ObjectiveTo understand the current situation of surgical treatment of hilar cholangiocarcinoma. MethodThe literature relevant to surgical treatment of hilar cholangiocarcinoma at home and abroad in recent years was reviewed. ResultsThe various surgical treatment schemes of hilar cholangiocarcinoma had advantages and disadvantages. At present, there were still disputes and no unified consensus on preoperative preparation, selection of intraoperative surgical resection range, and applications of laparoscopy and robot, etc. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. ConclusionIt is believed that accurate preoperative condition evaluation should be carried out for each patient with hilar cholangiocarcinoma, so as to formulate the best surgical treatment plan, achieve individualized accurate treatment and benefit patients.
ObjectiveTo systematically review the correlation between sleep quality and social support of the elderly.MethodsDatabases including PubMed, MEDLINE, The Cochrane Library, Springerlink, ProQuest, CMB, CNKI, VIP, and WanFang Data were searched to collect studies on the correlation between sleep quality and social support of the elderly from January 1996 to January 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 9 studies involving 2 427 elderly people were included. The meta-analysis showed that the combined correlation coefficient between sleep quality and social support was -0.40 (95%CI ?0.54 to ?0.26). The correlation between sleep quality and social support of the elderly varied with the year of publication and sample size, however without regular change. The correlation coefficient of the elderly from institutions (hospital or pension institutions) was higher than that of the community (?0.33 vs. ?0.26); the correlation coefficient of the elderly with health problems was higher than those without health problems (?0.32 vs. ?0.25); the results measured by non-random sampling method were higher than those measured by random sampling (?0.37 vs. ?0.23); and the results measured by Pittsburgh sleep quality index (PSQI) and social support rating scale (SSRS) were higher than those measured by PSQI and perceived social support scale (PSSS) (?0.30 vs. ?0.13).ConclusionsThe higher the level of social support of the elderly in China, the lower the score of PSQI, and the better the sleep quality, in which there are differences in different sample sources and physical conditions.
The cardiac conduction system (CCS) is a set of specialized myocardial pathways that spontaneously generate and conduct impulses transmitting throughout the heart, and causing the coordinated contractions of all parts of the heart. A comprehensive understanding of the anatomical characteristics of the CCS in the heart is the basis of studying cardiac electrophysiology and treating conduction-related diseases. It is also the key of avoiding damage to the CCS during open heart surgery. How to identify and locate the CCS has always been a hot topic in researches. Here, we review the histological imaging methods of the CCS and the specific molecular markers, as well as the exploration for localization and visualization of the CCS. We especially put emphasis on the clinical application prospects and the future development directions of non-destructive imaging technology and real-time localization methods of the CCS that have emerged in recent years.
With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.
ObjectiveTo systematically review the efficacy of convalescent plasma (CP) in the treatment of coronavirus disease 2019 (COVID-19). MethodsPubMed, EMbase, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of CP in the treatment of COVID-19 from inception to September 15th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.4.1 software. ResultsA total of 16 RCTs involving 15 301 patients were included. The results of meta-analysis showed that CP treatment did not reduce mortality compared with no-placebo (RR=0.99, 95%CI 0.93 to 1.05, P=0.63) or normal saline (RR=1.06, 95%CI 0.60 to 1.86, P=0.84). However, compared with standard plasma, the mortality of CP group was lower (RR=0.59, 95%CI 0.37 to 0.95, P=0.03). In addition, compared with no-placebo or normal saline, CP treatment could not improve the clinical condition at 28-30 days, reduce mortality at early treatment and in patients without invasive mechanical ventilation when randomized. ConclusionCurrent evidence shows that compared with no-placebo or normal saline, CP does not reduce mortality in patients with COVID-19. However, when the disease progresses to the point where standard plasma is required, CP may reduce mortality. In addition, use of CP in patients with early or non-critical COVID-19 failed to reduce mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To systematically evaluate the efficacy and safety of single and bilateral lung transplantation in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale (NOS). All results were analyzed using Review Manager V5.3 and STATA 17.0. Results A total of 8 studies were included covering 14076 patients, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. NOS scores were≥6 points. The results of meta-analysis showed that there was no statistical difference in the postoperative 1-year survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), and postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There was no statistical difference in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications are similar between them.
ObjectiveThe growth potential of children with short stature in middle and late adolescence may be limited by the effect of estrogen on epiphyseal closure. In recent years, the third generation of non-steroidal aromatase inhibitors (AIs) have been used in the treatment of short stature but with off-label. This study aimed to systematically review the efficacy and safety of the third-generation non-steroidal AIs in the treatment of children with short stature, and to provide evidences for rational drug use in clinical practice. MethodsWe searched PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP and CBM from inception to December 28, 2022. Relevant studies on the treatment for children with short stature using the recombinant human growth hormone (rhGH) combined with or without the third-generation non-steroidal AIs were collected. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 18 articles were finally included, involving 9 randomized controlled trials and 9 cohort studies, with a total of 1 053 patients. The Meta-analysis showed that: (1) in terms of efficacy, the final adult height (MD=2.48, 95%CI 2.02 to 2.94, P<0.01), predicted adult height (MD=4.27, 95%CI 2.71 to 5.83, P<0.01), predicted adult height difference (MD=4.26, 95%CI 3.23 to 5.28, P<0.01), bone age (MD=?0.62, 95%CI ?0.89 to ?0.36, P<0.01), bone age difference/actual age difference (MD=?0.47, 95%CI ?0.56 to ?0.37, P<0.01), and growth velocity (MD=1.34, 95%CI 0.89 to 1.78, P<0.01) at the end of treatment in the experimental group were better than those in the control group, but there was no statistical difference in the height at the end of treatment between the two groups (MD=4.03, 95%CI ?0.01 to 8.06, P=0.05). (2) in terms of safety, the total incidence of adverse events in the experimental group (RR=2.10, 95%CI 1.48 to 2.99, P<0.01) was higher than that in the control group, among which the incidence of adverse events in the endocrine system and skin and subcutaneous tissue system was statistically different between the two groups (P<0.05), and the incidence of adverse events in the hepatobiliary system, kidney and urinary system, metabolism and nutrition, gastrointestinal system, musculoskeletal system, blood and lymph system, vascular and lymphatic system, and neuropsychiatric system was not statistically different between the two groups (P>0.05). ConclusionCurrent evidence shows that the third-generation non-steroidal AIs combined with rhGH can effectively improve the final height of children with short stature, but it may increase the incidence of adverse drug events. Limited by the quality and the follow-up period of the included studies, high-quality studies are still needed to demonstrate the above conclusions and further evaluate the long-term safety of AIs in children with short stature.
Objective To evaluate the efficacy and safety of the midvastus approach in total knee arthroplasty. Methods We searched The Cochrane Library, EMBASE, PubMed, and CBM to identify clinical controlled trials comparing the midvastus approach with the medial parapatellar approach in total knee arthroplasty. The quality of the included studies was critically assessed and the data analyses were performed by the Cochrane Collaboration’s RevMan 5.0. Results Eight studies were included, involving 4 randomized controlled trials (RCTs), 2 quasi-RCTs and 2 non-RCTs. Meta-analyses showed that rate of lateral retinacular release (RR=0.75, 95%CI 0.52 to 1.08, P=0.12), range of motion at 6 week postoperation (MD=2.65, 95%CI –1.20 to 6.50, P=0.18), operation time (MD=1.04, 95%CI –3.50 to 5.58), and adverse events postoperation (OR=1.04, 95%CI 0.43 to 2.52, P=0.94) were similar between the midvastus approach and the medial parapatellar approach in total knee arthroplasty. One study showed that there was no significant difference in blood loss interoperation between the two approaches, and two showed that the midvastus approach had less blood loss interoperation than the medial parapatellar approach. There was no statistical analysis about the blood loss interoperation in one study. For the time of straight leg raise, there was no significant difference in two studies. But in one study, it showed that patients needed longer time for straight leg raise. Conclusion Based on the current evidence, the midvastus approach for total knee arthroplasty is as safe and effective as the medial parapatellar approach, but blood loss interoperation and time of straight leg raise are not decided. Due to the poor quality of the included trials, more high-quality RCTs are needed.
Esophageal cancer is an aggressive malignancy with high morbidity and poor prognosis. Symptoms of early esophageal cancer are insidious and difficult to detect, while advanced esophageal obstruction, lesion infiltration and metastasis seriously affect patients’ quality of life. Early detection and treatment can help to increase the survival chance of patients. Recently, artificial intelligence (AI) has shown remarkable success in diagnosis of esophageal cancer, highlighting the great potential of new AI-assisted diagnostic modalities. This paper aims to review recent progress of AI in the diagnosis of esophageal cancer and to prospect its clinical application.