ObjectiveTo systematically review the clinical significance of Raman spectroscopy (RS) in the auxiliary diagnosis of colon cancer (CC). MethodsPubMed, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests related to RS in the auxiliary diagnosis of CC from inception to October 1st, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 12.0 and Meta-Disc 1.4 software. ResultsA total of 21 studies involving 1 419 patients were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and positive posttest probability (PPP) for CC screening applying RS were 0.94 (95%CI 0.93 to 0.95), 0.91 (95%CI 0.90 to 0.92), 157.50 (95%CI 74.44 to 333.21), 10.40 (95%CI 6.62 to 16.33), 0.08 (95%CI 0.05 to 0.12) and 77%, respectively. The area under the curve (AUC) of summary receiver operating characteristic (SROC) curve was 0.98 (95%CI 0.96 to 0.99). ConclusionCurrent evidence shows that RS is a potentially useful tool for CC screening. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the effect of folic acid coated-crosslinked urethane-doped polyester elastomer (fCUPE) nerve conduit in repairing long distance peripheral nerve injury. MethodsThirty-six 3-month-old male Sprague Dawley rats weighing 180-220 g were randomly assigned to 3 groups, each consisting of 12 rats: CUPE nerve conduit transplantation group (group A), fCUPE nerve conduit transplantation group (group B), and autologous nerve transplantation group (group C), the contralateral healthy limb of group C served as the control group (group D). A 20-mm-long sciatic nerve defect model was established in rats, and corresponding materials were used to repair the nerve defect according to the group. The sciatic function index (SFI) of groups A-C was calculated using the Bain formula at 1, 2, and 3 months after operation. The nerve conduction velocity (NCV) of the affected side in groups A-D was assessed using neuroelectrophysiological techniques. At 3 months after operation, the regenerated nerve tissue was collected from groups A-C for S-100 immunohistochemical staining and Schwann cell count in groups A and B to compare the level of nerve repair and regeneration in each group. ResultsAt 3 months after operation, the nerve conduits in all groups partially degraded. There was no significant adhesion between the nerve and the conduit and the surrounding tissues, the conduit was well connected with the distal and proximal nerves, and the nerve-like tissues in the conduit could be observed when the nerve conduit stents were cut off. SFI in group A was significantly higher than that in group C at each time point after operation and was significantly higher than that in group B at 2 and 3 months after operation (P<0.05). There was no significant difference in SFI between groups B and C at each time point after operation (P>0.05). NCV in group A was significantly slower than that in the other 3 groups at each time point after operation (P<0.05). The NCV of groups B and C were slower than that of group D, but the difference was significant only at 1 month after operation (P<0.05). There was no significant difference between groups B and C at each time point after operation (P>0.05). Immunohistochemical staining showed that the nerve tissue of group A had an abnormal cavo-like structure, light tissue staining, and many non-Schwann cells. In group B, a large quantity of normal neural structures was observed, the staining was deeper than that in group A, and the distribution of dedifferentiated Schwann cells was obvious. In group C, the nerve bundles were arranged neatly, and the tissue staining was the deepest. The number of Schwann cells in group B was (727.50±57.60) cells/mm2, which was significantly more than that in group A [(298.33±153.12) cells/mm2] (t=6.139, P<0.001). ConclusionThe fCUPE nerve conduit is effective in repairing long-distance sciatic nerve defects and is comparable to autologous nerve grafts. It has the potential to be used as a substitute material for peripheral nerve defect transplantation.
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.
ObjectiveTo systematically review the survival rate of different vascularized bone flaps in mandibular defect repair and reconstruction by Bayesian network meta-analysis. MethodsThe PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The Bayesian network meta-analysis was carried out applying R software. ResultsA total of 24 studies involving 1 615 patients were included. The results of meta-analysis showed that the respective survival rates of fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were 95.62%, 94.09%, 98.16%, and 93.75%. Moreover, the network meta-analysis failed to show a statistically significant difference between all comparators. Conclusion?Current evidence shows that different vascularized bone flaps have similar survival rates in mandibular defect repair and reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the clinical efficacy and safety of postpartum hemorrhage (PPH) prophylaxis with a single dose of tranexamic acid (TXA). MethodsThe Embase, PubMed, WanFang Data, VIP, CNKI, ChiCTR and Cochrane Library were electronically retrieved to collect clinical studies related to appraising the efficacy and safety in parturients after cesarean section used TXA perioperatively from inception to September, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R software. A trial sequential analysis of outcomes was carried out to investigate the reliability and conclusiveness of findings. ResultsA total of 43 RCTs including 23 497 parturients that compared the prophylactic use of a single dose of TXA with placebo or no treatment in parturients undergoing cesarean delivery. The results of meta-analysis revealed that there was a significantly reduced risk of PPH (RR=0.52, 95%CI 0.40 to 0.67, P<0.01), total blood loss (SMD=?183.73mL, 95%CI ?220.87 to ?146.60, P<0.01), need for blood transfusion (RR=0.42, 95%CI 0.30 to 0.60, P<0.01), and use of additional uterotonics (RR=0.55, 95%CI 0.43 to 0.70, P<0.01) with TXA use. There were no statistical differences in thromboembolic events between TXA and control groups (RR=1.05, 95%CI 0.54 to 2.03, P=0.11), and results were consistently in favor of TXA use across subgroups, and trial sequential analyses. ConclusionTaken as a whole, existing evidence suggests that TXA can effectively reduce PPH in patients undergoing cesarean delivery. Further, prophylactic TXA administration for parturients significantly reduced blood loss and need for blood transfusion, without increasing adverse events and use of additional uterotonics, supporting its use as a safe and effective strategy for reducing PPH in this population.
Objective To review the clinical research progress of craniofacial duplication, improve clinicians’ recognition of this disease, and provide theoretical basis and practical references for its precise diagnosis and individualized treatment. Methods Recent domestic and international literature on craniofacial duplication as well as the diagnosis and treatment experiences of clinical cases in our team were reviewed. A comprehensive elaboration was conducted from embryonic development, etiological hypotheses, clinical classification, imaging manifestations, multidisciplinary diagnosis and treatment strategies, and prognostic follow-up. Special focus was placed on summarizing clinical features of jaw duplication, characteristics of occlusal disorder, and sequential orthodontic-orthognathic combined therapy. Results Craniofacial duplication is an extremely rare congenital craniofacial developmental malformation with highly heterogeneous phenotypes, involving multiple structures including lips, oral cavity, maxilla, and mandible. It is often complicated by cleft lip and palate, cervical vertebral fusion, hypertelorism, muscular dysfunction and other deformities, severely impairing patients’ mastication, phonation, deglutition, and facial aesthetics. Due to its extremely low incidence, scattered reported cases, and unclear pathogenesis, unified diagnostic criteria and therapeutic specifications have not been established worldwide. Developmental disorders of pharyngeal arches and cranial neural crest cells at embryonic weeks 4-8 are the core pathogenic trigger. The five etiological hypotheses have limited evidence levels, and no single theory can explain all clinical subtypes. The PAX7 gene variant identified by our team only serves as a genetic clue without functional verification to confirm its pathogenicity. The modified Hamberis 3-type classification and Sun 4-type mandibular duplication classification can clearly define the lesion scope, with matched surgical procedures, orthodontic regimens and recurrence risks for each subtype. Cone-beam computed tomography (CBCT) combined with three-dimensional reconstruction acts as the gold standard for diagnosis, and multidisciplinary sequential therapy can ameliorate facial appearance and oral function. Nevertheless, long-term follow-up data are scarce, and clinical management mainly relies on individualized experiences of clinicians. Conclusion Craniofacial duplication features complicated pathogenesis characterized by duplicated jaws, lips, and dental arches, with dysregulated development of embryonic pharyngeal arches and cranial neural crest cells as the core inducement. CBCT three-dimensional reconstruction enables accurate diagnosis, and multidisciplinary sequential therapy represents the optimal intervention strategy. Shortcomings including scarce clinical cases, unidentified pathogenic genes, absent standardized therapeutic protocols and insufficient long-term follow-up evidence remain prominent. Future research directions include constructing a multi-center case registry, conducting functional research on pathogenic genes, popularizing digital diagnosis and treatment techniques, and formulating standardized diagnostic and therapeutic guidelines. For pediatric patients with suspected malformations, CBCT examination should be performed as early as possible, and the principle of early diagnosis, early planning and early intervention shall be followed to restore oral function and optimize maxillofacial appearance.