Yiyang Zhao

The Effect of n-3 Polyunsaturated Fatty Acids on Plasma Lipids and Lipoproteins in Patients With Chronic Renal Failure—A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE To systemically review and analyze the effect of n-3 polyunsaturated fatty acid (PUFA) consumption on plasma lipids and lipoproteins in patients with end-stage renal disease. DESIGN Systemic review, with meta-analysis of randomized controlled clinical trials. METHODS We performed a systemic review and meta-analysis of the lipid-modulating effects of n-3 PUFAs by combining evidences from 10 randomized controlled trials including 557 patients with end-stage renal disease. RESULTS Pooled analysis revealed that n-3 PUFA intake significantly reduced serum triglyceride levels by -0.78 mmol/L (95% confidence interval: -1.12 to -0.44 mmol/L, P < .0001). Consumption of n-3 PUFAs also reduced the plasma low-density lipoprotein cholesterol levels by -0.09 mmol/L and elevated plasma high-density lipoprotein cholesterol levels by -0.25 mmol/L, but these changes were not statistically significant. Plasma levels of total cholesterols were elevated in both n-3 PUFA and control groups, with a lesser increase in the n-3 PUFA group, without statistical significance. Metaregression showed no correlation between the amounts or duration of n-3 PUFA intake and their lipid-modulating effects. CONCLUSIONS In our meta-analysis, n-3 PUFA consumption significantly lowered the serum triglyceride levels. No significant changes were found on the degrees of low-density lipoprotein cholesterol reduction and total cholesterol or high-density lipoprotein cholesterol elevation effects.

Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates.

Objective: The aim of the study was to evaluate the safety and efficacy of fish oil–containing (FO) lipid emulsions that are rich in &ohgr;-3 fatty acids for parenteral nutrition in preterm neonates by using data retrieved from randomized controlled trials. Methods: We performed a meta-analysis of 8 randomized controlled trials representing 483 premature neonates to compare FO with control (CO) lipid emulsions. Results: This meta-analysis revealed that the levels of &ohgr;-3 fatty acids in the form of docosahexaenoic acid, eicosapentaenoic acid, and arachidonic acid (% of total fatty acids) in plasma were statistically higher in FO groups (mean difference [MD] −0.7%, 95% confidence interval [CI] −1.05 to −0.36, P < 0.001; MD −1.31%, 95% CI −1.40 to −1.21, P < 0.001). The differences were found in red blood cell (RBC) membranes. The levels of arachidonic acid (% of total fatty acids) as &ohgr;-6 fatty acid in plasma and red blood cell membranes were significantly lower in FO groups (MD 1.27%, 95% CI 1.12–1.42, P < 0.001) (MD 0.92%, 95% CI 0.12–1.72, P = 0.02). The mean body weight, serum level of bilirubin, triglycerides or C-reactive protein, all-cause mortality, and rate of lipid emulsion–associated complications were, however, not different between FO and CO groups. Conclusions: The level of docosahexaenoic acid is efficiently improved by FO lipid emulsions. The changes observed in eicosapentaenoic acid and arachidonic acid, and the associated safety issue, however, remain to be clarified. Any clinical benefit or detrimental effect of using FO in premature neonates cannot be demonstrated by the present study.

Enhanced recovery after surgery program reduces length of hospital stay and complications in liver resection: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials.

Background: Many enhanced recovery after surgery (ERAS) guidelines have already been established in several kinds of surgeries. But due to concerns of the specific complications, it has not yet been considered the standard of care in liver surgery. Objective: The aim of this review is to assess the effect of ERAS in patients undergoing liver surgery. Methods: EMBASE, CNKI, PubMed, and the Cochrane Database were searched for randomized controlled trials (RCTs) comparing ERAS with conventional care in patients undergoing liver surgery. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. Results: Seven RCTs were included, representing 996 patients. Length of stay (LOS) (MD −3.17, 95% CI: −3.99 to −2.35, P < .00001, I2 = 89%) and time to first flatus (MD −0.9, 95% CI: −1.36 to −0.45, P = .0001, I2 = 98%) were both reduced in the ERAS group. There were also fewer complications in the ERAS group (OR 0.52, 95% CI: 0.37–0.72, P < .0001, I2 = 0%). Conclusion: The ERAS program can obviously enhance short-term recovery after liver resection. It is safe and worthwhile. A specific ERAS guideline for liver resection is recommended.

Hyperglycemia and its association with clinical outcomes for patients in the pediatric intensive care unit after abdominal surgery.

PURPOSE We investigated the incidence of hyperglycemia of patients in the pediatric intensive care unit (PICU) after receiving abdominal surgery and its association with clinical outcomes. METHODS A retrospective review was performed from November 1, 2010 to November 1, 2011 on all PICU admissions after abdominal surgery. Maximum serum glucose concentrations (Gmax) in PICU, PICU length of stay, total hospital length of stay, deep and systemic infection, wound infection and mortality rates were recorded and analyzed. RESULTS A total of 193 children met the inclusion criteria of our research. Maximum glucose levels ranged from 55.7 mg/dL to 415.9 mg/dL (median: 132 mg/dL). Hyperglycemia in PICU was prevalent, with 125 (64.8%) patients having Gmax >110 mg/dL during their PICU stay and 35 (18.8%) having Gmax >200 mg/dL. Average PICU length of stay and total hospital length of stay grew as the maximum glucose levels rose among the four plasma glycemic ranges. The highest serum glucose range patient group also had the highest wound infection rates (14.3% and 11.4%). CONCLUSIONS Hyperglycemia was prevalent among patients after major abdominal surgery in PICU and was correlated with increased PICU length of stay, total hospital length of stay. Appropriate glycemic control may improve clinical outcomes for this group of patients.

A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients

OBJECTIVES Data of randomly controlled trials comparing the hydrostatic and pneumatic reduction for intussusception in pediatric patients as initial therapy are lacking. The aim of this study was to conduct a randomly controlled trial to compare the effectiveness and safety of the hydrostatic and pneumatic reduction techniques. STUDY DESIGN All intussusception patients who visited West China Hospital of Sichuan University from January 2014 to December 2015 were enrolled in this study in which they underwent pneumatic reduction or hydrostatic reduction. Patients were randomized into ultrasound-guided hydrostatic or X-ray-guided pneumatic reduction group. The data collected includes demographic data, symptoms, signs, and investigations. The primary outcome of the study was the success rate of reduction. And the secondary outcomes of the study were the rates of intestinal perforations and recurrence. RESULTS A total of 124 children with intussusception who had met the inclusion criteria were enrolled. The overall success rate of this study was 90.32%. Univariable analysis showed that the success rate of hydrostatic reduction with normal saline (96.77%) was significantly higher than that of pneumatic reduction with air (83.87%) (p=0.015). Perforation after reduction was found in only one of the pneumatic reduction group. The recurrence rate of intussusception in the hydrostatic reduction group was 4.84% compared with 3.23% of pneumatic reduction group. CONCLUSION Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for pediatric patients suffering from intussusceptions, and should be firstly adopted in the treatment of qualified patients. LEVEL OF EVIDENCE Therapeutic study TYPE OF STUDY: Prospective study.

Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized controlled trials

BackgroundThere still are controversies in the impact of tight glycemic control (TGC) in critically ill children. The aim of this study was to assess the benefits and risks of TGC compared with conventional glycemic control (CGC) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) by using data retrieved from randomized controlled trials (RCTs).MethodEMBASE, CNKI, PubMed, and the Cochrane Database were searched for RCTs comparing TGC with CGC in critically ill children in PICU.ResultThe meta-analysis included five RCTs representing 3933 patients and compared TGC with CGC. Our result revealed that TGC did not reduce the 30-day mortality rates (OR 0.99, 95% CI 0.74–1.32, P = 0.95) and was not associated with decreasing health care-associated infections (OR 0.80, 95% CI 0.64–1.00, P = 0.05) compared with CGC, but significantly increased the incidence of hypoglycemia (OR 6.37, 95% CI 4.41–9.21, P < 0.001).ConclusionTight glycemic control was not associated with reducing the 30-day mortality rates and acquired infections compared with CGC in critically ill children. Significant increase of the incidence of hypoglycemia was revealed in TGC group. The conclusion should be interpreted with caution for the methodological heterogeneity among trials.

Risk factors for recurrence of intussusception in pediatric patients: A retrospective study

OBJECTIVES The aim of this study was to explore the risk factors associated with recurrence of intussusception after operative or nonoperative reduction in children. METHODS Between January 2004 and December 2012, patients with intussusception treated with nonoperative and operative reduction were retrospectively analyzed. We included the patients who were diagnosed with intussusception from the age of 0 year to 18 years who received nonoperative and operative reduction as an initial treatment. The data collected included demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), investigations (ultrasound findings) and the method of reduction. RESULTS The risk factors for recurrence of idiopathic intussusception were analyzed by the univariable analysis and multivariable analysis. In the univariable model, the significant risk factors for recurrence of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, poor prognosis signs on ultrasound scans, location of mass, and pathological lead point. After multivariable analysis was done, we found that the significant risk factors for recurrence of intussusception were age ≥ 2 years (OR = 5.597, P = 0.044), duration of symptoms ≥48 h (OR = 91.664, P < 0.001), rectal bleeding (OR = 4.758, P = 0.009), location of mass (left over right side) (OR = 0.038, P < 0.001), pathological lead point (OR = 0.002, P < 0.001). CONCLUSION Our study found that age ≥ 2 years, duration of symptoms≥48 h, rectal bleeding, location of mass (left over right side) and pathological lead point were risk factors for recurrence of intussusception. LEVEL OF EVIDENCE Prognosis study. TYPE OF STUDY Retrospective study.

Hyperglycemia and its association with clinical outcomes in postsurgical neonates and small infants in the intensive care unit.

PURPOSE The aim of the research was to investigate the association between postsurgical hyperglycemia of neonates and small infants (<6months) during their stays in intensive care unit and clinical outcomes. METHODS A retrospective study of 180 patients including neonates and small infants (<6months) admitted to pediatric intensive care unit (PICU) after major abdominal and thoracic surgeries from July 2012 to December 2014 was performed. Clinical data including serum glucose levels, surgical procedures, PICU length of stays, total length of hospital stays, systemic infections and wound infections were recorded and analyzed. Surgical diagnosis and Pediatric Risk of Mortality III (PRISM III) score were analyzed as confounding factors. RESULTS Maximum glucose values (Gmax) ranged from 4.8 to 32.9mmol/L (median level: 8.4mmol/L). Hyperglycemia was prevalent among this group of patients. 93.3% of them experienced hyperglycemia (>6.1mmol/L) and 20% had severe hyperglycemia (>11.0mmol/L). Both PICU length of stays and total hospital length of stays increased as Gmax increased (P<0.001). This trend was still statistically significant when either surgical diagnosis or PRISM score had been controlled as confounding factors. Death rates and infectious rates were not significantly different among four groups of patients with different Gmax. CONCLUSIONS Hyperglycemia was prevalent in postsurgical neonates and small infants in PICU and was associated with increased PICU and hospital stays.