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Summary Background Intensive care unit (ICU)-acquired pneumonia and ventilator-associated pneumonia (VAP) are associated with poor clinical and economic outcomes. Data regarding ICU-acquired pneumonia and VAP are not readily available from developing countries, including China. The objective of this meta-analysis was to evaluate the incidence, mortality rate, length of stay, and pathogens associated with ICU-acquired pneumonia in China. Methods A meta-analysis and systematic review of 334 publications published between January 2007 and May 2012 and retrieved from the Chinese BioMedical database, China National Knowledge Infrastructure, VIP Chinese Science and Technique Journals database, Wanfang database, and PubMed was conducted. Results The incidences of ICU-acquired pneumonia and VAP were 16.2% (95% confidence interval (CI) 12.8–20.4%) and 33.7% (95% CI 31.4–36.1%), respectively; mortality rates were 37.4% (95% CI 24.6–52.2%) and 34.5% (95% CI 29.2–40.1%), respectively. The durations of stay in the ICU and hospital were 12.4 (95% CI 9.6–15.3) and 17.7 (95% CI 15.6–19.7) days and 18.0 (95% CI 16.5–19.6) and 30.5 (95% CI 26.4–34.7) days for ICU-acquired pneumonia and VAP, respectively. Pseudomonas aeruginosa (19.9%) and Acinetobacter baumannii (13.9%) were the most frequently isolated pathogens, followed by Klebsiella pneumoniae (11.9%) and Staphylococcus aureus (10.4%); 82.9% of S. aureus isolates were reported to be methicillin-resistant. Conclusions ICU-acquired pneumonia/VAP remains a major cause of morbidity and mortality in patients in the ICU in China. Data on organisms causing disease in this population could help guide appropriate prevention strategies and treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: An increasing number of transarterial chemoembolization (TACE) plus sorafenib combination therapy has been applied for unresectable hepatocellular carcinoma (HCC). However, it remains controversial whether combination therapy is superior to sorafenib monotherapy. Therefore, we aimed to perform a meta‐analysis to evaluate the efficacy and safety of the combination therapy of TACE plus sorafenib for unresectable HCC. Methods: This meta‐analysis was based on the relative outcomes from a specific search of online databases between January 2008 and November 2019, and subgroup analyses were conducted to identify potential predictive factors. Results: A total of 3868 patients (TACE plus sorafenib vs sorafenib, 1181 vs 2687) were identified from nine studies, including one randomized controlled trial and eight retrospective cohort studies. The pooled results revealed that TACE plus sorafenib combination therapy significantly improves overall survival with the combined hazard ratio 0.74 (95% confidence interval [CI] = 0.66–0.84, P < 0.001), time to progression (hazard ratio = 0.73, 95%CI = 0.65–0.82, P < 0.001), and objective response rate (odds ratio = 2.19, 95% CI = 1.31–3.66, P = 0.003). Subgroup analysis indicated that patients who developed macrovascular invasion achieve significantly great overall survival (P for interaction = 0.001) with combination therapy, in contrast to nonmacrovascular invasion patients. In addition, no significant differences in adverse events were observed. Conclusion: This meta‐analysis demonstrated that TACE plus sorafenib combination therapy is superior to sorafenib monotherapy and should be recommended as an optimal treatment choice for unresectable HCC. [ABSTRACT FROM AUTHOR]

Background: Napping is a habit prevalent worldwide and occurs from an early age. However, the association between napping and the risk of incident cardiovascular disease (CVD) and all-cause mortality remains unclear.Methods: We conducted a systematic search of Medline, Embase, and Cochrane databases from inception to December 2019 for cohort studies investigating the association between napping and the risk of incident CVD and/or all-cause mortality. Overall estimates were calculated using random-effect models with inverse variance weighting. Dose-response meta-analysis was performed using restricted cubic spline models.Results: A total of 313,651 participants (57.8% female, 38.9% took naps) from 20 cohort studies were included in the analysis. All-cause mortality was associated with napping overall (HR 1.19, 95% CI 1.12-1.26). Pooled analysis detected no association between daytime nap and incident CVD. However, in subgroup analysis including only participants who were female (HR 1.31, 95% CI 1.09-1.58), older (HR 1.36, 95% CI 1.07-1.72), or took a long nap (HR 1.34, 95% CI 1.05-1.63), napping was significantly associated with a higher risk of CVD. Dose-response analysis showed a J-curve relation between nap time and incident CVD. The HR decreased from 0 to 25 min/day, followed by a sharp increase in the risk at longer times. A positive linear relationship between nap time and all-cause mortality was also observed.Conclusions: Long napping was associated with increased risks of incident CVD and all-cause mortality. Further, large-scale studies and genetic studies need to confirm our conclusion and investigate the underlying mechanisms driving these associations. [ABSTRACT FROM AUTHOR]

The study aimed to compare the reported oncological outcomes based on satisfactory lymph node dissection (LND) or lymph node sampling (LNS), systemic and loco-regional recurrence rate and long-term survival rate of patients with early-stage non-small-cell lung cancer (NSCLC) who underwent video-assisted thoracic surgery (VATS) lobectomy or thoracotomy lobectomy. A systematic review was conducted using PubMed, EMBASE and OVID-EBMR databases ranging from 1990 to 2011. The studies compared VATS and thoracotomy for patients with NSCLC, with results including LND or LNS where recurrence as well as survival rates were identified. Data were abstracted by two reviewers independently. Mean difference or risk ratio (RR) were pooled using RevMan 5.0 statistical software. 5389 cases were included, of which 2380 underwent VATS and 3009 underwent thoracotomy. There was no significant difference in the number of total LND or LNS procedures (MD: −0.63; 95% confidence intervals (95% CI): −1.47 to 0.21; P = 0.14) or mediastinal LND or LNS (MD: −0.51; 95% CI: −1.58 to 0.56; P = 0.35) between the two groups. Systemic (RR: 0.61; 95% CI: 0.48 to 0.78; P < 0.01) and loco-regional (RR: 0.66; 95% CI: 0.46 to 0.95; P = 0.03) recurrence rates were significantly lower in the VATS group. Moreover, a significantly higher survival rate (RR: 1.09; 95% CI: 1.03 to 1.15; P < 0.01) was also demonstrated by a Forest plot in the VATS group. These results suggest that VATS lobectomy might be an eligible alternative in place of thoracotomy in patients with early-stage NSCLC by reducing recurrence and improving survival rates. [ABSTRACT FROM AUTHOR]