针刺平行随机对照试验通常没有准确报告试验组和对照组的干预方法.为促进标准化,国际上有经验的针刺医师和研究者组成的小组制定了一些原则,即针刺临床对照试验中干预措施报告的标准(缩写为STRICTA).在征求意见过程中,一些期刊编辑协助对此标准进行了修改,使之与随机对照试验报告的标准(CON-SORT)格式一致,作为该指南对针剌研究报告的延伸.参与此事的杂志编辑已确定要发表该标准,建议其作者群按照此标准准备论文,并将邀请更多杂志采用该标准.目的是使针剌对照试验的干预措施充分报告,从而有利于对这些研究的严格评价、分析及这些措施的推广.
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
ObjectivesTo systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=−267.35, 95%CI −314.54 to −220.16, P<0.000 01), allogeneic blood transfusion (MD=−292.84, 95%CI −384.95 to −200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=−1.08, 95%CI −1.82 to −0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=−0.11, 95%CI −0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI −152.57 to 268.44, P=0.59).ConclusionsThe current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective Evidence-based medicine was used to make an individualized treatment plan for newly diagnosed prostatic hyperplasia in an elderly patient. Methods After clinical problems were discovered, evidence was collected from CBM, CNKI, The Cochrane Library, PubMed, EMBASE, ScienceDirect, Springer, and ProQuest databases according to our predefined search strategy. The search was done through 2008. The internal and external validity of the evidence was assessed. The evidence, combined with the patient value, was applied to the patient. Results A total of 39 systematic reviews involving 137 randomized controlled trials were identified. A rational treatment plan was made upon a critical evaluation of the data. After one year follow-up, the treatment protocol was proven correct. Conclusion The treatment efficacy in newly diagnosed prostatic hyperplasia in the elderly has been improved by determining an individualized treatment protocol according to evidence-based methods.
目的 补充与替代医学(complementary and alternative medicine, CAM)干预的安全性和有效性与儿科医疗工作者关系密切.本研究旨在确认CAM的儿科随机对照试验(RCT)的来源.方法 通过检索MEDLINE和其他12个期刊数据库以及根据已有儿科CAM系统评价的参考文献来检索相关RCT.结果 共查到908篇关于18岁以下儿童的CAM治疗的RCT.1965年以来,这类公开发表的RCT数量一直稳步增加.发表RCT最多的4本杂志是lt;美国临床营养杂志gt;、lt;儿科gt;、lt;儿科杂志gt;和lt;柳叶刀gt;.MEDLINE, CABHealth和EMBASE是检索这类研究最好的数据库;分别收录了93.2%,58.4%和42.2%发表儿科CAM RCT的杂志.结论 从事儿科CAM或对此感兴趣的人应定期检索MEDLINE, CABHealth和EMBASE数据库.上述的4种核心期刊也应在查阅之列.
ObjectiveTo systematically review the efficacy of different nucleosides (acids) in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of different nucleosides (acids) to prevent HBV reactivation after chemotherapy in cancer patients from inception to June 7th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 43 RCTs involving 3 269 patients were included. There were 7 interventions, namely entecavir (ETV), lamivudine (LAM), adefovir dipivoxil (ADV), telbivudine (LdT), tenofovir dipivoxil (TDF), lamivudine combined with entecavir (LAM+ETV), and lamivudine combined with adefovir dipivoxil (LAM+ADV). The results of network meta-analysis showed that the efficacy of reducing the reactivation rate of ETV, LAM, ADV, LdT, TDF, LAM+ETV, LAM+ADV were superior than the control group. The ETV, LAM and ADV were not as effective as LAM+ETV. The leading drug combinations were LAM+ETV (94.8%), LdT (81.5%) and LA+ADV (58.0%). ConclusionsCurrent evidence shows that LAM+ETV, LdT, and LA+ADV are more effective in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To evaluate the effectiveness and safety of different doses of interferon alfa (INF-α) in the treatment of chronic hepatitis C (CHC). Methods Such databases as MEDLINE, EMbase, CENTRAL, CBM, CNKI, VIP and WanFang Data were searched to collect the randomized controlled trials (RCTs) on different doses of INF-α in the treatment of CHC published before August, 2012. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and evaluated the quality of the included studies, and then meta-analysis was performed using RevMan 5.0 software. Results A total of 13 RCTs involving 1 442 patients were included. The results of meta-analysis on different doses of INF-α showed that, a) There was no significant difference in the complete response rate between the 3 MU dose group and the 1 MU dose group (RR=0.83, 95%CI 0.52 to 1.32, P=0.43), but there was significant difference in the sustained response rate between those 2 groups (RR=1.89, 95%CI 1.00 to 3.59, P=0.05); and b) No significant differences were found in the complete response rate among the 3 MU dose group, the 6 MU dose group, and the 1 MU dose group. Conclusion INF-α in dose of 3 MU, 3 times daily, is effective in treating CHC, but it would not rule out that higher dose takes more effective action. When INF-α is used to treat CHC, an individualized medication should be applied according to patients’ tolerance and economic status.
Objective To compare the outcome of uterine exteriorisation repair with in situ in caesarean section. Methods A randomized controlled trial with 220 cases were recruited. Woman with term singleton pregnancy underwent caesarean section and without severe complication were randomly allocated to the two groups (112 cases in exteriorisation group and 108 cases in situ group). Women in treatment group received exteriorisation when the uterus was sutured, While others had the uterus repaired in situ as control. Main outcome measures included perioperative haemodynamic parameters, loss of blood, changes in haemoglobin concentration, duration of operation, postoperative pain score and febrile days, gastrointestinal discomforts and function recovery as well as postoperative maternal morbidity.Data were analyzed by SPSS 11.0. Results Haemoglobin concentration dropped in both groups after caesarean section, and the drops in control group was significantly higher than that of treatment group (t=-2.902, P=0.004). In both groups, pulse before operation was markedly higher than when suturing the uterus and postoperation (Plt;0.05), but no difference was observed between the two groups. Systolic blood pressure of treatment group was lower than that of control group before operation, when suturing the uterus and after operation (F=5.246, P=0.022), but there was no difference among these 3 time points within the group. Onset of flatus was earlier in control group than in treatment group (t=5.567, P=0.000). No difference was identified between the two groups when receiving the different suturing methods. No severe maternal morbidity was observed.Conclusions Uterine exteriorisation and in situ repair have similar effects on intra- and postoperative outcomes. In routine process.
Objective To systematically evaluate the clinical effectiveness of platelet-rich plasma (PRP) combined with grafting material for the treatment of periodontal intrabony defects. Methods The following databases such as PubMed, The Cochrane Library, EMbase, CNKI, CBM and WanFang Data were searched on computer from inception to August, 2012 to collect the relevant randomized controlled trials (RCTs) on PRP combined with grafting material versus grafting material alone for periodontal intrabony defects. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies. RevMan 5.2 software was applied for meta-analysis. Results A total of 11 RCTs involving 342 patients were included. The pooled analysis on 7 RCTs showed that there was a significant difference in lower increase of clinical attachment loss (WMD=0.70, 95%CI 0.51 to 0.90, Plt;0.000 01) between the PRP combined with grafting material group and the grafting material alone group. But there was no significant difference in the gingival recession (WMD= −0.01, 95%CI −0.15 to 0.13, P=0.86). The pooled analysis on 9 RCTs showed that there was no significant difference in the reduction of plaque index (WMD= −0.04, 95%CI −0.09 to 0.02, P=0.20) between the two groups. Conclusion PRP combined with grafting material is superior to grafting material alone in the clinical attachment loss. But, there are no significant differences in gingival recession and plaque index. However, given the limited sample size and incomplete measure indexes of included studies, this conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.