利水类中药与利尿剂治疗心力衰竭的疗效与安全性—基于随机对照试验的系统评价

目的:系统评价利水类中药与利尿剂治疗心力衰竭的疗效及安全性。方法:计算机检索Pub Med、Embase、Cochrane Library、CBM、CNKI、VIP及Wan Fang Data等数据库,依据纳入及排除标准纳入利水类中药与利尿剂治疗心力衰竭的随机临床对照试验,由两名研究者独立评价纳入研究的质量、提取数据并交叉核对,使用Rev Man 5.2软件进行Meta分析,并采用加拿大卫生药品技术总署编写的ITC软件对两者实施间接比较。结果:Meta分析结果显示:在相同的常规治疗基础上,利水类中药临床疗效的总有效率高于利尿剂[RR=1.34,95%CI(1.13,1.60),P0.05]。ITC分析结果提示利水类中药+常规治疗在治疗心力衰竭的临床疗效总有效率与利尿剂+常规治疗比较的差异并无统计学意义[RR=1.023,95%CI(0.789,1.327),P=0.975]。纳入文献中,利水类中药与利尿剂治疗在NYHA心功能分级、6 min步行试验及水肿减轻程度等的疗效评价方面,均仅有1篇文献报道提示利水类中药的疗效优势,超声心动图与BNP(或NT-pro BNP)的疗效改善情况均无报道。3篇纳入文献报道了利尿剂与利水类中药治疗的相关不良反应,提示血钾异常等电解质紊乱不良反应的发生率以利尿剂治疗组更为明显。纳入的RCT均无严重不良事件的报道。结论:利水类中药联合常规治疗与利尿剂联合常规治疗的疗效比较因缺乏大样本、高质量的相关研究,目前尚无法得到较为可靠的结论。     

Efficacy of Traditional Chinese Medicine in the Treatment of Rash Caused by Epidermal Growth Factor Receptor Inhibitors: A Frequency Statistics and Meta‑Analysis

Objective: The aim of this study is to evaluate the efficacy of Traditional Chinese Medicine (TCM) in the treatment of rash caused by epidermal growth factor receptor inhibitors (EGFRIs). Materials and Methods: Foreign language database (such as PubMed, Web of Science, Cochrane Library, EMBASE) and Chinese language database (such as China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals [VIP], Wangfang, CBM disc) were searched for all trials of TCM in the treatment of rash caused by EGFRIs until January of 2019. We also looked through the references of relevant studies to supplement additional trials. The SPSS 25.0 was used for statistics of TCM with high frequency, and Review Manager 5.3 was used for meta-analysis. Results: A total of 22 studies were included in the study. We selected TCM whose frequency were >3.0%. They were Lonicera japonica（金银花）, Licorice Roots Northwest Origin（生甘草）, Cortex Dictamni（白鲜皮）, Radix Sophorae Flavescentis（苦参）, Schizonepeta（荆芥）, Saposhnikovia Divaricate（防风）. The meta?analysis revealed that the efficacy of TCM in treating EGFRIs?related rash was better than that of Western medicine or none. Conclusions: TCM could significantly relieve rash caused by EGFRIs, which is worth popularizing. Moreover, the mechanism deserves to be further explored.     

Traditional Chinese Medicine Based on Zheng Differentiation versus Angiotensin Receptor Blocker/Angiotensin-converting Enzyme Antagonist in Efficacy of Treating Diabetic Kidney Disease: A Meta-analysis of Randomized Clinical Trials

Objective: To compare the efficacy of traditional Chinese medicine(TCM) based on Zheng differentiation with angiotensin receptor blocker/angiotensin-converting enzyme inhibitor(ARB/ACEI) in treating diabetic kidney disease(DKD) from the aspects of decreasing urinary microalbumin, declining 24-h urinary protein, reducing endpoint events, and renal function protection. Methods: The Chinese Biomedical Literature Database(CBM), the Chinese Academy of Sciences database(CNKI), the VIP Chinese journal database, Wanfang DATA, Medline database, Cochrane library, excerpt medical database(Embase), and Web of science were used for literature searching. The reviewer manager5.3 software was utilized to analyze the data. Results: Twenty-four studies including 1956 participants were involved in this review. Results showed that TCM had a better effect(mean difference [MD],-23.20, 95% confidence interval [CI],-30.60 to-15.79, P 0.00001) than ARB/ACEI on lowering urinary albumin excretion rate(UAER) and urine albumin-to-creatinine ratio(MD-4.56 mg/mmol, 95% CI,-5.76 to-3.36, P 0.00001). Moreover, the advantage of decreasing UAER was greater as the follow-up period become longer(P = 0.04). TCM also had a better effect in 24-h urinal protein, decreasing 0.36 g/24 h(95% CI,-0.45 to-0.27, P 0.00001) more than the control in shorter follow-up period(ranged from 12 to 24 weeks) subgroup but only 0.08 g/24 h(95% CI,-0.13 to-0.03, P = 0.0006) in the longer follow-up period(24 weeks) subgroup. TCM worked as well as ACEI/ARB in reducing endpoint events(relative risk, 0.67, 95% CI, 0.20–2.224, P = 0.51)and decreasing urinary albumin concentration(UAC)(MD,-16.50, 95% CI,-46.28–13.28, P = 0.28). As for protecting renal function, TCM had an equal effect to AECI/ARB in improving creatinine clearance ratio(MD,-3.30, 95% CI,-6.66–0.03, P = 0.05) or estimated glomerular filtration rate(MD, 1.00, 95% CI,-0.59–2.58, P = 0.22). However, TCM had a better effect in releasing the glomerular hyperfiltration state(MD,-9.64, 95% CI,-14.45 to-4.84, P 0.0001). Conclusions: TCM based on Zheng differentiation can work as well as ACEI/ARB in treating DKD and even better in decreasing urinary microalbumin and releasing glomerular hyperfiltration. It is a good alternative treatment of DKD.     

针刺治疗抑郁症睡眠障碍临床疗效及安全性的Meta分析

目的系统评价针刺对照常规医药治疗抑郁症睡眠障碍的疗效和安全性。方法计算机检索Pubmed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网和万方数据库,由2名评价员分别独立检索针刺治疗抑郁症睡眠障碍的临床随机对照试验,检索时限为建库至2018年3月。由2名评价者独立检索、提取资料和评估方法学质量后,采用RevMan 5.3软件进行Meta分析。结果最终纳入15个研究,共1 081例受试者,Meta分析结果显示:(1)针刺组疗效与常规西药对照组无明显差异:①有效率:OR=1.55,95%CI(0.87,2.78);②汉密尔顿抑郁量表评分:OR=-1.47,95%CI(-3.44,0.50);③匹兹堡睡眠质量指数评定量表评分:OR=-2.07,95%CI(-4.26,0.13);④抑郁症测试表(SDS)抑郁严重度指数评分:OR=-3.31,95%CI(-5.22,-1.40),SDS评分:OR=-0.04,95%CI(-0.10,0.02)。(2)治疗后复发率针刺组与常规西药对照组无明显差异:①治疗后1个月随访:OR=0.43,95%CI(0.16,1.16);②治疗后3个月随访:OR=0.49,95%CI(-3.51,-2.71)。(3)不良反应发生率针刺组优于西药对照组:不良反应量表评分:OR=-3.38,95%CI(-4.84,-1.92)。结论本Meta分析结果显示,针刺治疗抑郁症睡眠障碍具有较好的临床疗效,不良反应发生率较常规西药低。     

日光疗法对老年痴呆患者激越行为影响的meta分析

目的 探讨日光疗法对老年痴呆患者激越行为的治疗效果。方法 检索Pubmed、Embase、Cochrane library、Web of science、中国生物医学数据库、中国知网、万方知识服务平台、维普数据库。利用RevMan5.4软件进行统计分析。结果 纳入6篇文献(英文5篇,中文1篇),日光疗法能够改善老年痴呆患者的激越行为[标准化均数差(standardized mean difference, SMD)=-0.43,95%CI(-0.80～-0.06),P=0.02];亚组分析结果显示,与对照组比较,光照周期>4周[SMD=-0.44,95%CI(-0.75～-0.13),P=0.006],每天光照2次[SMD=-0.47,95%CI(-0.92～-0.03),P=0.04],光照强度≤1 000 lux[SMD=-0.49,95%CI(-0.86～-0.12),P=0.01],差异均有统计学意义。光照时间亚组分析结果显示光照时间<2 h[SMD=-0.58,95%CI(-1.20～0.04),P=0.07],光照时间≥2 h[SMD=-0.27,95%CI(-...     

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PurposeMany epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma.ResultsEleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively.ConclusionOur meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.     

Controlled-release dinoprostone insert versus Foley catheter for labor induction: a meta-analysis

Objective: To compare the effectiveness and safety of controlled-release dinoprostone insert with Foley catheter balloon for cervical ripening and labor induction.

Methods: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and China Knowledge Resource Integrated Database were searched. Only randomized controlled trials comparing controlled-release dinoprostone insert with Foley catheter balloon were included. Risk ratio (RR) or mean difference (MD) with 95% con?dence interval (CI) was calculated.

Results: Six studies were included with 731 women received dinoprostone insert and 722 Foley catheter. Time from induction to delivery was significantly shortened in dinoprostone insert group compared to Foley catheter group (MD 5.73 h, 95% CI 1.26–10.20). There were no significant differences in vaginal delivery within 24 h (RR 0.75, 95% CI 0.43–1.30) or cesarean section (RR 0.94, 95% CI 0.80–1.12) between two ripening methods. Dinoprostone insert was related with increased rate of excessive uterine contraction (RR 0.07, 95% CI 0.03–0.19), but less oxytocin use (RR 1.86, 95% CI 1.25–2.77) when compared with Foley catheter.

Conclusions: Induction of labor with controlled-release dinoprostone insert seems to be more effective than Foley catheter. However, the former method causes excessive uterine contraction more frequently.     

Self-directed interventions to promote weight loss: a systematic review and meta-analysis

Many self-directed weight-loss interventions have been developed using a variety of delivery formats (e.g., internet and smartphone) and change techniques. Yet, little research has examined whether self-directed interventions can exclusively promote weight loss. MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library were systematically reviewed for randomised controlled trials evaluating self-directed interventions in relation to weight-loss outcomes in adults. Standardised mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. Twenty-seven trials incorporating 36 comparisons met our inclusion criteria. Participants using self-directed interventions lost significantly more weight (MD?=??1.56?kg, CI ?2.25, ?0.86 ranging from 0.6 to 5.3?kg) compared to those in the minimal intervention or no-treatment groups (3.1-month follow-up median). The majority of interventions were internet based (18 evaluations) and these were effective at 3 months (MD?=??1.74?kg, CI ?2.65, ?0.82 ranging from 0.6 to 4.8?kg) (SMD?=??0.48, 95% CI ?0.72, ?0.24, I²?=?82%; p?I²?=?76%; p?=?.004; 4 evaluations). Self-directed weight-loss interventions can generate modest weight loss for up to 6 months but may need to be supplemented by other interventions to achieve sustained and clinically meaningful weight loss.     

The efficiency and safety of trastuzumab for advanced gastric and gastroesophageal cancer: a meta-analysis of five randomized controlled trials

A meta-analysis was performed to examine the efficiency and safety of trastuzumab in patients with advanced gastric and gastroesophageal cancer (AGC). By searching multiple databases from 1990 to March 2016, all randomized controlled trials (RCTs) which compared the effect of trastuzumab-combined chemotherapy (TC) versus chemotherapy alone (CT) in gastric cancer would be included. Five RCTs with a total of 875 patients were included. Trastuzumab can improve the overall survival (OS) rate, progression-free survival (PFS), one-year survival rate, two-year survival rate and overall response rate (ORR) of patients with AGC. There were no difference between the two arms in terms of grade 3/4 adverse effects, such as vomiting, nausea, neutropenia, thrombocytopaenia and anemia. Diarrhea increased in TC group. Trastuzumab can significantly improve the survival rate, PFS, ORR of patients with AGC. It is safe and feasible and can be tolerated. It needs further prospective multinational multicenter RCTs with large samples to define the clinical benefits of trastuzumab.     

Lack of Association between MYO9B Gene Polymorphisms and Susceptibility to Coeliac Disease in Caucasians: Evidence from a Meta-Analysis

Objective: Coeliac disease (CD) is a complex disorder influenced by environmental and genetic factors. Recently, a number of studies reported MYO9B gene is associated with CD, but the results are controversial. The aim of this study is to clarify this dispute by means of a meta-analysis.

Methods: The databases of PubMed, Web of Science, and Embase updated to August 2015 were retrieved. Crude odds ratio (OR) and corresponding 95% confidence interval (95%CI) as effect size were calculated by fixed or random effect model according to the heterogeneity.

Results: A total of 8 studies including 2272 cases and 5419 controls were enrolled in this meta-analysis. There was no significant association both in allele and genotype comparisons between the MYO9B (rs2305764, rs2305767, rs1457092) polymorphism and CD in Caucasian populations. No publication bias was detected in this meta-analysis.

Conclusions: This meta-analysis indicates that MYO9B gene polymorphisms might be not associated with CD susceptibility in Caucasians. Further studies are still needed for definitive conclusions.