Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.
ObjectivesTo evaluate the association between high homocysteine (Hcy) levels and risk of contrast-induced nephropathy (CIN).MethodsCNKI, VIP, WanFang Data, PubMed, The Cochrane Library and Web of Science databases were electronically searched to collect the case-control studies on the association between Hcy and risk of CIN from inception to November 30th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using Stata 12.0 software.ResultsTen case-control studies involving 6 124 subjects were included. Meta-analysis showed that the high Hcy level was associated with an increased risk of CIN (OR=1.59, 95%CI 1.33 to 1.89, P<0.001), and the homocysteine level in CIN group was higher than that in non-CIN group (WMD=8.74, 95%CI 6.18 to 11.31,P<0.001).ConclusionsAccording to the current evidence, the high Hcy level is a risk factor for CIN. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
Objectives To evaluate the relationships between the Scavenger Receptor Class B1 (SCARB1) polymorphisms and susceptibility of cardiovascular diseases (CVDs). Methods Databases including PubMed, Web of Science, CNKI, WanFang Data and VIP were searched from inception to December 31st 2017 to collect case-control studies on relationships between Scavenger Receptor Class B1 (SCARB1) polymorphisms and susceptibility of CVDs. Paper screening, data extraction and assessment of risk of bias were carried out. Meta-analysis was then conducted by Stata 12.0 software. Results In total, 12 studies relevant to SCARB1 rs5888C/T, rs4238001 G/A and rs10846744 G/C polymorphisms were included. Meta-analysis showed that there was no significant association between the rs5888 C/T polymorphism and susceptibility of CVDs (C vs. T: OR=0.97, 95%CI 0.86 to 1.09, P=0.627), neither for the rs4238001 G/A (G vs. A: OR=0.87, 95%CI 0.64 to 1.17, P=0.344). However, the rs10846744 G/C polymorphism was significantly associated with CVDs risk (G vs. C: OR=1.30, 95%CI 1.11 to 1.52, P=0.001). Subgroup analysis showed that, for non-Asian subjects, there was a significant association between the rs5888 C/T polymorphism and susceptibility of CVDs (C vs. T: OR=0.82, 95% CI 0.68 to 0.99, P=0.040). Conclusions SCARB1 rs10864744 G/C polymorphism could be associated with risk of CVDs. Considering the quantity and quality limitation of the included studies, the conclusion has to be verified by more large-scale high quality studies.
ObjectivesTo systematically review the association between the SIX6 gene rs10483727 mutation and primary open angle glaucoma (POAG).MethodsPubMed, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect case-control studies on the SIX6 gene rs10483727 polymorphism and primary open angle glaucoma from inception to December 28th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by Stata 12.0 software.ResultsSeventeen case-control studies in 16 papers were included, involving 9 886 patients and 19 663 controls. The results of meta-analysis showed that rs10483727 polymorphism in SIX6 gene was associated with the risk of POAG in the Asians and Caucasians. However, no association was found in the Africans.ConclusionsThe current evidence shows that rs10483727 polymorphism in SIX6 gene is associated with the risk of POAG in the Asians and Caucasians.
ObjectiveTo systematically review the efficacy and safety of Deanxit for functional dyspepsia (FD).MethodsCBM, WanFang Data, CNKI, PubMed, LWW and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) on Deanxit for FD from inception to June 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using StataSE 12.0 software.ResultsA total of 53 RCTs were included. The results of meta-analysis showed that compared with conventional gastrointestinal drugs, combined with Deanxit had higher total effective rate (RR=1.30, 95%CI 1.21 to 1.39, P<0.01) and higher incidence of adverse reactions (RR=1.23, 95%CI 1.03 to 1.47, P=0.026).ConclusionsThe current evidence shows that, compared with conventional gastrointestinal drugs or placebo alone, combined with Deanxit have higher total effective rate and higher incidence of adverse reactions. Due to limited quality of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the application of enhanced funnel plots (EFP) and trial sequential analysis (TSA) in robustness assessment of meta-analysis results.MethodsData were extracted from published meta-analysis. The EFP was used to evaluate the robustness of the significance and heterogeneity of the current meta-analysis. The TSA was used to judge the sufficiency of the cumulative sample size of the current meta-analysis and to assess the robustness of conclusions based on current evidence.ResultsThe EFP showed that the meta-analysis results of low-density lipoprotein (LDL) was robust, and the meta-analysis results of triglyceride (TG), total cholesterol (TC) and high-density lipoprotein (HDL) were not stable. The TSA showed that the cumulative sample size of LDL had reached the required information size (RIS), and the current conclusion was stable. The cumulative Z value of TG, TC and HDL neither reached the RIS nor passed through the TSA monitoring boundary or futility boundary, indicating that current conclusions were not robust.ConclusionsThe combination of EFP and TSA can make a comprehensive judgment on the robustness of current meta-analysis results, and provide methodological support in the robustness assessment of results for future systematic reviews and meta-analyses.
ObjectiveTo explore the causal association between venous thromboembolism and cardiovascular disease risks using a two-sample bidirectional Mendelian randomization study. MethodsThe single-nucleotide polymorphism (SNP) data associated with venous thromboembolism (VTE) and cardiovascular diseases (CVD) from genome-wide association studies were obtained as instrumental variables. Inverse variance weighted (IVW) was used as the main Mendelian randomization method and other methods were used as supplementary methods. Cochran's Q test, the intercept term of MR-Egger, and MR-PRESSO were used to assess pleiotropy and heterogeneity to ensure the robustness of the results. ResultsThe IVW method suggested a causal association between venous thromboembolism and atrial fibrillation (OR=1.033, 95%CI 1.009 to 1.058, P=0.008), but no association was identified between VTE and coronary artery disease (OR=0.994, 95%CI 0.974 to 1.023, P = 0.551), heart failure (OR=1.021, 95%CI 0.992 to 1.050, P=0.159) and myocardial infarction (OR=1.012, 95%CI 0.971 to 1.055, P=0.568). The results of Cochran's Q test showed that there was no heterogeneity in the MR analyses of VTE and CVD. The MR-Egger intercept analysis and the MR-PRESSO global testing did not detect potential horizontal pleiotropy, and the results were robust. Reverse Mendelian randomization analysis was used to verify the presence of reverse causal associations. The reverse MR analysis demonstrated that reverse causal associations between venous thromboembolism and cardiovascular diseases were not evidenced. ConclusionThe results of the Mendelian randomization study demonstrated a causal association between venous thromboembolism and atrial fibrillation, but not with CAD, HF, or MI, providing a new perspective on the prevention and treatment of atrial fibrillation.
