ObjectiveTo investigate the predicting effect of PIK3CA mutations for the efficacy and prognosis of hepatocellular carcinoma (HCC) patients received surgical resection. MethodsPCR and DNA sequencing were used to detect the PIK3CA mutation status of 79 HCC tissues, its impact on the short and long term effects of the patients were analyzed. ResultsIn this group of patients, mutation rate of PIK3CA gene exon 9 was 39.24% (31/79), PIK3CA mutation rate correlated with lymph node status and tumor differentiation (P < 0.05). The therapeutic effect of patients with PIK3CA mutation was significantly poor than that of the non-mutated group (P < 0.05). The three-year cumulative survival of patients with PIK3CA mutation (33.33%) was significantly lower than non-mutated group's (60.00%) by Kaplan-Meier (P < 0.05). ConclusionPIK3CA gene mutation in exon 9 could impact the efficiency of surgical resection in patients with HCC and could predict a poor survival prognosis.
ObjectiveTo evaluate the efficacy and safety of Xueshuantong combined with conventional western medicine for angina pectoris in coronary heart disease (CHD) patients. MethodsWe searched the Cochrane Library (2013.12), Medline (2013.10), EMbase (unlimited-2013.10), China Nation Knowledge Infrastructure (unlimited-2013.10) and the Wanfang Database (unlimitied-2013.10), Weipu Database (unlimited-2013.10), and CBM (unlimited-2013.10) on computers for parallel group randomized controlled trials (RCTs) comparing Xueshuantong and placebo for patients with angina pectoris. Three researchers selected the trials based on the inclusion and exclusion criteria and then extracted the data, assessed the quality of each trial independently. After cross checking, the Cochrane Collaboration's RevMan 5.1 software was used to perform Meta-analysis. ResultsThirteen RCTs and a total of 1 298 participants were involved. Meta-analysis showed that Xueshuantong combined with the conventional western medicine had better curative effect on angina pectoris for CHD than conventional therapy; stable angina pectoris [RR=1.24, 95%CI (1.12, 1.37), P<0.000 1]; unstable angina pectoris [RR=1.22, 95%CI (1.15, 1.29), P<0.000 01]. There was also significant difference in total curative effect between the two groups [RR=1.22, 95%CI (1.16, 1.29), P<0.000 01]. Xueshuantong also had better curative effect on improving performance of electrocardiogtram (ECG): stable angina pectoris [RR=1.30, 95%CI (1.11, 1.51), P=0.000 8]; unstable angina pectoris [RR=1.18, 95%CI (1.10, 1.28), P<0.000 1]. There was also significant difference in total curative effect on improving performance of ECG between the two groups [RR=1.21, 95%CI (1.13, 1.29), P<0.000 01]. But there was no significant difference in adverse effects rate between the two groups [RR=4.50, 95%CI (0.99, 20.53), P=0.05]. ConclusionCompared with conventional therapy, Xueshuantong combined with conventional western medicine has better curative effect with improved performance of ECG. The adverse effect rate between the two groups is not significantly different. But because of the small scale, inferior quality, and bias risk of these trials, large-scale, rational designed, multicenter RCTs are needed to confirm our conclusions.
Objective To assess the efficacy and safety of Shenmai injection for children with viral myocarditis. Methods All randomized and quasi-randomized controlled trials (RCTs and quasi-RCTs) of Shenmai injection for children with viral myocarditis were searched from CBM (1981 to November 2009), CNKI (1980 to November 2009) and VIP (1989 to November 2009), The Cochrane Library (Issue 1,2010), PubMed (1966 to 2009), EMbase (1966 to 2009). Cochrane systematic reviews Handbook 5.0.1 was taken as a reference to quality evaluation of the included studies, and the Cochrane Collaboration’s RevMan 5.0 software was used for data analyses. Results A total of 15 RCTs were included. The quality of the included trials was low. The result of meta-analyses showed that: (1) The effective rate (RR 1.16, 95%CI 1.07 to 1.25) and the ECG improvement rate (RR 1.55, 95%CI 1.25 to 1.93) in Shenmai injection group were better than those in the control group. CK and CK-MB in Shenmai injection were lower than those in the control group, but the AST level was similar in the two groups. (2) The effective rate (RR 1.12, 95%CI 1.01 to 1.25) and the ECG improvement rate (RR 1.35, 95%CI 1.07 to 1.70) in Shenmai injection group were better than those in the western medicine plus routine therapy (RT) group. CK, AST and LDH in Shenmai injection group were lower than those in the western medicine plus RT group, but CK-MB was similar in the two groups. (3) The effective rate (RR 1.26, 95%CI 1.12 to 1.42) in Shenmai injection plus RT and western medicine group was better than that in RT and western medicine group. CK and LDH-1 in Shenmai injection plus RT and western medicine group were lower than those in RT and western medicine group. Adverse reactions of Shenmai injection in 4 studies included mild rash, rubicundity and chest distress. No severe adverse reactions were reported. Conclusion The evidence currently available shows that Shenmai injection may have some effect on children with viral myocarditis, including improving the effective rate, reducing myocardial enzymes and improving the ECG improvement rate. However, because of the low methodological quality of the included trials, this conclusion needs to be interpreted cautionsly, and more well-designed, high-quality RCTs need to be performed.
Objective To investigate the efficacy and safety of neo-adjuvant chemotherapy for stage ⅠB2-ⅡB cervical cancer. Methods From June 2012 to December 2014, 66 patients with stage ⅠB2-ⅡB cervical cancer were selected and treated by PT (cisplatin/ carboplatin and taxol/docetaxel) as neo-adjuvant chemotherapy prior to surgery. Neo-adjuvant chemotherapy response and toxicity were collected and analyzed. Results The extinctive condition of tumor by neo-adjuvant chemotherapy: the complete remission rate was 10.6% (7/66), partial remission rate was 59.1% (39/66), and the total effective rate was 69.7%. The main toxicities were myelosuppression (59.1%, 39/66) and gastrointestinal reactions (33.3%, 22/66). The toxicities could be tolerated or relieved by prevention and treatment. The effective rate of chemotherapy for cervical squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma was 72.6%, 33.3% and 0%, respectively, with significant differences among the three types (P<0.05). The effective rate of chemotherapy for high, medium and low differentiated cervical cancer was 100.0%, 77.3% and 55.9%, respectively, with significant differences among the three degrees (P<0.05). Conclusions Neo-adjuvant chemotherapy is proved to be a safe and effective complementary treatment for most patients with locally advanced cervical cancer. Due to the limitation of sample size, the correlations between therapeutic effect and tumor differentiation degree and between therapeutic effect and pathological type need further study.
Objective To systematically review the efficacy and safety of umeclidinium/vilanterol in the treatment of chronic obstructive pulmonary disease. Methods PubMed, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) about umeclidinium/vilanterol for chronic obstructive pulmonary disease from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Eight RCTs involving 8 992 patients were included. The results of meta-analysis showed that: (1) umeclidinium/vilanterol vs. placebo: umeclidinium/vilanterol could significantly improve Trough FEV1 (MD=0.20, 95%CI 0.17 to 0.23, P<0.000 01) and the quality of life: TDI score (MD=0.99, 95%CI 0.71 to 1.28,P<0.000 01), SGRQ score (MD=–4.00, 95%CI –5.35 to –2.66,P<0.000 01), SOBDA score (MD=–0.16, 95%CI –0.23 to –0.09,P<0.000 01), and reduce the use of rescue drugs (salbutamol), while not increase the adverse events. (2) umeclidinium/vilanterolvs. fluticasone propionate/salmeterol: UMEC/VI could improve lung function in patients with COPD: Trough FEV1 (MD=0.09, 95%CI 0.07 to 0.11, P<0.000 01), reduce the use of rescue drugs (salbutamol), and had lower adverse events. But there was no significant difference in the quality of life between two groups. (3) umeclidinium/vilanterolvs. single bronchodilator: umeclidinium/vilanterol could significantly improve spirometric parameters: Trough FEV1 (MD=0.08, 95%CI 0.07 to 0.10, P<0.000 01), and the quality of life: TDI score (MD=0.38, 95%CI 0.17 to 0.59,P=0.000 3), SGRQ score (MD=–1.18, 95%CI –2.06 to –0.29, P=0.009). Umeclidinium/vilanterol could significantly reduce the use of rescue drugs (salbutamol) without increasing the adverse events. Conclusion UMEC/VI is superior to placebo in the treatment of COPD patients, which can significantly improve lung function, control symptoms and improve the quality of life, with good safety and tolerance. Compared with salmeterol/fluticacin, UMEC/VI has a significant effect on improving lung function and controlling symptoms without increasing adverse effects, while UMEC/VI is easier to use with better patient compliance. UMEC/VI is superior to bronchodilator alone in improving lung function, controlling symptoms and improving the quality of life without increasing the incidence of adverse events. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo observe the efficacy of and influencing factors for kirschner wire limited internal fixation plus external fixation for patients with tarsometatarsal fracture dislocation. MethodsThe efficacy of kirschner wire limited internal fixation plus external fixation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed,and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. ResultsTwenty patients were included,consisting of 16 male and 4 female patients,ranging from 15 to 57 years old.The mean time of follow-up was 24.5 months,ranging from 11 to 41 months.At the time of follow-up,there were 5%(1/20),10%(2/20),50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69,70~79,80~89 and 90-100,respectively;and the excellent rate was 85% in total.In this cohort,the acceptance rate of the results of treatment was 95% at discharging and 85% at the final follow-up,and the difference between the above two time-points was not statistically significant.In addition,patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. ConclusionFor patients with tarsometatarsal fracture dislocation,treatment with kirschner wire limited internal fixation plus external fixation can not only effectively restore joint function,but also has minimum surgical trauma,and it is an effective method for the treatment of tarsometatarsal joint injuries.
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.
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.
ObjectivesTo systematically review the efficacy and safety of oral drugs for treating women with uncomplicated lower urinary tract infection.MethodsPubMed, The Cochrane Library, EMbase, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of oral drugs for treating females with uncomplicated lower urinary tract infection from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using " gemtc” packages in R 3.5.1 software.ResultsA total of 38 RCTs were included. The results of network meta-analysis showed that: quinolones (RR=1.24, 95%CI 1.11 to 1.37), furantoin (RR=1.21, 95%CI 1.06 to 1.37), trimethoprim-sulfamethoxazole (TMP-SMZ) (RR=1.20, 95%CI 1.06 to 1.35), fosfomycin (RR=1.17, 95%CI 1.04 to 1.31) and penicillin (RR=1.18, 95%CI 1.05 to 1.33) were superior to non-steroidal anti-inflammatory drugs (NSAIDS) in clinical cure. Quinolones were better than fosfomycin (RR=1.07, 95%CI 1.03 to 1.12), penicillin (RR=1.18, 95%CI 1.13 to 1.23) and cephalosporin (RR=1.13, 95%CI 1.08 to 1.19); furantoin was better than penicillin (RR=1.15, 95%CI 1.08 to 1.21) and cephalosporin (RR=1.10, 95%CI 1.04 to 1.17); TMP-SMZ was better than penicillin (RR=1.15, 95%CI 1.09 to 1.21) and cephalosporin (RR=1.11, 95%CI 1.04 to 1.16); fosfomycin was better than penicillin (RR=1.10, 95%CI 1.04 to 1.16) in bacteriological cure. The adverse effect rates of quinolones were lower than furantoin (RR=0.83, 95%CI 0.70 to 0.98), TMP-SMZ (RR=0.88, 95%CI 0.78 to 0.99) and fosfomycin (RR=0.74, 95%CI 0.59 to 0.93), and which of fosfomycin was higher than penicillin (RR=1.33, 95%CI 1.01 to 1.74) and NSAIDS (RR=1.46, 95%CI 1.11 to 1.92). All differences were statistically significant.ConclusionsCurrent evidence shows that uncomplicated lower urinary tract infection should be recommended to therapy containing quinolones. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusion.
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.