Therapeutic study, Level II.

Background To date, there are just several studies comparing distal locked nails with distal unlocked nails in treating intertrochanteric fractures. We report the first meta‐analysis about this issue. Methods Systematic search was conducted for studies in PubMed, Embase and Cochrane Library. Meta‐analyses were performed regarding intra operative outcomes, complications and functional outcomes. Results Pooled results showed insignificant difference between distal locking group and distal unlocking group in hip pain (relative risk (RR) 1.14, 95% confidence interval (CI) 0.59–2.19), distal tip fracture (RR 1.08, 95% CI 0.37–3.11), lag screw cut‐out (RR 1.60, 95% CI 0.54–4.78), delayed or nonunion (RR 1.32, 95% CI 0.25–7.06), deep vein thrombosis (RR 1.06, 95% CI 0.23–4.84), wound infection (RR 0.58, 95% CI 0.28–1.22), Harris hip score (standard mean deviation (SMD) 0.03, 95% CI −0.15 to 0.21) and walking ability. However, significant difference was detected in operation time (SMD 0.77, 95% CI 0.36–1.17), fluoroscopy exposure time (SMD 1.02, 95% CI 0.52–1.52), blood loss (SMD 0.80, 95% CI 0.62–0.99) and total incision length (SMD 1.16, 95% CI 0.86–1.47). Result of trial sequential analysis indicated conclusive evidence. Conclusion Current evidence indicates that the distal locked intramedullary nails should not be recommended as routine choice for stable intertrochanteric fractures.

BackgroundPancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP) which can be severe and cause death in approximately 10% of cases. Up to now, six randomized controlled trials (RCTs) have been found relevant to the effect of allopurinol on prevention of Post-ERCP pancreatitis (PEP). However, these results remained controversial.ObjectiveTo conduct a meta-analysis with RCTs published in full text to determine the effectiveness of prophylactic allopurinol of different dosages and administration time in the incidence and severity of PEP.MethodsLiterature search was performed in PubMed, Embase, Web of Science and Cochrane Library from databases inception to May 2014. RCTs comparing the effect of allopurinol with placebo on prevention of PEP were included. Statistical heterogeneity was quantitatively evaluated byχ2 test with the significance set P<0.10 or I2>50%.ResultsSix RCTs consisting of 1974 participants were eventually included. The incidences of PEP in allopurinol group and placebo group were 8.4%(83/986) and 9.9%(98/988) respectively. Meta-analysis showed no evident prevention effect of allopurinol on the incidence of PEP (RR 0.75, 95%CI 0.39–1.42) with significant heterogeneity (I2 = 70.4%, P = 0.005). When studies were stratified according to the dosages and administration time of allopurinol they applied, there was still no evident prevention effect of allopurinol on mild, moderate or severe PEP. However, statistically substantial heterogeneity was presented in the subgroup of moderate PEP when the effect of high dose of allopurinol was analyzed (Imoderate 2 = 82.3%, Pmoderate = 0.018). Statistically significant heterogeneity was also observed in subgroup of mild PEP, when the effect of long adminstration time of allopurinol was investigated (Imild 2 = 62.8%, Pmild = 0.068).ConclusionThe prophylactic use of allopurinol in different dosages and administration time had no effect in preventing incidence and severity of PEP.

Gansu province will fulfill the carbon reduction target under the national carbon neutrality strategy. As a developing province in China, Gansu will have to trade off carbon reduction targets and economic development. This study adopts a computable general equilibrium model to simulate the carbon reduction pathway and estimate the possible impacts on the economy, output and environment under a carbon-neutral target. Our results show carbon emission will peak around 2033 in the baseline scenario and decline slowly after the peak. While carbon emissions will peak around 2023 in the carbon neutral scenario and decline very fast from 154 million tons in 2023 to 40 million ton in 2060. The economy will continue to increase from 734 billion CNY in 2017–3375 billion CNY in 2050 under a carbon reduction target, which means the carbon neutral target will have very limited economic impacts by 2060. At the sector level, economic outputs vary among different sectors. The output will increase significantly, such as power generation 14%, water supply 8% and nonmental 4%. Some other sectors will decrease quickly, paper 15% and textile industry 7%. Carbon reduction will also contribute to air pollutants reduction, which is a benefit to air quality. Carbon neutral targets will bring more opportunities in Gansu due to green energy potential without economic burden. Proper carbon mitigation policy would avoid the adverse impact but bring more potential to the economy in Gansu.