ABSTRACT
Hypertonic dehydration is prevalent in the elderly, increases the risk of adverse events, reduces quality of life, and increases hospitalization and mortality.Current methods of diagnosing dehydration, such as physical signs, urine tests, urea nitrogen/creatinine, bioelectrical impedance and saliva, are not suitable for the diagnosis of dehydration in the elderly.There is no gold standard for the diagnosis of hypertonic dehydration in the elderly.The European Society for Clinical Nutrition and Metabolism(ESPEN)recommends the direct measurement of plasma/serum osmotic pressure or using an osmotic pressure formula[osmolarity(mmol/L)=1.86 ×(Na + + K + )+ 1.15×glucose+ urea+ 14](all measured in mmol/L)for the diagnosis of hypertonic dehydration.
ABSTRACT
Objective Explore the differences in effectiveness and safety between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early esophageal cancer (EEC).Methods Papers published from January 1990 to December 2012 in Medline,Embase,Cochrane library,Wanfang,VIP and CNKI were searched in English and Chinese respectively to identify the studies comparing ESD with EMR for EEC.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Revman 5.1.Outcome measures consisted of three effectiveness-relevant measures (rates of en bloc resection,curative resection,local recurrence) and four safety-relevant measures (bleeding,perforation,stenosis and operation time).Results A total of 8 non-randomized retrospective cohort studies (five full-text and three abstracts) were included.Meta-analysis showed significantly higher rates of en bloc resection [98.36％ (360/366) vs.41.79％ (252/603),P ＜ 0.01],curative resection [90.81％ (168/185) vs.50.65 ％ (194/383),P ＜ 0.01] and perforation [4.51％ (21/466) vs.1.25％ (8/640),P =0.03] in ESD group compared with EMR group,and the rate of local recurrence was significantly lower in ESD group [0.55％ (2/366) vs.13.76％ (83/603),P ＜0.01].There were no significant differences in the rates of bleeding [0.21％ (1/466) vs.0.63％(4/640),P =0.41] or stenosis [10.48％ (39/372) vs.10.15％ (41/404),P =0.89].Conclusion Compared with EMR,ESD showed obvious advantages of effectiveness and resemble risks for endoscopic resection of EEC,therefore ESD should be the first choice for endoscopic treatment of EEC.