What is the best surgical procedure of transverse colon cancer?An evidence map and minireview

Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.

Clinical features of multiple gastrointestinal stromal tumors:A pooling analysis combined with evidence and gap map

BACKGROUND Multiple gastrointestinal stromal tumors(MGISTs)are a very rare type of gastrointestinal stromal tumor(GIST)and are usually observed in syndrome.AIM The paper aimed to describe the clinical and oncological features of MGISTs and to offer evidence for the diagnosis and treatment.METHODS Data of consecutive patients with MGISTs who were diagnosed at Peking University People’s Hospital(PKUPH)from 2008 to 2019 were retrospectively evaluated.Further,a literature search was conducted by retrieving data from PubMed,EMBASE,and the Cochrane library databases from inception up to November 30,2019.RESULTS In all,12 patients were diagnosed with MGISTs at PKUPH,and 43 published records were ultimately included following the literature review.Combined analysis of the whole individual patient data showed that female(59.30%),young(14.45%),and syndromic GIST(63.95%)patients comprised a large proportion of the total patient population.Tumors were mainly located in the small intestine(58.92%),and both CD117 and CD34 were generally positive.After a mean 78.32-mo follow-up,the estimated median overall survival duration(11.5 years)was similar to single GISTs,but recurrence-free survival was relatively poorer.CONCLUSION The clinical and oncological features are potentially different between MGISTs and single GIST.Further studies are needed to explore appropriate surgical approach and adjuvant therapy.

针灸治疗纤维肌痛:证据图

Objective:The body of research on acupuncture as a treatment strategy for fibromyalgia(FM)is steadily growing.This evidence map identifies,describes,and summarizes the current status of studies conducted to evaluate the efficacy of acupuncture for FM,identify research gaps,and provide information that could guide the design of future studies.Methods:Seven electronic databases–Cochrane Library,PubMed,Embase,China Biomedical Literature Database,VIP,Wanfang Database,and Chinese National Knowledge Infrastructure–were searched for relevant articles on acupuncture for FM.The search period was from the dates of inception of the databases to December 19,2022.Original clinical studies and systematic reviews on the use of acupuncture-related modalities for the treatment of FM were included.The basic information,quality assessments,and evidence maps of the included studies are presented as charts and bubble plots.The quality assessment tools used for evaluating the different types of studies included in the present study were Cochrane Collaboration’s tool,Canadian Institute of Health Economics quality appraisal tool,and A MeaSurement Tool to Assess systematic Reviews 2.Results:Fifty studies were included in this study.Of these,39(78.00%)were randomized controlled trials(RCTs),6(12.0%)were case series,and 5(10.0%)were systematic reviews.The included studies focused on manual acupuncture and conventional treatment in the treatment and control groups,respectively.The outcomes analyzed in the RCTs included pain(94.9%),sleep quality(46.2%),depression(46.2%),physical function(46.2%),stiffness(35.9%),well-being(35.9%),work status(35.9%),anxiety(33.3%),fatigue(33.3%),quality of life(17.9%),and overall effective rate(10.3%).The methodological quality of most of the studies was low or critically low regardless of the study design.In most studies,the therapeutic effect of acupuncture was significantly superior to that of the comparator.

Treatment of Lung Cancer with Orally Administered Chinese Herbal Medicine: An Evidence Map between 1970–2020

Objective: Through showing the full picture of double-arm controlled clinical research and systematic review evidence in the field of orally administrated Chinese herbal medicine(CHM) for treatment of lung cancer, to provide a reference for future clinical research and to indicate a direction for future systematic reviews. Methods: A comprehensive search of clinical controlled studies was performed regarding orally administered CHM treatment for lung cancer published from January 1970 to September 2020. The language was restricted to Chinese and English. Relevant data were extracted, the quality of systematic reviews was evaluated, and the research evidence was visually displayed. Results: Randomized controlled trials were the most common type of research design. The research sample sizes were typically small. Oral CHM showed certain curative advantages in treating lung cancer. The key stages in oral CHM intervention for lung cancer are chemotherapy, radiotherapy, and late palliative treatment. The advantageous outcomes of oral CHM treatment of lung cancer are the short-term efficacy, quality of life, and adverse reactions. The perioperative stage, overall survival, pharmacoeconomic evaluation, and Chinese medicine decoctions are weak research areas. Conclusions: CHM has staged and therapeutic advantages in treating lung cancer. The overall methodological quality is poor, and the level of evidence requires improvement. It is necessary to carry out large-scale, standardized, and higherquality research in the superior and weak areas of CHM treatment of lung cancer.

针刺治疗慢性湿疹:基于随机对照试验、系统评价及meta分析的证据图

Background:Acupuncture is used to relieve symptoms,reducing recurrence,and improve the lives of patients with skin diseases.Objective:To identify,describe,and organize the available evidence on acupuncture for atopic eczema(AE)using evidence mapping of randomized controlled trials(RCTs),systematic reviews(SRs),and metaanalyses.Methods:We searched eight databases from inception to October 30,2021,for RCTs,SRs,and metaanalyses of acupuncture for patients with AE.Two reviewers screened the papers,before extracting the data and assessing the quality of the included studies.The basic and clinical characteristics,and quality of assessment of the studies were assessed using descriptive statistics and qualitative analyses.A bubble plot was used to visualize the evidence map to indicate the relationship between the type and frequency of outcomes,the quality and overall effects of acupuncture,and the outcomes of the studies.Results:Forty-five studies(Forty RCTs,five SRs,and meta-analyses)were included.The number of publications increased rapidly after 2013 and peaked in 2019.The most frequently applied intervention was one type of acupuncture therapy.The most frequent comparison was between acupuncture and active medicine.The symptomatic outcome was the most commonly used,and the quality of the included studies was relatively low.All included studies showed a significantly better outcome in the acupuncture group compared to the control group(P<0.05).Most outcomes in the included studies were of low or critically low quality.Several symptomatic outcomes and health-related quality of life outcomes in the included RCTs indicated moderate quality,while some symptomatic outcomes and global symptom improvement in the included SRs and meta-analyses indicated low quality.Conclusion:The majority of studies related to acupuncture for AE indicated promising results,but with relatively low quality;thus,further studies with more robust designs should be conducted to validate the results.

Interventions for preventing influenza: An overview of Cochrane systematic reviews and a Bayesian network meta-analysis

Background:Influenza places a heavy public health burden in numerous countries every year.In addition to vaccines,there are some interventions that are effective in preventing influenza.Objective:This overview of systematic reviews(SRs)aimed to evaluate the efficacy and safety of interventions for influenza prevention.Search strategy:We searched the Cochrane Database of Systematic Reviews,2020,Issue 1 for relevant Cochrane SRs using the keywords‘‘common cold,"‘‘influenza,"and‘‘flu."Inclusion criteria:Cochrane SRs that investigated the prevention of influenza were included.Participants included the general population without influenza or influenza-like symptoms,who were treated with preventative interventions and compared to individuals receiving no treatment or placebo.Data extraction and analysis:Two reviewers independently screened citations against pre-defined inclusion criteria and extracted data.The methodological quality of these SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-II(AMSTAR-II)guidelines.The primary outcome of our analysis was the incidence of influenza,and the secondary outcomes were the incidence of influenza-like illness and hospitalization.In addition to the narrative summary of SR findings,we also pooled data from homogeneous trials among these SRs and produced evidence mapping.We conducted a network meta-analysis to compare the effect across interventions and used the Cochrane approach to grading of recommendations,assessment,development,and evaluation(GRADE)to assess the quality of evidence.Results:Eleven Cochrane SRs were included,covering five medications,eleven vaccinations and four complementary therapies.Among these SRs,73%scored"high"quality on AMSTAR-II rating.We found that eight interventions,including amantadine,garlic,and six different vaccines,were beneficial for reducing the incidence of influenza compared to placebo,while oseltamivir,zanamivir,Ganmao capsule,Echinacea,and another three types of vaccine were probably beneficial.Ganmao capsule ranked highest for influenza prevention in the network meta-analysis,followed by amantadine,garlic,and vaccines of all types.Monovalent inactivated parenteral vaccine was found to be beneficial in reducing the incidence of influenza-like illness.None of the interventions reduced the hospitalization rate.Conclusion:High-quality evidence showed that garlic or vaccine had advantages in preventing influenza,and that vitamin C is not effective.The effect of other interventions needs to be further verified with highquality evidence.