Efficacy and safety of gastroscopic hemostasis in the treatment of acute gastric hemorrhage: A meta-analysis

BACKGROUND Gastric cancer(GC)is a malignant tumor with a high incidence and mortality rate worldwide for which acute bleeding is a common clinical complication.Gastro-scopic hemostasis is an important method for treating acute bleeding in GC;however,its efficacy and safety remain controversial.AIM To systematically analyze the efficacy and safety of gastroscopic hemostasis for the treatment of acute gastric hemorrhage.METHODS The PUBMED,Web of Science,Wiley Library,EMBASE,Wanfang,CNKI,and VIP databases were searched for studies related to gastroscopic hemostatic treatment for acute GC published through February 20,2023.The literature was screened according to the inclusion and exclusion criteria,data were extracted,and lite-rature quality was evaluated.The meta-analysis was performed using RevMan software(version 5.3),while Begg’s test for publication bias was performed using Stata 13.0 software.RESULTS Six randomized controlled trials and two retrospective analyses were retrieved.Five studies had a low,two had an uncertain,and one had a high risk of bias.Compared with the control group,the hemostatic rate of gastroscopic hemostasis was increased[relative risk(RR)=1.24;95%confidence interval(CI):1.08 to 1.43;P=0.003];the rate of rebleeding(RR=0.27;95%CI:0.09 to 0.80;P=0.02),rate of surgery transfer(RR=0.16;95%CI:0.06 to 0.43;P=0.0003),serum C-reactive protein level[mean difference(MD)=-5.16;95%CI:-6.11 to 4.21;P<0.00001],interleukin-6 level(MD=-6.37;95%CI:-10.33 to-2.42;P=0.002),and tumor necrosis factor-αlevel(MD=-2.29;95%CI:-4.06 to-0.52;P=0.01)were decreased;and the quality of life improvement rate was increased(RR=1.95;95%C I=1.41-2.71;P<0.0001).Begg’s test revealed no significant publication bias.CONCLUSION The efficacy and safety of endoscopic hemostasis were higher than those of the control group,suggesting that it is an effective treatment for acute GC hemorrhage.

The effects of nutritional ketosis induced by Bigu-herbs regimen and ketogenic diet on diseases and aging

The Bigu-herbs regimen,a Taoism(Taoism is an ancient Chinese Taoist philosophy system)special health-preserving technique to achieve longevity through strict abstinence from food,limits the intake of grains and uses herbs to replace normal diet to gain energy.Practicing Bigu-herbs regimen for several weeks to several years can make one lose weight,prevent diseases,and prolong life.The modern ketogenic diet(KD)mainly limits carbohydrate intake and increase fat intake.The low-carbohydrate,high-fat,and adequate protein diet is well known for its antiepileptic and neurotrophic effects.Limiting the intake of carbohydrate results in energy metabolism reprogramming to mobilize the steatolysis,energize and promote ketone bodies(KBs)production,achieving a state of nutritional ketosis(NK).The researchers summarized how ketone bodies or NK affects diseases and the aging process,as well as the side effects of KD.NK has a favorable effect on caloric intake,lipid parameters,glycemic index,and insulin sensitivity;moreover,it can be used as a treatment option for diabetes,obesity,and other metabolic disorders.NK is recognized as being neuroprotective and is good for epilepsy,Alzheimer’s disease,and emotional disturbance.Targeting the metabolic differences between tumor and normal cells,NK limits the use of glucose and impairs energy metabolism in cancer cells,inhibiting their growth and rendering them susceptible to clinical treatments.NK also affects inflammation and the release of cytokines,regulate gut flora,extend longevity and health span,and preserve physiologic functions.The side effects of KDs are controllable under the guidance of a specially trained dietitian and medical team.

Hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis:a meta-analysis

Objective:To evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)in the treatment of gastric cancer with peritoneal carcinomatosis.Methods:The relevant clinical controlled studies were retrieved from the databases of PubMed,Cochrane Library,Embase.Risk ratio(RR),as well as the respective 95%confidence interval(CI),was used as a statistical indicator.1-year survival,2-year survival,and safety were analyzed.Results:Two randomized controlled trials(RCTs)and 10 high-quality non-randomized controlled trials(NRCTs)were included,enrolling 837 patients(438 in the HIPEC group and 415 in the control group).Compared with the control group,HIPEC group turned out to be of greater improvement in long-term efficacy:1-year survival rate(1y-os)and 2-year survival rate(2y-os).Subgroup analysis of different treatment modes in NRCTs showed that,in terms of 1-year survival rate,(1)HIPEC combined with cytoreductive surgery(CRS)compared with CRS alone,RR=0.68,95%CI:(0.53,0.85);(2)HIPEC combined with intravenous chemotherapy±CRS versus chemotherapy alone,RR=0.54,95%CI:(0.39,0.74);(3)HIPEC combined with palliative gastrectomy versus palliative gastrectomy,RR=0.37,95%CI:(0.22,0.63).As for safety,there were no significant differences in adverse events between two groups.Conclusion:HIPEC can prolong the survival of gastric cancer patients with peritoneal carcinomatosis,and the incidences of adverse events were not increased.