Comparative efficacy of early TIPS, Non-early TIPS, and Standard treatment in patients with cirrhosis and acute variceal bleeding: a network meta-analysis.

BACKGROUND: Cirrhosis is a chronic disease characterized by chronic liver inflammation and diffuse fibrosis. A combination of vasoactive drugs, preventive antibiotics, and endoscopy is the recommended standard treatment for patients with acute variceal bleeding; however, this has been challenged. We compared the effects of early transjugular intrahepatic portosystemic shunt (TIPS), non-early TIPS, and standard treatment in patients with cirrhosis and acute variceal bleeding. MATERIALS AND METHODS: The present network meta-analysis was conducted in accordance with the criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the methodological quality of systematic reviews guidelines. The review has been registered with the International Prospective Register of Systematic Reviews. The PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and World Health Organization-approved trial registry databases were searched for randomized controlled trials (RCTs) evaluating early TIPS, non-early TIPS, and standard treatment in patients with cirrhosis and acute variceal bleeding. RESULTS: Twenty-four RCTs (1894 patients) were included in the review. Compared with standard treatment, early TIPS [odds ratio (OR), 0.53; 95% credible interval (Cr), 0.30-0.94; surface under the cumulative ranking curve (SUCRA), 98.3] had a lower risk of all-cause mortality (moderate-to-high-quality evidence), and early TIPS (OR, 0.19; 95% CrI, 0.11-0.28; SUCRA, 98.2) and non-early TIPS (OR, 0.30; 95% CrI, 0.23-0.42; SUCRA, 1.8) were associated with a lower risk of rebleeding (moderate-to-high-quality evidence). Early TIPS was not associated with a reduced risk of hepatic encephalopathy, and non-early TIPS (OR, 2.78; 95% CrI, 1.89-4.23, SUCRA, 0) was associated with an increased incidence of hepatic encephalopathy (moderate-to-high-quality evidence). There was no difference in the incidence of new or worsening ascites (moderate-to-high-quality evidence) among the three interventions. CONCLUSION: Based on the moderate-to-high quality evidence presented in this study, early TIPS placement was associated with reduced all-cause mortality [with a median follow-up of 1.9 years (25th-75th percentile range 1.9-2.3 years)] and rebleeding compared to standard treatment and non-early TIPS. Although early TIPS and standard treatment had a comparable incidence of hepatic encephalopathy, early TIPS showed superiority over non-early TIPS in this aspect. Recent studies have also shown promising results in controlling TIPS-related hepatic encephalopathy. However, it is important to consider individual patient characteristics and weigh the potential benefits against the risks associated with early TIPS. Therefore, we recommend that clinicians carefully evaluate the patient's condition, considering factors such as severity of variceal bleeding, underlying liver disease, and overall clinical status, before making a treatment decision. Further well-designed RCTs comparing early TIPS with non-early TIPS are needed to validate these findings and provide more definitive guidance.

Exploration of treatment methods for patients with post-stroke dysphagia: a network meta-analysis.

To compare the effects of various therapies in patients with post-stroke dysphagia. DATA SOURCES: We searched databases between January 1980 and 2022. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) on therapy for dysphagia after stroke. STUDY APPRAISAL AND SYNTHESIS METHODS: The outcomes were improvement in dysphagia, case fatality, and chest infection or pneumonia, reported as OR (odd ratio), 95% CrI (confidence interval), and SUCRA (the surface under the cumulative ranking curve analysis) score. Forty-two randomized controlled trials (2,993 patients, seven therapies, and one control) were included. In the improvement of dysphagia analysis, the following therapies were superior to the control: Acupuncture, behavioral interventions, drug therapy, neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES). In the case fatality analysis, OR and 95% CrI indicated none of the therapies were superior to the control. In the chest infection or pneumonia analysis, OR values showed that no therapy was superior to the control. Our Network Meta-analysis suggests that commonly used therapies for dysphagia after stroke have equal efficacies.

Comparison of the effect of skin closure materials on skin closure during cesarean delivery.

OBJECTIVE: To compare the effect of skin closure materials on skin closure during cesarean delivery. METHODS: We searched EMBASE、PubMed、Scopus、Cochrane CENTRAL for randomized controlled trials (RCTs) on the use of closure materials for skin closing effect during cesarean delivery. The outcomes were time to skin closure of dermal and epidermal layer, skin separation rate and wound complications(wound infection, hematoma,seroma, reclosure, readmission) reported as an odds ratio (OR) and surface under the cumulative ranking curve analysis (SUCRA) score. RESULTS: Twenty -six RCTs met the inclusion criteria. In the network meta-analysis (NMA) for time to skin closure of dermal and epidermal layer, pooled network OR values indicated that staple (network SMD, -337.50; 95% CrI: -416.99 to -263.18) was superior to absorbable suture. In the Skin separation NMA, pooled network OR values indicated that the absorbable suture (network OR, 0.37; 95% CrI: 0.19 to 0.70) were superior to staple. In the wound complications NMA, pooled network OR values indicated that the no interventions were superior to staple. CONCLUSION: In conclusion, our network meta-analysis showed that the risk of skin separation with absorbable suture after cesarean delivery was reduced compared with staple, and does not increase the risk of wound complications, but the wound closure time would slightly prolonged.

Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis.

OBJECTIVE: This study aimed to compare the efficacy of different antibiotic classes and dosages in preventing maternal infection after cesarean delivery. METHODS: Databases were searched for randomized controlled trials (RCTs) published between January 1980 and January 2021 on antibiotic use for the prevention of maternal infection after cesarean delivery. The outcomes were endometritis, febrile morbidity, and wound infection, reported as odds ratios (OR) and surface under the cumulative ranking curve analysis scores. RESULTS: A total of 31 RCTs met the inclusion criteria. In the network meta-analysis (NMA) for endometritis, pooled network OR values indicated that the following interventions were superior to placebo: cephalosporins (OR: 0.18, 95% credibility interval [CrI]: 0.07-0.45), penicillins (OR: 0.19, 95% CrI: 0.07-0.50), penicillins (multiple doses) (OR: 0.20, 95% CrI: 0.05-0.65), combination therapies (OR: 0.22, 95% CrI: 0.09-0.54), and cephalosporins (multiple doses) (OR: 0.25, 95% CrI: 0.08-0.74). In the NMA for febrile morbidity, placebo was more effective than the other interventions. In the NMA for wound infection, pooled network OR values indicated that the following interventions were superior to placebo: penicillin (OR: 0.14, 95% CrI: 0.05-0.37), cephalosporins (OR: 0.19, 95% CrI: 0.08-0.41), cephalosporins (multiple doses) (OR: 0.20, 95% CrI: 0.06-0.58), combination therapies (OR: 0.29, 95% CrI: 0.13-0.57), macrolides (OR: 0.33, 95% CrI: 0.15-0.74), and penicillins (multiple doses) (OR: 0.40, 95% CrI: 0.17-0.91). CONCLUSIONS: Compared with placebo, a single dose of commonly used antibiotics may prevent maternal infection after cesarean delivery. However, the incidence of febrile morbidity was not reduced.

Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report.

BACKGROUND: Aortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed. CASE SUMMARY: A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health. CONCLUSION: New retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.

Comparative efficacy of therapeutics for traumatic musculoskeletal pain in the emergency setting: A network meta-analysis.

OBJECTIVE: Musculoskeletal pain control is essential in the management of trauma patients in the emergency department (ED). Here, we performed a network meta-analysis of the use of analgesics to manage traumatic musculoskeletal pain. METHOD: This network meta-analysis (NMA) protocol was registered in PROSPERO (CRD42020150145). Electronic databases were searched for randomized controlled trials comparing systemic pharmaceutical interventions for treating traumatic musculoskeletal pain in the ED setting. The outcomes were global efficacy and changes in pain intensity. RESULTS: Eighteen studies (2656 patients, four medication classes) met the inclusion criteria. The top-ranking medication class for global efficacy was nonsteroidal anti-inflammatory drugs (NSAIDs; network odds ratio: 0.52, 95% credible interval: 0.34-0.81, surface under the cumulative ranking curve score: 86). No interventions were more effective at decreasing pain intensity than opioids at 60 min. CONCLUSION: NSAIDs were the most effective medications for treating traumatic musculoskeletal pain, and combination therapies may not have advantages in the ED setting.

Metal-organic frameworks as cathode materials for Li-O2 batteries.

Metal-organic frameworks (MOFs) with open metal sites enrich the population of O2 in the pores significantly and assist the Li-O2 reaction when employed as a cell electrode material. A primary capacity of 9420 mA h g(-1) is achieved in a cell with Mn-MOF-74; more than four times higher than the value obtained in a cell without an MOF.

Reversible and selective solvent adsorption in layered metal-organic frameworks by coordination control.

With various functionalities in the framework and high thermal stability, metal-organic frameworks (MOFs) have been extensively studied for the applications in adsorption and separation. In last decade, synthesizing new MOFs with desired structures and improved chemical stability to meet these applications has drawn great attention. In this report, by using an organic ligand with azolate moiety, benzo-bis(imidazole) (H2BBI), we synthesized two new 2D layered MOF structures with distinct topologies. Framework 1 {[Zn2Cl2(BBI)(MSM)2]n, MSM=methylsulfonylmethane}, constructed from tetrahedral Zn(II) and BBI, maintains its structure in organic solvents, such as methanol and benzene, and even in water. Meanwhile, framework 2 {[Cd2Cl2(BBI)(DMSO)2]n, DMSO=dimethyl sulfoxide} differs from framework 1, and is assembled from trigonal bipyramidal Cd(II) and square planar BBI. By removing the DMSO molecules coordinated to Cd(II) (25 weight% of the structure), 2 could transform to 3 {[Cd2Cl2(BBI)]n}, which was further characterized by high-resolution powder X-ray diffraction. The solvent-free 3 retains the original connectivity within each layer, and is capable of reversible and selective adsorption of DMSO molecules. The bistable four- and five-coordinated geometry exchange of Cd(II) is the origin of this adsorption with improved selectivity and capacity.