BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial ...BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.展开更多
Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,...Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.展开更多
BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic ...BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.展开更多
基金by Economic Development and Innovation Operative Programme Grant,No.GINOP 2.3.2-15-2016-00048 and No.GINOP-2.3.4-15-2020-00010Human Resources Development Operational Programme Grant,No.EFOP-3.6.2-16-2017-00006 and No.EFOP-3.6.1.-16-2016-00004.
文摘BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.
文摘Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.
文摘BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.
