Luming Shi

Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer

A defunctioning stoma is frequently created to minimize the impact of any subsequent anastomotic leak after a low rectal anastomosis. This review evaluates the need for routine stoma formation.

Cost‐effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria

Both liver resection (LR) and cadaveric liver transplantation (CLT) are potentially curative treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria and with adequate liver function. Adopting either as a first‐line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost‐effectiveness of LR against CLT for patients with HCC within the Milan criteria using a decision analytic model. A Markov cohort model was developed to simulate a cohort of patients aged 55 years with HCC within the Milan criteria and Child‐Pugh A/B cirrhosis, undergoing LR or CLT, and followed up over their remaining life expectancy. Analysis was performed in different geographical cost settings: the USA, Switzerland and Singapore. Transition probabilities were obtained from systematic literature reviews, supplemented by databases from Singapore and the Organ Procurement and Transplantation Network (USA). Utility and cost data were obtained from open sources. LR produced 3.9 quality‐adjusted life years (QALYs) while CLT had an additional 1.4 QALYs. The incremental cost‐effectiveness ratio (ICER) of CLT versus LR ranged from

Prospective evaluation of the Ages and Stages Questionnaire 3rd Edition in very‐low‐birthweight infants

111,821/QALY in Singapore to

Factors affecting neurodevelopmental outcome at 2 years in very preterm infants below 1250 grams: a prospective study

156,300/QALY in Switzerland, and was above thresholds for cost‐effectiveness in all three countries. Sensitivity analysis revealed that CLT‐related 5‐year cumulative survival, one‐time cost of CLT, and post‐LR 5‐year cumulative recurrence rates were the most sensitive parameters in all cost scenarios. ICERs were reduced below threshold when CLT‐related 5‐year cumulative survival exceeded 84.9% and 87.6% in Singapore and the USA, respectively. For Switzerland, the ICER remained above the cost‐effectiveness threshold regardless of the variations. Conclusion: In patients with HCC within the Milan criteria and Child‐Pugh A/B cirrhosis, LR is more cost‐effective than CLT across three different costing scenarios: the USA, Switzerland, Singapore. (Hepatology 2015;61:227–237)

Effects of Aortic Valve Replacement on Severe Aortic Stenosis and Preserved Systolic Function: Systematic Review and Network Meta-analysis

To evaluate the predictive and concurrent diagnostic agreement of the Ages and Stages Questionnaire 3rd Edition (ASQ‐3) with the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley‐III) in infants born preterm and very‐low‐birthweight (PT/VLBW; ≤1250g).

Nutritional intake and growth velocity in preterm extremely low-birthweight infants in Asia: Are we doing enough?

ObjectiveTo evaluate the neurodevelopmental outcomes of preterm very-low birth weight (PT/VLBW) infants at 2 years and identify risk factors associated with significant developmental delay or neurodevelopmental impairment (NDI).Study designWe evaluated 165 PT/VLBW infants born between January 2010 and December 2011, using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III). NDI was defined as the presence of neurosensory impairment or significant delay with Bayley-III score < 70 in any domain and risk factors for delay/NDI were assessed using logistic regressions.ResultsMedian Bayley-III composite scores in the cognitive, language and motor domains were 95, 89 and 94, respectively. NDI was present in 20% of the children, with 5–18% having significant delay in either cognitive, language or motor domain, seven (4%) children had cerebral palsy, three (2%) were deaf and none were blind. Regression models identified significant positive associations of delayed cognitive skills with male gender (Odds ratio (OR) 22.4, 95% confidence interval (CI) 1.5–341.1; P = 0.025), lack of anntenatal steroids (ANS) (OR 41.5, 95% CI 3.5–485.7; P = 0.003), and hypotension needing inotropes (OR 36.0, 95% CI 2.6–506.0; P = 0.008); delayed language skills with lower maternal education (OR 3.8, 95% CI 1.4–10.3; P = 0.10), lack of ANS (OR 2.8, 95% CI 1.1–7.4; P = 0.04), and 5 minute Apgar Score ≤ 5 (OR 7.4, 95% CI 1.4–38.4; P = 0.017) and delayed motor skills with chronic lung disease at 36 weeks (OR 38.3, 95% CI 2.4–603.4; P = 0.010). NDI was associated with lack of ANS (OR 2.91, 95% CI 1.21–7.00; P = 0.02) and use of postnatal steroids (OR 3.36, 95% CI 1.07–10.54; P = 0.0374).ConclusionRisk factors for both NDI and individual domain delay were identified and will be helpful in planning of specific and targeted early intervention services.

Non-steroidal anti-inflammatory drugs (NSAIDS) for trigger finger

The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm2) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m2; normal-flow (NL) and low-flow (LF)]. Network meta-analysis was conducted to assess all-cause mortality among each AS sub-type with rate ratio (RR) reported. The effects of AVR on prognosis were examined using network meta-regression. In the pooled analysis (15 studies and 9,737 patients), LF states (both HG and LG) were associated with increased mortality rate (LFLG: RR 1.88; 95% CI: 1.43-2.46; LFHG: RR: 1.77; 95% CI: 1.16-2.70) compared to moderate AS; and NF states in both HG and LG had similar prognosis as moderate AS (NFLG: RR 1.11; 95% CI: 0.81-1.53; NFHG: RR 1.16; 95% CI: 0.82-1.64). AVR conferred different survival benefits: it was most effective in NFHG (RRwith AVR/RRwithout AVR: 0.43; 95% CI: 0.22-0.82) and least in LFLG (RRwith AVR/RRwithout AVR: 1.19; 95% CI: 0.74-1.94).

Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis

To describe nutritional practices among preterm extremely low‐birthweight (ELBW) infants and their impact on growth and to compare differences in nutritional intervention and comorbidities between those with limited growth velocity (GV < 25th percentile) and those with GV > 25th percentile.

Expressing diagnostic test performance, whose perspective — God's or Man's?

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To review the benefits and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger. We will compare the effectiveness of topical, oral and injectable NSAIDs with placebo or corticosteroid.