Ⅱ型胸神经阻滞对乳腺癌患者术后免疫功能影响的Meta分析

目的:系统评价超声引导下Ⅱ型胸神经阻滞(UPB)联合全麻对乳腺癌患者术后免疫功能的影响。方法:系统检索PubMed、Embase、Cochrane Library、Web of Science、万方、知网和维普数据库,限定检索时间截止至2022年10月。应用Revman 5.4、Stata 15.1软件进行Meta分析。结果:共纳入6篇符合纳入标准的文献,共639例患者。Meta分析结果显示:与单纯全麻相比,UPB联合全麻患者术后CD3+(MD=3.86,95%CI:2.73,4.99)、CD4^(+)(MD=2.28,95%CI:1.19,3.36)、CD4^(+)/CD8^(+)(MD=0.16,95%CI:0.12,0.20)水平升高;术后CD8^(+)(MD=-1.34,95%CI:-1.93,-0.76)水平、术中瑞芬太尼用量(SMD=-1.72,95%CI:-2.00,-1.44)以及术后24 h的视觉模拟评分(MD=-0.77,95%CI:-1.49,-0.04)降低。结论:UPB联合全麻能增强乳腺癌患者术后免疫功能,减少术中瑞芬太尼用量,术后镇痛效果更好。

多烯磷脂酰胆碱注射液治疗酒精性肝病的系统评价与Meta分析

目的系统评价多烯磷脂酰胆碱注射液治疗酒精性肝病(ALD)的有效性和安全性。方法计算机检索PubMed、Embase、the Cochrane Library、ClinicalTrial.gov、中国知网、SinoMed、维普和万方数据库,搜集有关多烯磷脂酰胆碱注射液治疗ALD的随机对照临床试验(RCT),检索时限均为建库至2022年12月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Stata 17.0软件进行随机效应模型的Meta分析。结果最终纳入10个RCT,包含809例患者。Meta分析结果显示,多烯磷脂酰胆碱注射液组的有效率高于对照组[RR=1.12,95%CI(1.04,1.20),P=0.0038];与对照组相比,多烯磷脂酰胆碱注射液可以降低丙氨酸氨基转移酶(ALT)水平[MD=-18.92 U/L,95%CI(-27.75,-10.09),P<0.001]、天门冬氨酸氨基转移酶(AST)水平[MD=-31.19 U/L,95%CI(-46.27,-16.11),P=0.0001]、总胆红素(TBiL)水平[MD=-7.31μmol/L,95%CI(-10.75,-3.88),P<0.001]和γ-谷氨酰转肽酶(GGT)水平[MD=-48.93 U/L,95%CI(-54.64,-43.21),P<0.001]。仅1项研究报告了轻度的不良反应,6项研究均报告患者未出现明显不良反应。结论当前证据显示,多烯磷脂酰胆碱注射液治疗ALD可以提高有效率,改善肝功能指标(ALT、AST、TBiL、GGT)的水平,不良反应较少。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。

手法治疗肩周炎有效性和安全性的Meta分析

背景近年出现较多特色手法治疗肩周炎的随机对照试验(RCT),但缺乏新的关于手法治疗肩周炎有效性和安全性的系统评价。目的通过Meta分析方法评价手法治疗肩周炎的有效性和安全性,通过亚组分析了解包含“摇法”的手法是否较未包含“摇法”的手法效果更优。方法计算机检索PubMed、Cochrane Library、Embase、Medline、中国知网(包括中国硕博士学位论文全文数据库、中国优秀硕士学位论文全文数据库)、中国生物医学文献数据库、万方数据知识服务平台中有关手法治疗肩周炎有效性和安全性的RCT,试验组干预措施为手法,对照组干预措施为非药物疗法,检索时间为建库至2023-03-01。由2名研究人员提取资料,并进行质量评价。采用Revman 5.3软件进行Meta分析。结果最终共纳入12篇文献,893例肩周炎患者,其中试验组451例,对照组442例。Meta分析结果显示,视觉模拟疼痛量表(VAS):手法治疗改善VAS程度优于物理治疗、针灸治疗、常规治疗(SMD=1.09,95%CI=0.81~1.37,P<0.00001;SMD=1.05,95%CI=0.31~1.79,P=0.006;SMD=0.96,95%CI=0.67~1.26,P<0.00001);手法对照物理治疗的亚组分析结果显示,含“摇法”手法与未含“摇法”手法的效果差异显著(Z=4.39,P=0.04)。Constant-Murley(C-M)评分:手法治疗改善C-M评分程度优于物理治疗组(MD=2.79,95%CI=2.27~3.32,P<0.00001)。关节活动度:手法治疗改善被动前屈、被动外展、被动外旋程度优于物理治疗(SMD=1.40,95%CI=0.10~2.70,P=0.03;SMD=1.45,95%CI=0.18~2.71,P=0.02;SMD=1.77,95%CI=0.18~3.36,P=0.03)。亚组分析结果显示,在改善被动前屈和被动外展方面,含“摇法”手法与未含“摇法”手法的效果存在显著差异(Z=7.34,P=0.007;Z=2.25,P=0.03)。总体有效率:手法治疗总体有效率高于物理治疗(RR=1.16,95%CI=1.02~1.32,P=0.03);手法治疗和针灸治疗总体有效率比较,差异无统计学意义(RR=1.24,95%CI=1.00~1.54,P=0.05)。治愈率:手法治疗治愈率优于物理治疗和针灸治疗(RR=3.71,95%CI=1.29~10.67,P=0.01;RR=1.79,95%CI=1.09~2.94,P=0.02)。Egger's检验和Begger's检验提示无显著的发表偏倚(P=0.66、0.66)。手法操作导致的骨折、其他创伤等案例在纳入研究中均未见报道。结论现有文献证据表明手法治疗能有效降低肩周炎患者疼痛、肩关节功能障碍,提高患者肩关节活动度、总体有效率、治愈率,含有“摇法”的手法在VAS改善、被动前屈、被动外展方面能进一步提高疗效,总体手法安全性较高,但仍需更多大样本,高质量的RCT进一步证实。

香砂平胃颗粒治疗消化道疾病疗效和安全性的系统评价和Meta分析

目的对香砂平胃颗粒治疗消化道疾病的疗效及安全性进行系统评价。方法根据相关关键词,检索知网、万方、维普、PubMed、Embase数据库文献。采用Review Manager 5.0软件进行数据分析,计算合并的比值比(OR)或均数差(MD)及其95%置信区间(95%CI),检验异质性,评估发表偏倚。结果最终纳入14篇文献,研究质量较好,偏倚风险较低。Meta分析结果显示,香砂平胃颗粒联合西药治疗消化道疾病的总有效率高于西药单独治疗[95%CI=(3.69,9.28),P<0.001],各研究间无异质性(I2=0.0%,P=0.55)。在临床症状积分上,香砂平胃颗粒联合西药可显著改善餐后饱胀、早饱、上腹痛和上腹灼烧感(P<0.05);在胃肠激素水平上,显著改善胃动素、胃泌素和血浆P物质水平(P<0.001)。另外,香砂平胃颗粒可有效清除幽门螺杆菌(Hp),且不增加不良反应。结论与常规西药相比,香砂平胃颗粒联合西药可显著提高临床总有效率,明显改善临床症状积分、胃肠激素水平,有效清除Hp,不良反应少,安全性好。

Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery:A meta-analysis

BACKGROUND Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery.AIM To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients.METHODS Systematically searched the relevant literature from PubMed,Web of Science,Cochrane Library,Embase,CNKI,China Biomedical Database,Wanfang Database,and Weipu Chinese Journal Database self-established until October 1,2022.Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature,extracted data,and evaluated the risk of bias in the included studies.RESULTS A total of 23 pieces of literature were included,the quality of which was medium or above,and the total sample size was 43878.The results of meta-analysis showed that the patients were male(OR=1.58,95%CI:1.25-2.01,P=0.002)and≥60 years old(OR=2.60,95%CI:1.76-2.87,P<0.001),physical index≥25.3 kg/m2(OR=1.6,95%CI:1.00-1.12,P=0.040),smoking history(OR=1.89,95%CI:1.31-2.73,P<0.001),chronic obstructive pulmonary disease(OR=1.49,95%CI:1.22-1.83,P<0.001),enterostomy(OR=1.47,95%CI:1.26-1.70,P<0.001),history of abdominal surgery(OR=2.90,95%CI:1.67-5.03,P<0.001),surgical site(OR=1.2,95%CI:1.40-2.62,P<0.001),operation method(OR=1.68,95%CI:1.08-2.62,P=0.020),operation duration(OR=2.65,95%CI:1.92-3.67,P<0.001),abdominal adhesion grade(OR=2.52,95%CI:1.90-3.56,P<0.001),postoperative opioid history(OR=5.35,95%CI:3.29-8.71,P<0.001),tumor TNM staging(OR=2.58,95%CI:1.84-3.62,P<0.001),postoperative blood transfusion(OR=2.92,95%CI:0.88-9.73,P=0.010)is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors.CONCLUSION There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients after surgery.Clinical staff should identify relevant risk factors early and implement targeted intervention measures on the basis of personalized assessment to improve the clinical prognosis of patients.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

基于社区卫生工作者管理下的运动干预对2型糖尿病影响的Meta分析

背景2型糖尿病患者通常缺乏足够的安全运动意识,运动依从性不高,需要专业人员进行运动干预管理以更好地改善2型糖尿病患者的病情。值得参考的策略就是利用社区卫生工作者为患者提供运动干预的管理。目前关于运动干预管理方面的研究缺乏,且通常2型糖尿病患者健康管理的研究仅提及运动而没有具体的运动管理措施,尚缺少相关的定量系统评价。目的系统评价基于社区卫生工作者管理下的运动干预对2型糖尿病患者的健康影响及具体的运动干预方案。方法计算机检索8个中英文数据库,包括PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库(CBM),筛选基于社区卫生工作者管理下的运动干预对2型糖尿病患者影响的随机对照试验,其中干预组采取基于社区卫生工作者管理下的运动干预方案,对照组采取常规护理。检索时间从建库至2022-10-17。文献筛选、质量评价和数据提取由2名研究人员独立完成。使用RevMan 5.4和Stata 15.1软件进行Meta分析。通过亚组分析和敏感性分析寻找异质性来源。预先确定的亚组为干预周期(3个月、6个月、>6个月)、运动频率(3次/周、>3次/周)和单次运动时间(≤30 min/次、>30 min/次)。结果本研究最终纳入11篇文献,共有受试者1079例,其中干预组550例,对照组529例。Meta分析结果显示,基于社区卫生工作者管理模式下的运动干预较对照组更能降低2型糖尿病患者的糖化血红蛋白(MD=-1.07,95%CI=-1.31~-0.83,P<0.00001)、空腹血糖(MD=-1.26,95%CI=-1.57~-0.96,P<0.00001)、餐后2 h血糖(MD=-1.47,95%CI=-1.90~-1.04,P<0.00001)、总胆固醇(MD=-1.02,95%CI=-1.52~-0.51,P<0.0001)、低密度脂蛋白(MD=-0.62,95%CI=-0.87~-0.37,P<0.00001)和三酰甘油水平(MD=-0.71,95%CI=-1.13~-0.28,P=0.001),而对高密度脂蛋白的改善程度无显著差异(MD=0.09,95%CI=-0.02~0.21,P=0.11)。亚组分析结果显示,与3次/周的运动频率相比,>3次/周的运动频率对总胆固醇的改善更显著(P=0.02);与≤30 min/次的单次运动时间相比,>30 min/次的单次运动时间对餐后2 h血糖的改善更显著(P=0.001);与6个月以及更长时间的干预周期相比,干预周期为3个月的运动干预对糖化血红蛋白(P<0.00001)、三酰甘油(P=0.008)的改善更显著。Egger's检验显示糖化血红蛋白(P=0.34)、空腹血糖(P=0.281)未表现出显著的发表偏倚。证据质量评价结果显示,糖化血红蛋白和空腹血糖为低级证据,餐后2 h血糖和血脂相关结局指标为极低级证据。结论基于社区卫生工作者管理下的运动干预可以显著改善2型糖尿病患者的血糖和血脂水平。社区卫生工作者在今后针对2型糖尿病的运动干预管理中,推荐按照>30 min/次、>3次/周、持续≥3个月的有氧运动干预来制订运动方案。如果2型糖尿病患者伴有血脂异常的情况,则建议运动干预周期最好持续6个月及以上。

富血小板血浆联合植骨内固定治疗骨不连疗效的Meta分析

目的采用Meta分析的方法评价富血小板血浆(platelet rich plasma,PRP)联合植骨内固定治疗骨不连的临床疗效。方法系统检索PubMed、Ovid Embase、The Cochrane Library、中国知网、万方、维普、中国生物医学文献数据库中PRP联合植骨内固定与植骨内固定比较治疗骨不连的随机对照试验(randomized controlled trial,RCT),检索时限为建库至2023年10月9日。对纳入研究提取资料并进行质量评价,采用RevMan 5.3软件和R 4.3.1软件进行统计分析。结果共纳入10个RCT,包括骨不连患者522例,其中PRP联合治疗组260例、植骨内固定组262例,总体为中等质量。Meta分析结果显示,与植骨内固定组比较,PRP联合治疗组可增加骨不连愈合率[OR=3.73,95%CI(2.04,6.85),P<0.001],缩短骨不连临床愈合时间[SMD=-2.38,95%CI(-2.79,-1.98),P<0.001]和骨性愈合时间[SMD=-1.76,95%CI(-2.35,-1.16),P<0.001)],提高骨痂X线评分[MD=0.86,95%CI(0.47,1.25),P<0.001],降低治疗过程中并发症发生率[OR=0.32,95%CI(0.18,0.55),P<0.001]。两组在住院时间[MD=-3.08,95%CI(-6.99,0.83),P=0.12]和肢体功能优良率[OR=1.91,95%CI(0.90,4.05),P=0.09]方面的差异无统计学意义。结论PRP联合植骨内固定治疗骨不连是一种安全有效的方法,可增加骨不连愈合率,缩短愈合时间,降低并发症发生率。受样本量的影响,上述结论尚待更多高质量临床RCT加以证实。

我国居民糖尿病与脑卒中的关系——Metaanalysis

采用随机效应模型 (D -L法 )对检索到的国内 1 1篇有关糖尿病与脑卒中关系的研究文献进行综合定量分析 ,以评价二者之间的联系。结果总合并比值比 ( 95%可信区间 )为 3 3 9%( 2 2 7～ 5 0 6) ;按脑卒中类型分层合并分析 ,结果糖尿病与缺血性和出血性脑卒中联系的比值比分别为 4 56( 3 2 5～ 6 4 0 )和 2 79( 0 79～ 9 82 )。文中对该研究结果及本次Meta

师徒关系对徒弟工作态度的作用机制:来自元分析的证据

为厘清师徒关系对徒弟工作态度的作用机制和边界条件,运用元分析方法对包含103项独立研究、126个效应值及33617个研究样本的101篇文献进行了定量整合,结果表明:(1)徒弟组织支持感、自我效能感均能中介师徒关系对徒弟工作满意度和组织承诺的正面影响。进一步通过中介效应差异检验发现,徒弟组织支持感的中介作用显著大于徒弟自我效能感。同时,师徒关系也通过徒弟组织支持感、自我效能感的链式中介间接影响徒弟工作满意度和组织承诺。(2)文化情境调节了师徒关系与徒弟工作态度的关系。具体来看,集体主义、高权力距离、长期导向文化中师徒关系对徒弟工作满意度、组织承诺的积极影响强于个人主义、低权力距离、短期导向文化中师徒关系对二者的积极影响。以上结论不仅有助于深入理解师徒关系的积极作用,而且为师徒关系的实践提供了一定的指导。

饲粮中添加膳食纤维对肉鸡生长性能和肠道健康影响的Meta分析

本研究旨在通过Meta分析探讨饲粮中添加膳食纤维对肉鸡生长性能和肠道健康的影响。通过检索Web of Science、PubMed、中国知网、万方等数据库中2007—2022年关于膳食纤维对肉鸡生长性能和肠道形态影响的试验研究,共筛选到27篇文献,共计5310羽肉鸡。采用Re⁃view Manager 5.3软件对肉鸡平均日增重(ADG)、终末体重(FBW)、平均日采食量(ADFI)、料重比(F/G)和回肠绒毛高度(VH)、隐窝深度(CD)、绒毛高度/隐窝深度(VH/CD)及肌胃相对重量(GRW)进行分析。结果表明:与对照组相比,饲粮中添加膳食纤维显著提高了肉鸡ADG[合并效应值(MD)=1.01,95%置信区间(95%CI)为0.29~1.72,P=0.00600]、FBW(MD=45.05,95%CI为16.68~73.42,P=0.00200)和回肠VH(MD=36.58,95%CI为14.22~58.94,P=0.00100)及GRW(MD=0.16,95%CI为0.11~0.21,P<0.00001);显著降低了肉鸡F/G(MD=-0.04,95%CI为-0.06~-0.01,P=0.00800);而饲粮中添加膳食纤维对肉鸡ADF(MD=0.29,95%CI为-0.59~1.17,P=0.52000)及回肠CD(MD=5.51,95%CI为-1.83~12.86,P=0.14000)、VH/CD(MD=0.06,95%CI为-0.01~0.14,P=0.09000)的影响不显著。亚组分析表明,饲粮中添加不溶性膳食纤维(IDF)可显著提高肉鸡ADG(MD=1.34,95%CI为0.56~2.12,P=0.00070)及回肠VH(MD=50.37,95%CI为24.22~76.51,P=0.00020)、VH/CD(MD=0.25,95%CI为0.17~0.32,P<0.00001),显著降低了F/G(MD=-0.04,95%CI为-0.06~-0.02,P=0.00060);饲粮中添加可溶性膳食纤维(SDF)对肉鸡ADFI(MD=0.71,95%CI为-0.68~2.10,P=0.32000)、ADG(MD=0.69,95%CI为-0.65~2.03,P=0.31000]、F/G(MD=-0.04,95%CI为-0.09~0.01,P=0.09000)及回肠VH(MD=17.00,95%CI为-5.51~39.50,P=0.14000]、CD(MD=3.01,95%CI为-3.10~9.13,P=0.33000)、VH/CD(MD=-0.27,95%CI为-0.79~0.29,P=0.36000)的影响不显著。由此可见,肉鸡饲粮粗纤维含量在1.43%~6.17%时,添加膳食纤维具有改善肉鸡生长性能和肠道健康的作用。与SDF相比,IDF具有更好的提高肉鸡生长性能和肠道健康的作用。

职业院校教学创新团队建设框架分析——基于CNKI期刊49篇文献的系统性分析

如何建设和发展教学创新团队是职业院校研究者和实践者面对的重要课题。采用系统性文献综述法,分析职业院校教师创新团队建设实践的相关研究成果,并通过质性元分析方法提炼了依托理论、发展逻辑、行动策略和彰显创新四个核心类属,构建了教学创新团队建设“发展树”框架,该框架具有系统综合性、协调一致性和灵活创新性的特征。提出教学创新团队建设应以基础理论与“自选”理论为指导;把握与组织发展逻辑、政策牵引逻辑、协同促进逻辑相适应的主线;兼顾团队组建、统一思想、制度建设、文化建设、个体能力发展协同平台建设六大行动策略;从个体创新、组织创新两方面彰显创新。

转移性激素敏感性前列腺癌药物治疗方案的网状Meta分析

目的确定转移性激素敏感性前列腺癌(mHSPC)的最佳治疗方案,为临床决策提供依据。方法系统检索Medline、Embase、BIOSIS preview、the Cochrane Library和ClinicalTrials.gov数据库,收集关于mHSPC药物治疗,且疗效结局为总生存期(OS)和放射学无进展生存期(rPFS)、安全性结局为严重不良事件(SAEs)发生率的随机对照试验。检索时限为建库至2022年3月。由2名研究人员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,进行贝叶斯网状Meta分析。结果最终纳入8项研究,共计9437例患者,比较了7种治疗方案[醋酸阿比特龙、阿帕他胺、达罗他胺+多西他赛、多西他赛、恩杂鲁胺、标准非甾体抗雄激素(SNA)分别联合雄激素剥夺疗法(ADT)和单用ADT]的有效性和安全性。疗效指标中,能使患者OS获益最多的方案(除ADT+SNA外)是ADT+达罗他胺+多西他赛(HR=0.54,95%CI为0.44~0.66),随后为ADT+醋酸阿比特龙(HR=0.64,95%CI为0.57~0.71)、阿帕他胺(HR=0.65,95%CI为0.53~0.79)或恩杂鲁胺(HR=0.66,95%CI为0.53~0.82),最后是ADT+多西他赛(HR=0.79,95%CI为0.71~0.88)。能使患者rPFS获益最多的方案(除ADT+SNA外)为ADT+恩杂鲁胺(HR=0.39,95%CI为0.30~0.50),随后是ADT+阿帕他胺(HR=0.48,95%CI为0.39~0.60)、醋酸阿比特龙(HR=0.57,95%CI为0.51~0.64)或多西他赛(HR=0.62,95%CI为0.56~0.69);肿瘤负荷亚组分析的结果相同。在安全性方面,ADT+达罗他胺+多西他赛(OR=25.86,95%CI为14.08~51.33)和ADT+多西他赛(OR=23.35,95%CI为13.26~44.81)与SAEs发生率显著升高相关,ADT+醋酸阿比特龙(OR=1.42,95%CI为1.10~1.82)的SAEs发生率稍有增高,其他治疗方案的SAEs发生率无明显差异。结论与仅行ADT相比,ADT+达罗他胺+多西他赛三联疗法的OS获益最多,但其SAEs发生率大幅增高;与ADT+多西他赛相比,ADT+醋酸阿比特龙、阿帕他胺或恩杂鲁胺具有更多的OS获益。ADT+恩杂鲁胺在不提高患者SAEs发生率的前提下,提供了较多的rPFS获益。

基于元分析的我国上市公司股权激励对企业财务绩效的影响研究

随着股权激励制度的不断发展,关于我国上市公司如何进行股权激励的话题引起学者们的重视,然而用传统的分析方法对中国情境下股权激励与企业财务绩效关系的研究,至今尚未得出一致结论。鉴于此,本研究使用元分析(Meta analysis)方法,对股权激励水平与企业财务绩效关系的60篇文献样本,174个效应值,以及股权激励模式与企业财务绩效关系的27篇文献样本,90个效应值进行定量统计分析,以此得出关于股权激励与企业财务绩效关系的阶段性定论。研究结果表明:(1)股权激励水平能够显著提升企业财务绩效;(2)分别实施股票期权与限制性股票的模式均对企业财务绩效有显著的正向影响,且股票期权的激励效果要优于限制性股票;(3)情境调节因素(股权激励的模式、企业上市板块)和方法调节因素(企业财务绩效测量指标、数据类型)能够对股权激励水平与企业财务绩效关系产生显著的调节作用,而企业性质对二者关系不具有调节作用。从更加宏观的视角阐述股权激励与企业财务绩效关系的内在机制,探究可能导致研究结论存在不一致性的潜在调节因素,以期为未来研究提供参考,并为我国上市企业建立更加有效的股权激励制度提供建议。

针灸联合中药治疗薄型子宫内膜不孕症的Meta分析

目的 系统评价中医针药联合治疗薄型子宫内膜不孕症的临床疗效。方法 检索知网、万方、维普等数据库,时间限定为自入库至2021年7月,检索内容为针灸联合中药治疗薄型子宫内膜不孕症的随机对照试验(RCT),筛选文献并进行质量评价后,采用Rev Man 5.3软件进行Meta分析。结果 共纳入9项RCTs,共862例薄型子宫内膜不孕症患者。Meta分析显示:与西药治疗相比,针药联合使用在增加子宫内膜厚度[MD=1.65,95%CI(1.42,1.87),Z=14.33(P<0.0000 1)]、降低子宫动脉搏动指数(PI)[MD=-0.10,95%CI(-0.13,-0.07),Z=7.48(P<0.0000 1)]、子宫动脉阻力指数(RI)[MD=-0.05,95%CI(-0.07,-0.04),Z=9.48(P<0.0000 1)]、增加A型子宫内膜比例[RR=1.64,95%CI(1.34,2.00),Z=4.87(P<0.0000 1)]、提高妊娠率[RR=1.62,95%CI(1.37,1.93),Z=5.53(P<0.0000 1)]等方面,差异具有统计学意义。结论 针药联合治疗薄型子宫内膜不孕症比西药治疗具有更好的临床效果,但由于纳入文献质量偏低,该结论还需进一步验证。

Diabetes mellitus carries a risk of gastric cancer:A metaanalysis

AIM:To investigate the association and quantify the relationship between diabetes mellitus(DM) and gastric cancer(GC) by an updated meta-analysis.METHODS:The initial PubMed search identified 1233publications. Studies not reporting GC or those not reporting actual number of GC were excluded. Twelve pertinent studies were retrieved from the PubMed database or from a manual search and considered for the meta-analysis. Pooled risk ratios and 95%CI were estimated by a random-effects model. Subgroup analysis was performed according to gender or geographical regions. Heterogeneity and publication bias were evaluated by I2and funnel plot analysis,respectively.RESULTS:DM was significantly associated with GC with a RR of 1.41(P = 0.006)(95%CI:1.10-1.81).Subgroup analyses revealed that both sexes showed a significant association with GC,with a greater magnitude of risk in females(RR = 1.90; 95%CI:1.27-2.85;P = 0.002) than in males(RR = 1.24; 95%CI:1.08-1.43;P = 0.002). In addition,the link between DM and GC was significant in East Asian DM patients(RR = 1.77;95%CI:1.38-2.26; P < 0.00001) but not in Western DM patients(RR = 1.23; 95%CI:0.90-1.68; P = 0.2).There was no evidence of publication bias,but the results indicated significant heterogeneity.CONCLUSION:This updated meta-analysis has provided evidence of positive DM-GC associations. The limited information on potentially important clinical confounding factors in each study deserves further investigation.

Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy:A systematic review and metaanalysis

AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion criteria.Postoperative outcomes were compared between patients with and those without routine drainage.Pooled odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects models.RESULTS:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were analyzed.Patients without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two groups.CONCLUSION:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication rates.Future randomized trials should compare routine vs selective drainage.

Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated metaanalysis of randomized trials

BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy.

Prognostic value of c-Met in colorectal cancer:A metaanalysis

AIM: To assess the prognostic value of c-Met status in colorectal cancer. METHODS: We conducted a search in Pub Med, Web of Science, and the Cochrane Library covering all published papers up to July 2014. Only studies assessing survival in colorectal cancer by c-Met status were included. This meta-analysis was performed by using STATA11.0.RESULTS: Ultimately, 11 studies were included in this analysis. Meta-analysis of the hazard ratios(HR)indicated that patients with high c-Met expression have a significantly poorer overall survival(OR)(HR = 1.33, 95%CI: 1.06-1.59) and progression-free survival(PFS)(HR = 1.47, 95%CI: 1.03-1.91). Subgroup analysis showed a significant association between high c-Met expression and poorer overall survival in the hazard ratio reported(HR = 1.41, 95%CI: 1.08-1.74).CONCLUSION: The present meta-analysis indicated that high c-Met expression was associated with poor prognosis in patients with colorectal cancer.

Sleep-associated movement disorders and the risk of cardiovascular disease: A systematic review and metaanalysis

AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome(RLS)and periodic limb movements during sleep with CVD,but the results were still contradictory.We performed an extensive literature search on Pub Med,Medline and Web of Science published from inception to December 2014.Additional studies were manually searched from bibliographies of retrieved studies.Meta-analyses were conducted with Stata version 12.0(Stata Corp,College Station,Texas).Pooled odds ratios(ORs)and 95%CIs were calculated to assess the strength of association using the random effects model.Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity.The publication bias was detected using Egger’s test and Begg’s test.RESULTS:A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected.Among these studies,nine are cohort studies;two are case-control studies;and two are cross-sectional studies.The results showed that the summary OR of CVD associated with sleepassociated movement was 1.51(95%CI:1.29-1.77)in a random-effects model.There was significant heterogeneity between individual studies(P for heterogeneity=0.005,I2=57.6%).Further analysis revealed that a large-scale cohort study may account for this heterogeneity.A significant association was also found between RLS and CVD(OR=1.54,95%CI:1.24-1.92).In a fixed-effects model,we determined a significant relationship between sleep-associatedmovement disorders and coronary artery disease(CAD)(OR=1.34,95%CI:1.16-1.54;P for heterogeneity=0.210;I2=30.0%).Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.CONCLUSION:This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.