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| 1 | Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis显示文摘AIM:To conduct a meta-analysis to compare Rouxen-Y(R-Y) gastrojejunostomy with gastroduodenal Billroth Ⅰ(B-Ⅰ) anastomosis after distal gastrectomy(DG) for gastric cancer.METHODS:A literature search was performed to identify studies comparing R-Y with B-Ⅰ after DG for gastric cancer from January 1990 to November 2012 in Medline,Embase,Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library.Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed or random effects model.Operative outcomes such as operation time,intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture,bile reflux,remnant gastritis,reflux esophagitis,dumping symptoms,delayed gastric emptying and hospital stay were the main outcomes assessed.Meta-analyses were performed using RevMan 5.0 software(Cochrane library).RESULTS:Four randomized controlled trials(RCTs) and 9 non-randomized observational clinical studies(OCS) involving 478 and 1402 patients respectively were included.Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux(OR 0.04,95%CI:0.01,0.14;P < 0.00 001) and remnant gastritis(OR 0.43,95%CI:0.28,0.66;P = 0.0001),however needing a longer operation time(WMD 40.02,95%CI:13.93,66.11;P = 0.003).Metaanalysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux(OR 0.21,95%CI:0.08,0.54;P = 0.001),remnant gastritis(OR 0.18,95%CI:0.11,0.29;P < 0.00 001) and reflux esophagitis(OR 0.48,95%CI:0.26,0.89;P = 0.02).However,this reconstruction method was found to be associated with a longer operation time(WMD 31.30,95%CI:12.99,49.60;P = 0.0008).CONCLUSION:This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-Ⅰ reconstruction post DG.However there is a need for further adequately powered,welldesigned RCTs comparing the same. | Jun-Jie Xiong Kiran Altaf Muhammad A Javed Quentin M Nunes Wei Huang Gang Mai Chun-Lu Tan Rajarshi Mukherjee Robert Sutton Wei-Ming Hu Xu-Bao Liu | 2013 | World Journal of Gastroenterology2013，19，7： | 33 |
| 2 | Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma显示文摘AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings. | Jun-Jie Xiong Kiran Altaf Muhammad A Javed Wei Huang Rajarshi Mukherjee Gang Mai Robert Sutton Xu-Bao Liu Wei-Ming Hu | 2012 | World Journal of Gastroenterology2012，18，45： | 25 |
| 3 | Validation of the moderate severity category of acute pancreatitis defined by determinant-based classification显示文摘BACKGROUND: Recent international multidisciplinary consultation proposed the use of local(sterile or infected pancreatic necrosis) and/or systemic determinants(organ failure) in the stratification of acute pancreatitis. The present study was to validate the moderate severity category by international multidisciplinary consultation definitions.METHODS: Ninety-two consecutive patients with severe acute pancreatitis(according to the 1992 Atlanta classification) were classified into(i) moderate acute pancreatitis group with the presence of sterile(peri-) pancreatic necrosis and/or transient organ failure; and(ii) severe/critical acute pancreatitis group with the presence of sterile or infected pancreatic necrosis and/or persistent organ failure. Demographic and clinical outcomes were compared between the two groups.RESULTS: Compared with the severe/critical group(n=59), the moderate group(n=33) had lower clinical and computerized tomographic scores(both P<0.05). They also had a lower incidence of pancreatic necrosis(45.5% vs 71.2%, P=0.015),infection(9.1% vs 37.3%, P=0.004), ICU admission(0% vs27.1%, P=0.001), and shorter hospital stay(15±5 vs 27±12days; P<0.001). A subgroup analysis showed that the moderate group also had significantly lower ICU admission rates, shorter hospital stay and lower rate of infection compared with the severe group(n=51). No patients died in the moderate group but7 patients died in the severe/critical group(4 for severe group).CONCLUSIONS: Our data suggest that the definition of moderate acute pancreatitis, as suggested by the international multidisciplinary consultation as sterile(peri-) pancreatic necrosis and/or transient organ failure, is an accurate category of acute pancreatitis. | Tao Jin Wei Huang Xiao-Nan Yang Ping Xue Muhammad A Javed Kiran Altaf Robert Sutton Qing Xia | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，3： | 13 |
| 4 | Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis显示文摘AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission. METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated. RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAPvs Acute Physiology and Chronic Health Evaluation Ⅱ within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27vs 4.61, respectively. CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis. | Wei Huang Kiran Altaf Tao Jin Jun-Jie Xiong Li Wen Muhammad A Javed Marianne Johnstone Ping Xue Christopher M Halloran Qing Xia | 2013 | World Journal of Gastroenterology2013，19，28： | 7 |
| 5 | A systematic review and meta‐analysis of studies comparing laparoscopic and open distal pancreatectomy显示文摘 | Tao Jin Kiran Altaf Jun J. Xiong Wei Huang Muhammad A. Javed Gang Mai Xu B. Liu Wei M. Hu Qing Xia | 2012 | HPB2012，，11： | 2 |
| 6 | A systematic review and meta‐analysis of studies comparing laparoscopic and open distal pancreatectomy显示文摘 | Tao Jin Kiran Altaf Jun J. Xiong Wei Huang Muhammad A. Javed Gang Mai Xu B. Liu Wei M. Hu Qing Xia | 2012 | HPB2012，，11： | 1 |
| 7 | A systematic review and meta‐analysis of studies comparing laparoscopic and open distal pancreatectomy显示文摘 | Tao Jin Kiran Altaf Jun J. Xiong Wei Huang Muhammad A. Javed Gang Mai Xu B. Liu Wei M. Hu Qing Xia | 2012 | HPB2012，，11： | 1 |
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