Pearls of meta-analyses and systematic review in scientific evidence

Scientific evidence develops bit by bit from case reports,case series;to larger casecontrol,case-cohort;and further escalate to randomized controlled trials.This echoed the importance of continue publishing World journal of Clinical Cases,where novel and advancing discoveries start from a single case.In contrast,at the other end of the realm of evidence synthesis,systematic review and meta-analysis represent distinct yet interconnected processes.Butorphanol in epidural labor analgesia has long been studied since 1989,and with 70 publications from MEDLINE searches.However,there was no meta-analysis,nor any systematic review published so far.The latest in-press article published by Tang et al.on the protocol for the systematic review and meta-analysis on the safety and effectiveness of butorphanol in epidural labor analgesia is encouraging.We believe the findings of this study will be valuable for clinical practice as well as for future research.

Stroke care in the ChatGPT era:Potential use in early symptom recognition

Dear editor,Generative Pre-trained Transformer-based Chatbot(ChatGPT)[1]or similar natural language processing[2]and large language models[3]are artificial intelligence systems designed to understand and respond to human languages,allowing them to provide information,answer questions,and provide guidance on a wide range of topics.One of their key benefits is immediate access to information in a conversational format,as if a hotline call,which is essential in acute medical conditions.Currently,medical utilization of ChatGPT is a hot research topic.Because its intrinsic difference from search engines,ChatGPT has the potential to revolutionize our mode of information access.

COVID-19 vaccine-related retinal vascular occlusion

Retinal artery or vein occlusion(RAVO)is the ocular analog of cerebral stroke,and the iatrogenic causes,such as vaccines,were reported[1].The popularity of COVID-19 vaccines caused concerns about their potential association with RAVO[2,3].To investigate this potential association,we searched PubMed,MEDLINE,and EMBASE on March 28,2023,with the following keywords:[“retinal artery occlusion”OR“retinal vein occlusion”]AND“COVID-19 vaccines”.

Importance of well-designed meta-analyses in assessing medical and surgical treatments

When evaluating the efficacy of medical or surgical treatments,the most robust study design is often considered to be the high-quality randomized clinical trial(RCT).However,the true answer lies in the meta-analysis of high-quality RCTs.While RCTs have their merits,meta-analyses possess two crucial qualities that make them superior:Generalizability and the ability to verify replicability across different trials.A well-designed meta-analysis,defined here as a systematic review that pools data,holds significant advantages over individual RCTs.Retrospective and observational surgical research is prone to biases that are not mutually offsetting;instead,they accumulate.Selection bias,transfer bias,and assessment bias all taint retrospective studies more than randomized trials,making the novel treatment appear more effective than it truly is.Pooling studies suffering from these limitations in a meta-analysis amplifies these biases,causing an overestimation of treatment benefits.This becomes particularly concerning when the treatment itself carries substantial risks,as is often the case in surgical journals.The consequences can result in harm or even death for patients.While a well-designed meta-analysis is the best tool for assessing medical and surgical treatments,a weak meta-analysis amplifies biases and promotes flawed data.Thoughtful readers must become proficient in honing their methodological toolkits,delving deeper into topics like heterogeneity and publication bias.It is essential to avoid wasting time on meta-analyses drawing data from retrospective or observational research regarding surgical treatments.

Incidence of acute infectious conjunctivitis across the pre-and post COVID era:a 7-year-result from a tertiary acute hospital in Hong Kong

Acute infectious conjunctivitis(AIC)is one of the most common communicable diseases encountered in acute hospital settings.Transmission exists long before COVID-19.Research showed COVID-19 infections were associated with AIC,as the most common ocular manifestations[1].Thus,an increase in AIC during COVID-19 is expected[2].However,personal hygiene practices and public health measures throughout COVID-19 negatively impacted the incidence of influenza and other upper respiratory tract infections,as for AIC[3].Our retrospective study extracted the data between July 2016 to June 2023,from the hospital communicable ocular diseases database.We aim to reveal the incidence of AIC across the pre-and post-COVID era in a local regional acute hospital.A total of 1512 patients with AIC were identified in the last 7 years across the pre-and post-COVID era.Monthly incidences of AIC over the past 7 years were plotted as a line chart(Figure 1A).