Objective To evaluate the effectiveness of GnRH antagonist on vitro fertilization-embryo transfer (IVF-ET). Methods We searched CBMdisc (1979 to 2010), Wanfang (1994 to 2010), CNKI (1994 to 2010), VIP (1989 to 2010), PubMed (1997 to 2010), PML (1997 to 2010), FMJS (2000-2010), and 9 related journals to identify randomized controlled trials (RCTs) on the comparison between GnRH antagonist (GnRHA) and GnRH agonist (GnRHa). The quality of included trials was critically appraised. RevMan 4.2.7 software was used for statistical analysis. Results Six published RCTs involving 1 208 participants were included. Compared with the GnRHa group, stimulation duration in the GnRHA group was lower (WMD= –1.07, 95%CI –1.38 to –0.76), dose of gonadotrophins (Gns) in the GnRHA group was slightly lower (WMD= –0.49, 95%CI –1.63 to 0.66), endometrial thickness at the time of HCG administration was no significant difference in the two groups (WMD= –0.09, 95%CI –0.42 to 0.24), number of oocytes retrieved in the GnRHA group was lower (WMD= –1.80, 95%CI –2.48 to –1.12), OHSS rate in the GnRHA group was slightly lower (Peto OR= 0.77, 95%CI 0.35 to 1.72), pregnancy rate in the GnRHA group was slightly lower (Peto OR= 0.83, 95%CI 0.65 to 1.05), miscarraige rate as no significant difference in the two groups (Peto OR= 1.49, 95%CI 0.79 to 2.82). Conclusions Compared with GnRHa, GnRHA requires shorter stimulation duration and less Gn, less affected the pregnancy rate, and reduces the incidence of OHSS. The use of GnRHA in clinical practice is relatively flexible with good acceptability. GnRHA for the superovulation IVF-ET offers an alternative treatment. The above conclusion still needs more well-designed, multi-center, and large-scale RCTs to confirm and update.
Objective To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer. Methods We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Results One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, Plt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, Plt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial. Conclusion Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.
Objectives To evaluate the effectiveness of different antidepressant drugs in addition to standard clinical care in the prevention of postnatal depression. To compare the effectiveness of different antidepressant drugs and with any other form of intervention for postnatal depression i.e. hormonal, psychological or social support. To assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant.Methods The register of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group.Randomised studies of antidepressants alone or in combination with another treatment, compared with placebo or a psychosocial intervention in non-depressed pregnant women or women who had given birth in the previous six weeks (i.e. women at risk of postnatal depression). Data were extracted independently from the trial reports by the authors.Missing information was requested from investigators wherever possible. Data were sought to allow an intention to treat analysis.Results Two trials fullled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression.Nortriptyline (n=26) did not show any benefit over placebo (n=25). Sertraline (n=14) reduced the recurrence of postnatal depression and the time to recurrence when compared with placebo (n=8). Intention to treat analyses were not carried out in either trial.Conclusions It is not possible to draw any clear conclusions about the effectiveness of antidepressants given immediately postpartum in preventing postnatal depression and, therefore, cannot be recommended for prophylaxis of postnatal depression, due to the lack of clear evidence. Larger trials are needed which also include comparisons of antidepressant drugs with other prophylactic treatments to reect clinical practice, and examine adverse effects for the foetus and infant, as well as assess womens’ attitudes to the use of antidepressants at this time.
Objective To assess the effectiveness of letrozole in ovulation induction treatment. Methods We searched CBMdisc (1979 to 2009), Wanfang (1994 to 2009), CNKI (1994 to 2009), VIP(1989 to 2009), PubMed (1997 to 2009), PML (1997 to 2009), FMJS(2000 to 2009) and 9 relevant journals to identify randomized controlled trails (RCTs) comparing letrozole with clomiphene citrate in ovulation induction treatment. The quality of the included trials was critically appraised. RevMan 4.2.7 software was used for statistical analyses. Results Ten RCTs involving 3100 patients were included, among which 5 RCTs were graded A, 4 were graded B, and 1 was graded C. Five RCTs showed that endometrial thickness at the time of human chorionic gonadotrophin (HCG) administration in the letrozole group was significantly higher than that in the clomiphene group. One RCT showed that endometrial thickness at the time of HCG administration in the letrozole group was significantly lower than that in the clomiphene group. Three RCTs showed no significant differences between the two groups. Four RCTs showed that the number of dominant follicle at the time of HCG administration in the letrozole group was signficantly lower than that in the clomiphene group. One RCT showed that the number of dominant follicle at the time of HCG administration in the letrozole group was significantly higher than that in the clomiphene group. Two RCTs showed no significant differences between the two groups. Compared with clomiphene citrate, the pregnancy rate in the letrozole monotherapy group was slightly lower at the RR 1.03 and 95%CI 0.82 to 1.29, pregnancy rate in the combination group was higher at RR 1.73 and 95%CI 1.37 to 2.18. The ovulation rate in the letrozole group was higher and no significant differences were found between the two groups at RR 1.23 and 95%CI 0.97 to 1.57. Conclusions There may be differences between letrozole and clomiphene citrate in ovulation induction treatment in terms of endometrial thickness, number of dominant follicle, ovulation rate, and pregnancy rate, but no significant differences. Letrozole can make up for the shortcomings of clinical clomiphene in ovulation induction and serve as an alternative. This conclusion needs to be further confirmed through more well-designed, multi-centered, large-sample RCTs.
ObjectiveTo summarize the progress in the application of ankle and hindfoot arthrodesis.
MethodThe domestic and foreign related literature about the application of ankle and hindfoot arthrodesis was reviewed, summarized, and analyzed.
ResultsAnkle and hindfoot arthrodesis include the multi-joint fusion and the single joint fusion, and they involve tibiotalar joint, subtalar joint, talonavicular joint, and calcaneocuboid joint. The methods of fixation include screw, plate, intramedullary nail, and external fixation.
ConclusionsDifferent terminal illnesses of ankle and hindfoot have different choices in both the fusion location and the method of fixation, appropriate program for therapeutic purposes can also alleviate complication simultaneously.
Objective To assess the efficacy of lamivudine in patients with HBeAg positive chronic hepatitis B.Methods MEDLINE, SCI, Current Content Connect, The Cochrane Library, and Chinese Biomedical Database were searched from the beginning to September 2005, and the references of eligible studies were manually screened. R.andomized controlled trials comparing lamivudine with non-antiviral interventions （ placebo, no treatment and standard care ） in patients with chronic hepatitis B were eligible for inclusion. Two investigators independently assessed the quality and extracted the data. Heterogeneity was examined by Chi-square test. Fixed and random effect meta-analysis were used to pool the data. Subgroup analyses were used in treatment course. Results Eleven R.CTs were included （ n = 1 237 ）. All reported the effect of lamivudine （100 mg/d） , and one of them included lamivudine （25 mg/d）. The treatment duration of 52 weeks and less than 26 weeks were reported in eight and three RCTs, respectively. Six RCTs adequately applied randomization, while other five RCTs were not reported in detail. Four RCTs adequately enforced allocation concealment, five RCTs enforced blinding bitterly. The others were not reported in detail. It was found by meta-analysis that, compared with the control, lamivudine （100 mg/d, 52 W） could significantly clear HBeAg [42.6% vs. 13% , RR 3.20, 95% CI （2.33, 4. 38）] and clearHBVDNA [71.78% vs. 20, 36%, RR3.42, 95%CI （2.80,4.19）], normalize ALT [65% vs. 34.9%, RR1.91, 95%CI （1.64,2.21）], achieve HBeAgseroconversion [16.1% vs. 7.29% , RR2.12, 95%CI （1.24,3.80） ] and histology response [57. 9% vs. 26.2%, RR 2. 17, 95% CI （ 1.67,2.81 ） ] ; Lanfivudine （100 mg/ d, 12 W） could effectively clear HBV DNA [ 50.7% vs 3.92% , RR 8.68, 95% CI （1.72,43.74 ） ] , but was not effective in loss of HBeAg, HBeAg seroconversion and normalization of ALT, Lamivudine （25 mg/d） could effectively clear HBV DNA [97.7% vs. 22.2% , RR 4.41, 95% CI （2.86,6.79） ] and improve histology response [59.3% vs. 30% , RR1.98, 95% CI （1.31,2.99 ） ], but was not effective in HBeAg seroconversion. Conclusions Lamivudine （100 mg/ d） is effective in clearing HBV DNA and HBeAg, normalizing ALT and achieving HBeAg seroconversion.
To compare the effectiveness of dressing by a combination of traditional Chinese medicine (TCM)-Western medicine (WM) after TCM bath and by the silver sulfadiazine cream (SD-Ag) in treating residual deep burn wound. Methods A total of 128 cases of residual deep burn wound between July 2003 and December 2009 were randomly divided into the TCM-WM treatment group (70 cases) and the WM control group (58 cases). In the treatment group, there were 45 males and 25 females with an average age of 38.6 years (range, 18-60 years), including 34 cases of flame burns, 28 cases of molten steel burns, and 8 cases of chemical burns with an average burn area of 57.6% total body surface area (TBSA) and an average residual wound of 7.4% TBSA. In the control group, there were 50 males and 8 females with an average of 37.9 years (range, 20-59 years), including 26 cases of flame burns, 12 cases of hot water burns, 16 cases of molten steel burns, and 4 cases of chemical burns with an average burn area of 56.5% TBSA and an average residual wound of 6.9%TBSA. There was no significant difference in general data between 2 groups (P gt; 0.05), so the cl inical data of 2 groups had comparabil ity. In the treatment group, the patients had a bath with TCM, and then the wounds were treated with dressing change of combined TCM-WM. In the control group, the wounds were treated with SD-Ag after cleaning the wounds with chlorhexidine solution. The pain, wound heal ing time, and the rate of scar formation were observed in 2 groups after treatment. Results According to wound pain classification after medication, the results were excellent in 23 cases, good in 30 cases, fair in 17 cases in the treatment group; were excellent in 17 cases, good in 20 cases, fair in 13 cases, poor in 5 cases, and fairly poor in 3 cases in the control group. The wound heal ing time of the treatment group (13.45 ± 4.74) days was significantly shorter than that of the control group [(23.87 ± 14.45) days, P lt; 0.05)]. After 2 weeks of treatment, scar occurred in 15 patients (21.4%) of the treatment group and 35 patients (60.3%) of the control group, showing significant difference (P lt; 0.05). Conclusion Based on TCM bath, a combination of TCM-WM for the residual burn wounds is obviously superior to SD-Ag. It has the advantages of rapid heal ing, l ight pain, no obvious scar, and short hospital ization time.
Objective To update available evidence on safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in treatment of carotid artery stenosis by a meta-analysis of randomized controlled trials (RCTs).
Methods A comprehensive search was performed of PubMed, EMBASE, Cochrane Library, Web of science, WanFang, and CNKI databases (from January 1990 to July 2015), to collect articles and past systematic reviews, and then abstraced lists of recent scientific conferences which were related with safety and efficacy of CEA versus CAS in treatment of carotid artery stenosis. At last, Meta analysis was performed by RevMan 5.1 software.
Results Fifteen RCTs enrolling 9 828 patients were included in the Meta-analysis. Compared with CAS, CEA was associated with a significantly lower incidences of any stroke or death within 30 days after surgery (OR=0.63, 95% CI: 0.51-0.77, P＜0.05) and any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation (OR=0.61, 95% CI: 0.48-0.76, P＜0.05）, but associated with a significantly greater incidences of myocardial infarction (OR=1.81, 95% CI: 1.14-2.87, P=0.01) and cranial neuropathy (OR=18.28, 95% CI: 7.99-41.82, P＜0.05) within 30 days after surgery.
Conclusion In comparison with CAS, CEA is associated with a lower incidences of stroke or death and a greater incidence of myocardial infarction and cranial neuropathy within 30 days after surgery, and was associated with a significantly lower incidence of any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation. So the results of Meta-analysis support continued use of CEA as the standard method in treatment of carotid artery stenosis.
To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment (internal fixation group, n=35) and with artificial radial head replacement (replacement group, n=30). In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years (mean, 30.7 years); the causes of injury were traffic accidentin 12 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days (mean, 3 days). In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years (mean, 32.5 years); the causes of injury were traffic accident in 7 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days (mean, 1.5 days). There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups (P gt; 0.05), so that 2 series of patients had comparabil ity. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups (P lt; 0.05), but no significant difference in elbow pronation or supination weakness (P gt; 0.05). In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement group, elbow flexion angle lost beyond 30o in 1 case after 1 year, elbow stiffness occurred in 1 case because prosthesis was too long. According to Broberg and Morrey elbow scores system, the scores were 69.51 ± 10.23 in internal fixation group and 81.55 ± 12.06 in replacement group, showing significant difference (P lt; 0.05). The results were excellent in 15 cases, good in 5 cases, fair in 11 cases, and poor in 4 cases with an excellent and good rate of 57.1% in internal fixation group; the results were excellent in17 cases, good in 5 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 73.3%. Conclusion Artificial radial head replacement can achieve better joint function compared with open reduction combined with internal fixation in treating Mason type-III comminuted fractures of radial head.
Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel(NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm × 6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.
