ABSTRACT
Objective@#To evaluate the effectiveness of surgery combined with multiple interventions in treating patients with ear keloid by network meta-analysis.@*Methods@#Databases including " PubMed" , " Cochrane Library" were searched using key words " (((((((((((Ear, External[MeSH Terms]]] OR (Ears, Exernal]] OR (Outer Ear]] OR (Ear, Outer]] OR (Ears, Outer]] OR (External Ear]]] AND (((keloid[Mesh Terms]]] OR (keloids]]] AND ((((((surgery[MeSH Terms]]] OR (operative therapy]] OR (operative procedures]] OR (invasive procedures]] OR (operations]]]] AND (randomized controlled trial[pt]]" , database " Embase" was searched using key words ((′external ear′/exp] OR(′auricle′/exp] OR (′ear lobe′/exp]] AND ((′surgery′/exp] OR (′ear surgery′/exp]] AND (′keloid′/exp] AND (′randomized controlled trial′/exp] and Chineses journals full-text database, China biology medicine disc, VIP database, and Wanfang database were searched using key words in chinese version "耳瘢痕疙瘩,手术" to obtain the randomized controlled trails about surgery combined with multiple interventions in the treatment of ear keloid from the establishment of each database to June 2018. EndNote X7, Revman 5.3, STATA 14.0, GeMTC 14.3 statistical software were used to extract data from studies, study quality assessment, drawing network figure, publication bias analysis, traditional meta-analysis, heterogeneity test, consistency test, similarity test, network meta-analysis.@*Results@#A total of 18 trails involving 8 therapeutic measures were included, and 1 425 patients with ear keloid were included. All of the 18 trails had high risk of bias. The network figure shows that there are 28 different pairwise comparisons among the eight treatments. Of the 18 studies included, 10 were directly compared, and the remaining 18 were not directly evidenced, those comparisons will be made indirectly by the network meta-analysis. The basic symmetry of each point in the funnel plot and the P values of Beggs test and Eggers test were all greater than 0.05, shows that the existence of publication bias is less likely. Traditional meta-analysis showed that the efficiency of surgery + hormone, surgery + pressure, surgery + radiotherapy and surgery + hormone + radiotherapy were better than that of simple surgery, and the difference was statistically significant(P<0.05); the efficiency of surgery + hormone + radiotherapy was better than that of surgery + hormone, the difference was statistically significant(P=0.001); surgery + hormone + fluorouracil and surgery + hormone + radiotherapy had statistical significance(P<0.05). Efficiency is higher than surgery + radiotherapy, the difference is statistically significant. The rest of the direct comparisons are not statistically significant. All P values in the heterogeneity test were greater than 0.1 and I2 was less than 50%, so there was no significant heterogeneity in the study. 8 treatments formed 4 closed loops, the inconsistency factor IF ranged from 0.06 to 0.23, and the lower limit of 95% CI was 0, it means than the consistency of those loops were good. The similarity test of the 18 studies was good. Based on Bayesian theory, the random effect model of MCMC method was analyzed by network meta analysis. The results of 7 combined therapies were statistically significant compared with those of simple operation, and were superior to those of simple operation. The results of the seven combined therapies were statistically significant as follows: surgery + hormone + fluorouracil VS surgery + radiotherapy (OR = 0.28, 95% CI 0.08-0.93], surgery + hormone + fluorouracil was better than surgery + hormone; surgery + hormone + radiotherapy + VS surgery + hormone (OR = 0.06, 95% CI 0.01-0.23], surgery + hormone + radiotherapy Surgery + hormone + radiotherapy VS surgery + pressure (OR = 0.07, 95% CI 0.01-0.37], surgery + hormone + radiotherapy is better than surgery + pressure; surgery + hormone + radiotherapy VS surgery + radiotherapy (OR = 0.06, 95% CI 0.01-0.30], surgery + hormone + radiotherapy is better than surgery + radiotherapy. There was no significant difference in the curative effect between the other combined treatments. The SUCRA curves were drawn according to the randomized effect model of MCMC. The SUCRA values of each treatment measure were as follows: surgery, 0.4%; surgery + hormone, 33.0%; surgery + pressure, 52.2%; surgery + radiotherapy, 34.6%; surgery + imiquimod 53.3%; surgery + fluorouracil 51.6%; surgery + hormone + fluorouracil, 76.4%; surgery + hormone + radiotherapy, 34.6%; surgery + hormone + fluorouracil, 53.3%; surgery + hormone Radiotherapy, 98.4%. According to the results of SUCRA chart, the effectiveness of each treatment measure was sorted as follows: operation + hormone + radiotherapy > operation + hormone + fluorouracil > operation + imiquimod > operation + pressure > operation + fluorouracil > operation + radiotherapy > operation + hormone > operation.@*Conclusions@#Surgery combined with a variety of treatments for ear keloid were superior to simple surgical treatment, of which surgery + hormone + radiotherapy is the best.
ABSTRACT
Objective@#To systematically evaluate the effectiveness of epidermal growth factor (EGF) in treating patients with inhalation injury by meta analysis.@*Methods@#Databases including PubMed, Cochrance Library, and Embase were searched using key words " inhalation injury, smoke inhalation injury, epidermal growth factor, and EGF" , and Chinese Journals Full-text Database, China Biology Medicine disc, VIP Database, and Wanfang Database were searched using key words in Chinese version "吸入性损伤,表皮生长因子" to obtain the randomized controlled trails about EGF published publicly in the treatment of patients with inhalation injury from the establishment of each database to December 2017. The measurement indexes included content of total protein and albumin, colloid osmotic pressure (COP), the number of total cells, percentages of neutrophils, lymphocytes, and fibroblasts in bronchoalveolar lavage fluid (BALF), the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, the time of removal of tracheal tube, the amount of respiratory secretions, and the incidence of lung infection. Meta-analysis was conducted by RevMan 5.3 statistical software.@*Results@#A total of 6 trials involving 375 patients were included, with 182 patients in group EGF who received EGF treatment and 173 patients in conventional treatment group who received conventional treatment. All of the 6 trails had unclear risk of bias. The content of total protein and albumin and COP in BALF of patients in group EGF were lower than those in conventional treatment group, with standardized mean differences (SMDs) respectively -9.37, -26.77 , and -8.13 [with 95% confidence intervals (CIs) respectively -14.11--4.63, -41.85--11.69, -9.54--6.73, P<0.001]. The number of total cells and percentages of neutrophils and lymphocytes in BALF of patients in group EGF were lower than those in conventional treatment group, while the percentage of fibroblasts in BALF of patients in group EGF was higher than that in conventional treatment group, with SMDs respectively -20.22, -13.08, -12.28, 2.99 (with 95% CIs respectively -22.27--17.66 , -14.76--11.40, -13.86--10.70, 2.48-3.50, P<0.001). The time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube of patients in group EGF were shorter than those in conventional treatment group, with SMDs respectively -1.05, -1.22 , -1.11 (with 95% CIs respectively -1.36--0.74, -1.54--0.91, -1.39--0.82, P<0.001). The amount of respiratory secretions of patients in group EGF was lower than that in conventional treatment group, with SMD -1.44 (with 95% CI -1.90--0.98, P<0.001). The incidence rate of pulmonary infection of patients in group EGF was lower than that in conventional treatment group, with relative risk 0.46 (with 95% CI 0.24-0.89, P<0.05). There may be publication bias in the content of total protein, albumin, and COP in BALF (P<0.05), while the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube showed no significant publication bias (P>0.05).@*Conclusions@#Conventional treatment combined with EGF therapy can reduce respiratory inflammation of inhalation injury, promote restoration of respiratory epithelium, shorten the time of removal of tracheal tube, reduce the incidence of pulmonary infection of patients, and therefore has good effect on inhalation injury.
ABSTRACT
Facial scar and deformation caused by burn injury severely affect physical and psychological well-being of pediatric burn patients, which needs medical workers and pediatric burn patients′ family members to pay much attention to and to perform early rehabilitation treatment. Pressure therapy is an important rehabilitative strategy for pediatric burn patients with facial scar, mainly including wearing headgears and transparent pressure facemasks, which have their own features. To achieve better treatment results, pressure therapy should be chosen according to specific condition of pediatric burn patients and combined with other assistant therapies. Successful rehabilitation for pediatric burn patients relies on cooperation of both family members of pediatric burn patients and society. Rehabilitation knowledge should be provided to parents of pediatric burn patients to acquire their full support and cooperation in order to achieve best therapeutic effects and ultimately to rebuild physical and psychological well-being of pediatric burn patients.