| 7 | Increased risk of second malignancy in pancreatic intraductal papillary mucinous tumors: Review of the literature显示文摘AIM: To analyze the available evidence about the risk of extrapancreatic malignancies and pancreatic ductal adenocarcinoma associated to pancreatic intraductal papillary mucinous tumors(IPMNs).METHODS: A systematic search of literature was undertaken using MEDLINE, EMBASE, Cochrane and Web-of-Science libraries. No limitations for year of publication were considered; preference was given to English papers. All references in selected articles were further screened for additional publications. Both clinical series and Literature reviews were selected. For all eligible studies, a standard data extraction form was filled in and the following data were extracted: study design, number of patients, prevalence of pancreatic cancer and extrapancreatic malignancies in IPMN patients and control groups, if available.RESULTS: A total of 805 abstracts were selected and read; 25 articles were considered pertinent and 17 were chosen for the present systematic review. Eleven monocentric series, 1 multicentric series, 1 casecontrol study, 1 population-based study and 3 case report were included. A total of 2881 patients were globally analyzed as study group, and the incidence of pancreatic cancer and/or extrapancreatic malignancies ranged from 5% to 52%, with a mean of 28.71%.When a control group was analyzed(6 papers), the same incidence was as low as 9.4%.CONCLUSION: The available Literature is unanimous in claiming IPMNs to be strongly associated with pancreatic and extrapancreatic malignancies. The consequences in IPMNs management are herein discussed. | Gian Luca Baiocchi Sarah Molfino Barbara Frittoli Graziella Pigozzi Federico Gheza Giacomo Gaverini Antonio Tarasconi Chiara Ricci Francesco Bertagna Luigi Grazioli Guido AM Tiberio Nazario Portolani | 2015 | World Journal of Gastroenterology2015，21，23： | 1 |
| 16 | Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis显示文摘BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs. | Marion JLF Heymans Nanne P Kort Barbara AM Snoeker Martijn GM Schotanus | 2022 | World Journal of Orthopedics2022，13，3： | 0 |
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