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| 1 | Botulinum toxin injections after surgery for Hirschsprung disease:Systematic review and meta-analysis显示文摘BACKGROUND A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery.Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis,a potential life-threatening condition.Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections.AIM To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease.METHODS A systematic review and meta-analysis was done by searching PubMed,EMBASE and the Cochrane Library,using entry terms related to:(1)Hirschsprung disease;and(2)Botulinum toxin injections.14 studies representing 278 patients met eligibility criteria.Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection,proportion of patients with adverse effects and data on type botulinum toxin,mean dose,average age at first injection and patients with associated syndromes.Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors.RESULTS Botulinum toxin injections are effective in treating obstructive symptoms in on average 66%of patients[event rate(ER)=0.66,P=0.004,I2=49.5,n=278 patients].Type of botulinum toxin,average dose,average age at first injections and proportion of patients with associated syndromes were not predictive for this effect.Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures.There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections(ER=0.79,vs ER=0.46,Q=19.37,P<0.001).Botulinum toxin injections were not effective in treating enterocolitis(ER 0.58,P=0.65,I2=71.0,n=52 patients).There were adverse effects in on average 17%of patients(ER=0.17,P<0.001,I2=52.1,n=187 patients),varying from temporary incontinence to mild anal pain.CONCLUSION Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present,but mild and temporary. | Danielle Roorda Zarah AM Abeln Jaap Oosterlaan Lodewijk WE van Heurn Joep PM Derikx | 2019 | World Journal of Gastroenterology2019，25，25： | 4 |
| 2 | Integrated approach to teaching and testing in histology with real and virtual im- aging显示文摘 | Heidger PM Fred D Daniel C | 2002 | Anat Rec2002，269，2： | 1 |
| 3 | Developmental expression of protein kinase C activity in Schistosoma mansoni 显示文摘 | Wiest PM Daniel C Burnham F | 1992 | Am J Trop Med Hyg1992，46，： | 1 |
| 4 | Characterization of the limbal epithelial stem cell niche : novelimaging techniques permit in vivo observation and targeted bi- opsy of limbal epithelial stem cells显示文摘 | Shortt AJ Secker GA Munro PM Khaw PT Tuft S J Daniels JT | 2007 | Stem Cells2007，25，5： | 1 |
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| 6 | Integrated approach to teaching and testing in histology with real and virtual imaging显示文摘 | Heidger PM Fred D Daniel C | 2002 | Anat Rec2002，259，2： | 1 |
| 7 | Characterization of the limbal epithelial stem cell niche:novel imaging techniques permit in vivo observation and targeted bi-opsy of limbal epithelial stem cells显示文摘 | Shortt AJ Secker GA Munro PM Khaw PT Tuft SJ Daniels JT | 2007 | Stem Cells2007，25，6： | 1 |
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| 10 | Integrated approach to teaching and testing in histology with real and vir-tual imaging显示文摘 | Heidger PM Fred D Daniel C | 2002 | Anat Rec2002，269，2： | 1 |
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| 14 | Assessment of cardiac stress from massive pulmonary embolism with 12- lead ECG显示文摘 | Daniel KR Countney PM Kline JA | 2001 | Chest2001，120，： | 1 |
| 15 | Proliferation,differentiation,and long-torm culture of primary appocampal neurons显示文摘 | Ray A Daniel A Schinstine PM | 1993 | Neuro-biology1993，903，： | 1 |
| 16 | Coexpressionanalysis of CD133 and CD44 identifies proneural andmesenchymal subtypes of glioblastoma multiforme 显示文摘 | Brown DV Daniel PM D vAbaco GM | 2015 | Oncotarget2015，6，8： | 1 |
| 17 | Variation in practice of laparoscopic uterosacral nerve ablation : a European survey显示文摘 | Latthe PM Powell RJ Daniels J | 2004 | J Obstet Gynaecol2004，24，： | 1 |
| 18 | Developmental expression of protein kinase C activity in Schistosoma mansoni显示文摘 | Wiest PM Daniel C Burnham G | 1992 | Am J Trop Med Hyg1992，46，3： | 1 |
| 19 | Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein显示文摘 | Ridker PM Daniel son E Fonseca FA | 2008 | N Eng J Med2008，359，21： | 1 |
| 20 | Atrophy of the thymus in rats rendered diabetes by streptozotocin显示文摘 | Chatamra K Daniel PM Dendall MD | 1985 | Thorm Metabol Res1985，17，： | 1 |
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