Iron and ferritin effects on intensive care unit mortality:A metaanalysis

BACKGROUND The effect of serum iron or ferritin parameters on mortality among critically ill patients is not well characterized.AIM To determine the association between serum iron or ferritin parameters and mortality among critically ill patients.METHODS Web of Science,Embase,PubMed,and Cochrane Library databases were searched for studies on serum iron or ferritin parameters and mortality among critically ill patients.Two reviewers independently assessed,selected,and abstracted data from studies reporting on serum iron or ferritin parameters and mortality among critically ill patients.Data on serum iron or ferritin levels,mortality,and demographics were extracted.RESULTS Nineteen studies comprising 125490 patients were eligible for inclusion.We observed a slight negative effect of serum ferritin on mortality in the United States population[relative risk(RR)1.002;95%CI:1.002-1.004].In patients with sepsis,serum iron had a significant negative effect on mortality(RR=1.567;95%CI:1.208-1.925).CONCLUSION This systematic review presents evidence of a negative correlation between serum iron levels and mortality among patients with sepsis.Furthermore,it reveals a minor yet adverse impact of serum ferritin on mortality among the United States population.

A Meta-Analysis of the Prognostic and Clinicopathological Significance of circZFR in Human Gastrointestinal Cancers

Background: Studies of gastrointestinal (GIT) cancers have shown that circZFR could be involved in the development and progression of various GIT cancers. However, small sample sizes limit the clinical significance of these studies. Here, a meta-analysis was conducted to ascertain the actual involvement of circZFR in the development and prognosis of GIT cancers. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched up to December 31, 2023. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled to evaluate the association between circZFR expression and overall survival (OS). Publication bias was measured using the funnel plot and Egger’s test. Results: 10 studies having 659 participants were enrolled for meta-analysis. High circZFR expression was associated with poor OS (HR = 1.4, 95% CI: 1.20, 1.70). High circZFR expression also predicted larger tumor size (OR = 4.38, 95% CI 2.65, 7.25), advanced clinical stage (OR = 5.33, 95% CI 3.10, 9.16), and tendency for distant metastasis (OR = 2.89, 95% CI: 1.62, 5.11), but was not related to age, gender, and histological grade. Conclusions: In summary, high circZFR expression was associated with poor OS, larger tumor size, advanced stage cancer and tendency for distant metastasis. These findings suggested that circZFR could be a prognostic marker for GIT cancers.

Meta-analysis of transarterial chemoembolization combined with cryoablation vs transarterial chemoembolization alone for≥5 cm hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)ranks sixth globally in cancer incidence and third in mortality rates.Unfortunately,over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations,poor physical condition,and limited organ availability upon diagnosis.Clinical guidelines endorse transarterial chemoembolization(TACE)as the frontline treatment for intermediate to advanced-stage HCC.Cryoablation(CRA)is an emerging local ablative therapy increasingly used in HCC management.Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects,potentially improving long-term survival rates.However,the superiority of combined TACE+CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of≥5 cm.METHODS PubMed,EMBASE,Cochrane Library,CNKI,Wanfang,and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022.Meta-analysis was performed using RevMan 5.3 software.RESULTS After screening according to the inclusion and exclusion criteria,6 articles were included,including 2 randomized controlled trials and 4 nonrandomized controlled trials,with a total of 575 patients included in the meta-analysis.The results showed that the objective response rate[odds ratio(OR)=2.56,95%confidence interval(CI):1.66-3.96,P<0.0001],disease control rate(OR=3.03,95%CI:1.88-4.89,P<0.00001),1-year survival rate(OR=3.79,95%CI:2.50-5.76,P<0.00001),2-year survival rate(OR=2.34,95%CI:1.43-3.85,P=0.0008),and 3-year survival rate(OR=3.34,95%CI:1.61-6.94,P=0.001)were all superior to those of the control group;the postoperative decrease in alpha-fetoprotein value(OR=295.53,95%CI:250.22-340.85,P<0.0001),the postoperative increase in CD4 value(OR=10.59,95%CI:8.78-12.40,P<0.00001),and the postoperative decrease in CD8 value(OR=6.47,95%CI:4.44-8.50,P<0.00001)were also significantly higher than those in the TACE-alone treatment group.CONCLUSION Compared with TACE-alone treatment,TACE+CRA combined treatment not only improves the immune function of HCC patients with a diameter of≥5 cm,but also enhances the therapeutic efficacy and long-term survival rate,without increasing the risk of complications.Therefore,TACE+CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of≥5 cm.

A Robust Framework for Multimodal Sentiment Analysis with Noisy Labels Generated from Distributed Data Annotation

Multimodal sentiment analysis utilizes multimodal data such as text,facial expressions and voice to detect people’s attitudes.With the advent of distributed data collection and annotation,we can easily obtain and share such multimodal data.However,due to professional discrepancies among annotators and lax quality control,noisy labels might be introduced.Recent research suggests that deep neural networks(DNNs)will overfit noisy labels,leading to the poor performance of the DNNs.To address this challenging problem,we present a Multimodal Robust Meta Learning framework(MRML)for multimodal sentiment analysis to resist noisy labels and correlate distinct modalities simultaneously.Specifically,we propose a two-layer fusion net to deeply fuse different modalities and improve the quality of the multimodal data features for label correction and network training.Besides,a multiple meta-learner(label corrector)strategy is proposed to enhance the label correction approach and prevent models from overfitting to noisy labels.We conducted experiments on three popular multimodal datasets to verify the superiority of ourmethod by comparing it with four baselines.

Mechanism of imipenem-induced mental disorder: A meta-analysis

BACKGROUND Imipenem is a highly effective carbapenem antibiotic,which is widely used in the treatment of many serious bacterial infections.At the same time,it can also cause some adverse reactions,mental abnormalities are the most concerned central nervous system adverse reactions.Different patients respond differently to imipenem,and the effect of imipenem on psychiatric disorders is unclear.Therefore,meta-analysis summarizing the results of multiple previous studies can provide stronger evidence support for clinical guidelines to guide clinical rational use of imipenem to minimize risks.After reviewing the literature published between 2003 and 2017,seven controlled trials with a total of 550 patients were included,with 273 and 277 patients in the control and experimental groups,respectively.The sample size of the study ranged from a minimum of 30 cases to a maximum of 61 cases.Patients in the experimental group were treated with imipenem while the control group was treated with conventional drugs.Meta-analysis showed that the incidence of mental disorders in the experimental group was higher than that in the control group(odds ratio=3.66,95%confidence interval:1.11-12.11,P=0.030);however,there was no significant difference in the incidence of adverse reactions between the two groups(odds ratio=0.05,95%confidence interval:0.00 to 0.10,P=0.060).Funnel diagrams showed that the scattered points of each study were symmetrical and distributed in an inverted funnel shape;therefore,there was no publication bias.CONCLUSION Imipenem can cause mental disorders in patients.However,the low quality of the included literature may have affected the final results.Therefore,it is necessary to conduct a high-quality randomized controlled study with multiple samples to further confirm the mechanism of imipenem-induced mental disorders and provide effective guidance for clinical treatment.

Meta analysis of the efficacy of western medicine combined with Qiliqiangxin capsule versus western medicine alone in the treatment of chronic heart failure

Objective: To compare the clinical efficacy of conventional Western medicine combined with Qiliqiangxin capsule and western medicine alone in the treatment of chronic heart failure, and to prove that Qiliqiangxin capsule combined treatment has more advantages, providing reference for clinical decision-making in the treatment of chronic heart failure. Methods: Randomized controlled trials (RCTs) of conventional Western medicine treatment and Western medicine combined with Qiliqiangxin capsule in the treatment of chronic heart failure were searched in databases such as PubMed, Embase, Webofscience, CNKI, WanFang, VIP, and CBM. The bias risk assessment was conducted using the RCT tool recommended by Cochrane, and then the meta-analysis was performed using RevMan5.4 and Stata17 software. Compare the efficacy evaluation of cardiac function, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), cardiac stroke output (SV), 6-minute walking test (6MWT), and N-terminal proBNP in the conventional western medicine combined with Qiliqiangxin capsule group (hereinafter referred to as the treatment group) and the conventional western medicine group (hereinafter referred to as the control group). Results: A total of 20 RCTs meeting the criteria were included, including 2953 patients, including 1508 in the treatment group and 1445 in the control group. The results of meta-analysis showed that the treatment group had significantly better cardiac function evaluation, LVEF, LVEDD, SV, 6MWT, and NT-proBNP improvement than the control group. Its central functional efficacy evaluation (OR=2.09,95% CI: 1.71-2.55, P<0.001), LVEF (WMD=7.05,95% CI: 5.30-8.79, P<0.00001), LVEDD (WMD=6.73, 95% CI: 3.18-10.29, P=0.0002), SV (WMD=6.73, 95% CI: 3.18-10.29, P=0.0002), 6MWT (SMD=0.70,95% CI: 0.54-0.87, P<0.00001), NT-proBNP (SMD=-1.95,95% CI: -2.5 2 to 1.38 (P<0.0001), with statistically significant differences. Conclusion: Conventional western medicine combined with Qiliqiangxin capsule can significantly improve the clinical efficacy of heart failure, improve LVEF, LVEDD, SV, and NT-proBNP index, and improve exercise tolerance. It is worth using for reference in the treatment.

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.

Carbocysteine as Adjuvant Therapy in Acute Respiratory Tract Infections in Patients without Underlying Chronic Conditions: Systematic Review and Meta-Analysis

Objective: This study aims to systematically examine the existing evidence regarding the clinical benefits of carbocysteine as an adjunctive treatment in acute bronchopulmonary and otorhinological processes. Design: Systematic review and meta-analysis. Data sources: An electronic search was conducted across PubMed, Cochrane Library, clinicaltrials.gov, and the European Clinical Trial Register, with the search dated to May 2023. Bibliographic references from other literature reviews and meta-analyses were also reviewed. The search was limited to randomized clinical trials published in any language and year. It was completed by cross-checking the references of the located articles. Methods: Inclusion criteria covered studies assessing systemic or inhaled carbocysteine, regardless of dosing regimen. Concomitant medication use was acceptable if balanced between intervention and control groups. Authors independently extracted data, resolving disagreements through consensus. Methodological quality assessment relied on critical reading of each study. Dichotomous variables were analyzed using odds ratio (OR), and a final effect size was calculated. Statistical significance was established when confidence intervals did not cross the neutral value. Heterogeneity was assessed via the X2 test and I2 index. Results: Out of 318 initially identified studies, 4 met inclusion criteria. The meta-analysis for poor general condition yielded an OR of 0.45 in favor of intervention, p = 0.013, with non-significant heterogeneity. Cough events showed a percentage of 15.8% for carbocysteine vs. 27.2% for placebo. On the seventh day, expectoration rates were 18.37% for carbocysteinevs 33.3% for placebo. Conclusions: The observed clinical benefits align with carbocysteine’s mucoactive and muco-regulatory properties, complemented by anti-inflammatory and antioxidant actions. Carbocysteine stands out among mucolytic agents. In the context of persistent infectious diseases, the study emphasizes the need for further exploration of carbocysteine’s therapeutic potential as an adjunctive treatment for acute respiratory infections. These findings underscore its significance in the evolving landscape of respiratory healthcare.

Prevalence of Latent Tuberculosis Infection [LTBI] in Prison Officers: A Systematic Review and Meta-Analysis

This study aimed to perform a systematic review and meta-analysis to determine the LTBI prevalence in prison officers worldwide. A systematic search was performed in PubMed, WoS, Embase, and BVS, including all articles related to LTBI prevalence and risk factors. After critical evaluation and qualitative synthesis of the identified articles, a meta-analysis was used. Five studies carried out between 2012 and 2022 were included, with a total sample size of 1718 prison officers. The overall LTBI prevalence was 50% [95% confidence interval [CI]: 48% - 52%;n = 816], with high heterogeneity between studies. Smoking [OR = 1.76;CI 95% = 1.26 - 2.46] and males [OR = 2.08;CI 95% = 1.31 - 3.31] were positively related to a higher LTBI prevalence among prison officers. Thus, preventive measures and the rapid and accurate diagnosis of new cases should be emphasized to ensure tuberculosis control, especially among risk groups such as prison officers.

运动疗法对前交叉韧带重建后康复疗效影响的网状Meta分析

目的:运动干预被认为是前交叉韧带重建后康复的基础。然而,关于何种运动疗法在改善前交叉韧带重建后患者膝关节肌肉力量和功能方面更有效,目前仍未得出明确结论。为此,文章采用网状Meta分析方法,比较运动疗法治疗前交叉韧带重建后的疗效,为选择最佳运动疗法提供循证医学依据。方法:计算机检索PubMed,Web of Science,Embase,The Cochrane Library及EBSCO数据库运动疗法治疗前交叉韧带重建后的随机对照试验,检索时限均从建库至2023-11-20。结局指标包括股四头肌肌力、腘绳肌肌力、膝关节功能评分3个连续性变量。运用EndNote X9.1软件筛选文献。采用Cochrane风险偏倚评估工具对纳入的文献进行质量评价,根据GRADE评分对文章结果的证据强度进行评级,采用Stata 16.0进行网状Meta分析。结果:①共纳入36项随机对照试验,包括1179例前交叉韧带重建后患者,纳入文献整体质量中等;涉及9种运动疗法:等速训练、交叉训练、离心训练、水中康复、血流限制训练、运动控制训练、增强式训练、全身振动训练和综合训练;对照措施为常规康复训练。②网状Meta分析结果显示:与常规康复训练相比,离心训练(SMD=2.08,95%CI:0.56-3.60,P=0.007)对前交叉韧带重建后患者股四头肌肌力的改善效果最佳,其次是综合训练(SMD=1.69,95%CI:0.11-3.27,P=0.249)和全身振动训练(SMD=0.81,95%CI:0.11-1.51,P=0.042);在提升患者腘绳肌肌力方面,综合训练(SMD=2.08,95%CI:0.30-3.86,P=0.022)效果最佳,其次是增强式训练(SMD=1.51,95%CI:0.18-2.84,P=0.026)和等速训练(SMD=1.37,95%CI:0.06-2.67,P=0.039);综合训练(SMD=4.60,95%CI:2.40-6.80,P<0.001)改善膝关节功能评分最有效,其次是离心训练(SMD=1.75,95%CI:0.24-3.25,P=0.023)和水中康复(SMD=1.65,95%CI:0.07-3.24,P=0.041)。结论:低到中等强度的临床证据证实,在改善前交叉韧带重建后患者膝关节肌肉力量和功能方面,综合训练可能是最有效的运动疗法,其次是离心训练、增强式训练、等速训练、全身振动训练、水中康复。未来仍需更多高质量的临床随机对照试验来验证结论的可靠性。

颈前路减压融合ROI-C^(TM)自锁系统治疗退行性颈椎病的Meta分析

目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。

国人A型行为与冠心病关系的Meta-analysis

目的应用Meta-analysis方法对国内9个有关A型行为与冠心病关系的病例对照研究进行综合定量分析。方法采用Fleiss模型和DerSimonianandNanLaird模型（D—L模型）处理数据。结果累积病例为1139人，对照为967人。采用Fleiss模型计算合并OR为2.32（95％CI1.93～2.79），D—L模型计算合并OR为2.32（95％CI1.80～2.99）。失效安全数远大于56。结论A型行为与冠心病有关，失效安全数大，可能的偏倚和混杂因素影响小。

基于Meta-analysis的中国马铃薯地膜覆盖产量效应分析

为了定量综合分析中国近30 a地膜覆盖对马铃薯的增产效果,该研究综合已发表的田间试验研究数据,应用Meta-analysis方法定量分析使用地膜后马铃薯产量的增产率或减产率,并探讨其时空分异特征及其影响因素。通过文献检索,共获得84篇有关地膜覆盖马铃薯生产试验文献。经严格筛选,共从42篇文献中获得52组数据,分布于中国14个省(市、区),涵盖西北、西南和东南3个主要区域。主体数据经Meta分析表明:地膜覆盖在西北地区增产效应最显著,相对增产率为35.6%;其次是东南和西南地区,相对增产率分别为20%和12%;从全国时间序列看,1990年以后地膜相对增产率较高,但2010年后地膜增产效果有降低趋势;白色地膜与黑色地膜、垄作和平作对地膜增产效应影响不显著;在年均降水量<500 mm和年均温<10℃的区域地膜增产效应最明显,地膜相对增产率分别为40.5%和37.6%。进一步分析表明,2010年后地膜覆盖效果在年均降水量<500 mm且年均温<10℃的地区和年均降水量>500 mm且年均温>10℃的地区均呈现降低趋势,说明全球气候变暖可能对地膜增产产生负面影响,或随着使用年限增加地膜开始表现出对产量的负面效应。该研究可为地膜覆盖技术应用提供参考。

基于Meta-analysis的中国北方地区免耕玉米产量效应研究

【目的】定量分析免耕对中国北方地区玉米产量的时空效应和影响机制,为该地区免耕的科学应用和推广提供依据。【方法】以中国北方为研究区域,以传统耕作为对照,通过检索文献整合已发表的相关田间试验数据(截止2017年4月共获得68篇文献和82组试验数据,将数据按照区域(东北、华北和西北)、年降水量(<500 mm和≥500 mm)、年均气温(<10℃和≥10℃)、耕作模式(平作和垄作)、种植制度(连作和轮作)、是否秸秆还田、试验年份(2000年之前、2000—2009年和2010年之后)和免耕持续年限(1—2 a、3—5 a、6—9 a和≥10 a)进行分组),利用Meta-analysis方法系统探究免耕对玉米产量的时空效应与影响因素。具体分析过程包括异质性检验、综合效应量计算、发表偏倚检验、敏感性分析、累积Meta-analysis和亚组分析(影响因素分析)。【结果】与传统耕作相比,免耕总体上可显著提高玉米产量,平均增产率为3.1%(置信区间0.7%—5.5%,数据不存在发表偏倚和极端值)。2000年之前,免耕的累积增产效应不稳定(平均-0.7%—6.6%);2000年之后,免耕与传统耕作的累积产量差异逐渐由不显著变为显著。在东北地区,免耕表现出显著的增产效应(平均5.3%,置信区间1.5%—9.2%);而在华北和西北地区,免耕的增产效应不显著,分别为-2.6%—6.4%和-1.0%—6.4%。在年降水量<500 mm、年均气温<10℃的地区和轮作、秸秆还田条件下,免耕的增产率显著提高,平均分别为5.4%(置信区间1.7%—9.1%)、3.8%(置信区间0.8%—6.7%)、4.4%(置信区间1.3%—7.5%)和3.3%(置信区间0.8%—5.8%)。平作和垄作下,免耕的增产效应均不显著。2010年之后,免耕的增产效应显著提高(平均6.1%),且变幅较小(2.5%—9.7%)。随着免耕持续年限的延长,玉米增产率呈先增加后降低的趋势,当持续3—5 a时,免耕的增产效应显著且达到峰值(平均3.8%,置信区间1.6%—6.0%)。【结论】在年降水量较少或年均气温较低的区域,轮作或秸秆还田条件下,有利于发挥免耕的增产效应;东北地区较华北和西北地区更适宜免耕;3—5 a为较合理的免耕持续年限。

支架外固定与钢板内固定治疗桡骨远端粉碎性骨折的Meta分析

目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,纳入2013年10月至2023年10月发表的关于外固定支架和钢板内固定治疗粉碎性桡骨远端骨折的随机对照试验文献,按照纳入标准和排除标准筛选文献,使用Review Manager进行文献质量评价和Meta分析。结果:(1)纳入8篇文献,其中中文文献4篇,英文文献4篇、总样本量648例,外固定支架组328例,钢板内固定组320例;(2)术后3个月,钢板内固定组的背伸、掌屈、旋后范围优于外固定支架组;术后12个月,钢板内固定组的握力、掌倾角、掌屈、旋前和旋后范围优于外固定支架组;钢板内固定组在术后感染方面优于外固定支架组,其余结局指标两组差异均无显著性意义。结论:现有8项证据表明,在粉碎性桡骨远端骨折的治疗方式选择上,外固定支架与切开钢板内固定都有良好的治疗效果,综合其他因素钢板内固定更胜一筹,但是对于一些高度严重的粉碎性桡骨远端骨折、骨质较差、严重污染的开放性骨折以及软组织肿胀而无法进行切开手术的特殊患者,外固定支架才是首选。此次研究结果具有局限性,未来还需要开展更多高质量、大样本、多中心的随机对照试验研究,另外需重视远期疗效、其他次要指标的观察,补充优化当前研究结果。

我国居民饮酒与脑卒中关系的Meta-analysis研究

为了评价我国居民饮酒与脑卒中的联系，采用随机效应模型（Ｄ—Ｌ法）对检索到的国内１４篇有关流行病学研究文献进行综合定量分析，结果总合并比值比（９５％可信区间）为１．８９０９（１．５５０２～２．３０６４）；按脑卒中类型分层合并分析，结果饮酒与出血性脑卒中、缺血性脑卒中和脑卒中（未区分亚型）联系的比值比分别为２．２５９０（１．４２４０～３．５８３６）、２．０１３０（１．４８８８～２．７２１９）和１．４７４９（１．２８３６～１．６９４８）。本研究认为饮酒是我国居民脑卒中及其亚型重要的危险因素，控制饮酒是脑卒中病因预防的一项重要措施。

Meta－analysis方法及其在药物临床评价中的应用

Ｍｅｔａ－ａｎａｌｙｓｉｓ是一评价药物有效性和安全性的重要方法。该法试图综合所有相关临床试验的结果而得到药物疗效的全面和准确的评价。该法运用特定的统计学方法，量化并合并分析各单独临床试验的结果而得出结论。对肯定或排除在单个临床试验中，可能不易观察到的相对较弱的药理作用或不良反应，Ｍｅｔａ－ａｎａｌｙｓｉｓ也是一强有力的工具。本文简要介绍该法，并列举其在抗心律失常药物和抗高血压药物等临床评价中的应用实例进行了验证。对实施该法应注意的一些问题也进行了探讨。

基于Meta-analysis的循证检索探讨

目的:调查Meta-analysis的作者们报道检索策略效果证据的范畴。材料:对近10年EBSCO数据库MEDLINE全文子集标引“Meta-analysis”为出版物类型的论文,进行随机抽样调查(n=100)。方法:将这些论文分为三类。结论:最后分析的93篇论文样本中,A类占8.6%(8篇),B类占61.3%(57篇),C类占30.1%(28篇)。讨论:A类论文报道了先前有效的、公开发表了的或者基于专家意见的检索策略。专家评审标准一定要力争得到进一步发展,那就要求Meta-analysis的作者,对他们检索策略的效果证据要加以报道。

Meta-analysis:一种新的定量综合方法

Meta-analysis是一种定量综合研究结果的方法,在国外已应用于医学各领域,其在诊断、治疗、危险度评价、干预、预防及决策等方面起着独特的作用.本文阐述了Meta-analysis研究方法的基本原理、研究过程与内容,介绍了二个常用统计方法即固定效应模型和随机效应模型,并有部分实例应用.

肝癌危险因素的Meta－analysis一16个病例对照研究资料的综合分析

本文运用Ｍｅｔａ－ａｎａｌｙｓｉｓ方法对国内有关肝癌危险因素的１６个病例对照研究结果进行了定量综合分析。运用ＤｅｒＳｉｍｏｎｉａｎ和Ｌａｉｒｄ的随机效应模型处理数据。ＨＢｓＡｇ阳性的合并ＯＲ值为１１．６１（６；３７～２ｌ．１４），ＰＡＲ为６０．１５％。肝炎史、家族肝癌史、饮沟塘水为肝癌危险因素；饮井水为保护因素；吸烟、饮酒作用尚不能肯定。同时，对可能存在的偏倚和混杂因素进行了讨论和分析。