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Pediatric Surgery International Mar 2021Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis.
METHODS
MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS
Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = - 2.80; 95% CI - 3.11 to - 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17-4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = - 3.38; 95% CI - 4.29 to - 2.48; p < 0.00001), earlier time to bowel movement return (MD = - 0.57; 95% CI - 0.79 to - 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08-0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = - 2.00; 95% CI - 3.01 to - 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10-1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13-3.16; p = 0.58) were not different between the two groups.
CONCLUSIONS
Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.
Topics: Adolescent; Adult; Anastomosis, Surgical; Anastomotic Leak; Child; Digestive System Surgical Procedures; Enteral Nutrition; Humans; Intestines; Length of Stay; Pediatrics; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Time Factors
PubMed: 33595685
DOI: 10.1007/s00383-020-04830-w -
Arteriosclerosis, Thrombosis, and... Apr 2021[Figure: see text]. (Meta-Analysis)
Meta-Analysis
[Figure: see text].
Topics: Animals; Anti-Inflammatory Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Dilatation, Pathologic; Disease Models, Animal; Disease Progression; Female; Fibrinolytic Agents; Male; Mice; Mice, Inbred C57BL; Mice, Knockout, ApoE; Protease Inhibitors; Receptors, LDL; Renin-Angiotensin System; Time Factors
PubMed: 33567871
DOI: 10.1161/ATVBAHA.121.315942 -
Journal of Traditional Chinese Medicine... Dec 2020To evaluate the effectiveness and safety of a Shenlingbaizhu (SLBZ) formula in the treatment of irritable bowel syndrome (IBS). The effectiveness of SLBZ with or without... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness and safety of a Shenlingbaizhu (SLBZ) formula in the treatment of irritable bowel syndrome (IBS). The effectiveness of SLBZ with or without conventional treatment was compared to that of conventional treatment alone.
METHODS
A comprehensive literature search of four Chinese electronic databases, three English language databases, and two English language trial registries from inception to June 2019 was performed. Two authors independently screened the citations and retrieved full publications of randomized trials on the use of SLBZ with or without conventional treatment for IBS. The methodological quality of the trials was assessed with the Cochrane Collaboration's tool for assessing the risk of bias. Data were extracted and subjected to Meta-analysis to compare the efficacy of the SLBZ formula with or without conventional treatment to conventional treatment alone.
RESULTS
Thirteen trials (comprising a total of 868 patients with IBS) were included in this review. The risk of bias of all 13 included trials was assessed as moderate. The SLBZ formula was associated with significant improvements in cure rate [relative risk (RR) score of 2.38, 95% confidence interval (CI) 1.43 to 3.95, I 2 = 0%; 8 trials, n = 487, fixed-effects model (FEM)], diarrhea severity score [mean difference (MD) score of -0.62, 95% CI -1.05 to -0.20, I 2 = 88%; 4 trials, n = 286, random effects model (REM)], abdominal pain severity score (MD score of -0.61, 95% CI -0.70 to -0.52, I 2 = 63%; 4 trials, n = 286, FEM), and abdominal distention severity score (MD score of -0.88, 95% CI -1.54 to -0.21, I 2 = 91%; 3 trials, n = 226, REM) compared to the conventional treatment alone. Adverse events were reported in five trials but only one of these indicated any adverse events associated with SLBZ.
CONCLUSION
Based on the 13 trials reviewed here, the SLBZ formula with or without conventional treatment appeared to be safe and more effective in improving the cure rate and reducing the severity of diarrhea, abdominal pain, and abdominal distention compared to conventional treatment alone. However, these trials only generated a moderate quality of evidence, and well-designed and high-quality random controlled trials of the SLBZ formula for the treatment of IBS are required to confirm the efficacy of this treatment option.
Topics: Drugs, Chinese Herbal; Humans; Irritable Bowel Syndrome; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33258340
DOI: 10.19852/j.cnki.jtcm.2020.06.001 -
Expert Review of Gastroenterology &... Jun 2020Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.)....
INTRODUCTION
Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures.
AREA COVERED
In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI.
EXPERT OPINION
EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.
Topics: Constriction, Pathologic; Dilatation; Endoscopy, Gastrointestinal; Gastrointestinal Diseases; Humans; Prosthesis Implantation; Recurrence; Secondary Prevention; Stents
PubMed: 32380885
DOI: 10.1080/17474124.2020.1766966 -
Epidemiology and Infection Feb 2020In recent years, outbreaks of hand-foot-mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big... (Meta-Analysis)
Meta-Analysis
In recent years, outbreaks of hand-foot-mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big threat to public health. This study aimed to quantitatively assess all qualified studies and identify the risk factors for HFMD death. A systematic search of the databases PubMed, Medline, Embase and the Cochrane Library was performed. Study heterogeneity and publication bias were estimated. Seven case-control studies involving 1641 participants (634 died and 1007 survived) were included in the meta-analysis. Human enterovirus 71 infection, male, age ⩽3 years, vomiting, cyanosis, convulsion, duration of fever ⩾3 days, atypical rashes and abdominal distention were not significantly related to HFMD death (P ⩽ 0.05). Lethargy (odds ratio (OR) = 6.62; 95% CI 3.61-12.14; I2 = 0%; P < 0.0001), pneumonoedema/pneumorrhagia (OR = 4.09; 95% CI 2.44-6.87; I2 = 0%; P < 0.0001), seizures (OR = 6.85; 95% CI 2.37-19.74; I2 = 0%; P = 0.0004), dyspnoea (OR = 8.24; 95% CI 2.05-33.19; I2 = 83%; P = 0.003) and coma (OR = 3.76; 95% CI 1.85-7.67; I2 = 0%; P = 0.0003) were significantly associated with HFMD death, which were risk factors for HFMD death.
Topics: Asia; Child, Preschool; Enterovirus A, Human; Female; Hand, Foot and Mouth Disease; Humans; Incidence; Infant; Male; Risk Factors; Survival Analysis
PubMed: 32102711
DOI: 10.1017/S0950268819002279 -
International Journal of Nursing Studies Dec 2019Currently the nasogastric tube (NGT) is routinely inserted in clinical after abdominal surgery for decompression in China, yet the practice varies between regions, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Currently the nasogastric tube (NGT) is routinely inserted in clinical after abdominal surgery for decompression in China, yet the practice varies between regions, the role of NGT for the patients after hepatic surgery remains unclear. Therefore, this present meta-analysis aimed to assess the efficacy and safety of NGT placement after hepatic surgery.
DESIGN
A systematic review and meta-analysis DATA SOURCES: PUBMED, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) and Wanfang Database (until Mar 30, 2019) were systematically searched.
REVIEW METHODS
Randomized controlled studies (RCTs) comparing the efficacy and safety of NGT and no NGT treatment after hepatic surgery were included. Data were synthesized using a random-effects or fixed effect model according to the heterogeneity. Outcomes were presented as Mantel-Haenszel style odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals (95% CIs).
RESULTS
Seven studies with 1306 patients were eligible for inclusion. Compared with NGT treatment, the no NGT decompression could shorten the time to first defecation (MD -0.59; -0.79, -0.39), reduce the time to start diet (MD -0.46; -0.90, -0.03), and decrease the length of hospital stay (MD 0.48; -0.93, -0.03), but it could also increase the risk of NGT re-intubation (OR 6.8; 1.77, 26.72), no significant differences were detected on the first passage of flatus (MD -0.34; -0.86, 0.18), the incidence of nausea (OR 0.81; 0.40, 1.67), vomiting (OR 1.06; 0.19, 5.93), abdominal distention (OR 0.87; 0.60, 1.25).
CONCLUSION
Given that very limited information for some endpoints in this present meta-analysis, the routinely insertion of NGT after hepatic surgery is not justified, the no NGT decompression seems to be more beneficial to the prognosis of patients after hepatic surgery, more related studies on this issue are needed.
Topics: China; Humans; Intubation, Gastrointestinal; Liver
PubMed: 31629211
DOI: 10.1016/j.ijnurstu.2019.103406 -
European Journal of Gastroenterology &... Oct 2019Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on liver function improvement. The consensus on effects and safety of stem cell therapy has not been reached, thus it is essential for us to conduct a systematic review and meat-analysis to investigate the efficacy and safety of stem cell therapy for viral hepatitis-induced LC.
MATERIALS AND METHODS
Medline, Embase, SinoMed and Cochrane Library databases were searched with appropriate keywords through 5 August 2018. We included eight trials involving 467 patients. The pooled weight mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed or random effects model. Quality assessment and publication bias were also performed. The selected studies were considered for meta-analysis using RevMan V5.3.
RESULTS
Compared with traditional therapy group, autologous stem cell transplantation increased the level of albumin (WMD: 2.47, 95% CI: 1.05-3.90, P < 0.001), but decreased the level of total bilirubin (WMD: -2.26, 95% CI: -3.61 to -0.90, P = 0.001), alanine aminotransferase (WMD: -9.16, 95% CI: -16.47 to -1.85, P = 0.01) and prothrombin time (WMD: -3.02, 95% CI: -4.83 to -1.22, P = 0.001). Clinical symptoms such as edema, fatigue, anorexia and abdominal distention were alleviated. Model for End-Stage Liver Disease and Child-Pugh scores were decreased after stem cell therapy. Whereas, there was no statistically significant difference between two groups regarding aspartate aminotransferase, prothrombin time activity, ascites and pleural fluid. No procedure-related complications were found.
CONCLUSION
Autologous stem cell transplantation might have beneficial effects on patients with viral hepatitis-induced LC and is relatively safe for these patients. Further high-quality randomized controlled trials are needed.
Topics: Hepatitis, Viral, Human; Humans; Liver Cirrhosis; Models, Statistical; Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome
PubMed: 31206409
DOI: 10.1097/MEG.0000000000001455 -
Orphanet Journal of Rare Diseases Jun 2019Congenital tuberculosis is rare and carries a high mortality rate. Our objective was to summarize the current experience of the diagnosis and treatment of patients with... (Review)
Review
BACKGROUND
Congenital tuberculosis is rare and carries a high mortality rate. Our objective was to summarize the current experience of the diagnosis and treatment of patients with congenital tuberculosis.
METHODS
In total, 73 reported cases of congenital tuberculosis published in Chinese and 19 patients with congenital tuberculosis admitted to West China Second University Hospital, Sichuan University, were retrospectively reviewed.
RESULTS
Sixty-four male and 28 female patients were identified. The majority of the patients were less than 3 weeks old at the time of presentation (range, 0-67 days). With regard to the tuberculosis type, 89 patients had pulmonary tuberculosis, and 20 patients had hepatic tuberculosis. There was active tuberculosis in 71 mothers, no tuberculosis in 12 mothers, and an unknown history of tuberculosis in 9 mothers. Fever, cyanosis, jaundice, shortness of breath, cough, pulmonary moist rales, hepatomegaly, splenomegaly and abdominal distention were the main clinical symptoms at the time of presentation. The abnormal ratios of chest, abdomen and head radiographic images were 97.53, 75 and 81.25%, respectively. The positive rates of acid-fast staining of sputum smears and tuberculosis bacillus DNA were 62.50 and 66.67%, respectively. The misdiagnosis rate was 59.78%. The overall mortality due to congenital tuberculosis was 43.48%. Respiratory failure was the most common cause of death. Sixty-five patients received anti-tuberculosis therapy, and of those, only 16 (15.38%) died.
CONCLUSIONS
The clinical manifestations and radiographic findings of congenital tuberculosis are nonspecific. It is important to thoroughly evaluate the mothers of infants with suspected congenital tuberculosis. Good outcomes can be achieved in infants with the early identification of congenital tuberculosis and early administration of anti-tuberculosis treatment.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Respiratory Insufficiency; Retrospective Studies; Tuberculosis; Tuberculosis, Hepatic; Tuberculosis, Pulmonary; Young Adult
PubMed: 31182120
DOI: 10.1186/s13023-019-1101-x -
Evidence-based Complementary and... 2019To comprehensively evaluate the efficacy and safety of acupuncture combined with Chinese herbal medicine (CHM) in treating irritable bowel syndrome with diarrhea (IBS-D). (Review)
Review
PURPOSE
To comprehensively evaluate the efficacy and safety of acupuncture combined with Chinese herbal medicine (CHM) in treating irritable bowel syndrome with diarrhea (IBS-D).
METHODS
Relevant randomized controlled trials (RCTs) were systemically retrieved from electronic databases from inception to March 2018, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical Database (CBM, SinoMed), China Science and Technology Journal Database (VIP), and Wan Fang Data. Meanwhile, pooled estimates, including the 95% confidence interval (CI), were calculated for primary and secondary outcomes of IBS-D patients. Besides, quality of relevant articles was evaluated using the Cochrane Collaboration's risk of bias tool, and the Review Manager 5.3 and Stata12.0 softwares were employed for analyses.
RESULTS
A total of 21 RCTs related to IBS-D were included into this meta-analysis. Specifically, the pooled results indicated that (1) acupuncture combined with CHM might result in more favorable improvements compared with the control group (relative risk [RR] 1.29; 95% CI 1.24-1.35; P =0.03); (2) the combined method could markedly enhance the clinical efficacy in the meantime of remarkably reducing the scores of abdominal pain (standardized mean difference [SMD] -0.45; 95% CI -0.72, -0.17; P = 0.002), abdominal distention/discomfort (SMD -0.36; 95% CI -0.71, -0.01; P = 0.04), diarrhea (SMD -0.97; 95% CI -1.18, -0.75; P < 0.00001), diet condition (SMD -0.73; 95% CI -0.93, -0.52; P<0.00001), physical strength (SMD -1.25; 95% CI -2.32, -0.19; P = 0.02), and sleep quality (SMD -1.02; 95% CI -1.26, -0.77; P < 0.00001) compared with those in the matched groups treated with western medicine, or western medicine combined with CHM. Additionally, a metaregression analysis was constructed according to the name of prescription, acupuncture type, treatment course and publication year, and subgroup analyses stratified based on the names of prescriptions and acupoints location were also carried out, so as to explore the potential heterogeneities; and (3) IBS-D patients treated with the combined method only developed inconspicuous adverse events; more importantly, the combined treatment had displayed promising long-term efficacy.
CONCLUSIONS
Findings in this study indicate that acupuncture combined with CHM is suggestive of an effective and safe treatment approach for IBS-D patients, which may serve as a promising method to treat IBS-D in practical application. However, more large-scale, multicenter, long-term, and high-quality RCTs are required in the future, given the small size, low quality, and high risk of the studies identified in this meta-analysis.
PubMed: 31110553
DOI: 10.1155/2019/7680963 -
Endoscopy International Open Apr 2019Ambient air is the most commonly used gas for insufflation in endoscopic procedures worldwide. However, prolonged absorption of air during endoscopic examinations... (Review)
Review
Efficacy and safety of carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography in randomized controlled trials: a systematic review and meta-analysis.
Ambient air is the most commonly used gas for insufflation in endoscopic procedures worldwide. However, prolonged absorption of air during endoscopic examinations may cause pain and abdominal distension. Carbon dioxide insufflation (CO i) has been increasingly used as an alternative to ambient air insufflation (AAi) in many endoscopic procedures due to its fast diffusion properties and less abdominal distention and pain. For endoscopic retrograde cholangiopancreatography (ERCP), use of CO for insufflation is adequate because this procedure is complex and prolonged. Some randomized controlled trials (RCTs) have evaluated the efficacy and safety of CO as an insufflation method during ERCP but presented conflicting results. This systematic review and meta-analysis with only RCTs evaluated the efficacy and safety of CO i versus AAi during ERCP. A literature search was performed using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Outcomes evaluated were abdominal pain and distension, complications, procedure duration, and CO levels. Eight studies (919 patients) were included. Significant results favoring CO i were less abdominal distension after 1 h (MD: -1.41 [-1.81; -1.0], 95 % CI, I² = 15 %, < 0.00001) and less abdominal pain after 1 h (MD: -23.80 [-27.50; -20.10], 95 %CI, I² = 9 %, < 0.00001) and after 6 h (MD: -7.00 [-8.66; -5.33]; 95 % CI, I² = 0 %, < 0.00001). Use of CO i instead of AAi during ERCP is safe and associated with less abdominal distension and pain after the procedure.
PubMed: 31041365
DOI: 10.1055/a-0854-3739