ObjectiveTo explore the best neoadjuvant treatment strategy for esophageal cancer and provide a theoretical basis for clinical formulation of neoadjuvant treatment plan. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to May 2022. Two researchers independently performed literature screening and data extraction. The quality of the studies was evaluated by the Cochrane risk of bias tool, and data analysis was performed in RStudio environment using R3.6.3 software. ResultsA total of 24 studies were included, covering 5 286 patients treated with surgery alone, neoadjuvant chemotherapy (NCT), neoadjuvant radiotherapy (NRT), or neoadjuvant chemoradiotherapy (NCRT) followed by combined surgical treatment. The risk of bias of the studies was low. The results of the network meta-analysis showed that combined surgical treatments after NCRT [HR=0.77, 95%CI (0.70, 0.85)] and NCT [HR=0.89, 95%CI (0.81, 0.98)] were effective methods to improve patients' overall survival (OS) compared with surgery alone. In addition, NCRT could significantly reduce the incidence of local recurrence [OR=0.43, 95%CI (0.30, 0.58)] and distant metastasis [OR=0.71, 95%CI (0.52, 0.93)] in patients with esophageal cancer. However, NCRT [RR=1.30, 95%CI (0.77, 2.20)] increased the mortality rate of patients at 30 d after surgery. ConclusionThe available evidence suggests that NCRT combined with surgery is the best option for treating patients with resectable esophageal cancer, but this treatment carries the risk of increased 30 d postoperative mortality. Future studies should focus on optimizing the NCRT regimen with the aim of improving patients’ OS while effectively reducing postoperative mortality. In addition, more high-quality randomized controlled trials are needed to support the results of the study.
ObjectivesTo systematically review the correlation between NFKB1 gene, NFKBIA gene and lung cancer susceptibility.MethodsWeb of Science, PubMed, VIP, CNKI and WanFang Data databases were electronically searched to collect case-control studies on the correlation between NFKB1 gene rs4648127, rs28362491 polymorphisms and NFKBIA gene rs696 polymorphism and lung cancer susceptibility from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 7 case-control studies were included. The results of meta-analysis showed that: no correlation was found between rs4648127 and lung cancer susceptibility (C vs. T: OR=1.065, 95%CI 0.323 to 3.512, P=0.918). A positive correlation was found in hospital population between rs28362491 (D vs. I: OR=1.290, 95%CI 1.117 to 1.489, P=0.001; DD vs. II: OR=1.707, 95%CI 1.273 to 2.289, P<0.001; DD vs. ID+II: OR=1.409, 95%CI 1.100 to 1.806, P=0.008) and lung cancer. Rs696 polymorphism (A vs. G: OR=1.215, 95%CI 1.105 to 1.336, P<0.001; AA vs. GG: OR=1.438, 95%CI 1.194 to 1.731, P<0.001; GG vs. AG+AA: OR=1.566, 95%CI 1.341 to 1.829, P<0.001) was correlated with lung cancer susceptibility.ConclusionsCurrent evidence shows that NFKB1 gene rs4648127 may not be associated with lung cancer. The rs28362491 pdymorphism of NFKB1 gene in hospital population and rs696 pdymorphism of NFKBIA gene may be positively correlated with lung cancer susceptibility. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To compare the long-term outcome between breast-conserving therapy with mastectomy therapy for early stage invasive breast cancer through a Meta analysis of the randomized controlled trials published worldwide. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and so on. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicators for assessment including death number at the end of follow-up, locoregional and total recurrence. The results were analyzed with RevMan 4.2.2 software. Results Six articles were involved in the Meta analysis with total 3 933 patients. No statistical difference was found in the death at the end of follow-up between breast-conserving therapy group and mastectomy therapy group (OR=1.05, 95% CI=0.93—1.19， P=0.45). Locoregional and total recurrence rate of breast-conserving therapy group were statistical higher than those in mastectomy therapy group (OR=1.64, 95% CI: 1.10—2.44， P=0.01； OR=1.42, 95% CI: 1.22—1.64， Plt;0.01). Conclusions Breast-conserving therapy and mastectomy therapy have comparable effects on mortality in patient with early stage invasive breast cancer, even after long-term follow up. However, breast-conserving therapy is associated with significantly greater risk of locoregional recurrence.
Objective To systematically review the effect of different nutrient interventions on the physical function of elderly people with frailty through network meta-analysis. Methods The PubMed, Cochrane Library, EMbase and Web of Science were electronically searched to collect randomized controlled trials of different nutrient interventions on physical function of the elderly with frailty, from database inception to June 30, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using ADDIS 1.16.8, GeMTC 14.3, and Stata 15.0 software. Results A total of 13 studies involving 1 144 patients were included. There was no statistically significant difference in handgrip strength, time up to go test, gait speed, and short physical performance battery (SPPB) among different nutrient interventions. Significant differences were not found in vitamin D+ whey protein (VDWP) vs. placebo and Leu vs. placebo in handgrip strength, or VDWP vs. placebo in SPPB. The probability ranking diagram showed that the most effective of handgrip strength, time up to go test, gait speed, and SPPB were milk protein concentrate (MPC80), L-carnitime (L-Car), leucine (Leu), and MPC80, respectively. Conclusion The current evidence suggests that nutritional intervention did not significantly improve physical function in the frail elderly. MPC80, Leu, L-Car, and VDVEWP may play a role in improving the physical function of frail elderly people. Nutritional support programs that increase the above nutrients, combined with exercise training may become a better way to improve the physical function of frail elderly.
目的 对电动牙刷和手动牙刷在去除菌斑、维护牙龈健康、对色素和牙结石的作用、可靠性、不良作用和成本等进行比较.方法 计算机检索Cochrane口腔健康协作组临床试验资料库(截至2004年6月17日)、Cochran临床对照试验中心资料库(Cochrane图书馆2004第2期)、MEDLINE(1966～2004)、EMBASE(1980～2004第2周)和CINAHL(1982～2004第2周),并与制造商联系以获取更多资料.根据下列标准纳入随机对照试验:随机分配研究对象;参加者为手运动无障碍的普通人群;干预措施为无监督的手动或电动牙刷刷牙,至少4周;主要结局指标为试验期间菌斑和牙龈炎的变化.由6个作者独立评价并纳入研究资料.用随机效应模型进行Meta分析,用标准化均数差(SMD)及其95%CI测量效果.检查可能的异质性来源,并针对研究质量和发表偏倚进行敏感性分析.为便于讨论,将SMD转换为百分率.结果 对包含3 855例研究对象的42个试验进行系统评价,结果显示,旋转振动型电动牙刷去除菌斑和减低牙龈炎的效果在短期内明显优于手动牙刷,并在3个月以上的研究中显示降低了牙龈炎指数.在1～3个月的研究中,菌斑SMD为-0.43 [95%CI (-0.72, 0.14)],牙龈炎SMD为-0.62 [95%CI (-0.90, 0.34)],Quigley Hein菌斑指数降低11%,Loe and Silness龈炎指数降低6%.在3个月以上的研究中,菌斑指数SMD为-1.29 [95%CI (-2.67, 0.08)], 龈炎指数为-0.51 [95%CI (-1.76, 0.25)],Ainamo Bay探诊出血指数降低17%.短期研究之间有异质性,敏感性分析显示当选择高质量的研究时结果是肯定的,没有证据表明有发表偏倚.采取其他设计的电动牙刷并不比手动牙刷更优.对成本、可靠性和不良作用的报道不一致,已报道的不良作用都是局限的、暂时的.结论 旋转振动型电动牙刷去除牙菌斑、减少牙龈炎的效果优于手动牙刷.遵守方法学指南和更标准化的设计有益于将来的研究和Meta分析.
ObjectiveTo systematically review the efficacy and safety of roflumilast for patients with chronic obstructive pulmonary disease (COPD). MethodsWe searched PubMed, Web of Science, SpringerLink, Ovid, ClinicalTrials.gov, CBM, WanFang Data and CJFD to collect randomized control trials (RCTs) of roflumilast for COPD patients from inception to December 2014. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 10 RCTs were included. The results of meta-analysis showed that. Roflumilast could significantly improve trough FEV1 (WMD=54.82, 95%CI 46.36 to 63.28, P<0.000 01), and other spirometric parameters; Roflumilast could reduce the exacerbation rate (RR=0.84, 95%CI 0.75 to 0.94, P<0.000 01), and improve TDI score (WMD=0.23, 95%CI 0.04 to 0.42, P=0.002), but did not improve SGRQ score (WMD=-0.48, 95%CI -2.39 to 1.43, P=0.63); Roflumilast could increase some adverse events including diarrhea, headache, nausea, and weight loss. ConclusionCurrent evidence shows roflumilast could significantly improve pulmonary function, reduce the mean exacerbation rate in COPD patients, and has good safety.
Objective To evaluate the effectiveness of combination therapy with lamivudine (LAM) and hepatitis B immunoglobulin (HBIG) versus LAM monotherapy in prevention of hepatitis B virus recurrence after liver transplantation. Methods Databases including MEDLINE (Ovid), PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, VIP, and CNKI were searched up to Dec. 2008. Clinical trials including randomized controlled, non-randomized concurrent-control and case-control studies about combination therapy with HBIG and LAM versus LAM monotherapy in prevention of hepatitis B virus recurrence after liver transplantation were screened. Trial selection and data extraction were conducted by two reviewers independently. Meta-analysis was performed using RevMan 5.0.18 software. Results Eleven non-randomized concurrent-control studies involving 1 421 patients (1 035 patients in combination therapy group, and 386 patients in LAM monotherapy group) were included. The results of meta-analyses showed: Compared with LAM monotherapy group, the risks of hepatitis B virus recurrence, YMDD mutation, and death associated with HBV recurrence were significantly reduced by 73% (RR=0.27, 95%CI 0.20 to 0.37, Plt;0.000 01), 72% (RR=0.28, 95%CI 0.15 to 0.53, P=0.000 01), and 79% (RR=0.21, 95%CI 0.09 to 0.49, P=0.000 3) respectively in combination therapy group after liver transplantation; overall survival rates of both recipients and grafts in combination therapy group were similar to LAM monotherapy group (RR=1.03, 95%CI 0.95 to 1.11, P=0.51; RR=1.04, 95%CI 0.97 to 1.12, P=0.26). Conclusion Current evidence indicates that compared with LAM monotherapy, combination therapy with LAM and HBIG could reduce the risks of hepatitis B virus recurrence, YMDD mutation, and death associated with HBV recurrence after liver transplantation.
ObjectiveTo systematically review the efficacy and safety of flibanserin for hypoactive sexual desire disorder in premenopausal women. MethodsWe searched PubMed, EMbase, MEDLINE, The Cochrane Library (Issue 7, 2014), CBM, CNKI, VIP and WanFang Data from their inception to August 2014, to collect randomized controlled trials (RCTs) on the effectiveness and safety of flibanserin for hypoactive sexual desire disorder in premenopausal women. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. And then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 4 RCTs involving 3 881 patients were included. The results of meta-analysis showed that:compared with the placebo group, the flibanserin group was superior in increasing the number of satisfying sexual events (SSE) (MD=0.72, 95%CI 0.51 to 0.92, P<0.000 01), improving the eDiary desire score (MD=2.21, 95%CI 1.45 to 2.97, P<0.000 01), FSFI domain score (MD=0.29, 95%CI 0.24 to 0.35, P<0.01) and FSFI total score (MD=1.82, 95%CI 1.47 to 2.17, P<0.000 01), and decreasing the FSDS-R item 13 score (MD=-0.24, 95%CI -0.31 to -0.17, P<0.000 01) and FSDS-R total score (MD=-2.70, 95%CI -3.43 to -1.96, P<0.000 01). However, the incidence of adverse events in the flibanserin group was higher than that of the placebo group (OR=1.31, 95%CI 1.11 to 1.54, P=0.001). ConclusionThe current evidence suggests that, in premenopausal women with HSDD, flibanserin treatment is effective but may increase the incidence of adverse events.
ObjectiveTo systematically review the efficacy and safety of Heluo Shugan capsule in the treatment of hepatitis B fibrosis. MethodWe searched PubMed, The Cochrane Library (Issue 8, 2015), CBM, CNKI, VIP and WanFang Data from their inception to August 2015, to collect randomized controlled trials (RCTs) on Heluo Shugan capsule for hepatitis B fibrosis. 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. ResultsA total of 15 RCTs involving 1 840 patients were included. The results of meta-analysis showed that: (1) As for reduced level of serum hyaluronic acid (HA), Heluo Shugan capsule was superior to placebo (MD=82.31, 95%CI 37.44 to 127.19, P=0.000 3), but worse than Fuzheng Huayu capsule (MD=-137.45, 95% CI-196.29 to-78.62, P < 0.000 01), Fufang Biejia Ruangan tablet (MD=-51.19, 95% CI-67.58 to-34.81, P < 0.000 01) and Anti-fibrosis decoction (MD=-82.13, 95% CI-102.37 to-61.88, P < 0.000 01). (2) As for reduced level of serum laminin (LN), Heluo Shugan capsule was superior to placebo (MD=36.83, 95% CI 11.84 to 61.82, P=0.004), but worse than Fufang Biejia Ruangan tablet (MD=-36.00, 95% CI-64.29 to-7.71, P=0.01), Ganfujian capsule (MD=-22.14, 95% CI-37.28 to-7.00, P=0.004) and Anti-fibrosis decoction (MD=-38.64, 95% CI-75.00 to-2.29, P=0.04). (3) As for reduced level of serum procollagen type III peptide (PCIII), Heluo Shugan capsule was superior to placebo (MD=47.17, 95% CI 32.68 to 61.66, P < 0.000 01), but worse than Fuzheng Huayu capsule (MD=-4.80, 95% CI-9.08 to-0.51, P=0.03), Dahuang Zhechong pills (MD=-53.77, 95% CI-105.01 to-2.53, P=0.04), Ganfujian capsule (MD=-46.82, 95% CI-66.30 to-27.34, P < 0.000 01) and Anti-fibrosis decoction (MD=-28.68, 95% CI-55.59 to-1.77, P=0.04). (4) As for reduced level of serum type-IV-collagen (IV-C), Heluo Shugan capsule was superior to placebo (MD=72.77, 95% CI 47.65 to 97.89, P < 0.000 01), but worse than Fuzheng Huayu capsule (MD=-34.69, 95% CI-56.65 to-12.73, P=0.002), Dahuang Zhechong pills (MD=-21.26, 95%CI-38.79 to-3.73, P=0.02), Fufang Biejia Ruangan tablet (MD=-69.04, 95%CI-124.38 to-13.69, P=0.01), Ganfujian capsule (MD=-19.84, 95% CI-37.41 to-2.27, P=0.03) and Anti-fibrosis decoction (MD=-37.98, 95% CI-72.99 to-2.96, P=0.03). ConclusionCurrent evidence shows that, Heluo Shugan capsule was superior to placebo, but worse than Fufang Biejia Ruangan tablet, Fuzheng Huayu capsule, Dahuang Zhechong pills, Ganfujian capsule and Anti-fibrosis decoction in reducing the level of serum hepatic fibrosis. Due to the limited quantity and quality of included studies, more high-quality, large-scale RCTs are need to verify the above conclusion.