ObjectiveTo compare the effectiveness of antecolic duodenojejunostomy (ADJ) and retrocolic duodenojejunostomy (RDJ) after pylorus-preserving pancreaticoduodenectomy (PPPD).
MethodsRandomized controlled trials (RCTs) of ADJ versus RDJ after PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and Wanfang database from inception to April 2014, as well as Google. After quality assessment of RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version, Meta analysis was performed by RevMan 5.1 software.
ResultsFour RCTs of 462 patients in total were included in this Meta-analysis. The results of Meta-analysis showed that, there were no significant differences in the operation time (MD=14.02, 95% CI:-41.42-69.46, P=0.62), incidence of postoperative complications (RR=1.09, 95% CI:0.81-1.48, P=0.56), incidence of delayed gastric emptying (RR=0.63, 95% CI:0.31-1.28, P=0.20), incidence of pancreatic fistula (RR=1.13, 95% CI:0.72-1.75, P=0.60), incidence of abdominal abscess (RR=0.92, 95% CI:0.54-1.58, P=0.77), and mortality (RR=0.61, 95% CI:0.24-1.60, P=0.32) between ADJ group and RDJ group.
ConclusionsThe effectiveness of ADJ is similar with RDJ after PPPD, so the reconstruction way after PPPD can be routed according to the surgeon's preference.
Objective To systematically evaluate the effects of psychotherapy for cancer patients with depression. Methods We searched The Cochrane Library, PubMed, EMbase, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database up to October 2010 to identify randomized controlled trials (RCTs) comparing psychotherapy plus conventional treatment with conventional treatment alone. The data were analyzed by using RevMan 5.0 software. Results Eleven RCTs involving 1 670 participants were included. The results of meta-analyses showed: (1) A significant difference was found between psychotherapy plus conventional treatment and conventional treatment alone in decrease of depression score (SMD= – 0.40, 95%CI – 0.70 to – 0.11); (2) No difference was observed between the two groups in decrease of anxiety score (SMD= – 0.68, 95%CI – 1.37 to 0.01), but the result was changed when a sensitivity analysis was done (SMD= – 0.30, 95%CI – 0.52 to -0.08). Conclusion Compared with conventional treatment alone, psychotherapy combined with conventional treatment could improve depressive states in cancer patients, but the result still needs to be confirmed by high-quality and large-sample RCTs.
ObjectiveTo systematically evaluate short-term efficacy of omega-3(ω-3) polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy.
MethodsThe literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes ofω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. All the relevant studies were screened and the data were extracted before January 2015. The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman 5.3 software.
ResultsSixteen RCTs involving 1019 patients (511 in the study group, 508 in the control group) were enrolled into the analysis. The results of meta analysis:①In the cell immunity:The proportions of CD3, CD4, CD4/CD8 in the study group were significantly higher than those in the control group[CD3:WMD=6.09, 95% CI (2.40, 9.77), P=0.001; CD4:WMD=5.25, 95% CI (3.30, 7.20), P < 0.00001; CD4/CD8:WMD=0.40, 95% CI (0.22, 0.58), P < 0.0001].②In the humoral immunity:The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA:WMD=0.56, 95% CI (0.36, 0.77), P < 0.00001; IgG:WMD=2.88, 95% CI (0.63, 5.13), P=0.01].③The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27, 95% CI (0.10, 0.43), P=0.002].④In the cytokines:The levels of interleukin-6 and tumor necrosis factor (TNF)-αin the study group were significantly lower than those in the control group[interleukin-6:WMD=-16.75, 95% CI (-25.00, -8.50), P < 0.0001; TNF-α:WMD=-6.25, 95% CI (-10.55, -1.95), P=0.004].⑤The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36, 95% CI (0.20, 0.66), P=0.0008].
ConclusionFor postoperative patients with gastrointestinal malignancy, ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function, decrease postoperative inflammatory reaction, and reduce rate of infective complications.
ObjectiveTo systematically review the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with sorafenib and TACE only treating the intermediate or advanced hepatocellular carcinoma (HCC) in Chinese people.
MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data for randomized controlled trials (RCT) on TACE combined with sorafenib (TACE combined with sorafenib group) and TACE (TACE alone group) from inception to December 2014 were searched. The literatures and data were screened and extracted. The meta analysis was performed using RevMan 5.1 software.
ResultsSix RCTs involving 498 patients with HCC were included. The results of meta analysis showed that the objective response rate[OR=2.28, 95% CI (1.52-3.42), P < 0.000 1] and the disease control rate[OR=6.62, 95% CI (4.12-10.65), P < 0.000 01] were higher, the 1-year survival rate[OR=3.27, 95% CI (2.06-5.22), P < 0.000 01] and 2-year survival rate[OR=4.55, 95% CI (2.28-9.07), P < 0.000 1] were longer, the safety and tolerability of adverse reactions were better in the TACE combined with sorafenib group as compared with the TACE alone group.
ConclusionsIn Chinese people, compared with TACE alone group, TACE combined with sorafenib group have higher objective response rate, disease control rate, 1-year survival rate, and 2-year survival rate. However, due to the lower quality of included literatures, these conclusions should be treated cautiously.
ObjectiveTo evaluate the effectiveness of levetiracetam (LEV) added on to usual care, in treating children refractory partial seizure epilepsy.MethodsWe searched the Cochrane library, EMBASE and PubMed between January 1998-January 2017, We systematically searched CNKI database and Wanfang data, Chinese biology medline and the manual retrieval related magazines.RevMan 5.3 statistical software for Meta analysis.ResultsAccording to the enrollment criteria, fourtrials were included involving 498 participants according to the intent-to-treat, 268 for LEV, and 230 for placebo groups.We assessed the following outcomes: 50% or greater seizure reduction, seizure freedom, adverse effects, proportion of dropouts and quality of life. There was no evidence of statistical heterogeneity between trials.We assessed outcomes by using a meta-analysis to calculate odds ratio (OR) with 95% confidence intervals (95% CI). For the 50% or greater reduction in focal seizure frequency outcome, the OR was significantly in favour of LEV [OR=2.94, 95% CI(1.99, 4.34)].Participants were significantly more likely in LEV groups than placebo groups to get seizure free[OR=5.31, 95% CI(2.49, 11.32)]. There was no significance between LEV groups and placebo groupsin the rate of Treatment withdrawal[OR=0.76, 95% CI(1.32, 1.82)]. Somnolence[OR=2.57, 95% CI(1.36, 4.86)]and changes in behaviour [OR=2.54, 95% CI(1.56, 4.14)] were significantly associated with LEV. Other adverse effects were not significantly associated with LEV in children.ConclusionThe existing evidence suggests that LEV add in treatment of children refractory epilepsy have definite curative effect, LEV long-term treatment effect is stable, good security, retention rate is higher, can be used in clinical further promotion.
Objective To estimate the effect of desensitizing toothpaste containing arginine on dentine hypersensitivity. Methods Such databases as CNKI, PubMed, Web of Science and Cochrane Trials Register (Issue 4, 2008) were retrieved, and Google was used as a supplementary tool to search the information up to March 2010. Randomized controlled trials (RCTs) of treating dentine hypersensitivity with arginine-containing toothpaste were included, and the relevant information was extracted and the quality evaluation was undertaken. Meta-analyses were performed with RevMan 5.0 software. Results Five RCTs with 397 patients were included. The results of meta-analyses showed that at 8 weeks, arginine-containing toothpaste was significantly different from potassium-containing toothpaste in terms of tactile sensitivity test (SMD=1.32, 95%CI 0.68 to 1.96) and air blast test (SMD= –0.77, 95%CI –1.22 to 0.32) with a better therapeutic effect. Conclusion Current literature evidence shows that the arginine-containing toothpaste is effective for the dentine hypersensitivity. However, this study is based on a small number of RCTs and samples, so further studies with high-quality and large-sample RCTs are needed.
Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Objective To Evaluation of Accuracy and Quality of Diagnostic Test of CEA for the Diagnosis of NSCLC in Chinese Patients. Methods We searched Chinese Biological Medicine Database (CBM, 1978 to 2009) and China National Knowledge Infrastructure (CNKI, 1994 to 2009). Diagnostic tests of CEA for the diagnosis of NSCLC were included. Data were extracted, and the quality of included studies was evaluated according to the six criteria of diagnostic tests. The heterogeneity test and The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results A total of 84 relevant articles were retrieved and 11 were included in our review. Eleven studies involving 925 patients (861 NSCLC patients, all diagnosed by the gold standard) were included. Meta-analyses showed that the heterogeneity among studies was high (P=0.000 2, I2=69.1%), the pooled sensitivity was 0.542 and the pooled specificity was 0.869. Subgroup analyses indicated that 5 of the studies which used the ECLIA (P=0.376, I2=5.4%, AUC= 0.748 3) and 4 of the studies which lung adenocarcinoma (P=0.186, I2=37.6%, AUC=0.900 2) and 4 of the studies which lung squamous cell carcinoma (P=0.955，I2=0.00%, AUC=0.762 0) had no heterogeneity. serum CEA is low sensitive and high specific on the diagnosis of NSCLC. The sensitivity and diagnostic accuracy rate of CEA were higher in adenocarcionoma than squamous cell cance. Conclusion CEA could be regarded as one of the reference tests in patients with NSCLC, Serum CEA is more sensitive and specific than lung squamous cell carcinoma on lung adenocarcinoma. but more high quality trials are required.
ObjectiveTo further compare the effect of intravitreal injection of bevacizumab (IVB) and photodynamic therapy (PDT) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia by meta-analysis.
MethodsPertinent publications were identified through systemic searches of PubMed, EMBASE and the Cochrance Controlled Trials Register. All clinical comparative studies of IVB or PDT as initial treatment for CNV secondary to pathologic myopia were included. Meta analysis of these clinical trials was performed to analyze the effect of IVB and PDT for CNV secondary to pathologic myopia. Measurements included best corrected visual acuity (BCVA) and central foveal thickness (CFT).
ResultsA total of 6 comparative studies involving 351 eyes were included. There were 196 eyes in IVB group and 215 eyes in PDT group. Funnel plots, Egger linear regression and Begg method did not show publication bias. Compared with PDT group, at 3, 6 and 12 months after IVB treatment, BCVA significantly increased . However, change of CFT at 3, 6 and 12 months did not vary significantly between IVB group and PDT group (3 months: WMD=-22.49, 95% CI=-93.49 to 48.52, P=0.53; 6 months: WMD=-17.34, 95% CI=-56.00 to 21.31, P=0.38; 12 months: WMD=-5.32, 95% CI=-56.37 to 45.74, P=0.84).
ConclusionPatients with CNV secondary to pathologic myopia experienced a significant benefit of visual improvement after IVB, but reduction in CFT after the IVB or PDT did not vary significantly.
Objective To evaluate the effectiveness and safety of probiotic agents for ulcerative colitis. Methods We searched electronically the Cochrane Central Register of Controlled Trials (Issue 1, 2007), MEDLINE (1978 to 2007), EMBASE (1978 to 2007), OVID Database (1978 to 2007), Chinese Biological Medicine Database (CBM Disc) (1978 to 2007), CNKI (1979 to 2007), Chinese VIP Database (1989 to 2007) and Wanfang Database (1978 to 2007). We also checked the reference lists of retrieved articles and hand-searched 4 kinds of important journals to identify randomized controlled trials of probiotic agents for ulcerative colitis. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2 software. Results Thirteen trials involving 1146 patients were included. Meta-analyses showed that probiotic agents were not superior to aminosalicylates for the clinical remission rate (OR 0.93, 95% CI 0.53 to 1.66; P=0.82); but the combination of probiotic agents and aminosalicylates were superior to aminosalicylates alone (OR 2.69, 95% CI 1.57 to 4.61; P=0.0003). In terms of the clinical relapse, the rate for probiotic agents was superior to that for placebo (OR 0.03, 95% CI 0.00 to 0.15; Plt;0.0001); but not superior to aminosalicylates (OR 0.95, 95% CI 0.65 to 1.38; P=0.79). The combination of probiotic agents and aminosalicylates was not superior to aminosalicylates alone (OR 0.57, 95% CI 0.24 to 1.32; P=0.19). As for the incidence of adverse effects, probiotic agents were not superior to aminosalicylates (OR 0.85, 95% CI 0.43 to 1.70; P=0.65); and the combination of probiotic agents and aminosalicylates was not superior to aminosalicylates alone (OR 0.30, 95% CI 0.06 to 1.54; P=0.15). Conclusion Probiotic agents are not superior to aminosalicylates based on the evidence in this review, but the combination of probiotic agents and aminosalicylates is superior to aminosalicylates alone in maintaining remission. Probiotic agents are superior to placebo but not superior to aminosalicylates, and the combination of probiotic agents and aminosalicylates is not superior to aminosalicylates alone in preventing relapse. Probiotic agents have good tolerability. However, all these findings should be interpreted with caution and more clinical trials are needed.
