difference; (2) On Kaplan-Meier-curves, DFS (HR=1.86, 95%CI 1.20 to 2.88,P=0.006) and OS (HR=2.43, 95%CI 1.63 to 3.62,P<0.000 1) were both significantly decreased in patients with PNI positive group. Conclusion PNI represents a decreasing disease-free survival and overall survival in patients with early-stage cervical cancer, and is one of the poor prognosis factors which be informed management decisions regarding adjuvant therapy. However, there is no evidence that PNI is an independent factor affecting the prognosis. In view of the limitation of the studies, a large sample prospective controlled trial is warranted to verify the above conclusion.
Objective To evaluate the efficacy and safety of furazolidone-based first-line therapy for Helicobacter pylori infection. Methods The randomized controlled trials (RCTs) of furazolidone-based first-line therapy for Helicobacter pylori infection were identified from Cochrane Library (Issue 1, 2009), PubMed (1992 to January 2009), OVID (1994 to January 2009), Wanfang Data (1994 to January 2009), CNKI (1994 to January 2009), and VIP Data (1994 to January 2009). The quality of included RCTs was assessed, and the meta-analysis was conducted with RevMan5.0 software. Results Among five included RCTs involving 499 patients, four were graded as B in methodology quality and the left one was graded as C. As to the intention-to-treat (ITT) analysis, the Helicobacter pylori eradication rate was 78.3% in furazolidone group and 66.8% in control group (RR=1.18, 95%CI 0.86 to 1.62), while the Per Protocol (PP) analysis, the eradication rate of furazolidone group and control group was 83.1% and 70.9% respectively (RR=1.17, 95%CI 0.88 to 1.57). The incidence rate of mild side-effects was 40.8% in furazolidone group and 39.4% in control group (RR=1.03, 95%CI 0.79 to 1.36), and while that of severe side-effects in furazolidone group and control group was 7.8% and 3.7% respectively (RR=1.86, 95%CI 0.84 to 4.09). Conclusions With similar efficacy and safety as control group has, the furazolidone-based therapy could be recommended as a first-line therapy for Helicobacter pylori infection. The high-quality RCTs with large sample are required to prove the above conclusion for the limitation of quantity and quality of included studies.
Objective To explore the association between the preoperative systemic immune-inflammation index (SII) and prognosis in non-small cell lung cancer (NSCLC) patients. Methods A comprehensive literature survey was performed on PubMed, Web of Science, EMbase, The Cochrane Library, Wanfang, and CNKI databases to search the related studies from inception to December 2021. The hazard ratio (HR) and 95% confidence interval (CI) were combined to evaluate the correlation of the preoperative SII with overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) in NSCLC patients. Results A total of 11 studies involving 9 180 patients were eventually included. The combined analysis showed that high SII levels were significantly associated with worse OS (HR=1.61, 95%CI 1.36-1.90, P<0.001), DFS (HR=1.50, 95%CI 1.34-1.68, P<0.001), and RFS (HR=1.17, 95%CI 1.04-1.33, P<0.001). Subgroup analyses also further verified the above results. Conclusion Preoperative SII is a powerful prognostic biomarker for predicting outcome in patients with operable NSCLC and contribute to prognosis evaluation and treatment strategy formulation. However, more well-designed and prospective studies are warranted to verify our findings.
Objective To compare the perioperative results between uniportal and three-portal thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). Methods Electronic databases including PubMed, Web of Science, EMbase, CNKI, Wanfang were systematically searched from the establishment of each database until April 2022. Literature screening, data extraction and bias risk assessment were independently conducted by two researchers. All combined results were performed by RevMan 5.3 and Stata 16.0. The quality of the literature and the risk of bias were evaluated using the Cochrane Bias Risk Assessment Tool. Results Eighteen eligible randomized controlled trials (1 597 patients) were identified eventually, including 800 patients undergoing uniportal thoracoscopic lobectomy and 797 patients undergoing three-portal thoracoscopic lobectomy. Meta-analysis results showed that compared to the three-portal approach, uniportal lobectomy took longer operation time (WMD=7.63, 95%CI 2.36 to 12.91, P=0.005) with less intraoperative blood loss (WMD=–28.81, 95%CI –42.54 to –15.08, P<0.001). Furthermore, patients undergoing uniportal lobectomy achieved lower visual analogue score within 24 hours after the operation (WMD=–1.60, 95%CI –2.26 to –0.94, P<0.001), less volume of drainage after the operation (WMD=–25.30, 95%CI –46.22 to –4.37, P=0.020), as well as shorter drainage duration (WMD=–0.36, 95%CI –0.72 to –0.01, P=0.040). Besides, patients undergoing uniportal lobectomy were also observed with shorter length of hospital stay (WMD=–2.28, 95%CI –2.68 to –1.88, P<0.001) and lower incidence of postoperative complications (RR=0.49, 95%CI 0.38 to 0.63, P<0.001). However, the number of lymph nodes harvested during the operation (WMD=–0.01, 95%CI –0.24 to 0.21, P=0.930) was similar between the two groups. Conclusion Both uniportal and three-portal thoracoscopic lobectomy for NSCLC are safe and feasible. The uniportal approach is superior in reducing short-term postoperative pain, postoperative complications and shortening the length of hospital stay.
OBJECTIVE: To investigate the therapeutic effect of flap transplantation in repairing soft tissue defects of children. METHODS: From January 1997 to May 2002, 75 cases of different soft tissue defects (52 males and 23 females, with the age of 3-14 years) were repaired by axial and non-axial flaps transfer, and axial flaps transplantation by microvascular anastomosis. The flaps area ranged from 3 cm x 5 cm to 15 cm x 42 cm. Emergency operation was performed in 26 cases and secondary operation in 49 cases (infective wound such as osteomyelitis and plate extra-exposed of fracture). The defect regions included the forearm, back of the hand, thumb, index finger, leg and foot. The types of flap graft and application range included 39 cases of axial flaps transfer or transplantation (27 cases of along- or contra-transfer of transplantation and 12 cases of microvascular anastomosis). The non-axial flaps transfer were designed along- or contra-transfer near the wound area in 36 cases. The ratio of length to width was 2.5:1-3.5:1 in 27 cases, and larger than 3.5:1 in 9 cases. Adequate anesthesia method should be chosen according to the characteristics of children, non-traumatic operating during surgery and postoperative supervision and nursing of flaps should also be paid enough attention. RESULTS: After operation, blood circulation crisis occurred in 2 cases (1 case of artery failure and 1 case of vein failure). The flaps survived in 37 cases and partially survived in 1 case and necrosed in 1 case. The survival rate was 96.2%. The postoperative follow-up period was 3 to 60 months, the blood supply, elasticity and texture of flaps were good. The effect of repair was satisfactory. CONCLUSION: Different types of transplantation of blood-supply of flaps may repair the different types of soft tissue defects in children. Free flap transplantation is safe and beneficial in children, different defects of soft tissue were repaired by axial and non-axial flaps transfer, axial flaps transplantation by microvascular anastomosis. Non-traumatic operating and postoperative supervision and nursing of flaps should also be paid enough attention.
Objective
To systematically review the efficacy and safety of tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy in advanced non-small cell lung cancer(NSCLC).
Methods
An electronically search was conducted in The Cochrane Library, PubMed and EMbase databases from inception to December 2016 to collect randomized controlled trials (RCTs) about tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy for NSCLC. 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.
Results
A total of 12 RCTs involving 6 559 patients were finally included. The results of meta-analysis showed that: The median progression free survival (PFS) (HR=0.86, 95%CI 0.81 to 0.91, P<0.001) and objective response rate (ORR) (HR=1.43, 95%CI 1.20 to 1.70,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy were significantly longer than those of the chemotherapy group. There were no significant differences between two groups in incidence of median overrall survival (OS) (HR=0.91, 95%CI 0.82 to 1.00,P=0.06), fatigue (RR=1.03, 95%CI 0.97 to 1.11, P=0.33), dyspnea (RR=1.01, 95%CI 0.91 to 1.13, P=0.82) and cough (RR=1.01, 95%CI 0.89 to 1.15, P=0.91). However, the incidence of neutrocytopenia (RR=1.16, 95%CI 1.05 to 1.28, P=0.003), thrombocytopenia (RR=1.46, 95%CI 1.23 to 1.73, P<0.001), diarrhea and hypertension (RR=2.91, 95%CI 2.28 to 3.71,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy group were significantly higher than those of the chemotherapy group. The tyrosine kinase inhibitors combined with chemotherapy group had lower rate of anemia (RR=0.86, 95%CI 0.75 to 0.98,P=0.03).
Conclusion
Compared with chemotherapy alone, tyrosine kinase inhibitors combined with chemotherapy can improve the median PFS and ORR while it can be used as a treatment for advanced non-small cell lung cancer patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo analyze the relevant risk factors affecting postoperative relapse-free survival (RFS) in the primary gastrointestinal stromal tumors (GIST) and develop a Nomogram predictive model of postoperative RFS for the GIST patients. MethodsThe patients diagnosed with GIST by postoperative pathology from January 2011 to December 2020 at the First Hospital of Lanzhou University and Gansu Provincial People’s Hospital were collected, and then were randomly divided into a training set and a validation set at a ratio of 7∶3 using R software function. The univariate and multivariate Cox regression analysis were used to identify the risk factors affecting the RFS for the GIST patients after surgery, and then based on this, the Nomogram predictive model was constructed to predict the probability of RFS at 3- and 5-year after surgery for the patients with GIST. The effectiveness of the Nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve, and the clinical utility of the Nomogram and the modified National Institutes of Health (M-NIH) classification standard was evaluated using the decision curve analysis (DCA). ResultsA total of 454 patients were included, including 317 in the training set and 137 in the validation set. The results of multivariate Cox regression analysis showed that the tumor location, tumor size, differentiation degree, American Joint Committee onCancer TNM stage, mitotic rate, CD34 expression, treatment method, number of lymph node detection, and targeted drug treatment time were the influencing factors of postoperative RFS for the GIST patients (P<0.05). The Nomogram predictive model was constructed based on the influencing factors. The C-index of the Nomogram in the training set and validation set were 0.731 [95%CI (0.679, 0.783)] and 0.685 [95%CI (0.647, 0.722)], respectively. The AUC (95%CI) of distinguishing the RFS at 3- and 5-year after surgery were 0.764 (0.681, 0.846) and 0.724 (0.661, 0.787) in the training set and 0.749 (0.625, 0.872) and 0.739 (0.647, 0.832) in the validation set, respectively. The calibration curve results showed that a good consistency of the 3-year and 5-year recurrence free survival rates between the predicted results and the actual results in the training set, while which was slightly poor in the validation set. There was a higher net benefit for the 3-year recurrence free survival rate after GIST surgery when the threshold probability range was 0.19 to 0.57. When the threshold probability range was 0.44 to 0.83, there was a higher net benefit for the 5-year recurrence free survival rate after GIST surgery. And within the threshold probability ranges, the net benefit of the Nomogram was better than the M-NIH classification system at the corresponding threshold probability. ConclusionsThe results of this study suggest that the patients with GIST located in the other sites (mainly including the esophagus, duodenum, and retroperitoneum), with tumor size greater than 5 cm, poor or undifferentiated differentiation, mitotic rate lower than 5/50 HPF, negative CD34 expression, ablation treatment, number of lymph nodes detected more than 4, and targeted drug treatment time less than 3 months need to closely pay attentions to the postoperative recurrence. The discrimination and clinical applicability of the Nomogram predictive model are good.
Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=?1.64, 95%CI (?2.25, ?1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
