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Objective: Cardiovascular disease (CVD) and cerebrovascular disease are the leading cause of death around the world all the time. A novel marker described as the stress hyperglycemia ratio (SHR) can reflect the acute hyperglycemic status and is associated with poor outcomes in patients with acute illness, such as stroke and myocardial infarction (MI). Our previous study has shown that SHR was strongly related to the clinical outcomes of stroke patients. Nevertheless, the association between SHR and clinical outcomes in patients with CVD is still unclear and controversial. Consequently, in the current study, we analyzed the association of SHR and clinical outcomes in CVD patients by systematic review and meta-analysis., Materials and Methods: We searched the electronic databases to identify SHR studies of patients who met the eligibility criteria for CVD. We performed our study complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We utilized a ten terms tool to assess the potential bias of included studies. Major adverse cardiovascular and cerebrovascular events (MACCEs), all-cause death, left ventricular ejection fraction (LVEF), and other exciting outcome data were extracted for statistical analysis. Moreover, we used the DerSimonian and Laird random-effects model to perform the meta-analysis and conducted subgroup analyses to identify factors associated with substantial heterogeneity., Results: The study cohort included nine studies comprising 32,292 patients with CVD. Our meta-analysis found that MACCEs in the high SHR group were 1.68 folds compared with that in the low SHR group [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.41-2.00, p < 0.00001]. Besides, all-cause death in the high SHR group was 1.52 folds compared with that in the low SHR group (OR 1.52, 95% CI 1.15-2.01, p < 0.00001). Higher SHR meant the lower LVEF (mean difference [MD] -2.03, 95% CI [-3.28-0.79], p = 0.001). The risk of cardiogenic shock and stroke were 2.47 and 1.53 folds in the high SHR group, respectively, compared with the low SHR group. Yet, no statistically significant difference was observed for revascularization (OR 0.88, 95% CI 0.77-1.01, p = 0.08), recurrent MI (OR 1.27, 95% CI 0.69-2.33, p = 0.44), and left ventricular end-diastolic diameter (LVEDD) (MD 0.61, 95% CI [-1.65, 2.87], p = 0.60) between the two groups. Subgroup analyses identified that different study design was associated with heterogeneity about MACCEs and LVEF. Besides, studies from different countries were associated with heterogeneity about all-cause death., Conclusions: Higher SHR significantly increases the occurrence of MACCEs and all-cause death and decreases LVEF. Moreover, Higher SHR means a higher risk of cardiogenic shock and stroke. Nevertheless, SHR had no relationship with revascularization, recurrent MI, and LVEDD. As a novel and non-invasive marker, SHR should be paid more attention to in clinical practice. Future investigation should focus on the diagnostic value of SHR in CVD and the early control of stress hyperglycemia. Although no randomized, double-blind studies have been conducted, the available massive sample studies reflect the actual situation in the clinic and assist clinical decision-making.

Objective: Intracoronary injection of pro-urokinase (Pro-UK) during percutaneous coronary intervention (PCI) seems to be a promising treatment in improving myocardial perfusion. In this systematic review and meta-analysis, we aimed at investigating the efficacy and safety of intracoronary Pro-UK injection during PCI in ST elevation myocardial infarction (STEMI) patients., Materials and Methods: A comprehensive literature searched on PubMed, Embase, Cochrane, Ovid-MEDLINE, Ovid-Embase, Ovid-Cochrane Databases and ClinicalTrials.gov from inception until June 1, 2022, in English only. The primary outcome was myocardial perfusion, including thrombolysis in myocardial infarction (TIMI) grades, corrected TIMI frame count (CTFC), TIMI myocardial perfusion grades (TMPG). The secondary outcomes were ST-segment resolution (STR), major adverse cardiovascular events (MACE), myocardial marker, cardiac function and hemorrhagic complications., Results: We identified 5 studies (all RCTs) involving 761 participants. Under PCI procedure, compared with placebo, intracoronary Pro-UK injection may improve myocardial perfusion, including increasing the TIMI grades [odd ratio (OR) 0.46; 95% confidence interval (CI) 0.28-0.75; p = 0.002; I2 = 0%] , CTFC (OR -3.47; 95% CI [-5.60, -1.33]; p = 0.001; I2 = 0%) and TMPG (OR 0.17; 95% CI [0.06-0.44]; p = 0.0003; I2 = 0%), increase the rate of STR (OR 2.25; 95% CI [1.56-3.26]; p < 0.0001; I2 = 0%), reduce the incidence of MACE (OR 0.51; 95% CI [0.33-0.81]; p = 0.004; I2 = 0%) and reduce myocardial infarct size (CK, standardized mean difference [SMD] -0.45; 95% [CI] [-0.62, -0.28]; p < 0.00001; I2 = 10%. CK-MB, [SMD] -0.43; 95% CI [-0.68, -0.18]; p = 0.0007; I2 = 60%. cTnI, [SMD] -0.31; 95% CI [-0.46, -0.17]; p < 0.0001; I2 = 0%). Moreover, the treatment may improve the cardiac functions (LVFE, pooled mean difference [MD] 1.23; 95% CI [0.66-1.79]; p < 0.0001; I2 = 24%. LVEDd, pooled MD -0.13; 95% CI [-0.17, -0.09]; p < 0.00001; I2 = 0%). But there is no statistically significant difference between the Pro-UK group and placebo in the occurrence of hemorrhagic complications (OR 1.19; 95% CI [0.75-1.87]; p = 0.46; I2 = 0%)., Conclusions: Intracoronary Pro-UK injection during PCI in STEMI patients is an effective and safe treatment to perform. The treatment may improve myocardial perfusion and rate of STR, as well as decreasing the incidence of MACE and myocardial infarct size. Importantly, the treatment may improve the cardiac functions and life quality. In the future, more multi-centered and massive sample studies are required.

Objective: Surgery is the mainstay of treatment for chronic subdural hematoma (CSDH). However, the best surgical method is still controversial. Three different methods including burr hole craniostomy (BHC), minicraniotomy (MC), and twist drill craniostomy (TDC) are commonly utilized. Besides, large craniotomy, trephine craniotomy [TC (single or double)], small craniotomy, and endoscopic removal are befittingly used in some situations, too. Hence, we performed a systematic review and meta-analysis to compare the effects between BHC and MC for surgical treatment in CSDH., Materials and Methods: A literature research was conducted according to the PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared BHC and MC for CSDH. The following endpoints were compared between BHC and MC: recurrence rate, reoperation rate, duration of operation, days of hospital treatment, postoperative complications, mortality, and rate of good outcome., Results: Thirteen papers [n = 3,559 (3,580 operation sites), BHC: 1,936 operation sites, MC: 1,644 operation sites] met the inclusion criteria. The recurrence rate (OR: 0.56, 95% CI: 0.34-0.91, p = 0.02; I2 = 66%) was lower and the reoperation rate was also significantly lower (OR: 0.45, 95% CI: 0.25-0.81, p = 0.008; I2 = 72%) in the BHC group compared with the MC group. The duration of operation (MD: -20.15 min, 95% CI: -28.99 to -11.31, p < 0.00001; I2 = 0%) was significantly shorter in the BHC group compared with the MC group. Nevertheless, there was no statistically significant difference between the two groups in mortality (OR: 1.22, 95% CI: 0.92-1.61, p = 0.16; I2 = 38%), postoperative complications (OR: 0.68, 95% CI: 0.033-1.37, p = 0.28; I2 = 82%), days of hospital treatment (MD: 1.59, 95% CI: -10.44 to 13.62, p = 0.14; I2 = 85%) and rate of good outcome (OR: 1.40, 95% CI: 0.94-2.08, p = 0.10; I2 = 0%)., Conclusions: A systematic review and meta-analysis of the included literature showed that BHC reduces the recurrence rate, reoperation rate and duration of operation compared to MC. BHC is much more minimal invasive when compared to MC. More invasions may signify more post-operative complications, which may cause the increasing rate of recurrence and reoperation. No significant difference in mortality, post-operative complications, days of hospital treatment and rate of good outcome was observed between the two groups.