Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure. Methods The Cochrane Library, Web of Science, PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 16 randomized controlled trials, including 15 312 patients, involving 5 interventions, namely dapagliflozin, empagliflozin, canagliflozin, sotagliflozin and ertugliflozin were included. Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death, hospitalization for heart failure, all-cause mortality, risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors (P>0.05). Compared with placebo, both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure, hospitalization for heart failure, or compound cardiovascular mortality (P<0.05), while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality, all-cause mortality, and serious adverse events (P<0.05). However, there was no significant difference between them (P>0.05). The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second, except for the combined outcome of heart failure or cardiovascular death. Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure, and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the efficacy and safety of interferon based antiviral therapy for children with hepatitis B. Methods PubMed, EMbase, The Cochrane Library, WanFang Data and CNKI databases were searched to collect randomized controlled trials (RCTs) of interferon based antiviral therapy for children with hepatitis B from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 studies involving 723 patients were included. The results of meta-analysis showed that: follow-up <12 months, the virological response rate (RR=2.82, 95%CI 1.98 to 4.02, P<0.000 01), serum HBeAg clearance rate (RR=3.02, 95%CI 1.95 to 4.67,P<0.000 01) and ALT normalization rate (RR=1.42, 95%CI 1.19 to 1.70,P=0.000 1) were significantly higher in the interferon group than the control group. Follow-up >12 months, the virological response rate (RR=1.75, 95%CI 1.18 to 2.60, P=0.006) and serum HBeAg clearance rate (RR=2.17, 95%CI 1.28 to 3.65, P=0.004) were also significantly higher in the interferon group. Severe adverse effects were not reported in included studies. Conclusion Current evidence shows that higher virological response is found in HBV infected children with interferon treatment. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Pain is one of the common complications of most diseases. Due to the unknown mechanism of pain, its treatment has been controversial. Repeated peripheral magnetic stimulation for pain has the advantages of non-invasiveness, painlessness, and well-targeted. However, the parameters of repeated peripheral magnetic stimulation for pain are not uniform due to various factors such as frequency, location of action, and coil type. In this paper, the parameters and efficacy of repeated peripheral magnetic stimulation for various kinds of pain such as acute and chronic low back pain, myofascial pain, migraine, peripheral neuralgia and post-traumatic pain are described, in order to providea theoretical basis for future research. In addition, the mechanism of repeated peripheral magnetic stimulation for pain has not been known, and this article will briefly summarize and explain on this.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo systematically review the efficacy and safety of dexamethasone in the treatment of viral myocarditis.MethodsThe Cochrane Library, PubMed, EMbase, Biosis Preview, Web of Science, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on dexamethasone for patients with viral myocarditis from inception to April 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 7 RCTs involving 749 patients were included. The results of meta-analysis showed that the dexamethasone treatment group exhibited an increased efficacy rate (RR=1.26, 95%CI 1.18 to 1.34, P<0.000 01), decreased levels of C-reactive protein (CRP) (MD=−11.49, 95%CI −19.25 to −3.72, P=0.004), cardiac troponin I (cTnI) (MD=−26.14, 95%CI −40.82 to −11.47, P=0.0005), and creatine kinase MB (CK-MB) (MD=−20.06, 95%CI −28.35 to −11.77, P<0.000 01), and a decreased adverse event rate (RR=0.40, 95%CI 0.24 to 0.65, P=0.000 3).ConclusionsCurrent evidence shows that dexamethasone can significantly improve the efficacy rate, reduce the levels of CRP, cTnI, and CK-MB, and reduce the incidence of adverse events in patients with viral myocarditis. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo evaluate the efficacy and safety of glucosamine hydrochloride in the treatment of osteoarthritis. MethodsA total of 150 patients with osteoarthritis treated between April 2014 and April 2015 were randomly divided into control group and trial group with 75 in each. Patients in the trial group accepted oral glucosamine hydrochloride, while those in the control group were given diclofenac sodium. Lequesne index, total effective rate and the incidence of adverse reactions of both groups were calculated before and 2, 4, 6 and 8 weeks after treatment, and 2 weeks after drug withdrawal. ResultsIn both groups, Lequesne index started to decrease after 2 weeks of treatment (P<0.05), and reached the minimum value at treatment week eight (P<0.05). The Lequesne index 2 weeks after drug withdrawal was still obviously lower than that before treatment (P<0.05). There was no significant differences in the total effective rate at treatment week eight (83.1% for the control group and 80.9% for the trial group) or the total effective rate 2 weeks after drug withdrawal (80.0% for the control group and 79.4% for the trial group) between the control group and the trial group (P>0.05). The incidence of adverse reactions of the trial group (6.7%) was significantly lower than that of the control group (21.3%) (P<0.05). ConclusionGlucosamine hydrochloride is effective and safe in the treatment of osteoarthritis, which is suitable for long-term treatment.
Objective This is a meta-analysis of the efficacy of noninvasive ventilation (NIV) with helmet compared to NIV with face mask in patients with acute respiratory failure (ARF). Methods " Helmet, face mask or facial mask” and " mechanical ventilation or noninvasive ventilation” were used as key words both in Chinese and English to search all the trials in PubMed, OVID, Embase, Scopus and Cochrane Library, websites, reference lists of articles, CNKI and Wanfang Database from inception to December 2016. Two reviewers independently assessed the methodological quality of the trials and extracted information. Revman 5.3 was used for data analysis. Results Ten randomized controlled trials (RCTs) and six case-control trials were included. NIV with a helmet reduced the intubation rate (OR=0.35, 95%CI 0.24 to 0.51, P<0.000 01), in-hospital mortality rate (OR=0.51, 95%CI 0.34 to 0.76, P=0.001), and NIV-related complications (OR=0.10, 95%CI 0.06 to 0.15, P<0.000 01) compared to NIV with face mask. There was no significant difference in gas exchange between two groups. In the subgroup analysis, types of ARF and ventilation mode did not affect the intubation rate and the complications relevant to NIV, but NIV with helmet mainly decreased the in-hospital mortality of the patients with hypoxemic ARF or pressure support ventilation. Conclusions NIV with a helmet can decrease the endotracheal intubation rate, in-hospital mortality, and NIV-related complications of the patients with ARF. And helmet is as effective as face mask in improving the gas exchange. However, larger or multicenter RCTs are needed to analyze the role of NIV with a helmet in this condition.
ObjectiveTo systematically review the efficacy and safety of acupuncture on postpartum depression (PPD).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of acupuncture in treatment of PPD from inception to February 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata16.0 software.ResultsA total of 13 RCTs involving 899 patients were included. The results of meta-analysis showed that there was no significant difference between hand acupuncture and fluoxetine hydrochloride in HAMD score (MD=0.45, 95%CI −0.52 to 1.41, P=0.36), clinical effective rate (RR=0.93, 95%CI 0.70 to 1.23, P=0.59), and clinical cure rate (RR=0.88, 95%CI 0.44 to 1.76, P=0.73). However, hand acupuncture was superior in safety to fluoxetine hydrochloride (RR=0.04, 95%CI 0.01 to 0.28, P<0.05). There was no significant difference in clinical effective rate (RR=1.08, 95%CI 0.87 to 1.36, P=0.49) and cure rate (RR=1.31, 95%CI 0.84 to 2.04, P=0.24) between both groups.ConclusionsThe current evidence shows that there are no differences between hand acupuncture and non-acupuncture in reducing HAMD score, improving the clinical effective rate and clinical cure rate. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectivesTo systematically review the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis.MethodsPubMed, EMbase, The Cochrane Library, VIP, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis from inception to June 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 970 patients were included. The results of meta-analysis showed that: there was no statistical difference between iguratimod and methotrexate in ACR20 (RR=1.06, 95%CI 0.91 to 1.23, P=0.49), ACR50 (RR=0.93, 95%CI 0.73 to 1.19, P=0.55), ACR70 (RR=0.92, 95%CI 0.62 to 1.39, P=0.70), morning stiffness time (MD=0.45, 95%CI –0.26 to 1.16, P=0.22), tender joint count (MD=0.07, 95%CI –2.31 to 2.45, P=0.95), swollen joint count (MD=–0.30, 95%CI –1.44 to 0.84, P=0.61), health assessment questionnaire (MD=0.01, 95%CI –0.05 to 0.07, P=0.73) and the rate of adverse effects (RR=0.66, 95%CI 0.41 to 1.07, P=0.09). Meta-analysis of 2 RCTs using double-blind method showed that, iguratimod was superior to methotrexat in the patient (MD=4.11, 95%CI 0.11 to 8.10, P=0.04) and physician (MD=4.81, 95%CI 0.93 to 8.69, P=0.01) global assessment of disease activities.ConclusionsCurrent evidence shows that the efficacy and safety of iguratimod in the treatment of rheumatoid arthritis are similar to methotrexate. And iguratimod is superior in global assessment of disease activities by patients and doctors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer.Methods The Meta-analysis was applied to analyze 8 randomized controlled quantitative studies published at domestic and abroad. These patients treated by HIPC after radical operation with colorectal cancer were included for the treatment group, and those treated only by radical operation with colorectal cancer for the control group. Relative risk (RR) of outcome variable of 3-year and 5-year survival rate and safety between the two groups were compared. Results There were 8 selected literatures, including 1 501 cases, in which 765 cases for treatment group, and 736 cases for control group. RR of 5-year survival rate of the total patients was 2.39 (95% CI: 1.66-3.45). RR of 3-year survival rate of the total patients was 2.13 (95% CI: 1.45-3.13). The results demonstrated that HIPC could improve 5-year and 3-year survival rate, and sensitivity analysis confirmed the conclusions more reliable. The security was described in 5 literatures, the available information showed smaller potential security issue. Conclusions HIPC after radical operation of advanced colorectal cancer can increase 5-year and 3-year survival rate of patients, improve the prognosis of patients. Whether patients with increased incidence of postoperative complications related to the HIPC is no clear-cut conclusions for lack of related research.