Association of Ureaplasma urealyticum Colonization with Development of Bronchopulmonary Dysplasia: A Systemic Review and Meta-analysis

There is controversy regarding the roles of Ureaplasma urealyticum （U. urealyticum） colo- nization in the development of hronchopulmonary dysplasia （BPD）. This study explored the association between U. urealyticum and bronchopulmonary dysplasia at 36 weeks post-menstrual age （BPD36）. Studies published before December 31, 2013 were searched from Medline, Embase, Ovid, Web of Sci- ence, and Cochrane databases, with the terms ＂Ureaplasma urealyticum＂, ＂chronic lung disease＂, or ＂BPD36＂ used, and English language as a limit. The association between U. urealyticum colonization and BPD36 was analyzed with RevMan 4.2.10 software, using the odds ratio （OR） and relative risk （RR） for dichotomous variables. Out of the enrolled 81 studies, 11 investigated the BPD36 in total 1193 in- fants. Pooled studies showed no association between U. urealyticum colonization and subsequent de- velopment of BPD36, with the OR and RR being 1.03 （95% CI=0.78-1.37; P=-0.84） and 1.01 （95% CI= 0.88-1.16, P=-0.84）, respectively. These findings indicated no association between U. urealyticum colo- nization and the development of BPD36.

Systemic review and network meta-analysis:Prophylactic antibiotic therapy for spontaneous bacterial peritonitis

BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choice of antibiotics remains unclear.AIM To evaluate the efficacy of various antibiotics for prophylaxis of SBP based on randomized control trials(RCTs).METHODS Electronic databases were searched through November 2018 for RCTs evaluating the efficacy of therapies for primary or secondary prophylaxis of SBP.The primary outcome was the development of SBP.Sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010 were performed.The secondary outcome was the risk of all-cause mortality or transplant.The outcomes were assessed by rank of therapies based on network meta-analyses.Individual meta-analyses were also performed.RESULTS Thirteen RCTs(1742 patients)including norfloxacin,ciprofloxacin,rifaximin,trimethoprim-sulfamethoxazole(TMP-SMX),or placebo/no comparator were identified.Individual meta-analyses showed superiority of rifaximin over norfloxacin as well as norfloxacin and TMP-SMX over placebo.Network metaanalysis demonstrated the rank of efficacy in reducing the risk of SBP as:Rifaximin,ciprofloxacin,TMP-SMX,norfloxacin,and placebo/no comparator.Rifaximin ranked highest in sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010.Similarly,rifaximin ranked highest in reducing the risk of death/transplant.CONCLUSION The present comprehensive network meta-analysis provides RCT based evidence for superior efficacy of rifaximin compared to other antibiotics for the prophylaxis of SBP and reducing risk of death/transplant.Further RCTs are warranted to confirm our findings.

Emergency medicine in the United States:a systemic review

BACKGROUND:Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable suggestions and guidance.DATA SOURCES:This systemic review is based on the author's extensive experience through active involvement in the national and international development of emergency medicine.RESULTS:Emergency physicians in the U.S.emergency departments and sometimes other settings provide urgent and emergency care to patients of all ages,including definitive diagnosis of emergent conditions,prolonged stabilization of patients when necessary,airway management,and life-saving procedures using rapid sequence intubation and sedation.They use a multitude of diagnostic technologies including laboratory studies,bedside ultrasound and other sophisticated radiology,such as CT scan,and MRI.CONCLUSION:In the U.S.,emergency medicine fits extremely well into the overall medical system,and is clearly the most efficient way to provide emergency patient care.

Investigating the therapeutic efficacy of psilocybin in advanced cancer patients: A comprehensive review and meta-analysis

BACKGROUND Psilocybin,a naturally occurring psychedelic compound found in certain species of mushrooms,is known for its effects on anxiety and depression.It has recently gained increasing interest for its potential therapeutic effects,particularly in patients with advanced cancer.This systematic review and meta-analysis aim to evaluate the effects of psilocybin on adult patients with advanced cancer.AIM To investigate the therapeutic effect of psilocybin in patients with advanced cancer.METHODS A comprehensive search of electronic databases was conducted in PubMed,Cochrane Central Register of Controlled Trials,and Google Scholar for articles published up to February 2023.The reference lists of the included studies were also searched to retrieve possible additional studies.RESULTS A total of 7 studies met the inclusion criteria for the systematic review,comprising 132 participants.The results revealed significant improvements in quality of life,pain control,and anxiety relief following psilocybin-assisted therapy,specifically results on anxiety relief.Pooled effect sizes indicated statistically significant reductions in symptoms of anxiety at both 4 to 4.5 months[35.15(95%CI:32.28-38.01)]and 6 to 6.5 months[33.06(95%CI:28.73-37.40)].Post-administration compared to baseline assessments(P<0.05).Additionally,patients reported sustained improvements in psychological well-being and existential distress fo-llowing psilocybin therapy.CONCLUSION The findings provided compelling evidence for the potential benefits of psilocybin-assisted therapy in improving quality of life,pain control,and anxiety relief in patients with advanced cancer.

Systematic review of long-term Xingnao Kaiqiao needling efficacy in ischemic stroke treatment

OBJeCTIve：To systematically evaluate the long-term effect and safety ofXingnao Kaiqiao nee-dling method in ischemic stroke treatment. DATA ReTRIevAL： We retrieved relevant random and semi-random controlled trials that used theXingnao Kaiqiao needling method to treat ischemic stroke compared with various control treatments such as conventional drugs or other acupuncture therapies. Searched databases included China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and PubMed, from May 2006 to July 2014. SeLeCTION CRITeRIA： Two authors independently conducted literature screening, quality evaluation, and data extraction. The quality of articles was evaluated according to the Cochrane Reviewers’ Handbook 5.1, and the study was carried out using Cochrane system assessment methods. RevMan 5.2 was used for meta-analysis of the included studies. MAIN OUTCOMe MeASUReS： Mortality rate, recurrence rate, and disability rate were observed. ReSULTS：Nine randomized and semi-randomized controlled trials treating 931 cases of ischemic stroke were included in this review. Meta-analysis results showed that there were no sig-niifcant differences in mortality reduction （risk ratio （RR） = 0.58, 95% conifdence interval （CI）： 0.17–1.93,Z = 0.89,P = 0.37） or recurrence rate （RR = 0.55, 95%CI： 0.18–1.70,Z = 1.04,P = 0.30） of ischemic stroke patients between theXingnao Kaiqiao needling and control treatment groups. However, theXingnao Kaiqiao needling method had a tendency towards higher efifcacy in mor-tality reduction and recurrence rates. TheXingnao Kaiqiao needling method was signiifcantly better than that of the control treatment in reducing disability rate （RR = 0.51, 95%CI： 0.27–0.98, Z = 2.03,P 〈 0.05）. CONCLUSION：TheXingnao Kaiqiao needling method has a better effect than control treatment in reducing disability rate. The long-term effect ofXingnao Kaiqiao needling against ischemic stroke is better than that of control treatment. However, the limitations of this study limit the strength of the conclusions. Randomized controlled trials with a strict, reasonable design, and multi-center, large-scale samples and follow-up are necessary to draw conclusions aboutXingnao Kaiqiao needling.

Effects of cilostazol on the progression and regression of symptomatic intracranial artery stenosis:it reduces the risk of ischemic stroke

OBJeCTIve：To assess the efifcacy and safety of cilostazol on the progression and regression of symptomatic intracranial artery stenosis. DATA ReTRIvAL： We searched the main databases for eligible trials including Medline （from 1966 to June 2014）, Embase （from 1980 to June 2014）, Cochrane Library （Issue 6, 2014）, Chinese National Knowledge Infrastructure （from 1995 to June 2014）, Current Controlled Trials （http：//controlled-trials.com）, Clinical Trials.gov （http：//clinicaltrials.gov）, and Chinese Clinical Trial Registry （http：//www.chictr.org）. All studies regarding prevention and treatment of symptomatic intracranial arterial stenosis by cilostazol were collected. The Mesh or text keywords were the En-glish words： “cilostazol, phosphodiesterase 3 inhibitor, atherosclerosis, and ischemic stroke.” No restrictions were put on publications or publication language. SeLeCTION CRITeRIA：Grade A or B randomized controlled trials were selected according to the quality of evaluation criteria from the Cochrane Collaboration, in which cilostazol and aspi-rin were used to evaluate the effects of cilostazol in the treatment of patients with symptomatic intracranial artery stenosis. The quality of study methodology was evaluated based on criteria de-scribed in Cochrane Reviewer’s Handbook 5.0.1. RevMan 5.2 software was used for data analysis. MAIN OUTCOMe MeASUReS： Clinical efifcacy and safety of cilostazol in stopping progression and promoting regression of symptomatic intracranial artery stenosis were measured by magnet-ic resonance angiography and transcranial Doppler. ReSULTS：Two randomized controlled trials with a total of 203 patients were included in this study. The results showed that while cilostazol was associated with a significantly reduced progression of intracranial artery stenosis （OR = 0.21, 95%CI： 0.09–0.47,P 〈 0.01）, it had no beneifcial effect on symptom regression （OR = 1.42, 95%CI： 0.80–2.51,P = 0.24）. During the follow-up period, although some adverse effects developed, including headache, gastrointestinal disturbance, and dizziness, incidences of bleeding were lower than in aspirin-treated patients. CONCLUSION：Cilostazol may prevent the progression of symptomatic intracranial artery ste-nosis, which could reduce the incidence of ischemic stroke.

Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials

Background:Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis(AP),but there is no consensus on the optimal fluid rate.This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs.controlled fluid resuscitation(CFR)in AP.Methods:The Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,Embase,and Web of Science databases were searched up to September 30,2022,for randomized controlled trials(RCTs)comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission.The following keywords were used in the search strategy:"pancreatitis,""fluid therapy,""fluid resuscitation,"and"randomized controlled trial."There was no language restriction.The Grading of Recommendations Assessment,Development and Evaluation(GRADE)framework was used to assess the certainty of evidence.Trial sequential analysis(TSA)was used to control the risk of random errors and assess the conclusions.Results:A total of five RCTs,involving 481 participants,were included in this study.For primary outcomes,there was no significant difference in the development of severe AP(relative risk[RR]:1.87,95%confidence interval[CI]0.95-3.68;P=0.07;n=437;moderate quality of evidence)or hypovolemia(RR:0.98,95%CI:0.32-2.97;P=0.97;n=437;moderate quality of evidence)between the aggressive and CFR groups.A significantly higher risk of fluid overload(RR:3.25,95%CI:1.53-6.93;P<0.01;n=249;low quality of evidence)was observed in the aggressive fluid resuscitation(AFR)group than the controlled group.Additionally,the risk of intensive care unit admission(P=0.02)and the length of hospital stay(P<0.01)as partial secondary outcomes were higher in the AFR group.TSA suggested that more studies were required to draw precise conclusions.Conclusion:For AP patients without organ failure on admission,CFR may be superior to AFR with respect to both efficacy and safety outcomes.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;CRD 42022363945.

It's Time for a Change in Linguistics—a Brief Review of the 18th International Systemic Congress

About the CongressThe 18th International Systemic Congress was convened in Tokyo,Japanfrom 29th July to 2nd August 1991.It took place on the ever-green garden-like campus of the International Christian University,with more than onehundred participants from about twenty countries and regions.Among

Calcium dobesilate for diabetic retinopathy: a systematic review and meta-analysis

Many randomized clinical controlled trials have confirmed the efficacy and safety of calcium dobesilate in treating diabetic retinopathy(DR).This systematic review critically evaluated the evidence that links calcium dobesilate to DR.In this fixed-effects meta-analysis,a total of 221 pertinent English-language articles published between January 1975 and October 2013 were identified.Systematic searches of PUBMED,Springer Link and the Cochrane Clinical Trials Database were conducted using the keywords "diabetic retinopathy" and "calcium dobesilate".The extracted information included the study design,inclusion and exclusion criteria,setting,sample size,participant mean age,treatment regime,mean change in best corrected visual acuity,laboratory parameters,capillary fragility,intraocular pressure and fundus manifestations based on the findings of fluorescent angiography.The summary statistics indicated that calcium dobesilate was significantly associated with improving retinal microaneurysms(RR: 0.62,95%CI: 0.42?0.90,P=0.01),retinalhemorrhages(RR: 0.39,95% CI: 0.17?0.88,P=0.02); exudates(RR: 0.31,95% CI: 0.12?0.81,P=0.02),reduction of whole blood viscosity(MD: ?0.57 CP,95% CI: ?0.75 to ?0.38,P<0.001),plasma viscosity(MD: ?0.36 CP,95% CI: ?0.63 to ?0.09,P=0.01) and blood cholesterol(MD: ?0.48 mg m L?1,95% CI: ?0.64?0.33,P<0.00001).Intraocular pressure was also significantly reduced(MD: ?5.59 mm Hg,95% CI: ?6.69 to ?4.50,P<0.00001).The results indicate that calcium dobesilate effectively treats DR at the systematic and local ocular levels.

Danshen Injection as Adjuvant Treatment for Unstable Angina Pectoris： A Systematic Review and Meta-analysis

To systematically evaluate the clinical effectiveness and safety of Danshen Injection ( DS) as one adjuvant treatment for conventional therapy with Western medicine (WM) for unstable angina pectoris (UAP). Using literature databases, a thorough and systematic retrieval of randomized controlled trials (RCTs) comparing DS plus WM with WM was conducted from inception to April 2015. The extracted data from included studies was analyzed by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests conducted by Stata 12.0 were used to evaluate the potential presence of publication bias. A total of 17 RCTs, which involving 1,433 participants, were identified and reviewed. The meta-analysis indicated that the combined use of DS and WM was significantly superior to WM alone for UAP in terms of the total effectiveness rate of angina pectoris [risk ratio (RR) =1.23, 95% confidence interval (CI): 1.17, 1.29, P < 0.01] and the total effectiveness rate of electrocardiogram (ECG) [RR=1.18, 95%CI: 1.06, 1.30, P=0.001]. Additionally, DS could also further reduce the content of fibrinogen, adjust blood lipid level, correct T wave inversion, and so on. Fifteen adverse drug reactions were reported in two studies, Four of which appeared in the experimental group. Based on the systematic review, the combined use of DS and WM was more effective than WM alone, it can be further widely used in clinic, however, there was no exact conclusion for its safety.

Systematic review and Meta-analysis of 26 randomized controlled clinical trials of Compound Danshen Dripping Pill for non-proliferating diabetic retinopathy

Objective:Diabetic retinopathy(DR) is the retinal consequence of chronic progressive diabetic microvascular leakage and occlusion.Non-proliferating diabetic retinopathy(NPDR) is the early stage of DR.It eventually occurs to some degree in all patients with diabetes mellitus.In recent years,many clinical trials have shown that Compound Danshen Dripping Pill(CDDP) may be associated with the improvement of NPDR symptoms.The aim of this study was to quantitatively summarize the association between CDDP and the therapeutic effects of NPDR.Methods:It was conducted that a systematic literature search of Pub Med,Web of Science,CNKI,VIP and Wanfang Data updated in June 2020 with the following search terms:"diabetic retinopathy° or"retinopathy° or "DR° or "NPDR°,in combination with "Compound Danshen Dripping Pill° or "Salvia miltiorrhiza° or "Danshen°.Risk ratio(RR) and weighted mean difference(WMD) with their 95% confidence interval(CI) was calculated between treatment and control groups.The sensitivity analyses were undertaken by removing each individual study when high heterogeneity appeared.Subgroup analysis,Metaregression,and publication bias analysis were also conducted.The strength of evidence was evaluated with the Grading of Recommendation,Assessment,Development,and Evaluation(GRADE) method.Results:Twenty-six RCTs involving 2047 subjects were included to conduct a Meta-analysis after screening the studies,extracting the data,and assessing the study quality.The Stata15.0 software was utilized for processing.Meta-analysis indicated that curative effects of treatment group with CDDP was significantly better than control [RR = 0.54,95% CI(0.40,0.73);moderate-quality evidence].In addition,the results showed that CDDP was significantly associated with improving retinal hemorrhages[WMD =-0.62,95% CI(-0.78,-0.46);low-quality evidence],the vision [WMD = 0.14,and 95% CI(0.09,0.19),low-quality evidence],fundus fluorescence angiography [RR = 0.37 and 95% CI(0.23,0.60);low-quality evidence],reduction of retinal microaneurysm [WMD =-3.74 and 95% CI(-4.38,-3.11);moderate-quality evidence],hemangioma volume [WMD =-3.15,95%CI(-3.45,-2.85);moderate-quality evidence],macular thickness [WMD =-5.52,95%CI =(-64.27,-48.78);low-quality evidence],mean defect [WMD =-1.65 and 95% CI(-1.95,-1.34);very low-quality evidence],fasting blooding glucose [WMD =-0.95,95% CI(-1.19,-0.70);low-quality evidence),hemoglobin A1c[WMD =-0.62,95% CI(-0.93,-0.30);low-quality evidence],high sensitive C reaction protein[WMD =-5.66,95% CI(-8.01,-3.31);low-quality evidence].Sensitivity,subgroup,and Metaregression analyses were also assessed.Conclusion:The study demonstrated that CDDP has beneficial clinical effects for treating NPDR and improve the vision.Moreover,it indicated that oral CDDP in NPDR patients led to significant regulation of serum level of fasting blooding glucose,hemoglobin A1c and high sensitive C reaction protein,which was associated with the pathogenesis of NPDR.However,high-quality and large randomized clinical trials will be needed to prove the consequence in future.

Dexamethasone implant in naive versus refractory patients with diabetic macular edema:a Meta-analysis

AIM:To evaluate the efficacy and safety of the intravitreal dexamethasone implant in naive and refractory patients with diabetic macular edema(DME).METHODS:PubMed,Embase,Web of Science,and Medline databases were searched.The main outcomes were best-corrected visual acuity(BCVA)and central retinal thickness(CRT).The secondary outcomes included mean number of injections,intraoperative or postoperative complications including intraocular pressure(IOP)elevation and cataract.RESULTS:Ten comparative studies involving a total of 1000 DME eyes including 402 naive eyes and 598 refractory eyes were selected.The postoperative BCVA in the naive group was significantly better than in the refractory group[mean difference(MD)-0.11,95% confidence interval(CI)-0.17 to-0.05,P=0.0003;MD 8.69,95%CI 5.08 to 12.30,P<0.00001].Additionally,the naive group got greater improvement of BCVA change as well as more gains of BCVA letters than the refractory group[MD 7.71,95%CI 2.02 to 13.40,P=0.008;odds ratio(OR)2.99,95%CI 2.05 to 4.37,P<0.00001].The subgroup analysis revealed that the naive group had significantly higher BCVA gains of≥5,≥10,and≥15 letters compared to the refractory group(P=0.002,0.0001,0.003,respectively).No significant difference was detected between the two groups in either postoperative CRT(MD-22.36,95%CI-46.39 to 1.66,P=0.07)or the overall mean number of injections(MD-0.08,95%CI-0.38 to 0.22,P=0.61).Intraoperative and postoperative complications including the elevation of IOP(OR 0.47,95%CI 0.20 to 1.13,P=0.09)and cataract(OR 1.78,95%CI 0.97 to 3.24,P=0.06)showed no significant differences between the two groups during the follow-up time.CONCLUSION:Intravitreal dexamethasone implants for DME can improve anatomical and functional outcomes in both naive and refractory eyes and have a well-acceptable safety profile.Moreover,naive eyes maintain better visual outcomes than refractory eyes.It provides further evidence of better visual response when used for naive eyes as firstline therapy.

A Systematic Analysis of Systems Approach and Flood Risk Management Research:Trends,Gaps,and Opportunities

Flooding is a global threat,necessitating a comprehensive management approach.Due to the complexity of managing flood hazards and risks,researchers have advocated for holistic,comprehensive,and integrated approaches.This study,employing a systems thinking perspective,assessed global flood risk management research trends,gaps,and opportunities using132 published documents in BibTeX format.A systematic review of downloaded documents from the Scopus and Web of Science databases revealed slow progress of approximately 11.61% annual growth in applying systems thinking and its concomitant approaches to understanding global flood risk management over the past two decades compared to other fields like water resource management and business management systems.A significant gap exists in the application of systems thinking methodologies to flood risk management research between developed and developing countries,particularly in Africa,highlighting the urgency of reoriented research and policy efforts.The application gaps of the study methodology are linked to challenges outlined in existing literature,such as issues related to technical expertise and resource constraints.This study advocates a shift from linear to holistic approaches in flood risk management,aligned with the Sendai Framework for Disaster Risk Reduction 2015-2023 and the Sustainable Development Goals.Collaboration among researchers,institutions,and countries is essential to address this global challenge effectively.

Differences in the involved sites among different types of demyelinating optic neuritis in traditional MRI examination:A systematic review and meta-analysis

Background:Magnetic resonance imaging(MRI)plays a significant role in assessing optic neuropathy and providing more detailed information about the lesion of the visual pathway to help differentiate optic neuritis from other visual disorders.This study aims to systematically review the literature and verify if there is a real difference in lesion location among different demyelinating optic neuritis(DON)subtypes.Methods:A systematic search was conducted including 8 electronic databases and related resources from the establishment of the database to August 25th,2020.We classified DON into 5 subtypes and divided the visual pathways into five segments mainly comparing the differences in the involved visual pathway sites of different subtypes.Results:Fifty-five studies were included in the analysis,and the abnormal rate was as high as 92%during the acute phase(within 4 weeks of symptom onset).With respect to lesion location,the orbital segment of the optic nerve was the most frequently involved(87%),whereas optic tract involvement was very rare.Involvement of the orbital segment was more common in myelin oligodendrocyte glycoprotein antibody-related optic neuritis(MOGON)(78%)and chronic relapsing inflammatory optic neuropathy(CRION)(81%),while the lesion was found to be located more posteriorly in neuromyelitis optica spectrum disorder-related optic neuritis(NMOSD-ON).With respect to lesion length,approximately 77%of MOG-ON patients had lesions involving more than half of the optic nerve length.Conclusions:MRI examination is recommended for DON patients in the acute phase.In MOG-ON,anterior involvement is more common and the involved length is mostly more than 1/2 of the optic nerve length,whereas posterior involvement,intracranial segment,optic chiasm,or optic tract,is more common in NMOSD-ON.

Cerebrospinal Fluid Leakage after Thoracic Decompression

Objective： The objective of this study is regular and special features. to review cerebrospinal fluid leakage （CSFL） after thoracic decompression and describe its Data Sources： Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. ＂Cerebrospinal fluid＂, ＂leakage＂, ＂dural tears＂, and ＂thoracic decompression＂ were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data. Study Selection： All retrieved literature was scrutinized, and tbur categories were recorded： incidence and risk factors, complications, treatment modalities, and prognosis. Results： CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only. Conclusions： CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological fators play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be aware of it.

Efficacy and safety of vitamin D3 in patients with diabetic nephropathy： a meta-analysis of randomized controlled trials

Background Several studies found that vitamin D3 might alter glucose metabolism,protect kidney from injury and even proposed the mechanisms.But results from previous studies have been conflicting.The aim of this study was to evaluate the efficacy and safety of vitamin D3 in patients with diabetic nephropathy.The underlying mechanism of vitamin D3 decreasing proteinuria is also discussed.Methods We conducted a search of English and Chinese articles using database of Pubmed,Embase,Sinomed,CNKI,Wanfang and clinical trial register centers,for randomized controlled trials of vitamin D3 in diabetic nephropathy patients.Two reviewers performed independently.Meta-analysis was used when studies were homogeneous enough.Results Twenty studies,including 1 497 patients with diabetic nephropathy,were involved in this systemic review.Vitamin D3-treated patients with diabetic nephropathy had a statistically significant reduction in 24-hour proteinuria （weighted mean difference-0.44,95% CI-0.54 to-0.34,Z=8.80,P 〈0.000 01） and urine albumin/creatine ratio （standardized mean difference-0.29,95% CI-0.48 to-0.10,Z=2.96,P=0.003）.But vitamin D3 supplementation did not significantly reduce blood pressure and hemoglobin A1c compared with control group.The potential mechanisms about the renal protection of vitamin D3,including the inhibition of rennin-angiotensin system,the protection of kidney from inflammation,fibrosis and the structure change of kidney are discussed.In addition,vitamin D3 did not significantly increase the incidence of adverse effects,including total adverse effects,gastrointestinal adverse effects and fluctuation of blood pressure.Conclusions Vitamin D3 can ameliorate proteinuria and protect kidney from injury in patients with diabetic nephropathy.This renoprotective effect is independent of blood pressure and glucose reduction.And it does not increase any adverse effects than control,even in combination therapy with angiotensin converting enzyme inhibitors/angiotensin receptor blockers.But due to the limited randomized controlled trials of high quality,more clinical researches should be taken in the future.

Sclerosing cholangitis in critically ill patients： an important and easily ignored problem based on a German experience

Intensive care unit （ICU） is important in the rehabilitation of critically ill patients. In the past decades, many patients who received aggressive treatment in ICU developed sclerosing cholangitis in multiple centers. Sclerosing cholangitis in critically ill patients （SC-CIP） is a relatively new issue. To investigate the causes, clinical manifestation, treatment, and prognosis of SC-CIP, we searched for published cases in the databases of PubMed, Highwire, and Elsevier from 2001 to 2012. Data were extracted using a standard form and retrospectively analyzed. Twelve eligible studies covering 88 patients, with 64 men and 24 women, were mainly reported by German centers. The mean age was 49.8 years. All of the patients recovered from critical illnesses, such as trauma, infection, burn, and major surgeries. High pressure positive end-expiratory pressure （PEEP, peak level at 12.8 cm H20） was utilized for all patients, with the average duration of 36.3 d. In addition, vasopressor agents were administered in approximately 60% of SC-CIE A rapid increase in cholestasis and irregular strictures in the intrahepatic bile ducts was observed in the following months. With an average follow-up period of 17.9 months, poor outcomes were observed in 54 patients, including 34 deaths. In conclusion, ischemic injury of the biliary tree, which may be affected by PEEP and/or vasopressor administration, affects cholangiopathic procedure. As a newly discovered type of secondary sclerosing cholangitis, SC-CIP is a severe progressive complication of patients in ICU and should be carefully monitored by clinicians.