Comparative effectiveness of different hepatocellular carcinoma screening intervals or modalities: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals.@*METHODS@#PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio.@*RESULTS@#In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no significant differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% confidence interval [CI]: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group.@*CONCLUSIONS@#The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered.@*REGISTRATION@#No. CRD42020148258 at PROSPERO website ( https://www.crd.york.ac.uk/PROSPERO/ ).

Introduction on 'assessing the risk of bias of individual studies' in systematic review of healthcare intervention programs revised by the Agency for Healthcare Research and Quality / 中华流行病学杂志

This paper summarizes the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions revised by the Agency for Healthcare Research and Quality (AHRQ) and introduces how to use Revman software make risk of bias graph or risk of bias summary.AHRQ tool can be used to evaluate following study designs:RCTs,cohort study,case-control study (including nested case-control),case series study and cross-sectional study.The tool evaluates the risk of bias of individual studies from selection bias,performance bias,attrition bias,detection bias and reporting bias.Each of the bias domains contains different items,and each item is available for the assessment of one or more study designs.It is worth noting that the appropriate items should be selected for evaluation different study designs instead of using all items to directly assess the risk of bias.AHRQ tool can be used to evaluate risk of bias individual studies when systematic reviews of health care interventions is including different study designs.Moreover,the tool items are relatively easy to understand and the assessment process is not complicated.AHRQ recommends the use of high,medium and low risk classification methods to assess the overall risk of bias of individual studies.However,AHRQ gives no recommendations on how to determine the overall bias grade.It is expected that future research will give corresponding recommendations.

Introduction on 'assessing the risk of bias of individual studies' in systematic review of healthcare intervention programs revised by the Agency for Healthcare Research and Quality / 中华流行病学杂志

This paper summarizes the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions revised by the Agency for Healthcare Research and Quality (AHRQ) and introduces how to use Revman software make risk of bias graph or risk of bias summary.AHRQ tool can be used to evaluate following study designs:RCTs,cohort study,case-control study (including nested case-control),case series study and cross-sectional study.The tool evaluates the risk of bias of individual studies from selection bias,performance bias,attrition bias,detection bias and reporting bias.Each of the bias domains contains different items,and each item is available for the assessment of one or more study designs.It is worth noting that the appropriate items should be selected for evaluation different study designs instead of using all items to directly assess the risk of bias.AHRQ tool can be used to evaluate risk of bias individual studies when systematic reviews of health care interventions is including different study designs.Moreover,the tool items are relatively easy to understand and the assessment process is not complicated.AHRQ recommends the use of high,medium and low risk classification methods to assess the overall risk of bias of individual studies.However,AHRQ gives no recommendations on how to determine the overall bias grade.It is expected that future research will give corresponding recommendations.

Contrast analysis of nutritional status between patients of alcoholic cirrhosis and viral cirrhosis / 肠外与肠内营养

Objective:To compare the nutritional status between alcoholic cirrhosis and viral cirrhosis,and to provide reference information for the nutritional support strategy.Methods:95 alcoholic cirrhosis and 260 viral cirrhosis patients were involved in the study.The patients were reviewed with NRS 2002 and SGA within 48 hours after admission.The general information and liver function parameters including gender,age,BMI,Child-Pugh score,ALB,PA and Hb were recorded.Results:The NRS 2002 nutritional risk rate of alcoholic cirrhosis and viral cirrhosis patients was 76.80％ and 65.00％,respectively.The SGA malnutrition rate of alcoholic cirrhosis and viral cirrhosis patients was 67.40％ and 61.90％,respectively.There was statistically significant difference between the two groups in gender,Child-Pugh A rate,ALB,PA,Hb and NRS 2002,while there was no significant difference in age,Child-Pugh B rate,Child-Pugh C rate,BMI and SGA.Conclusion:Nutritional dysfunction exists in both of the two types of liver cirrhosis.The nutritional risk rate and the anemia rate in alcoholic cirrhosis patients are significantly worse than those in viral cirrhosis patients.

Teicoplanin concentration in cerebrospinal fluid during intravenous infu-sion in patients following neurosurgery operation / 中国感染控制杂志

Objective To understand teicoplanin concentration in cerebrospinal fluid (CSF)during intravenous in-fusion in patients following neurosurgery operation,and evaluate whether drug concentration can be increased if blood-brain barrier was damaged, and effect of continuous pump of drug on drug concentration in CSF. Methods The post-neurosurgical surgery patients with surgical site/ventricular drainage were enrolled in the study, patients were divided into routine administration group(a dose of teicoplanin of 400 mg/12 h was administered for 30 min)and continuous administration group (a dose of 400 mg teicoplanin was administered for 30 min followed by a continuous infusion of 200 mg/6 h).CSF specimens were collected at respective time points of administration, teicoplanin concentration in specimens was measured.Results For routine administration group,drug concentration in CSF was (0.004 ± 0.0123 )mg/L immediately after teicoplanin was bumped,the peak concentration was (0.712 ± 1.028)mg/L after 1-hour bumping,then concentration decreased gradually,which were (0.254 ±0.222),(0.173 ± 0.152),and (0.355±0.207)mg/L at 12,18,and 24 hours of bumping respectively.For continuous administration group, drug concentration in CSF was(0.017±0.020))mg/L immediately after teicoplanin was bumped,the peak concentration reached (0.587±0.255)mg/L after 4-hour bumping,then concentration were (0.429±0.416),(0.325±0.254),(0.476 ±0.686),and (0.318 ±0.464)mg/L at 6,12,18,and 24 hours of bumping respectively,teicoplanin concentration was relatively stable 6 hours later,which were (0.318±0.464)mg/L-(0.476±0.686)mg/L.The area under the curve during 24 hours (AUC0-24 )in routine administration group and continuous administration group were 5.590 mg/L·h and 9.082 mg/L·h respectively.For two groups of patients,teicoplanin concentration only at the area near peak value a-chieved 50% minimum inhibitory concentration(MIC50 )for coagulase negative staphylococcus (CNS),but the time for a-chieving concentration higher than CNS MIC50 was far less than 50% of total administration time;teicoplanin concentration in CSF of both groups of patients didn’t achieve MIC50 for Staphylococcus aureus .Conclusion After continuous infusion of teicoplanin,drug concentration in CSF can be increased compared with routine administration group,but still can’t achieve the effective MIC;the increase of blood drug concentration is benefit to drug concentration in CSF,it is necessary to in-crease the dose appropriately to achieve clinical effectiveness.

Precise laparoscopic Roux-en-Y gastric bypass in the treatment of 140 patients with obesity and metabolic diseases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of precise laparoscopic Roux-en-Y gastric bypass(LRYGB) in the treatment of obesity and metabolic diseases.</p><p><b>METHODS</b>Clinical and follow-up data of obese patients underwent precise LRYGB in our department between June 2011 and April 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 140 obese patients were included in this study. All the precise LRYGB procedures were successfully performed with no conversion to open surgery or perioperative death. Average operation time was (138.0±21.3) min, postoperative hospital stay was (5.2±1.2) d. No severe complications was observed. The percentages of excess weight loss in 1, 3, 6, and 12 month after operation were (26.4±8.6)%, (53.3±6.7)%, (75.3±7.9)%, (78.5±8.5)%, respectively. The improvement rates of fatty liver, hyperlipidemia, hypertension and type 2 diabetes mellitus were 84.6%(33/39), 92.3%(12/13), 77.3%(17/22) and 82.4%(14/17).</p><p><b>CONCLUSIONS</b>Precise LRYGB is a modified and optimized traditional surgical technique which does not significantly increase the operative time. It is safe and feasible. The postoperative weight loss effect is significant and it can effectively improve the related co-morbidities.</p>

Effects of zingiber alcohol extract on inflammation-associated cytokines in rat with carbon tetrachloride induced hepatic fibrosis / 重庆医学

Objective To investigate effects of zingiber alcohol extract(ZGB)on the inflammation-associated cytokines in rats with carbon tetrachloride(CCL4)induced hepatic fibrosis.Methods 24 adult male SD rats were randomly divided into three groups:normal control group(CON,n=8),hepatic fibrosis model group(HF,n=8),and zingiber administration group(ZGB,n=8).The rats in the HF and ZGB groups were administrated by subcutaneous injection of 50%CCL4 3 mL/kg,twice per week for 8 weeks,the first time dosage was doubled.At the same time the ZGB group received daily intragastric ZGB(300 mg/kg a day),while the CON and HF groups received daily intragastric isovolumic normal saline for 8 weeks.The animals were executed at the end of 8 weeks.Serum samples were collected for detecting the content of ALT,AST.The liver samples were used for assessing the Hyp content,detectingα-SMA level by Western blotting and TNFα,IL-1 b,IL-6 mRNA levels by the real-time PCR.The histological ob-servation of the liver tissue was done with HE stain.Results As compared with the HF group,the serum levels of ALT and AST in the ZGB group were markedly decreased,and the content of Hyp in liver tissue was decreased(P<0.05).The Western blot re-sults showed that the expression amount ofα-SMA protein in the ZGB group was significantly lower than that in the HF group(P<0.05);the real-time quatitative PCR showed that the expression levels of TNFα,IL-1b,IL-6 were decreased compared with the HF group(P<0.05).The hepatocyte degeneration degrees observed by the optical microscope in the ZGB group were significantly alle-viated compared with the HF group.Conclusion ZGB has better anti-hepatic fibrosis and hepatocyte-protective effect,one of its mechanisms could be that ZGB could reduce the release of pro-inflammatory cytokines TNFα,IL-1b and IL-6,thus delay or hinder the progress course of liver fibrosis.

Intraoperative contrast-enhanced ultrasonic imaging in the evaluation of pathologic grades of cerebral gliomas and peritumoral cerebral edema / 中华超声影像学杂志

ObjectiveTo explore the value of intraoperative contrast-enhanced ultrasonography in distinguishing gliomas,peritumorous cerebral edema and peripheral normal cerebral tissues,and grading cerebral gliomas.MethodsIntraoperative contrast-enhanced ultrasonic imaging in 80 patients diagnosed cerebral gliomas were studied retrospectively.The blood perfusion patterns of gliomas,peritumorous cerebral edema and peripheral normal cerebral tissues were observed closely after contrast and parameters were recorded.ResultsAfter contrast-enhanced ultrasound,peripheral normal cerebral tissues showed homogeneous enhancement,the tumor tissues and peritumorous cerebral edema of high-grade gliomas (HGG) showed high enhancement,but peritumorous cerebral edema of low-grade gliomas (LGG) showed nearly homogeneous enhancement.Absolute peak intensity(API) of the tumor tissues were higher than those of peripheral normal cerebral tissues and peritumorous cerebral edema ( P ＜0.05).Time to peak (TTP) of the tumor tissues in HGG were shorter than those of peripheral normal cerebral tissues and peritumorous cerebral edema ( P ＜ 0.05).TTP of the tumor tissues in LGG compared with those of peripheral normal cerebral tissues and peritumorous cerebral edema,two groups had no statistical significance ( P ＞ 0.05).ConclusionsIntraoperative contrast-enhanced ultrasonography can reflect the boundary of the brain edema,which is useful to guide surgical resection effectively and helpful to grade cerebral gliomas.

Millimeter Wave on Subcutaneous Fluid Collection and Post-operative Headache after Craniotomy / 中国康复理论与实践

@#Objective To explore the clinical features of subcutaneous fluid collection and post-operative headache after craniotomy and assess the efficacy and side effects of the millimeter wave treatment.MethodsA total of 32 neurosurgical patients with post-operative subcutaneous fluid collection were involved in this study and divided into traditional and millimeter wave treatment groups randomly. Subcutaneous fluid volume after 3 days, time for complete fluid absorption, time of hospital stay, incidence of related infections and severe headache between two groups were assessed.ResultsThe fluid reduction is 93.8% in the millimeter wave treatment group and 76.5% in the traditional treatment group 3 days after treatment (P<0.05); time for complete fluid absorption was also shorter in the millimeter wave treatment group; there is no infection in the millimeter wave treatment group and 3 cases in the traditional treatment group, millimeter wave treatment also reduced the occurrence of severe post-operative headache; there is no treatment-related side-effects in the millimeter treatment group.ConclusionMillimeter wave treatment is an efficacious and safe method for subcutaneous fluid collection after craniotomy, and can reduce the occurrences of related infections and post-operative pain.

Effect of Multimodal Analgesia on Incision of Scalp Pain after Craniotomy / 中国康复理论与实践

@# Objective To explore the clinical features and the management of incision of scalp pain after craniotomy. Methods 129 patients after craniotomy without postoperative neuralgia were involved. The onset, severity, and characteristics of the pain were recorded within 1 week after the craniotomy. Patients with moderate-severe pain were given oxycodone and acetaminophen (treatment group) or rotundine (control) for 3 d. Results 39.5%（51/129）of patients experienced moderate to severe postoperative pain. After treatment, 76.9% （20/26） in treatment group and 36.0% （9/25） in control were released from the pain (P<0.01). The pain intensity differences and sum of pain intensity differences were more in treatment than in control (P<0.01). Conclusion Incision of scalp pain is common after craniotomy. Oxycodone and acetaminophen, called multimodal analgesia is efficacious and safe for it.

Effect of Combined Therapy on Headache after Craniotomy / 中国康复理论与实践

@#Objective To observe the effect of the combined therapy on headache after craniotomy.Methods 30 patients complained severe headache after craniotomy were divided into the treatment group (n=15, received the combined therapy mainly including nerve block) and control group (n=15, received professional medicine). The visual analogue scale (VAS), admission days after surgery, and medical fees of the patients in two groups were compared.Results The VAS scores of the patients in the treatment group decreased significantly after treatment ( P<0.01), the admission days after surgery significantly shortened ( P<0.01), and the fees of examination, medicine, and ward bed significantly decreased compared with the control group.Conclusion The combined therapy mainly including nerve block is effective on headache after craniotomy.