A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease

Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.Methods: We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.Results: In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.Conclusion: CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.

Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary outcomes.RESULTS: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis, SEMS had lower overall stent dysfunction compared to PS(21.6% vs 46.8%, P < 0.00001) and fewer re-interventions(21.6% vs 56.6%, P < 0.00001), with no difference in complications(13.7% vs 15.9%, P = 0.16). In the secondary analysis, the mean survival rate was higher in the SEMS group(182 d vs 150 d, P < 0.0001), with a higher patency period(250 d vs 124 d, P < 0.0001) and a lower cost per patient(4193.98 vs 4728.65 Euros, P < 0.0985).CONCLUSION: SEMS are associated with lower stent dysfunction, lower re-intervention rates, better survival, and higher patency time. Complications and costs showed no difference.

Cytomegalovirus in inflammatory bowel disease： Asystematic review

AIM: To identify definitions of cytomegalovirus(CMV) infection and intestinal disease, in inflammatory bowel disease(IBD), to determine the prevalence associated with these definitions.METHODS: We conducted a systematic review and interrogated Pub Med, EMBASE and Cochrane for literature on prevalence and diagnostics of CMV infection and intestinal disease in IBD patients. As medical headings we used "cytomegalovirus" OR "CMV" OR "cytomegalo virus" AND "inflammatory bowel disease" OR "IBD" OR "ulcerative colitis" OR "colitis ulcerosa" OR "Crohn's disease". Both Me SH-terms and free searches were performed. We included all types of English-language(clinical) trials concerning diagnostics and prevalence of CMV in IBD.RESULTS: The search strategy identified 924 citations, and 52 articles were eligible for inclusion. We identified 21 different definitions for CMV infection, 8 definitions for CMV intestinal disease and 3 definitions for CMV reactivation. Prevalence numbers depend on used definition, studied population and region. The highest prevalence for CMV infection was found when using positive serum PCR as a definition, whereas for CMV intestinal disease this applies to the use of tissue PCR > 10 copies/mg tissue. Most patients with CMV infection and intestinal disease had steroid refractory disease and came from East Asia.CONCLUSION: We detected multiple different definitions used for CMV infection and intestinal disease in IBD patients, which has an effect on prevalence numbers and eventually on outcome in different trials.

Scraping therapy for knee osteoarthritis: a systematic review and Meta-analysis

OBJECTIVE:To systematically evaluate the efficacy of scraping therapy on knee osteoarthritis(KOA).METHODS:A computerized search was conducted in several databases,including PubMed,Web of Science,Cochrane Library,China National Knowledge Infrastructure Database,China Science and Technology Journal Database,Wanfang,and Chinese BioMedical Literature Database,from the establishment date of these databases to April 9,2023.Randomized controlled trials(RCTs)on scraping therapy for KOA were collected in accordance with the“Participants-Intervention-Control-Outcome-Study design”criteria.The methodological evaluation of the included studies was carried out using RoB 2.0,and Meta-analysis was conducted using RevMan.The Grades of Recommendations Assessment,Development and Evaluation(GRADE System)was applied to grade the quality of evidence.RESULTS:A total of 12 RCTs with 997 subjects were included in the Meta-analysis.Results indicated that compared with the control group,the scraping therapy treatment group exhibited increased Lysholm scores[mean difference(MD)=4.96,95%confidence intervals(CI)(3.18,6.74),P<0.00001]and Hospital for Special Surgery scores[MD=8.35,95%CI(3.92,12.78),P=0.0002]and decreased visual analog scale scores[MD=-2.11,95%CI(-3.79,-0.44),P=0.01]and Western Ontario and McM aster University Osteoarthritis Index scores[MD=-6.77,95%CI(-8.99,-4.56),P<0.00001)].The quality of evidence obtained in this Meta-analysis was low according to the GRADE system.CONCLUSION:The available evidence suggests that scraping therapy may have certain clinical efficacy in the treatment of KOA.However,further high-quality RCTs are needed to confirm the findings.

Content analysis of systematic reviews on effectiveness ofTraditional Chinese Medicine

OBJECTIVE:To evaluate evidence for the efficacy of Traditional Chinese Medicine(TCM) in systematic reviews.METHODS:Chinese(TCM Periodical Literature Database,Chinese Biological Medicine database,Chinese Medical Current Contents,China Hospital Knowledge Database journal fulltext database,Virtual Machining and Inspection System,and Wanfang) and English(Cochrane Database of Systematic Reviews,PubMed and Embase) databases were searched.RESULTS:Three thousand,nine hundred and fifty-five articles were initially identified,606 of which met the inclusion criteria,including 251 in English(83 from the Cochrane Database) and 355 in Chinese.The number of articles published each year increased between 1989 and 2009.Cardiocerebrovascular disease was the most studied target disease.Intervention measures included TCM preparations(177 articles),acupuncture(133 articles) and combinations of TCM and Western Medicine(38 articles).Control measures included positive medical(177 articles),basic treatment(100 articles),placebo(219 articles),and blank and mutual(107 articles).All articles included at least one reference;the greatest number was 268.Six of 10 articles with high quality references demonstrated curative effectsagainst target diseases including upper respiratory tract infection,dementia and depression.Interventions that were not recommended were tripterygium for rheumatoid arthritis and TCM syndrome differentiation for pediatric nocturia.In 10.4% of the studies,the authors concluded that the intervention had a curative effect.The assessors agreed with the authors' conclusions in 88.32% of cases,but rejected 8.94%(54 articles).CONCLUSION:1) Training in systematic review methods,including topic selection,study design,methods and technology,should be improved.2) Upper respiratory tract infection,dementia and depression may become the predominant diseases treated by TCM,and the corresponding interventions could be developed into practical applications.3) Use of non-recommended interventions should be controlled,and there should be more research on side effects.