Medicine
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To appraise the current reporting methodological quality of randomized clinical trials (RCTs) in 3 leading diabetes journals. We systematically searched the literature for RCTs in Diabetes Care, Diabetes and Diabetologia from 2011 to 2013. Characteristics were extracted based on Consolidated Standards of Reporting Trials (CONSORT) statement. ⋯ No improvements were found in these 3 years. This study shows that methodological reporting quality of RCTs in the major diabetes journals remains suboptimal. It can be further improved to meet and keep up with the standards of the CONSORT statement.
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Review Meta Analysis
Reevaluation of Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma: A Meta-Analysis of Randomized Controlled Trials Over the Past 20 Years.
The effect of neoadjuvant chemotherapy on the survival of patients with thoracic esophageal squamous cell carcinomas (ESCCs) remains controversial. The optimal management strategy for resectable ESCCs varies regionally based on local randomized controlled trials. A systematic review and meta-analysis was conducted to re-evaluate this controversial issue. ⋯ Cisplatin and fluorouracil were adopted as neoadjuvant chemotherapy regimens. The role of neoadjuvant chemotherapy for ESCC is worth re-investigating. The design of randomized controlled trials should adopt new chemotherapy regimens as well as define the surgical procedure and the details of the lymphadenectomy.
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Review Meta Analysis
Intraoperative Radiotherapy Versus Whole-Breast External Beam Radiotherapy in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis.
There has not been a clear answer about the efficacy of intraoperative radiotherapy (IORT) for women with early-stage breast cancer. The aim of this meta-analysis was to summarize the available evidence comparing the efficacy and safety of IORT with those of whole-breast external beam radiotherapy (EBRT) for women with early-stage breast cancer. MEDLINE, EMBASE, the Web of Science, and the Cochrane Library were searched up to October 2014. ⋯ Overall mortality did not differ significantly. IORT should be used in conjunction with the prudent selection of suitable patients. It is imperative to identify women with a low risk of local recurrence.
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Review Meta Analysis
Prognostic Role of Hypothyroidism in Heart Failure: A Meta-Analysis.
Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive. We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. ⋯ However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76). We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.
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Randomized Controlled Trial Multicenter Study
Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database.
The aim of the study was to evaluate preoperative variables predictive of lethal morbidities in critically ill surgical patients at a national level. There is no report of risk stratification for morbidities associated with mortality in critically ill patients with acute diffuse peritonitis (ADP). We examined data from 16,930 patients operated during 2011 and 2012 in 1546 different hospitals for ADP identified in the National Clinical Database of Japan. ⋯ A total of 18 to 29 preoperative variables were selected per morbidity and yielded excellent C-indices for each (septic shock: 0.851; progressive renal insufficiency: 0.878; prolonged ventilation >48 h: 0.849; systemic sepsis: 0.839; CNS morbidities: 0.848; acute renal failure: 0.868; pneumonia: 0.830; and SSI: 0.688). We report the first risk stratification study on lethal morbidities in critically ill patients with ADP using a nationwide surgical database. These risk models will contribute to patient counseling and help predict which patients require more aggressive surgical and novel pharmacological interventions.