Moist dressings in the treatment of pressure injuries: A network meta-analysis.

AIMS: The aim of this network meta-analysis is to analyze the difference in therapeutic effects between moist dressings and traditional dressings in the treatment of pressure injury (PI), explore the healing, healing time, direct cost, and number of dressing changes of different moist dressings for the management of pressure injuries. BACKGROUND: The incidence of pressure injury is high and the burden of disease is high, but there is no consensus on how to choose moist dressing treatment. DESIGN: A systematic review with network meta-analysis was performed. DATA SOURCES: We searched the Chinese Biomedicine Literature Database and China National Knowledge Infrastructure, Wanfang Database, VIP database, PubMed, Web of Science, EMBASE.com, CENTRAL (Cochrane Central Register of Controlled Trials) and CINAHL to obtain randomized controlled trials (RCTs) on the treatment of PI with moist dressings. REVIEW METHODS: R studio software and Stata 16.0 software were used to compare different moist dressings and traditional dressings. RESULTS: 41 RCTs of moist dressings in the treatment of PI were included. A total of seven kinds of moist dressings, Vaseline gauze and traditional gauze dressing were involved. All RCTs were at a medium to high risk of bias. Overall, moist dressings had more advantages than traditional dressings in terms of various outcome indicators. CONCLUSION: The effect of moist dressings in treating PI is more advantageous than traditional dressings. However, in terms of direct cost and the number of dressings changes, more research is needed to improve the credibility of the network meta-analysis. The results of the network meta-analysis show that the silver ion dressing and alginate dressing are the best choices in the treatment of PI. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a network meta-analysis, which does not require the participation of patients and the public.

Reporting quality and risk of bias of Cochrane individual participant data meta-analyses: A cross-sectional study.

OBJECTIVES: This study aimed to assess the reporting quality and risk of bias of Cochrane individual participant data meta-analyses (IPD-MAs). METHODS: We searched the Cochrane Library and identified the Cochrane IPD-MAs. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data (PRISMA-IPD) assessed the reporting quality of included Cochrane IPD- MAs, and the Risk Of Bias In Systematic reviews (ROBIS) tool was used to assess the risk of bias. We performed stratified and correlation analyses to explore factors affecting the quality. RESULTS: Forty-six Cochrane IPD-MAs were included in our study. Twenty-six Cochrane IPD-MAs (56.5%) had statistical or epidemiological authors involved, and 31 (67.4%) contained only IPD data. Thirty-five studies (76.1%) did not report whether they used 1-stage or 2-stage methods, and forty (87.0%) did not report the statistical techniques used for missing participant data. We found that the entire compliance reported PRISMA-IPD items of Cochrane IPD-MAs published after 2015 (n = 18; Mean ± SD: 26.61 ± 2.75) was higher than those studies published in 2015 and before (n = 28; Mean ± SD: 22.61 ± 4.73), the difference was statistically significant (p = 0.002). A strong positive correlation was found between the fully reported PRISMA-IPD items and fully accordance ROBIS items (Spearman's: ρ = 0.653, p < 0.001). CONCLUSIONS: The quality of Cochrane IPD-MAs is not high, especially in the reporting of statistical methods. There was room for further improvement in IPD retrieval, IPD integrity and statistical analyses.

Efficacy and safety of carnitine supplementation on NAFLD: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The efficacy and safety of L-carnitine supplementation on non-alcoholic fatty liver disease (NAFLD) are unclear. This systematic review and meta-analysis aimed to assess the efficacy and safety of L-carnitine supplementation on NAFLD. METHODS: We searched in four databases (PubMed, Embase, Cochrane Library, and Web of Science) from inception to 1 November 2022 (updated on March 20, 2023) for potentially relevant records without language restrictions. We collected information on the first author, publication year, country, setting, study design, population characteristics, duration of follow-up, outcome variables of interest, and sources of funding. We used a modified Cochrane risk of bias tool to assess the risk of bias, used GRADE to assess the certainty of evidence, and used the Credibility of Effect Modification Analyses (ICEMAN) tool to assess the credibility of any apparent subgroup effect. RESULTS: This systematic review and meta-analysis included eight eligible randomized controlled trials (RCTs). Compared to placebo, low certainty evidence show that L-carnitine supplementation significantly changes (reduced) more in AST levels and ALT levels (MD: - 26.38, 95%CI: - 45.46 to - 7.30), and moderate certainty evidence show that L-carnitine supplementation significantly changes (reduced) more in HDL cholesterol levels (MD: 1.14, 95%CI: 0.21 to 2.07) and triglyceride levels (MD: - 6.92, 95%CI: - 13.82 to - 0.03). Moderate credibility of ICEMAN results shows that L-carnitine supplementation has no difference in changes of AST and ALT levels in younger ones (MD: 0.5, 95%CI: - 0.70 to 1.70) but has significant changes (reduced) in adults (MD: - 20.3, 95%CI: - 28.62 to - 12.28) compared to placebo. CONCLUSION: L-carnitine supplementation may improve liver function and regulate triglyceride metabolism in patients with NAFLD, and with no significant adverse effects.

Effects of Luteolin on Biofilm of Trueperella pyogenes and Its Therapeutic Effect on Rat Endometritis.

Trueperella pyogenes is an opportunistic pathogen that causes suppurative infections in animals. The development of new anti-biofilm drugs will improve the current treatment status for controlling T. pyogenes infections in the animal husbandry industry. Luteolin is a naturally derived flavonoid compound with antibacterial properties. In this study, the effects and the mechanism of luteolin on T. pyogenes biofilm were analyzed and explored. The MBIC and MBEC of luteolin on T. pyogenes were 156 µg/mL and 312 µg/mL, respectively. The anti-biofilm effects of luteolin were also observed by a confocal laser microscope and scanning electron microscope. The results indicated that 312 µg/mL of luteolin could disperse large pieces of biofilm into small clusters after 8 h of treatment. According to the real-time quantitative PCR detection results, luteolin could significantly inhibit the relative expression of the biofilm-associated genes luxS, plo, rbsB and lsrB. In addition, the in vivo anti-biofilm activity of luteolin against T. pyogenes was studied using a rat endometritis model established by glacial acetic acid stimulation and T. pyogenes intrauterine infusion. Our study showed that luteolin could significantly reduce the symptoms of rat endometritis. These data may provide new opinions on the clinical treatment of luteolin and other flavonoid compounds on T. pyogenes biofilm-associated infections.

Comparative efficacy and acceptability of cognitive behavioral therapy delivery formats for insomnia in adults: A systematic review and network meta-analysis.

This review compared the efficacy and acceptability of different delivery formats for cognitive behavioral therapy for insomnia (CBT-I) in insomnia. We searched five databases for randomized clinical trials that compared one CBT-I delivery format against another format or control conditions for insomnia in adults. We used pairwise meta-analyses and frequentist network meta-analyses with the random-effects model to synthesize data. A total of 61 unique trials including 11,571 participants compared six CBT-I delivery formats with four control conditions. At post-intervention, with low to high certainty evidence, individual, group, guided self-help, digital assisted, and unguided self-help CBT-I could significantly increase sleep efficiency and total sleep time (TST) and reduce sleep onset latency (SOL), wake after sleep onset (WASO), and insomnia severity compared with treatment as usual (MD range for sleep efficiency: 7.81%-12.45%; MD range for TST: 16.14-33.96 min; MD range for SOL: -22.42 to -13.81 min; MD range for WASO: -40.84 to -19.48 min; MD range for insomnia severity: -6.40 to -3.93) and waitlist (MD range for sleep efficiency: 7.68%-12.32%; MD range for TST: 12.67-30.49 min; MD range for SOL: -19.07 to -10.46 min; MD range for WASO: -47.10 to -19.15 min; MD range for insomnia severity: -7.59 to -5.07). The effects of different CBT-I formats persisted at short-term follow-up (4 wk-6 mo). Individual, group, and digital assisted CBT-I delivery formats would be the more appropriate choices for insomnia in adults, based on post-intervention and short-term effects. Further trials are needed to investigate the long-term effects of different CBT-I formats.

Reproductive Health in First-degree Relatives of Patients With Polycystic Ovary Syndrome: A Review and Meta-analysis.

CONTEXT: Polycystic ovary syndrome (PCOS) is a highly heritable disease. Emerging evidence elucidated the elevated prevalence of reproductive abnormalities in first-degree relatives (FDRs) of patients with PCOS. OBJECTIVE: To explore the reproductive health in FDRs of patients with PCOS. METHODS: Ten databases were searched in December 2020 (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese Biological Medical Literature, Chinese National Knowledge Infrastructure, Chinese Journals Full-text Database, WanFang, and World Health Organization international clinical trials registry platform). This study included cohort, case-control, or cross-sectional studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was followed. Dichotomous data from each of the eligible studies were combined by the Mantel-Haenszel model. Standard mean differences with 95% CIs were assessed. Heterogeneities were assessed using I2 statistics, and the quality of evidence was evaluated by a US Agency for Healthcare Research and Quality Evidence-based Practice Center program and Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: Thirty-eight studies were included. The prevalence of PCOS (0.22; 95% CI, 0.16 to 0.29), menstrual irregularities (0.28; 95% CI, 0.22 to 0.34, P < .01), and ovary morphological changes were elevated in female PCOS FDRs. Female FDRs also presented with increased levels of luteinizing hormone, total testosterone (standard mean difference, 0.53; 95% CI, 0.28 to 0.78, P < .01), unconjugated testosterone, free androgen index, dehydroepiandrosterone sulfate (DHEAS), and antimüllerian hormone levels. Subgroup analyses indicated that some of these changes begun in pubertal girls. Furthermore, fathers of PCOS patients had a higher risk of premature baldness. The DHEAS level was elevated in male FDRs. CONCLUSION: The findings of this analysis suggested that FDRs of patients with PCOS suffered from reproductive endocrinological dysregulations. Thus, more attention should be focused on this population.

A systematic review of recommendations on screening strategies for breast cancer due to hereditary predisposition: Who, When, and How?

BACKGROUND: Breast cancer is a global health problem that cannot be underestimated. Many studies have shown that breast cancer is related to pathogenic mutations in hereditary predisposition genes. Clinical practice guidelines play a vital role in guiding the selection of breast cancer screening. Little is known about the quality and consistency of guidelines' recommendations and their changes over these years. METHODS: We reviewed the existing screening guidelines for genetic susceptibility to breast cancer and assessed the methodological quality, and summarized the recommendations to aid clinicians to make decisions. We conducted a systematic search in PubMed, Embase, Web of Science, and guideline-specific databases, aiming to find the guidelines of breast cancer due to hereditary predisposition. The necessary information was exacted by Excel. We also summarized different evidence grading systems. The qualities of the guidelines were assessed by the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. RESULTS: A total of 54 recommendations from 13 guidelines were extracted. Generally speaking, the recommendations were consistent, mainly focusing on mammography and MRI. CONCLUSIONS: The recommendations differ in details. Moreover, different guidelines are based on different grading systems, and some guidelines are not divided for age limits, which may limit the promotion and implementation of the guidelines. It is suggested that improvement can be made in this regard in the future.

Effectiveness and safety of different dressings therapy for pressure injuries: A protocol for systematic reviews and network meta-analysis.

BACKGROUND: Pressure injuries, also known as pressure ulcers, are local skin injuries. Once a pressure injury occurs, clinical treatment is relatively difficult, the treatment cycle is long, and the treatment cost is high, which brings heavy burdens to patients and society. Therefore, look for a reliable pressure injuries treatment method is 1 of the focus of clinical nursing workers. OBJECTIVE: At present, there are many kinds of dressings to treat pressure injuries, and there is no uniform conclusion about which dressing is the most effective. Therefore, we systematically evaluate the effects of different dressings on the treatment of pressure injuries. METHODS: We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, CNKI, CBM, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use R software to carry out network meta-analysis. RESULTS: This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION: Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER: INPLASY2020100087.

Characterisation of soil erosion and overland flow on vegetation-growing slopes in fragile ecological regions: A review.

Grasses and shrubs occupy large areas of fragile ecosystems following ecological restoration. Therefore, it is increasingly important to assess and monitor the environmental safety of pastures. However, previous studies on this topic lacked systematicity and directionality. In this study, we reviewed the literature on runoff and erosion to summarise the core issues for future research, resolve the current research bottleneck, and promote the balance of soil, water, and energy in fragile ecological areas. The results of the review indicate that coverage remained the main vegetation feature considered when characterising rangeland slope erosion and runoff. Erosion energy should be comprehensively considered based on the influence of vegetation on rainfall distribution and runoff erosivity. Rangeland slope erosion and runoff changes can only be explained by integrating the above- and below-ground characteristics of vegetation. Additionally, the impact of vegetation on runoff separation and the sediment transport processes at different erosion stages under rainfall conditions vary. Therefore, studying the comprehensive indicators of vegetation at different erosion stages in response to erosion and runoff will be vital in rangeland erosion research. From the perspective of disciplinary development, this study can promote the further development of soil erosion, ecology, soil science, hydrology, hydraulics, and other disciplines.

Circulating Irisin Level and Thyroid Dysfunction: A Systematic Review and Meta-Analysis.

Both thyroid hormones and irisin have profound influences on the metabolism of the human body. Based on their similarities, several studies have been conducted to explore changes in irisin levels in patients with hypothyroidism and hyperthyroidism. This study was conducted in accordance with the PRISMA statement and the MOOSE reporting guideline. Based on a preregistered protocol (PROSPERO-CRD42019138430), a comprehensive search of eight databases was performed from inception to April 2020. Studies with original data collected from patients with thyroid dysfunction were included. Subgroup analysis was performed based on the different types of clinical manifestations and patient characteristics. The quality of each study and the presence of publication bias were assessed by the Newcastle-Ottawa score (NOS) and funnel plot with Egger's test, respectively. A total of 11 studies with 1210 participants were included. Ten studies were identified as high-quality studies. Pooled analysis indicated decreased irisin levels in patients with hypothyroidism (MD -10.37, 95% CI -17.81 to -2.93). Subgroup analysis revealed an even lower level of irisin in patients with clinical-type hypothyroidism (MD -17.03, 95% CI -30.58 to -3.49) and hypothyroidism caused by autoimmune disease (MD -19.38, 95% CI -36.50 to -2.26). No differences were found after achieving euthyroid status from levothyroxine treatment in patients with hypothyroidism compared with controls. No differences were found between patients with hyperthyroidism and controls. Correlation analyses revealed a possible negative correlation between irisin and TSH and positive correlations between irisin and both fT3 and fT4. Irisin was correlated with TSH receptor antibodies.

Risk factors and prevalence of diabetic retinopathy: A protocol for meta-analysis.

BACKGROUND: Diabetic retinopathy (DR) is one of the serious complications of diabetes mellitus. Without further treatment, it can evolve into the stage of proliferation, which will lead to the formation of new blood vessels, vitreous hemorrhage, or anterior retinal hemorrhage, which will lead to severe vision loss and increase the risk of blindness. METHODS: The research literature on the risk factors of diabetic retinopathy published as of July 1, 2020 was searched through MEDLINE, Embase, ovid, Web of Science, Wanfang, CNKI, and other databases, The search strategy has been first developed in MEDLINE using MeSH subject headings combined with free-text terms and Stata12.0 software was used for meta-analysis. RESULTS: This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION: Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER: The registration number is INPLASY202070107, the DOI number is 10.37766/inplasy2020.7.0107.

The effectiveness of different teaching methods on medical or nursing students: Protocol for a systematic review and network meta-analysis.

BACKGROUND: One of the major challenges in nursing and medical education is to foster the critical thinking ability and autonomous learning ability for students. But the effect of different teaching methods on these abilities of nursing or medical students has not been conclusive, and few studies have directly compared the differences in the effects of different teaching methods. As a result, it is necessary for students to evaluate the impact of different teaching methods on critical thinking ability and autonomous learning ability. METHODS: A systematic search will be performed using Chinese National Knowledge Infrastructure, Wanfang Data (Chinese database), VIP Information (Chinese database), Chinese Biomedical Literature, and English language databases, including PubMed and Embase, Web of Science, CINAHL Complete (EBSCO0, Cochrane library to identify relevant studies from inception to July 10, 2020. We will include random controlled trials that evaluated the different teaching methods. The Quality Assessment of Diagnostic Accuracy Studies 2 quality assessment tool will be used to assess the risk of bias in each study. Standard pairwise meta-analysis and network meta-analysis will be performed using STATA V.12.0, MetaDiSc 1.40, and R 3.4.1 software to compare the diagnostic efficacy of different hormonal biomarkers. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will summarize the direct and indirect evidence to determine the effectiveness of different teaching methods for medical or nursing students and attempt to find the most effective teaching method. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required, because this study is a meta-analysis based on published studies. INPLASY REGISTRATION NUMBER: INPLASY202070017.

Irisin level and neonatal birthweight: A systematic review and meta-analysis.

Irisin is an important crosstalk myokine between adipose and muscle tissue. Disorders in irisin secretion can lead to fetal growth abnormalities and even lead to metabolic syndromes in adult life. This study aimed to evaluate the association between irisin level in umbilical cord blood and maternal serum with neonatal birthweight. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline were followed. A comprehensive search of eight databases (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CBM, CNKI, WANFANG and VIP) was performed from inception to November 2019. Studies with original date reporting irisin levels in newborns of small for gestational age (SGA) and newborns of large for gestational age (LGA) were included. Additionally, studies reporting correlation coefficients of irisin with birthweight were analyzed. Newcastle-Ottawa score system and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were applied. Seventeen studies with 1866 participants were included. Pooled analysis indicated decreased cord irisin levels in SGA newborns (MD -10.57, 95 % CI -13.41 to -7.73) and increased irisin levels in LGA newborns (MD 3.80, 95 % CI 1.91-5.70). Umbilical cord irisin level was positively correlated with neonatal birthweight (r = 0.41 95 %CI 0.04 to 0.68). The pooled correlation coefficient of maternal serum irisin with birthweight has no statistical significance. This meta-analysis suggested that the umbilical cord irisin levels were impaired in fetal growth abnormalities. Umbilical cord blood irisin level was positively correlated with birthweight.

Intensive care unit acquired weakness: A protocol for an overview of systematic reviews and meta-analysis.

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. There are already systematic reviews on ICU-AW. Therefore, we provide a protocol for an overview of systematic reviews to improve the effectiveness of the construction of an evidence-based practice for prevention of ICU-AW. METHODS: We will search the PubMed, CINAHL, EMBASE, and the Cochrane Library for the relevant systematic review or meta-analyses about ICU-AW. Study selection, data extraction, and the quality assessment of the included studies will be performed independently by 2 reviewers. And the methodological quality, report quality and evidence quality will be evaluated by Assessment of Multiple Systematic Reviews-2 tool, Preferred Reporting Items for Systematic Reviews and Meta Analyses Statement checklist and Grading of Recommendations Assessment, Development and Evaluation system, respectively. RESULTS: This overview of systematic reviews and meta-analysis will collect the evidence published about the ICU-AW. CONCLUSION: We hope that our research will contribute to clinicians and public decision making about the ICU-AW. REGISTRATION NUMBER: INPLASY202070067.

An evidence map of clinical practice guideline recommendations and quality on diabetic retinopathy.

To present an evidence map for explicating research trends and gaps, we systematically review clinical practice guidelines (CPGs) on diabetic retinopathy (DR) and assess the quality of CPGs and consistency of recommendations. A literature search was performed in PubMed, Embase, Web of Science, CPG databases, and website of diabetes society to include the CPGs. The basic information, methodological quality, and reporting quality of CPGs, recommendations for DR were exacted by the Excel 2013. Methodological and reporting quality of DR CPGs were evaluated by AGREE II instrument and RIGHT checklist. The bubble plot format of evidence map was made by Excel 2013. Nineteen CPGs proved eligible, which included eight DR CPGs and 11 comprehensive diabetic CPGs. The identified CPGs were of mixed quality and they scored poorly in the rigor of development, applicability domains by AGREE II. Field two (background) had the highest reporting rate (86.31%) and field five (review and quality assurance) obtained the lowest reporting rate (31.58%) among the seven domains of RIGHT checklist. According to the recommendations of CPGs, there were three inconsistencies in the screening of DR, and CPGs recommendations for treatment were consistent on the whole. At the same time, recommendations for laser therapy were not accurate. Some recommendations were not specific and clear in some DR CPGs. This evidence map could collect and evaluate the characteristics of published CPGs, add to our knowledge and promote the development of trustworthy CPGs for DR.

Appraisal and recommendation synthesis of guidelines and consensuses for interventions of pressure ulcers: A protocol for systematic review.

BACKGROUND: Pressure ulcers (PU) bring a considerable physical and mental burden on patients and their families, and have put families and government under tremendous pressure to cover the cost for treatment. Therefore, this protocol proposes to evaluate the quality of existing PU clinical practice guidelines (CPGs) and compare the similarities and differences between its recommendations in order to improve the treatment efficacy and reduce the PU treatment cost. METHODS: Electronic databases and specific databases of CPGs will be searched. Study selection and data collection will be performed independently by two reviewers. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) will be used to assess the methodological quality and reporting quality of included CPGs. Bubble plot will be used to describe the difference of the quality, and mind mapping will be plotted to illustrate the comparison of recommendations of a guideline when needed. R software, MindMaster and Excel will be used. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This systematic review will provide comprehensive evidence of CPGs of PU. PROSPERO REGISTRATION NUMBER: CRD42020149176.

Updating systematic reviews can improve the precision of outcomes: a comparative study.

OBJECTIVES: The objective of this study was to investigate the main characteristics and the precision of outcomes between updated and original systematic reviews (SRs). STUDY DESIGN AND SETTING: We searched PubMed and Embase.com on 31 March 2019 and included 30 pairs of updated and original SRs. We calculated changes in outcomes and the precision of effect size estimates in updated SRs, compared with original SRs. Review Manager 5.3 software was adopted to create forest plots showing comparable outcomes. RESULTS: The average update time was 56.0 months, and incorporating new trials (23 SRs, 76.7%) was the main reason for the update. Compared with original SRs, 24 (80.0%) updated SRs included more randomized controlled trials and 22 (73.3%) updated SRs involved a larger number of patients. Of the 130 comparable outcomes, only three (2.3%) outcomes were observed with a significant change in three SR updates. No new data from randomized controlled trials were added to 36 (27.7%) outcomes during the update process. Of the 94 outcomes including new evidence, 83 (88.3%) showed an improvement in precision, 5 (5.3%) showed a decrease in precision, and 6 (6.4%) did not exhibit changes in precision. CONCLUSION: Updating SRs could increase the precision of most comparable outcomes, although the conclusions of almost all updated SRs were similar to original SRs.

Infectious Complications in Severe Acute Pancreatitis: Pathogens, Drug Resistance, and Status of Nosocomial Infection in a University-Affiliated Teaching Hospital.

BACKGROUND: Secondary infection is an important factor affecting mortality and quality of life in patients with severe acute pancreatitis. The characteristics of secondary infection, which are well known to clinicians, need to be re-examined in detail, and their understanding among clinicians needs to be updated accordingly. AIM: This study aims to investigate the characteristics and drug resistance of pathogens causing severe acute pancreatitis (SAP) secondary infection, to objectively present infection situation, and to provide reference for improved clinical management. METHODS: A retrospective analysis was performed on 55 consecutive patients with SAP who developed secondary infection with an accurate evidence of bacterial/fungal culture from 2016 to 2018. The statistics included the spectrum and distribution of pathogens, the drug resistance of main pathogens, and associations between multiple infectious parameters and mortality. RESULTS: A total of 181 strains of pathogens were isolated from (peri)pancreas; bloodstream; and respiratory, urinary, and biliary systems in 55 patients. The strains included 98 g-negative bacteria, 58 g-positive bacteria, and 25 fungi. Bloodstream infection (36.5%) was the most frequent infectious complication, followed by (peri)pancreatic infection (32.0%). Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Stenotrophomonas maltophilia were predominant among gram-negative bacteria. Gram-positive bacterial infections were mainly caused by Enterococcus faecium and Staphylococcus spp. Fungal infections were predominantly caused by Candida spp. The drug resistance of pathogens causing SAP secondary infection was generally higher than the surveillance level. Patients in the death group were older (55 ± 13 years vs. 46 ± 14 years; p = 0.039) and had longer intensive care unit (ICU) stay (14 vs. 8; p = 0.026) than those in the survival group. A. baumannii infection (68.4% vs. 33%; p = 0.013), number of pathogens ≥ 4 (10 vs. 6; p = 0.005), pancreatic infection (14 vs. 15, p = 0.024), and urinary infection (8 vs. 5; p = 0.019) were significantly associated with mortality. CONCLUSION: Gram-negative bacteria are the main pathogens causing SAP secondary infection, in which nosocomial infections play a major role. The drug resistance profile of gram-negative bacteria is seriously threatening, and the commonly used antibiotics in SAP are gradually losing their effectiveness. Much attention should be paid to the rational use of antibiotics, and strategies should be established for infection prevention in SAP.

Methodological and reporting quality in non-Cochrane systematic review updates could be improved: a comparative study.

OBJECTIVES: The aim of the study was to compare the methodological and reporting quality of updated systematic reviews (SRs) and original SRs. STUDY DESIGN AND SETTING: We included 30 pairs of non-Cochrane updated and original SRs, identified from a search of PubMed and Embase.com. We used Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) to assess methodological quality and Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) for reporting quality. Stratified analyses were conducted to compare the differences between updated SRs and original SRs and explore factors that might affect the degree of quality change. RESULTS: Of the 60 non-Cochrane SRs, only two (3.3%) were of low quality, the remaining 58 (96.7%) were of critical low quality. There were no statistically significant differences in methodological quality between the updated SRs and original SRs, although the compliance rates of eight items of updated SRs were higher than that of original SRs. Updated SRs showed an improvement on 15 PRISMA items, but no items with statistically significant differences. The differences in fully reported AMSTAR-2 and PRISMA items between original SRs and updated SRs were also not statistically significant after adjusting for multiple review characteristics. CONCLUSION: The methodological and reporting quality of updated SRs were not improved compared with original SRs, although the quality could be further improved for both updated SRs and original SRs.