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BACKGROUND: Multiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which interventions are the best option. METHODS: We conducted a systematic review to identify randomized clinical trials (RCTs) that compared complications, revisions, reoperations, and functional outcomes among TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty), HTO (high tibial osteotomy), BCA (bicompartmental knee arthroplasty), BIU (bi-unicompartmental knee arthroplasty), and KJD (knee joint distraction). The PubMed, Embase, and Cochrane databases were reviewed for all studies comparing two or more surgical interventions. Direct-comparison meta-analysis and network meta-analysis (NMA) were performed to combine direct and indirect evidence. The risk of bias was assessed using the revised Cochrane risk of bias tool for RCTs. RESULTS: This NMA and systematic review included 21 studies (17 RCTs), with a total of 1749 patients. The overall risk-of-bias assessment of the RCTs revealed that 7 studies had low risk, 5 had some concerns, and 9 had high risk. SUCRA (the surface under the cumulative ranking curve) rankings revealed that KJD had the greatest risk of appearing postoperative complications, revisions, and reoperations, and UKA or TKA had the lowest risk. The majority of comparisons among various treatments showed no difference for functional outcomes. CONCLUSION: Each surgical intervention is noninferior to other treatments in functional outcomes, but UKA and TKA are better options to treat OA according to SUCRA rankings by comparing complications, revisions, and reoperations. KJD is an imperfect option for treating OA. Other treatments should be carefully considered for each patient in accordance with their actual conditions. However, this conclusion is limited by the selection of reviewed publications and individual variation of surgical indications for patients. TRIAL REGISTRATION: This study was registered with Research Registry (reviewregistry1395).
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Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/surgery , Network Meta-Analysis , Treatment Outcome , Tibia/surgery , Knee Joint/surgeryABSTRACT
Objective:To study the radiotherapy sensitization of recombinant human endostatin in patients with cervical cancer.Methods:Sixty patients with advanced cervical cancer (stage ⅡB to ⅣA) from July 2017 to November 2018 in the Second Affiliated Hospital of Dalian Medical University were selected. The patients were divided into experimental group and control group according to random number table with 30 cases each. The patients in experimental group were treated with recombinant human endostatin combined with concurrent chemoradiotherapy, while the patients in control group only received chemoradiotherapy. The serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were measured 1 week before treatment and 1 week after treatment, and short-term efficacy was evaluated 3 months after treatment.Results:The objective remission rate (ORR) and disease control rate (DCR) in experimental group were higher than those in control group: 93% (28/30) vs. 87% (26/30) and 97% (29/30) vs. 93% (28/30), but there were no statistical differences between 2 groups ( P>0.05). There was no statistically significant difference in the occurrence of adverse reactions between 2 groups ( P>0.05). Compared with that before treatment, the serum VEGF and bFGF after treatment were significantly lower, experimental group: (88.07 ± 37.53) ng/L vs. (227.27 ± 142.61) ng/L and (21.03 ± 5.75) ng/L vs. (38.34 ± 18.17) ng/L, control: (120.04 ± 81.22) ng/L vs. (197.34 ± 142.41) ng/L and (24.04 ± 7.29) ng/L vs. (39.78 ± 13.35) ng/L, and there were statistical differences ( P<0.01); after treatment, the serum VEGF and bFGF in experimental group were lower than those in control group, but there were no statistical difference between 2 groups ( P>0.05). Conclusions:For patients with advanced cervical cancer, recombinant human endostatin combined with concurrent chemoradiotherapy can further decrease the serum levels of VEGF and bFGF, improve the sensitivity of chemoradiotherapy, and enhance the short-term efficacy.
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To explore the relationship between sleep duration and brachial-ankle pulse wave velocity(baPWV) in patients with type 2 diabetes mellitus(T2DM). A total of 1 755 patients with T2DM received standardized management of metabolic disease from March 1, 2018 to February 29, 2020 were included. All patients were classified into three groups according to the sleep duration: short(≤6 h), medium(>6 h to 8 h) and long(>8 h). Increased arterial stiffness was defined as baPWV≥1 600 cm/s. The prevalence of baPWV≥1 600 cm/s was 39.7%, 30.8% and 38.6% in short, medium and long sleep duration group, respectively( P<0.01). Multivariate logistic regression analysis showed that patients with long sleep duration( OR=1.317, P<0.05) but not short sleep duration( OR=1.169, P>0.05) had a higher risk for baPWV≥1 600 cm/s compared with the reference group with medium sleep duration. Stratified analyses by sex showed that the OR were 1.735( P<0.05) among female and 1.131( P>0.05) among male respectively for baPWV≥1 600 cm/s in long sleep duration group when compared with medium sleep duration group. Sleep duration>8 h was found to be associated with elevated baPWV in patients with T2DM. There were gender differences in the correlation between long sleep duration and baPWV.
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Objective@#To explore the association between thyroid hormones and visceral fat area(VFA) in the patients with type 2 diabetes.@*Methods@#A total of 729 patients with type 2 diabetes, who joined National Metabolic Management Center(MMC) through Ningbo First Hospital from March, 2018 to July, 2019, were enrolled in this study. Blood tests were taken to assess their thyroid hormones and biochemical indexes. VFA and subcutaneous fat area(SFA) were obtained through bioelectrical impedance analysis. Statistics were later analyzed by Spearman correlation analysis and multivariate linear regression.@*Results@#Spearman correlation analysis showed that VFA were positively correlated with T3、FT3(r=0.225 and 0.211, P<0.01), and VFA were inversely correlated with FT4(r=-0.112, P<0.01). No correlation was found between VFA and either of T4 or TSH(P>0.05). Multivariate linear regression analysis indicated that VFA was independently correlated with FT4 and FT3(P<0.01). An increment of 1 pmol/L in FT4 was associated with 1.759 cm2 increase in VFA, and increment of 1 pmol/L in FT3 was associated with 3.256 cm2 decrease in VFA.@*Conclusion@#VFA in patients with type 2 diabetes are correlated with FT3 and FT4.
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Objective:To explore the association between thyroid hormones and visceral fat area(VFA) in the patients with type 2 diabetes.Methods:A total of 729 patients with type 2 diabetes, who joined National Metabolic Management Center(MMC) through Ningbo First Hospital from March, 2018 to July, 2019, were enrolled in this study. Blood tests were taken to assess their thyroid hormones and biochemical indexes. VFA and subcutaneous fat area(SFA) were obtained through bioelectrical impedance analysis. Statistics were later analyzed by Spearman correlation analysis and multivariate linear regression. Results:Spearman correlation analysis showed that VFA were positively correlated with T 3、FT 3( r=0.225 and 0.211, P<0.01), and VFA were inversely correlated with FT 4( r=-0.112, P<0.01). No correlation was found between VFA and either of T 4 or TSH( P>0.05). Multivariate linear regression analysis indicated that VFA was independently correlated with FT 4 and FT 3( P<0.01). An increment of 1 pmol/L in FT 4 was associated with 1.759 cm 2 increase in VFA, and increment of 1 pmol/L in FT 3 was associated with 3.256 cm 2 decrease in VFA. Conclusion:VFA in patients with type 2 diabetes are correlated with FT 3 and FT 4.
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OBJECTIVE： To prepare Ganshen granules， formulate its quality standards primarily and establish its HPLC fingerprint. METHODS： Using feeding speed， roller speed， roller pressure and roller clearance as factor， grain forming rate as index， single factor test and orthogonal test were used to optimize the granulation technology of Ganshen granules. According to 2015 edition of Chinese Pharmacopeia （part Ⅳ） （shorted for pharmacopeia）， moisture， granulation and dissolution were determined. TLC was used for the qualitative identification of Lycium barbarum， Astragalus membranaceus， Codonopsis pilosula in the Ganshen granules. HPLC method was used to determine the contents of betaine， calycosin-7-glucoside and lobetyolin in Ganshen granules. Fingerprints of 10 batches of Ganshen granules were drawn. RESULTS： The optimal dry granulation technology of Ganshen granules included that 25 r/min feeding speed， 8 r/min roller speed， 7 MPa roller pressure and 1.1 mm roller clearance， The grain forming rate is 85.83％. The moisture， granulation and solubility of Ganshen granule were all in line with pharmacopeia standard. TLC of L. barbarum， A. membranaceus and C. pilosula showed the same color spots on the corresponding positions of the reference chromatogram. The linear range of sample mass of betaine is 4.32-8.64 μg， and the linear range of mass concentration of calycosin-7-glucoside and lobetyolin were 5-30 and 10-60 μg/mL， respectively. RSDs of precision， reproducibility and stability tests （24 h） were all lower than 2.0％ （n＝5）. Average recoveries were 97.02％， 99.25％ and 101.04％ （all RSD＜1.7％， n＝6 or n＝9）. The contents of them were 4.298、0.054、0.025 mg/g， respectively. The similarity of HPLC fingerprints of 10 batches of Ganshen granules to control fingerprint was higher than 0.95. CONCLUSIONS： The optimal granulation technology of Ganshen granule is stable and feasible， and established quality standard and HPLC fingerprint can provide reference for quality control of Ganshen granule.
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Objective To discuss the effect of main organ-preserving pancreatectomy operations on the postoperative complications and the long-term quality of life.Methods The clinical data of 320 patients undergoing pancreatic surgery from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University were retrospectively analyzed and all the patients were divided into traditional pancreatectomy surgery group and organ-preserving pancreatectomy surgery group.The traditional pancreatectomy surgery group included pancreaticoduodenectomy (PD),distal pancreatectomy (DP),and laparoscopic distal pancreatectomy (LDP);and the organ-preserving pancreatectomy surgery group included pylorus-preserving pancreaticoduodenectomy (PPPD),spleen-preserving distal pancreatectomy (SPDP),enucleation pancreatectomy (EP),and middle-preserving pancreatectomy (MSP).Face to face clinic visit or telephone follow-up was scheduled every three months until May 31,2017.The operation time,intraoperative hemorrhage,intraoperative blood transfusion,postoperative complications (hemorrhage,pancreatic fistula,biliary fistula,abdominal infection,delayed gastric emptying),postoperative hospitalization stay,secondary surgery and the survival status within 30 days after surgery,the pancreatic endocrine function,exocrine function and the long-term quality of life were recorded.Results The operation time,intraoperative hemorrhage and intraoperative blood transfusion were not statistically different between PD and PPPD groups,DP and SPDP groups,LDP and LSPDP groups,DP and MSP groups,and DP and EP groups,respectively (all P values ＞0.05).Compared with MSP group,the hospitalization time in DP group was shorter [(18.61 ±12.46)d vs (26.88 ± 15.22)d],the occurrence rate of postoperative pancreatic fistula (24.07％ vs 56.25％),bleeding (3.70％ vs 25.00％),abdominal infection (1.85％ vs 18.75％),delayed gastric emptying (5.56％ vs 31.25％),secondary surgery (0 vs 25.00％),and glycemic control rate were decreased (27.78％ vs 0),and all the differences were statistically significant (all P values ＜ 0.05).After discharge,the incidence of chronic diarrhea in the PD group was higher than that in the PPPD group (17.31％ vs 2.08％).The fatigue in the DP group was higher than that in the SPDP,MSP and EP groups,and fatigue,social function,overall health score of the LDP group were lower than those in LSPDP group;emotional function in the DP group was better than that in MSP group,and all the differences were statistically significant (all P values ＜ 0.05).Conclusions The organ-preserving pancreatectomy can reduce the trauma of the operation,postoperative complications and postoperative pancreatic endocrine and exocrine dysfunction,and improve the long-term quality of life.
