Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
Objective To evaluate the effectiveness of mifepristone concomitant with misoprostol for medical abortion. Methods We searched the related original studies worldwide, and controlled prospective studies and systematic reviews based on randomized controlled trials （RCTs）. Nine electronic databases were searched. Ten journals and reference lists of eligible studies were handsearched. Two reviewers independently screened the studies for eligibility, evaluated the quality, and extracted the data from eligible studies, with confirmation by cross checking. Any disputes were decided by a third person. Meta-analysis was conducted using statistical software RevMan 4.2. After heterogeneity test was done （α=0.05 ） , data without heterogeneity were pooled using a fixed effect model, and those with heterogeneity could be solved by sensitivity＂ analysis, subgroup analysis or random effect model. Results We found eight original trials （n = 3 348 ） that compared medical abortion with surgical abortion, nine trials （n =6 116） that investigating the effect of gestational ages on medical abortion, five trials （n = 1 934） on the use of mifepristone and two trials （n =2381 ） on intervals of administration of mifepristone and misoprostol were located. Quality of foreign studies was better than that of Chinese studies. Therate of complete abortion was higher in surgical abortion group than that in medical abortion group with odds ratio （OR） 0. 18 and 95% confidence interval （CI） 0. 11 to 0.27. The rate of incomplete abortion and abortion failure was higher in medical abortion group with OR 3.32, and 95% CI 1.79 to 6.17, OR 7.36, 95% CI 4. 17 to 12.98, respectively. The rate of complete abortion in the group with gestational age over 49 days was lower than that with gestational age under 49 days with OR 0.51 and 95% CI 0.43 to 0.61. The rate of incomplete abortion and abortion failure was higher in the group with gestational age over 49 days with OR 1.66, 95% CI 1.32 to 2.09 and OR 3.37, 95% CI 2.30 to 4. 94.There were no significant differences observed in the rates of complete abortion, incomplete abortion, abortion failed, time of expelling pregnant sac and time of menses recovery between the single and multi-dosage of mifepristone. Except for the rate of complete abortion, which was higher in 〈48h group, there was a comparable effectiveness for different intervals of mifepristone and ntisoprostol. Conclusions This review showes that it is important to improve the quality of Chinese original studies. Although the effectiveness is better in the surgical abortion group, the rate of complete abortion of medical abortion achieved is 91.6% （1 648/1 800）. This is acceptable for clinicians and women who do not want to be pregnance. The rate of complete abortion is lower in the gestation over 49 days, which had a statistically difference, but little clinical significance. It is necessary to consider increasing the gestational age of medical abortion, especially for those women who have contradictions of surgical abortion or are afraid of operation. Effectiveness of single dosage of mifeprostone is similar to that ofmulti-dosage, but single dosage might be more convenient. This review suggests that shortening the interval ofmifepristone and misoprostol administration should be considered and the best and shortest interval time need to be identified with better evidence.
ObjectiveTo systematically review the efficacy and safety of vaccines for the coronavirus disease 2019 (COVID-19) . Methods The CNKI, VIP, WanFang Data, PubMed, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) on the safety and efficacy of COVID-19 vaccines from their inception to June 30th, 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software and Stata 12.0 software. Results A total of 13 RCTs involving 139 015 subjects were included. The results of meta-analysis showed that the sero-antibody conversion rate (RR=37.883, 95%CI 8.086 to 177.491, P<0.001) and infection prevention rate (RR=1.011, 95%CI 1.006 to 1.017, P<0.001) of the vaccine group were higher than those of the placebo group. The incidence of adverse reactions in the vaccine group was higher than that in the placebo group (OR=1.839, 95%CI 1.165 to 2.903, P=0.009), which mainly included pain, redness, swelling, fever, headache and itching (P<0.05). However, the incidence of serious adverse reactions was not significantly different from that of the placebo group. Conclusion The current evidence shows that the efficacy of the COVID-19 vaccines is high. The most prevalent adverse reactions are mild and moderate, and severe adverse reactions are the same as those of the placebo group. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To evaluate the efficacy and safety of different doses of intravenous immunoglobulin (IVIG) in the treatment of relapsing-remitting multiple sclerosis (RRMS). Methods We searched for randomized controlled trials of different doses of IVIG in the treatment of RRMS. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses with The Cochrane Collaboration’s Revman 4.2.0 software. Results Three randomized controlled trials of different dose of IVIG in the treatment of RRMS were included. One was of high quality and the other two were of lower quality. Heterogeneity was identified in one study which reported IVIG in postpartum RRMS. Two studies reported the relapsefree rate and no significant difference was noted between IVIG and placebo. Two studies reported the annual relapse rate, and no significant difference was observed (OR -0.00, 95% CI -0.36 to 0.36, P=0.98). Two studies reported the MRI lesions, and no difference was identified, either. The incidence of adverse events was similar between IVIG and placebo. Conclusion There is insufficient evidence to support the dose-effect relationship of IVIG in the treatment of RRMS. Therefore, an individualized dosing regimen should be applied according to patients’ tolerance and economic status.
Objective To evaluate the efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma (OAG) and ocular hypertension (OH). Methods All the randomized controlled trials (RCTs) about treating primary open-angle glaucoma and ocular hypertension with latanoprost and travoprost were collected by searching MEDLINE, EMbase, OVID and CNKI. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and the meta-analysis was conducted with RevMan 5.0 software. Results A total of 13 RCTs involving 1 433 patients were included. The results of meta-analyses showed that, a) At the second week, travoprost showed greater intraocular pressure (IOP) lowering efficacy compared with latanoprost (WMD= –1.47, 95%CI –2.62 to –0.33). At the first month (WMD= –0.50, 95%CI –1.52 to 0.52) and the sixth month (WMD= –0.12, 95%CI –0.85 to 0.61), the difference of IOP reduction between latanoprost and travoprost group was not significant; and b) The latanoprost-treated group showed fewer reported conjunctival congestion than the travoprost-treated group (OR=0.47, 95%CI 0.35 to 0.63). The difference in adverse events of eye pain (OR=0.55, 95%CI 0.27 to 1.12) and iris or skin depigmentation (OR=1.25, 95%CI 0.53 to 2.92) between latanoprost and travoprost group was not significant. Conclusion Latanoprost and travoprost are comparable in lowering IOP for OAG and OH patients. Latanoprost shows greater ocular tolerability with lower incidence of side effects as conjunctival congestion. This conclusion is not powerful enough in proof due to the medium methodology quality of the included studies, so a large number of high-quality RCTs with large sample are needed for objectively, entirely and precisely evaluating the efficacy.
Background Hepatitis B is one of the major infectious diseases of mankind, and up to now, there is no effective way to handle it. Recent clinical trials have shown the potential advantages of Kurorinone an extract of Chinese herb, in treament of chronic HBV infection. Objectives Systermically review the safety and efficacy of Kurorinone in treatment of chronic HBV infection. Search strategy With the searching terms including Kurorinone, its products’ name, hepatitis B and chronic carrier status, the trials registers of the Cochrane Hepato- Biliary Group, the Cochrane Complementary Medicine Field, and the central database of the Cochrane Library as well as MEDILINE, EMBASE and Chinese Biomedical CD Database were searched from their date of inception onward. 20 Chinese medical journals and relevant academic conference proceedings have been searched by hand. The reference lists of identified documents were checked as the complementary search. Inclusion Criteria All RCTs that tested Kurorinone for chronic HBV infection were included in this review. Method of the review According the demand of Cochrane systematic review, selection of trial for inclusion, assessment of methodological quality, data extraction and data syntheses would be conducted for each included trial.
ObjectiveTo systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).MethodsThe databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).ConclusionsBoth F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.