TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:An updated meta-analysis

AIM: To compare the liver transplantation-free (LTF) survival rates between patients who underwent transjugular intrahepatic portosystemic shunts (TIPS) and those who underwent paracentesis by an updated meta-analysis that pools the effects of both number of deaths and time to death.

Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: An evidence-based review

Nowadays,transjugular intrahepatic portosystemic shunt(TIPS)has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis.Accumulated evidence has shown that its indications are being gradually expanded.Notwithstanding,less attention has been paid for the selection of an appropriate stent during a TIPS procedure.Herein,we attempt to review the current evidence regarding the diameter,type,brand,and position of TIPS stents.Several following recommendations may be considered in the clinical practice:(1)a 10-mm stent may be more effective than an 8-mm stent for the management of portal hypertension,and may be superior to a 12-mm stent for the improvement of survival and shunt patency;(2)covered stents are superior to bare stents for reducing the development of shunt dysfunction;(3)if available,Viatorr stent-grafts may be recommended due to a higher rate of shunt patency;and(4)the placement of a TIPS stent in the left portal vein branch may be more reasonable for decreasingthe development of hepatic encephalopathy.However,given relatively low quality of evidence,prospective well-designed studies should be warranted to further confirm these recommendations.

Equol inhibits proliferation of human gastric carcinoma cells via modulating Akt pathway

AIM: To investigate the anti-tumor effects of equol in gastric cancer cells and the underlying molecular mechanisms.METHODS: MGC-803 cells were employed for in vitro experiments in this study. Cells were treated with control(vehicle,0.1% DMSO) or equol under specified dose titration or time courses. Cell viability was examined by MTS assay,and the levels of Ki67 were determined by q PCR and immunofluorescent assay. Changes in cell cycle distribution and apoptosis rate were detected by flow cytometry. The m RNA expression of cyclin E1 and P21WAF1 was determined by q PCR. The protein levels of cell cycle regulators,PARP and Caspase-3 cleavage,and the phosphorylation of Akt were examined by Western blot. In addition,to characterize the role of elevated Akt activation in the anti-tumor effect exerted by equol,Ly294002,a PI3K/AKT pathway inhibitor,was used to pretreat MGC-803 cells. RESULTS: Equol(5,10,20,40,or 80 μmol/L) inhibited viability of MGC-803 cells in a dose- and timedependent manner after treatment for 24,36,or 48 h(P < 0.05 for all). Equol also decreased the m RNA(P <0.05 for 12 and 24 h treatment) and protein levels of Ki67. Equol treatment significantly induced G0/G1 cell cycle arrest(P < 0.05),with the percentages of G0/G1 cells of 32.23% ± 3.62%,36.31% ± 0.24%,45.58% ± 2.29%,and 65.10% ± 2.04% for equol(0,10,20,or 30 μmol/L) treatment,respectively,accompanied by a significant decrease of CDK2/4(P < 0.05 for 24 and 48 h treatment) and Cyclin D1/Cyclin E1(P < 0.05),and an increased level of P21WAF1(P < 0.05). A marked increase of apoptosis was observed,with the percentages of apoptotic cells of 5.01% ± 0.91%,14.57% ± 0.99%,37.40% ± 0.58%,and 38.46% ± 2.01% for equol(0,5,10,or 20 μmol/L) treatment,respectively,accompanied by increased levels of cleaved PARP and caspase-3. In addition,we found that equol treatment increased P-Akt(Ser473 and Thr308) at 12 and 24 h compared to vehicle-treated control; longer treatment for 48 h decreased P-Akt(Ser473 and Thr308). P-Akt at Thr450,however,was decreased by equol treatment at all time points examined(P < 0.05 for all). Moreover,Akt inhibition by Ly294002 could not prevent but led to enhanced G0/G1 arrest and apoptosis. CONCLUSION: Equol inhibits MGC-803 cells proliferation by induction of G0/G1 arrest and apoptosis. Its anti-cancer effects are likely mediated by dephosphorylation of Akt at Thr450.

EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis:A meta-analysis

AIM: To evaluate the clinical effects of transjugular intrahepatic portosystemic shunt (TIPS) vs endoscopic variceal sclerotherapy (EVS) in the management of gastric variceal (GV) bleeding in terms of variceal rebleeding, hepatic encephalopathy (HE), and survival by meta-analysis.METHODS: Medline, Embase, and CNKI were searched. Studies compared TIPS with EVS in treating GV bleeding were identified and included according to our predefined inclusion criteria. Data were extracted independently by two of our authors. Studies with prospective randomized design were considered to be of high quality. Hazard ratios (HRs) or odd ratios(ORs) were calculated using a fixed-effects model when there was no inter-trial heterogeneity. Oppositely, a random-effects model was employed.RESULTS: Three studies with 220 patients who had at least one episode of GV bleeding were included in the present meta-analysis. The proportions of patients with viral cirrhosis and alcoholic cirrhosis were 39% (range 0%-78%) and 36% (range 12% to 41%), respectively. The pooled incidence of variceal rebleeding in the TIPS group was significantly lower than that in the EVS group (HR = 0.3, 0.35, 95% CI: 0.17-0.71, P = 0.004). However, the risk of the development of any degree of HE was significantly increased in the TIPS group (OR = 15.97, 95% CI: 3.61-70.68). The pooled HR of survival was 1.26(95% CI: 0.76-2.09, P = 0.36). No inter-trial heterogeneity was observed among these analyses. CONCLUSION: The improved effect of TIPS in the prevention of GV rebleeding is associated with an increased risk of HE. There is no survival difference between the TIPS and EVS groups. Further studies are needed to evaluate the survival benefit of TIPS in cirrhotic patients with GV bleeding.

Integrative thinking facilitates traditional medical research

Traditional medicine,especially traditional Chinese medicine,has made indelible contributions to the reproduction and development of the Chinese nation.In the current era dominated by western medicine,the development of traditional medicine has encountered great challenges and difficulties.People with lofty ideals put forward that traditional medicine should take the road of modernization,especially advocating the modernization of traditional Chinese medicine.It is true that the research and practice of traditional medicine must advance with the times and keep up with the times,but we must also guard against the trap of modernization,that is,the plight of traditional Chinese medicine.This is because reductionist western medicine cannot effectively explain the profound Oriental wisdom and culture.At present,some problems in traditional medical research have caused us to worry.

Systematic reviews and meta-analyses: Why are they clinically significant?

This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.

Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy:Results from a meta-analysis of randomized controlled trials and prospective studies

BACKGROUND Double-balloon,single-balloon,and spiral enteroscopy(DBE,SBE,and SE)have revolutionized the management of intestinal diseases.However,evidence about efficacies of these methods is lacking.We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE,SBE,and SE.METHODS We searched randomized controlled trials and prospective studies in MEDLINE,PubMed,EMBASE,Cochrane Library,and Chinese CQVIP database.Studies referencing the comparison of at least two of these three methods were included.Primary outcome was diagnostic yield.Other outcomes were therapeutic yield,total enteroscopy,examination time,time to maximum insertion,and depth of maximal insertion(DMI).RESULTS Eleven studies including 727 patients were identified:DBE vs SE(n=6),DBE vs SBE(n=4),and SBE vs SE(n=1).The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE[odds ratio(OR)=1.19,95%confidence interval(CI):0.68-2.08;OR=1.17,95%CI:0.61-2.23]and DBE with SBE(OR=0.85,95%CI:0.55-1.33;OR=1.71,95%CI:0.64-4.60).Total enteroscopy,examination time,time to maximum insertion,and DMI were similar between SBE and DBE.DBE was superior to SE with regard to DMI[mean difference(MD)=36.76,95%CI:5.09-68.43],with longer time to maximum insertion(MD=15.14,95%CI:12-18.27)and examination time(MD=12.98,95%CI:9.57-16.38).CONCLUSION DBE and SBE have similar clinical outcomes.Compared with DBE,SE seems to have similar diagnostic and therapeutic yields,but shorter procedural time in cost of less depth of insertion.SE needs further evaluation vs SBE.DBE is recommended for complete enteroscopy.

Duplicates in systematic reviews: A critical, but often neglected issue

The number of systematic reviews is gradually increas-ing over time. Also, the methods to perform a systematic review are being improved. However, little attention has been paid for the issue regarding how to fnd duplicates in systematic reviews. On the basis of the survey and systematic reviews by our team and others, we review the prevalence, significance and classification of duplicates and the method to fnd duplicates in a systematic review. Notably, although a preliminary method to fnd duplicates is established, its usefulness and convenience need to be further confrmed.

医疗机构工作人员是否需要戴口罩?——基于最佳证据的论述

目的目前关于医疗机构工作人员是否需要戴口罩仍存在较大争议,本研究意在评价和总结针对这一问题的现有最佳证据,以期为临床医务工作人员使用口罩提供参考。方法计算机检索PubMed、Cochrane图书馆、Web of Science、CINAHL、中国知网、万方、维普、中国生物医学文献数据库,指南数据库平台及相关专业学会组织,检索时限为建库至2019年10月27日,以获取相关指南、专家共识、系统评价,应用国际公认的质量评价工具对纳入的证据进行质量评价,汇总现有证据对医疗机构人员是否需要戴口罩这一问题的相关推荐内容。结果共纳入35篇文献,其中6篇指南,27篇专家共识,2篇系统评价,证据质量整体较高。现有证据均推荐使用口罩作为个人防护措施之一,且与不使用呼吸防护设备相比,戴口罩在预防院内感染方面具有明显的优势,并根据不同的应用情景如手术区域、实验室区、产科等提出多项推荐意见。结论现有证据充分认可戴口罩作为个人防护措施之一在医疗机构中预防院内感染的重要作用。但本研究纳入的证据质量仍有一定的局限性。临床医务工作人员应当结合自身工作经验、临床实际情况等因素综合考虑,合理、规范使用口罩。

An analysis of patents for anesthetic laryngoscopes

The anesthetic laryngoscope is one of the most popular medical tools for obtaining a clear view of the larynx and facilitates tracheal intubation. The number of anesthetic laryngoscope patents, coming mainly from the anesthesiologists, has rapidly increased. Each product has a specialized use for particular patients. However, it is unclear to what extent anesthetic laryngoscopy gained acceptance in operating theaters. By retrieving patent data for more than 90 countries from the Online Retrieval of Bibliographic Information Time-share(ORBIT) system, we reviewed the anesthetic laryngoscope patent literature published before July 6, 2015, and manually analyzed patent status, general development trends, areas of competition, technology patentees, and technology classifications. The study showed that the number of anesthetic laryngoscope patent applications has stayed at a high level in the last decade. Most patent activity was carried out in the USA, with China and a number of European countries trailing behind. In addition, the patent analysis provided an opportunity to understand the trends in the development of anesthetic laryngoscope technology, to identify shortcomings in clinical use of anesthetic laryngoscopes, to assist medical manufacturing specialists in improving the design and products, and to suggest to anesthesiologists modifications of the clinical signs of difficult tracheal intubation based on the new commercial anesthetic laryngoscopes applied in the front-line.