Objective To assess the efficacy and safety of Chinese medicinal herbs for asymptomatic hepatitis B virus(HBV) infection. Data Source The trials registers of the Cochrane Hepato-Biliary Group, the Cochrane Library and the Cochrane Complementary Medicine Field were searched in combination with MEDLINE, EMBASE, and handsearches of Chinese journals and conference proceedings. Data Selection Randomized clinical trials with 3 months follow-up comparing Chinese medicinal herbs versus placebo, no intervention, non-specific treatment, or interferon treatment for asymptomatic HBV carriers were included. No language and blinding limitations were applied. Data Extraction Data were extracted independently by two reviewers. The methodological quality of trials was assessed by the Jadad-scale plus allocation concealment. Results Three randomized clinical trials (307 patients) with low methodological quality following patients for three months or more after the end of treatment were included. Herbal compound Jianpi Wenshen recipe showed significant effects on clearance of HBV markers compared to interferon: relative risk 2.40 (95 % CI 1.01 to 5.72) for clearance of serum HBsAg, and 2.54 (1.13 to 5.70) for seroconversion of HBeAg to anti-HBe. Phyllanthus amarus and Astragalus membranaceus showed no significant antiviral effect compared with placebo. Analysis of pooling eight randomized clinical trials with less than three months follow-up did not show a significant benefit of Chinese medicinal herbs on viral markers. No serious adverse event was observed. Conclusions There is insufficient evidence for treatment of asymptomatic HBVcarriers using Chinese medicinal herbs due to the low quality of the trials. Further randomized, double blind, placebo-controlled trials are needed.
ObjectiveTo investigate the effect of the interval between neoadjuvant chemoradiotherapy (nCRT) and surgery on the clinical outcome of esophageal cancer.MethodsPubMed and EMbase databases from inception to March 2018 were retrieved by computer. A random-effect model was used for all meta-analyses irrespective of heterogeneity. The meta-analysis was performed by RevMan5.3 software. The primary outcomes were operative mortality, incidence of anastomotic leakage, and overall survival; secondary outcomes were pathologic complete remission rate, R0 resection rate, and positive resection margin rate.ResultsA total of 17 studies with 18 173 patients were included. Among them, 13 were original studies with 2 950 patients, and 4 were database-based studies with a total of 15 223 patients. The results showed a significant positive correlation between the interval and operative mortality (Spearman coefficient=0.360, P=0.027). Dose-response meta-analysis revealed that there was a relatively better time window for surgery after nCRT. Further analysis for primary outcomes at different time cut-offs found the following results: (1) when the time cut-off point within 30-70 days, the shorter interval was associated with a reduced operative mortality (7-8 weeks: RR=0.67, 95% CI 0.55-0.81, P<0.05; 30-46 days: RR=0.63, 95%CI 0.47-0.85, P<0.05; 60-70 days: RR=0.64, 95%CI 0.48-0.85, P<0.05); (2) when the time cut-off point within 30-46 days, the shorter interval correlated with a reduced incidence of anastomotic leakage (RR=0.39, 95%CI 0.21-0.72, P<0.05); when the time cut-off point within 7-8 weeks, the shorter interval could achieve a critical-level effect of reducing the incidence of anastomotic leakage (RR=0.73, 95%CI 0.52-1.03, P>0.05); (3) when the time cut-off point within 7-8 weeks, increased interval significantly was associated with the poor overall survival (HR=1.17, 95% CI 1.00-1.36, P<0.05). Secondary outcomes found that the shorter interval could significantly reduce the positive resection margin rate (RR=0.53, 95% CI 0.38-0.75, P<0.05) when time cut-off point within 56-60 days.ConclusionShortening the interval between nCRT and surgery can reduce the operative mortality, the incidence of anastomotic leakage, long-term mortality risk, and positive resection margin rate. It is recommended that surgery should be performed as soon as possible after the patient's physical recovery, preferably no more than 7-8 weeks, which supports the current study recommendation (within 3-8 weeks after nCRT).
ObjectiveTo systematically evaluate the clinical efficacy and adverse reactions of paclitaxel and carboplatin with or without bevacizumab in the treatment of non-small cell lung cancer (NSCLC).MethodsThe databases including PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched from inception to October 2022 to collect randomized controlled trials of the clinical efficacy of paclitaxel and carboplatin with or without bevacizumab for the treatment of NSCLC. RevMan 5.4 software was used for meta-analysis.ResultsEight randomized controlled trials were enrolled, involving a total of 1 724 patients. Meta-analysis showed that for the treatment of NSCLC, the disease control rate, overall response rate, 1-year survival rate, and 2-year survival rate were higher in the trial group (paclitaxel and carboplatin combined with bevacizumab) than those in the control group (paclitaxel and carboplatin) (P<0.05); however, the incidences of the adverse reactions, such as leukopenia, hemorrhage, proteinuria and hypertension, etc, were higher in the trial group than those in the control group (P<0.05). There were no statistical differences between the trial group and the control group in the incidences of fatigue, thrombocytopenia, neutropenia or hyponatremia, etc (P>0.05). In addition, the median progression-free survival and overall survival were longer in the trial group than those in the control group.ConclusionFor the treatment of NSCLC, paclitaxel and carboplatin combined with bevacizumab is superior in terms of disease control, overall response and prolonging patient survival, etc, but will be associated with more adverse reactions.
Background AIDS (acquired immune deficiency syndrome) has become the most devastating disease which humankind has ever encountered. Human immune-deficiency virus (HIV) is transmitted through blood, sexual behavior and mother-to-baby, with more efficient transmission through blood transfusion. HIV risk among blood transfusion was severe due to lack of effective and correctly applied screening method and rigorous management, especially in some developing countries. Since the first HIV screening reagent was approved by FDA to screen the blood in 1985, the fourth generation test has been produced till now. Initially, HIV test was primarily used to screen the blood supply, it also became an important aspect of HIV prevention, especially screening among people donating blood. Today, HIV testing is seen as an integral part of both the nation’s prevention and treatment efforts. Objective To assess the effectiveness of any intervention tests for HIV screening among people donating blood, and find appropriate tests for HIV screening to decrease the risk of HIV transmission by blood transfusion. Search strategy MEDLINE, Cochrane Controlled Trials Register (CENTRAL/CCTR), AIDSLINE, EMBASE, CBM were be searched with the terms: "HIV", "AIDS", "screening", "test", "blood donor", "blood bank" and the detailed screening method. The websites of WHO, UNAIDS, CDC, FDA, and their related links were searched. Letters were mailed to various agencies and experts in this field to acquire unpublished reports. Inclusion criteria RCT and CCT for screening HIV among blood. donors will be included. Observational studies such as cohort studies, cased-control studies, and historical controlled studies will be used for sensitivity analysis. Method of the review According to the principles of Cochrane Review, selection of trials for inclusion, quality assessment of studies, data extraction and syntheses were conducted by reviewers.
Objective To systematically review the value of rapid on-site evaluation (ROSE) for diagnosing pulmonary and mediastinal lesions with endobronchial ultrasound (EBUS). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were searched by computer to collect the studies of ROSE and EBUS in the diagnosis of pulmonary and mediastinal lesions from inception to August 2022. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Meta-analysis was implemented by RevMan 5.4 and Stata 12.0 software. ResultsA total of 15 studies (9 retrospective studies and 6 prospective studies) with 3 577 patients were included. The meta-analysis results of main outcomes showed that the adequacy of the sample (RD=0.10, 95%CI 0.05 to 0.15, P<0.000 1), overall diagnosis rate (RD=0.07, 95%CI 0.04 to 0.10, P<0.000 1) and the diagnosis rate of the malignant lesion (RD=0.06, 95%CI 0.02 to 0.09, P=0.004) of the ROSE combined with EBUS group were significantly higher than those of the EBUS group. Subgroup analysis showed that the diagnosis rates of pulmonary lesions (RD=0.12, 95%CI 0.08 to 0.17, P<0.000 01) and mediastinal lesions (RD=0.06, 95%CI 0.01 to 0.12, P=0.02) in the ROSE group was significantly higher than those in the EBUS group. The overall diagnosis rate and malignant diagnosis rate of ROSE combined with EBUS were 90% and 92%. The meta-analysis results of secondary outcomes showed that the number of lesions punctures (MD=–1.16, 95%CI –1.89 to –0.43, P=0.002) in the ROSE combined with EBUS group were significantly less than that in the EBUS group; there was no statistical difference in operation time (MD=0.09, 95%CI –5.22 to 5.39, P=0.97) or incidence of complications (RD=–0.06, 95%CI –0.13 to 0.01, P=0.1) between the two groups. Conclusion ROSE can improve the diagnostic efficiency of EBUS in pulmonary and mediastinal lesions, and has the value of the clinical application.
ObjectiveTo overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.ResultsA total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.ConclusionCurrent evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.
Literature bias, which can reduce the validity of a systematic review, comes mainly from the fact that all the related studies can not be collected without exception. The following three types of literature bias are most common. (1) Publication bias. The reason is that some studies can not get published, or the publication has been delayed. (2) Literature retrieval bias. This bias is the result that not all published studies are retrieved during the course of systematic review. (3) Literature inclusion bias. While an improper literature selection strategy is adopted, some useful studies are kicked out by error, leading to such bias. A funnel plot (Y-axis is rumple size, X-axis effect) is usually useful to assess literature bias in a systematic review.
Backgroud Iodine deficiency is the main cause for potentially preventable mental retardation in childhood and is still prevalent in large parts of the world. Objectives To assess the effects of iodised salt in comparison with other forms of iodine supplementation or placebo in the prevention of iodine deficiency disorders.Search strategy We searched the Cochrane Library, Medline, the Register of Chinese trials developed by the Chinese Cochrane Centre, and the Chinese Med Database. We performed handsearching of a number of journals (Chinese Journal of Control of Endemic Diseases, Chinese Journal of Epidemiology, Chinese Journal of Preventive Medicine, and Studies of Trace Elements and Health up to February 2001), and searched reference lists, databases of ongoing trials and the Internet. Date of latest search: November 2001. Selection Criteria We included prospective controlled studies of iodised salt versus other forms of iodine supplementation or placebo in people living in areas of iodine deficiency. Studies reported mainly goitre rates and urinary iodine excretion as outcome measures. Data collection amp; analysis As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format. Main results We found six prospective controlled trials relating to our question. Four of these were described as randomised controlled trials, one was a prospective trial that did not specify allocation to comparison groups, and one was a large population-based study comparing different interventions. Comparison interventions included non-iodised salt, iodised water, iodised oil, iodation with potassium iodide versus potassium iodate. Numbers of participants in the trials ranged from 35 to 334; over 20 000 people were included in the population-based study. There was a tendency towards goitre reduction with iodised salt, although this was not significant in all studies. There was aim an improved iodine status in most studies (except in small children in one of the studies), although urinary iodine excretion did not always reach the levels recommended by the WHO. Reviewers’ conclusions The results suggest that iodised salt is an effective and safe means of improving iodine status. However, high quality controlled studies are needed to address questions of dosage and best means of iodine supplementation in different population groups.
Until Issue 2 in 2008, the Cochrane Database of Systematic Reviews had included 23 systematic reviews
concerning colorectal tumors by the colorectal cancer group. These reviews involved prevention, diagnosis, treatment,
prognosis and follow-up. The preventive ability of non-steroid anti-inflammatory drugs, accuracy of chromoscopy, shortterm
outcomes of laparoscopic colorectal resection and outcomes of laparoscopic total mesorectal excision were confirmed.
Meanwhile, the effect of dietary fibre in prevention, mechanical preoperative preparation, and prophylactic anastomotic
drainage was questioned. Because of the low quality of trials, no firm conclusions were revealed in some reviews, such as
traditional Chinese medicine in chemotherapy. Through the study of Cochrane systematic reviews, medical practitioners
and researchers can obtain high-quality evidence, and identify future research direction in the field of colorectal cancer.
Objective
To evaluate the effect of fast track surgery (FTS) after esophageal cancer surgery.
Methods
The randomized controlled trial (RCT) and observational studies about FTS for esophageal cancer in PubMed、EMbase、The Cochrane Library、Web of Science、CBM、CNKI and WanFang databases were searched up to May 2017. Then the studies were screened according to the inclusion and exclusion criteria by two researchers. Data were analyzed by Stata12.0 software.
Results
Totally 13 RCTs and 5 observational studies with 2 447 patients were eligible for analysis. Compared with the control group, incidence of postoperative complications (OR=0.53, 95%CI 0.40 to 0.71, P<0.05) significantly reduced in the FTS group, but there was no significant difference between the two groups in readmission rate (OR=1.21, 95%CI 0.83 to 1.76, P=0.313) and 30 d mortality rate (OR=0.72, 95%CI 0.43 to 1.20, P=0.207).
Conclusion
FTS can safely and effectively accelerate the recovery of patients with esophageal cancer and it owns important clinical values.
