粪便基因甲基化对结直肠肿瘤诊断价值的Meta分析

目的系统评价粪便基因异常甲基化诊断结直肠肿瘤的准确性。方法计算机检索TheCochraneLibrary、PubMed、EMbase、CBM、WebofScience、CNKI和WanFangData,收集粪便基因甲基化诊断结直肠肿瘤的研究,检索时限为1990年1月至2012年2月,同时依据QUADAS条目评价纳入研究质量,采用Meta—Discl．4软件进行数据分析。结果最终共纳入32个研究,3951例患者。Meta分析结果显示：粪便基因甲基化对于检测结直肠肿瘤的合并敏感度（Sen）、特异度（Spe）、诊断比值比（DOR）、SROC曲线下面积（AUC）及Q木值分别为92％195％CI（91％,93％）]、63％[95％CI（61％,65％）]、20．79[95％CI（15．13,28．57）]、O．8619（SE=0．0204圾0．7926（SE=0．0198）;对于检测结直肠癌的合并Sen、Spe及SROCAUC分别为91呱95％CI（89％,92％）]、75％[95％CI（73％,77％）圾0．9007;而对于结直肠腺瘤的合并Sen、Spe及SROCAUC分别为79％[95％CI（76％,83％）]、7596[95％CI（73％,77％）]及0．8457。结论粪便基因异常甲基化对于诊断结直肠肿瘤具有较高的敏感性（92％）和中度特异性（63％）,可作为诊断结直肠肿瘤的无创性初筛方法。     

人类重组活化蛋白C治疗严重脓毒症的Meta分析

目的系统评价人类重组活化蛋白C（rhAPC）治疗严重脓毒症的有效性及安全性。方法计算机检索MEDLINE、EMbase、TheCochraneLibrary、VIP、CNKI、CBM和WanFangData等数据库，全面收集rhAPC治疗严重脓毒症的随机对照试验（RCT），检索时限均为建库至2012年7月，并追溯纳入研究的参考文献。Fh两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan5．0软件进行Meta分析。结果共纳入5个RCT，6307例患者。Meta分析结果显示：rhAPC组同安慰剂组相比，两者在严重脓毒症患者28天病死率[RR=I．00，95％CI（0．84，1．19），P=I．00]和90天病死率[RR=1．00，95％CI（O．87，1．14），P=0．96]方面差异均无统计学意义。对不同急性生理及慢性健康评分11（AcutePhysiologyandChronicHealthEvaluation1I，APACHE1I）严重脓毒症患者的28天病死牢进行亚组分析，结果显示两组差异也无统计学意义[APACHEII评分〈25分：RR=1．06，95％CI（O．93，1．21），P=0．37；APACHEⅡ评分≥25分：RR=0．93，95％CI（O．69，1．24），P=0．60o不同活化蛋白C缺乏程度患者28天病死率的亚组分析结果显示，两组差异也无统计学意义[APC缺乏〈80％：RR：0．96，95％CI（O．56，1．65），P=0．89；APC缺乏〉80％ RR=0．61，95％CI（0．34，1．08），P=0．09o此外，rhAPC能使严重脓毒症患者严重m血事件发生的风险增加1．62倍[RR=I．62，95％CI（1．17，2．23），P=0．004]，但两组在严重不良反应总发生率方面，差异无统计学意义[RR=I．04，95％CI（O．92，1．18），P=0．53o结论现有证据表明，rhAPC并不能改善严重脓毒症患者的预后，反而会增加l叶J血风险。     

中西药治疗功能性消化不良随机对照试验的系统评价

目的系统评价中草药与西药治疗功能性消化不良的疗效、安全性差异。方法计算机检索MEDLINE、OVID、SpringerLink、Cochrane图书馆、中国生物医学文献数据库（CBM）及CNKI数据库,检索年限均从建库至2008年12月。手工检索纳入研究的参考文献及相关杂志、会议论文集、学位论文汇编等。按Cochrane系统评价方法筛选试验、评价质量、提取资料,并用RevMan 4．2．8软件进行Meta分析。结果共纳入7个随机对照试验,981例患者,其中治疗组647例,对照组334例。纳入试验的方法学质量均较高（Jadad计分≥3分）,3个A级,2个B级,2个C级。Meta分析结果显示：①达立通颗粒与西沙必利比较,两组临床总有效率[RR=1．03,95％CI（0．97,1．09）,P=0．36]、痞满证疗效[RR=1．06,95％CI（0．96,1．18）,P=0．23]、胃排空疗效[RR=1．05,95％CI（0．76,1．45）,P=0．78]、中医证候积分[WMD=0．41,95％CI（-1．05,1．87）,P=0．58]、舌脉象变化[RR=1．00,95％CI（0．69,1．45）,P=0．98]及不良反应发生情况[RR=1．00,95％CI（0．69,1．45）,P=0．46]差异均无统计学意义;②胃舒安颗粒与西沙必利比较,两组临床总有效率[RR=1．02,95％CI（0．96,1．07）,P=0．53]、痞满证疗效[RR=1．06,95％CI（0．97,1．15）,P=0．19]、胃排空疗效[RR=1．05,95％CI（0．86,1．28）,P=0．63]、中医证候积分[WMD=0．70,95％CI（0．11,1．29）,P=0．02]及不良反应发生情况[RR=0．33,95％CI（0．02,5．28）,P=0．44]差异亦无统计学意义;⑧健脾益气方剂[RR=1．16,95％CI（1．00,1．34）,P=0．05]、理气复胃口服液[RR=1．00,95％CI（O．91,1．11）,P=0．94]和健脾消胀冲剂[RR=0．88,95％CI（0．76,1．00）,P=0．06]与莫沙必利比较,其临床总有效率差异均无统计学意义;④和胃消痞胶囊与吗丁啉比较,其临床总有效率[RR=1．11,95％CI（0．87,1．41）,P=0．42]、痞满证疗效[RR=I．07,95％CI（0．93,1．24）,P=0．35]的差异也无统计学意义。结论现有证据表明,中草药治疗功能性消化不良的疗效、安全性与西药组相当,各疗效指标无明显差异。由于纳入研究方法学质量不均,及各研究间诊断标准、评价方法、失访描述等方面存在的差异,上述结论尚需更多设计严格的高质量RCT研究加以证实。     

他汀类药物预防卒中再发的系统评价

目的系统评价他汀类药物预防脑卒中再发的临床疗效。方法计算机检索CochraneLibrary、PubMed、EMbase、CBM、CSJD、CIFD等数据库,并辅以手工和其他检索,收集全世界关于他汀类药物预防卒中再发的随机对照试验,检索时间截至2008年5月。由两名研究者独立提取资料,根据CochraneHandbook4．12的质量评价标准筛选试验、评价质量和提取资料,用RevMan5．0进行统计学分析。结果共纳入6个随机对照试验,包括9675例患者。结果显示：与安慰剂相比,他汀类药物在预防卒中复发率[RR=0．94,95％CI（0．84,1．04）,P=0．21]、致死性卒中发生率[RR=0．77,95％CI（0．48,1．25）,P=0．30]方面差异无统计学意义;在短暂性脑缺血发作发生率[RR=0．80,95％CI（0．69,0．92）,P=0．002]方面差异有统计学意义。结论当前证据表明,他汀类药物预防卒中再发及致死性卒中发生效果不佳,但可预防短暂性脑缺血发作。     

养血清脑颗粒治疗偏头痛的系统评价

目的系统评价养血清脑颗粒治疗偏头痛的疗效及安全性。方法计算机检索Cochrane图书馆（2007年第3期）、EMbase（1974—2007．6）、PubMed（1966～2007．6）、VIP（1989～2007．6）、CNKI（1979～2007．6）和CBMdisc（1978～2007．6），收集养血清脑颗粒与西比灵（氟桂利嗪）比较治疗偏头痛的所有临床随机对照试验（RCT）或半随机对照试验，按Cochrane系统评价的方法评价纳入研究质量，并使用RevMan4．2．7软件对纳入研究进行Meta分析。结果最终纳入8个研究，包括5个RCT，3个半随机对照试验。Mata分析结果显示，养血清脑颗粒与西比灵比较，其总有效率[RR=1．07，95％CI（1．00，1．15），P=0．06]、头痛持续时间[WMD=1．33，95％CI（-0．87，3．52），P=0．24]、头痛发作次数[WMD=0．93，95％CI（-1．00，2．86），P=0．35]差异均无统计学意义。一个研究报告，养血清脑颗粒与西比灵比较，两组脑部ACA[WMD=3．70，95％CI（-3．46，10．86）]、MCA[WMD=0．60，95％CI（-10．37，11．57）]、ICA[WMD=3．40，95％C1（-4．35，11．15）]、DCA[WMD=-2.30，95％CI（-9．52，4．92）]差异均无统计学意义。结论养血清脑颗粒治疗偏头痛有效，在总有效率、头痛持续时间、脑部血流量方面与西比灵疗效相似，但按现有证据，尚不能认为养血清脑颗粒治疗偏头痛优于西比灵。由于本系统评价纳人研究的方法学质量较低，且例数较少，因此尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够长的随机对照试验验证其疗效及安全性。     

奈达铂联合化疗治疗晚期非小细胞肺癌疗效和安全性的Meta分析

目的系统评价奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌的有效性和安全性。方法计算机检索Cochrane Library、PubMed、EMbase、CBM、VIP和WanFangData数据库,检索时限均为建库至2012年1月,收集关于奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌的随机对照试验（RCT）。由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan5．0软件进行Meta分析。结果共纳入15个RCT,1076例患者。Meta分析结果显示：与顺铂联合化疗比较,奈达铂联合化疗能降低恶心呕吐[RR=0．56,95％CI（0．48,0．65）,P〈0．00001]、肾功能损伤[RR=0．47,95％CI（0．30,0．74）,P=0．001]的风险,但会增加血小板减少的风险[RR=1．59,95％CI（1．20,2．11）,P=0．00130在客观缓解率[RR=1．09,95％CI（0．92,1．29）,P=0．03]、白细胞减少[RR=I．05,95％CI（0．92,1．19）,P=0．50]及血红蛋白减少[RR=0．92,95％CI（0．80,1．07）,P=0．30]方面,两组差异均无统计学意义。结论奈达铂联合化疗与顺铂联合化疗比较治疗晚期非小细胞肺癌,奈达铂联合化疗能显著降低恶心呕吐以及肾功能损伤发生的风险,但两组客观缓解率相当,奈达铂联合化疗发生血小板减少的风险更高。受纳入研究质量限制和可能存在的发表偏倚影响,上述结论尚需更多高质量的随机对照试验加以验证．     

甲状旁腺激素预防和治疗绝经后骨质疏松症疗效的系统评价

目的系统评价甲状旁腺激素（PTH）预防和治疗绝经后骨质疏松症的疗效和安全性。方法计算机检索MEDLINE（1966～2008．3）、EMBASE（1974—2008．3）、Cochrane图书馆临床试验资料库（2008年第1期）、Current Controlled Trials、The National Reseach Register、中国生物医学文献数据库（1983—2008．3）、中国期刊全文数据库（1994～2008．3），并手工检索相关领域其它杂志。检索不受语种限制，时间截至2008年3月。纳入以患原发性质疏松症或骨量减少的绝经后女性为研究对象、比较甲状旁腺激素与其它疗法疗效的随机对照试验，评价纳入研究的质量，并用RevMan4．2．10软件进行Meta分析。结果共纳入12个随机对照试验，包括5550例患者。Meta分析结果显示：PTH单用或与其它药物联用与对照组比较，减少椎体骨折风险达66％[RR=0．34，95％CI（0．26，0．45），P〈0．00001]；增加腰椎[SMD=0．41，95％CI（0．19，O．63），P=0．0003]和股骨颈[SMD=0．19，95％CI（0．10，0．28），P〈0．0001]的骨密度优于对照组。PTH发生副作用导致的退出和失访多于对照组[Peto—OR=1．69，95% CI（1．39，2．05），P〈0．00001]。结论PTH预防和治疗绝经后骨质疏松症疗效肯定，能提高腰椎及股骨颈的骨密度，降低椎体骨折的风险。PFH对绝经后骨质疏松症的疗效优于阿伦磷酸盐，但不宜和阿伦磷酸盐联合使用，骨量严重低下和有骨质疏松性骨折的绝经后女性是PTH较适合的人群。     

腹腔镜不同术式治疗卵巢子宫内膜异位囊肿疗效及安全性的系统评价

目的系统评价腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及安全性。方法计算机检索The Cochrane Library、MEDLINE（1966～2011．11）、EMbase（1980～2011．11）、CNKI（1980—2011．11）、CBM（1980—2011．11）和WanFangData（1978～2011．11）,并手T检索相关文献,收集关于腹腔镜卵巢子宫内膜异位囊肿剥除术与凝同术比较治疗卵巢子宫内膜异位囊肿疗效及安全性的随机对照试验（RCT）,检索时限截至2011年11月。南2位研究者根据纳入与排除标准筛选文献、提取资料并评价质量后,采用RevMan5．1软件进行Meta分析。结果最终纳入5个研究。Meta分析结果显示：腹腔镜卵巢子宫内膜异位囊肿剥除术能降低子宫内膜异位症患者的痛经复发率[RR=0．29,95％CI（0．15,0．55）,P=0．0002]、性交痛复发率[RR=0．27,95％CI（0．09,0．77）,P=0．01]、非经期盆腔痛复发率[RR=0．19,95％CI（0．05,0．76）,P=0．02]、卵巢子宫内膜异位囊肿术后1、2年复发率[1年：RR=0．33,95％CI（0．15,O．74）,P=0．007;2年：RR=0．49,95％CI（0．26,0．95）,P=0．03]以及短期再次手术风险[RR=0．25,95％CI（0．07,O．85）,P=0．03],并增加不孕患者术后12个月和24个月的自然妊娠率[术后12个月：RR=2．82,95％CI（1．44,5．50）,P=0．002;术后24个月：RR=2．62,95％CI（1．47,4．68）,P=0．001]。此外,患者腹腔镜子宫内膜异位囊肿凝固术后6个月的卵巢储备功能优于剥除术[WMD=-4．26,95％CI（-5．98,-2．55）,P〈0．00001）,但两者术后5年的卵巢储备功能差异无统计学意义[WMD=0．27,95％CI（-0．18,0．73）,P=0．24]。结论腹腔镜子宫内膜异位囊肿剥除术能减少患者痛经、性交痛、非经期盆腔痛以及子宫内膜异位症的复发,还能降低短期再次手术的风险,并增加确诊为不孕患者的术后自然妊娠率。鉴于现有临床研究数量尚少,上述结论尚需开展更多高质量RCT加以验证。     

七氟醚在儿科麻醉维持中的系统评价

目的系统评价七氟醚在儿科麻醉维持中的效果及其并发症。方法电子检索PubMed、EBSCO、OVID、Springer、外文生物医学期刊全文数据库和CBMdisc、CNKI，检索文献起止时间均从建库至2008年4月，检索纳入文献的参考文献，纳入七氟醚用于儿科麻醉维持的所有随机对照试验，按Cochrane系统评价方法评价纳入研究的方法学质量，并提取有效数据，用RevMan 4．2．10软件进行Meta分析。结果共纳入20个随机对照试验，包括1592例患儿。Meta分析结果显示：①苏醒时间：七氟醚与丙泊酚相似[WMD=0.22，95％CI（～2．86，3．30）]，比地氟醋漫[WMD=5．01，95％CI（2．87，7．16）]，比异氟醚快[WMD=-0.55，95％CI（-0.74，-0.37）]。②术后出苏醒室时间：七氟醚与丙泊酚[WMD=-4．39，95％CI（-10.02，1．25）]、地氟醚[WMD=1.13，95％CI（～3．25，5．51）]、异氟醚[WMD=-8．17，95％CI（-17．94，1．60）]相比，差异均无统计学意义；③术后躁动：七氟醚明显比丙泊酚高[RR=5．53，95％CI（2．99，10.21）]，比地氟醚低[RR=0.55，95％CI（0.35，0.88）]，与异氟醚差异无统计学意义[RR=1．24，95％CI（0.85，1．80）]；④术后恶心呕吐（PONV）：七氟醚比丙泊酚发生率高[RR=2．17，95％CI（1．21，3．90）]，与地氟醚相比，差异无统计学意义[RR=0.88，95％CI（0.61，1．25）]⑤眼心反射：七氟醚比丙泊酚发生率低[RD=-0.42，95％CI（-0.56，-0.27）]，与地氟醚相比，差异无统计学意义[RR=0.93，95％CI（0.61，1．41）]。结论现有有限的资料证明：在早期苏醒时间上，七氟醚与丙泊酚相似，比地氟醚慢，而比异氟醚快；在术后恢复时间上，七氟醚与其它三者间无差异；七氟醚的术后躁动明显比丙泊酚多，但与吸入麻醉药相比，七氟醚有优势；在术后恶心呕吐上，吸入麻醉药要比静脉麻醉药发生率高；七氟醚眼心反射要明显小于丙泊     

国内针刺与西药治疗抑郁症疗效比较的系统评价

目的评价国内针刺与西药比较治疗抑郁症的疗效。方法计算机检索CNKI（1979～2007）、VIP（1989～2007）、万方数据库（1998～2007）、CBM（1978～2007），手工检索天津中医药大学图书馆过刊资料库及相关会议论文集，收集国内针刺和西药比较治疗抑郁症的临床随机对照试验，由两名评价者独立提取资料并进行方法学质量评估。统计学分析采用RevMan 4．2．8软件。结果共纳入8个随机对照试验（共619例）。Meta分析结果显示，（1）总有效率：针刺与氟西汀（百忧解）[RR=1．03，95％CI（0．94，1．14）]、多虑平[RR=1．14，95％CI（0．91，1．43）]、阿米替林[RR=0．95，95％CI（0．70，1．29）]和博乐欣[RR=1．02，95％CI（0．90，1．16）]无差别。（2）HAMD评分情况：2周HAMD评分：针刺与氟西汀（百忧解）[WMD=0．03，95％CI（-1．26，1．31）]和阿米替林[WMD=-0．33，95％CI（-1．88，1．23）]无差别；4周HAMD评分：针刺与氟西汀[WMD=-0．24，95％CI（-1．85，1．37）]、阿米替林[WMD：-0．57，95％CI（-2．02，0．88）]无差别；6周HAMD评分：针刺与氟西汀[WMD=-0．19，95％C1（-1.51，1．13）]无差别。（3）2、4、6、8周SDS评分情况：针刺与氟西汀比较均无差别。（4）不良反应：2篇文献均报道针刺组无一例不良反应发生，而西药组发生不良反应的例数分别为31例和25例。结论针刺治疗抑郁症的疗效与西药比较尚无差别，值得注意的是针刺治疗抑郁症尚未发现不良反应。但尚需要更多高质量的随机双盲对照试验来进一步证实针刺治疗抑郁症的疗效。     

Chemopreventive effect of nonsteroidal anti-inflammatory drugs on the development of a new colorectal polyp or adenoma in a high-risk population: a meta-analysis

Background

Although many experimental, epidemiologic, and clinical studies have suggested that aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in reducing and preventing colorectal adenomas, randomized, controlled trials (RCTs) are still being carried out to obtain statistically reliable results.

Objective

The aim of this meta-analysis was to review long-term, prospective RCTs investigating the effect of NSAIDs on the relative risk (RR) for developing ≥1 new colorectal polyp or adenoma in a high-risk population.

Methods

We conducted a comprehensive search of MEDLINE, PubMed, and other electronic databases (including Inter-Science, Science Direct, Ebsco, Synergy, and Proquest) (key terms: nonsteroidal anti-inflammatory drugs, aspirin, colorectal, and polyps; years: 1974-2004) for English-language articles. Eligible studies were analyzed in terms of demographic data, adverse effects, and effect of NSAIDs on the RRs.

Results

Four long-term, prospective RCTs were used in the statistical analysis. A total of 2069 high-risk patients were enrolled; 1880 patients completed the studies, and 1127 were in active-treatment groups (aspirin 81-325 mg/d or sulindac 150-300 mg/d). Our meta-analysis of these studies revealed that the overall RR for developing ≥ 1 new colorectal polyp or adenoma was significantly reduced by using aspirin or other NSAIDs (RR = 0.809; 95% CI, 0.718-0.912).

Conclusions

The results of this meta-analysis suggest that regular use of aspirin 81 to 325 mg/d or sulindac 150 to 300 mg/d for ≥1 year was associated with a decrease in the RR for developing ≥ 1 new colorectal polyp or adenoma to 0.80 (95% CI, 0.718-0.912) in patients at high risk.     

Cardiovascular safety of lumiracoxib: a meta-analysis of all randomized controlled trials > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis

BACKGROUND: The cardiovascular (CV) safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors has been the subject of considerable debate. OBJECTIVE: The objective of this study was to determine the risk of CV events with lumiracoxib by meta-analysis of all completed, randomized controlled trials (RCTs) of > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis. METHODS: The Novartis Lumiracoxib Clinical Trial Database, which includes all clinical studies conducted to date with lumiracoxib, was reviewed. Data were extracted from RCTs of > or =1 week and up to 1 year in duration, the maximum study duration; 34,668 patients were included in standard and cumulative meta-analyses. Twenty-two RCTs of lumiracoxib 100 to 1200 mg daily were identified; 22,781 patients were included in 1-year trials. Mean age of the patients was 61.5 years and 74% were female. More than 50% of the patients in these studies had hypertension at baseline and 6% had diabetes. Parameters analyzed were the Antiplatelet Trialists' Collaboration (APTC) composite CV end point of myocardial infarction (MI), stroke (ischemic and hemorrhagic), and CV death; MI alone; and stroke alone. Twenty-one of the 22 RCTs have been published. RESULTS: For all 3 parameters, relative risk (RR) was calculated versus non-naproxen NSAIDs, naproxen, and placebo. The results were as follows: for the APTC end point versus non-naproxen NSAIDs: RR 0.83, 95% CI, 0.46-1.51; versus naproxen: RR 1.49, 95% CI, 0.94-2.36; versus placebo: RR 1.08, 95% CI, 0.41-2.86; for MI alone versus non-naproxen NSAIDs: RR 0.80, 95% CI, 0.28-2.25; versus naproxen: RR 1.69, 95% CI, 0.82-3.48; versus placebo: RR 1.27, 95% CI, 0.25-6.56; and for stroke alone versus non-naproxen NSAIDs: RR 0.91, 95% CI, 0.35-2.35; versus naproxen: RR 1.42, 95% CI, 0.70-2.91; versus placebo: RR 0.59, 95% CI, 0.13-2.74. Cumulative meta-analyses of lumiracoxib versus all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen) did not find any significant differences in APTC, MI alone, or stroke alone. CONCLUSION: This meta-analysis of 34,668 patients receiving > or =1 week and up to 1 year of treatment found no evidence that lumiracoxib was associated with a significant increase in CV risk compared with naproxen, placebo, or all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen).     

PEER umbrella systematic review of systematic reviews: Management of osteoarthritis in primary care

ObjectiveTo determine how many patients with chronic osteoarthritis pain respond to various non-surgical treatments.Data sourcesPubMed and the Cochrane Library.Study selection Published systematic reviews of randomized controlled trials (RCTs) that included meta-analysis of responder outcomes for at least 1 of the following interventions were included: acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, cannabinoids, counseling, exercise, platelet-rich plasma, viscosupplementation, glucosamine, chondroitin, intra-articular corticosteroids, rubefacients, or opioids.Synthesis In total, 235 systematic reviews were included. Owing to limited reporting of responder meta-analyses, a post hoc decision was made to evaluate individual RCTs with responder analysis within the included systematic reviews. New meta-analyses were performed where possible. A total of 155 RCTs were included. Interventions that led to more patients attaining meaningful pain relief compared with control included exercise (risk ratio [RR] of 2.36; 95% CI 1.79 to 3.12), intra-articular corticosteroids (RR = 1.74; 95% CI 1.15 to 2.62), SNRIs (RR = 1.53; 95% CI 1.25 to 1.87), oral NSAIDs (RR = 1.44; 95% CI 1.36 to 1.52), glucosamine (RR = 1.33; 95% CI 1.02 to 1.74), topical NSAIDs (RR = 1.27; 95% CI 1.16 to 1.38), chondroitin (RR = 1.26; 95% CI 1.13 to 1.41), viscosupplementation (RR = 1.22; 95% CI 1.12 to 1.33), and opioids (RR = 1.16; 95% CI 1.02 to 1.32). Preplanned subgroup analysis demonstrated no effect with glucosamine, chondroitin, or viscosupplementation in studies that were only publicly funded. When trials longer than 4 weeks were analyzed, the benefits of opioids were not statistically significant.ConclusionInterventions that provide meaningful relief for chronic osteoarthritis pain might include exercise, intra-articular corticosteroids, SNRIs, oral and topical NSAIDs, glucosamine, chondroitin, viscosupplementation, and opioids. However, funding of studies and length of treatment are important considerations in interpreting these data.     

全髋关节置换术后应用非类固醇类抗炎药有效性和安全性的荟萃分析

背景:全髋关节置换后非类固醇类抗炎药常被用来预防异位骨形成,但是其有效性和安全性尚无定论.目的:用荟萃分析的方法定量评价全髋关节置换术后应用非类固醇类抗炎药的有效性和安全性.方法:计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库,追查纳入文献的参考文献,全面搜集有关全髋关节置换后应用非类固醇类抗炎药的随机对照试验,用RevMan5.0软件进行统计分析.结果与结论:共纳入13篇随机对照试验(4 706例患者),Meta分析结果显示:与安慰剂组相比,低剂量的阿司匹林组在预防异位骨形成方面差异无显著性意义[RR=0.99,95%CI(0.87,1.14),而中到高剂量的非类固醇类抗炎药组在预防异位骨形成方面差异有显著性意义[RR=0.44,95%CI(0.30,0.64);在轻度的胃肠道不良反应方面两组差异有显著性意义[RR=2.15,95%CI(1.28,3.61)],在改善髋关节疼痛方面和躯体功能方面差异无显著性意义[MD=-0.1,95%CI(-0.1,0.4)];7 Gy放疗组和非类固醇类抗炎药相比异位骨形成发生率分别为11.1%和16.0%.除低剂量的阿司匹林外,全髋关节置换术后应用中到高剂量非类固醇类抗炎药可显著降低患者异位骨的形成,但非类固醇类抗炎药组轻度的胃肠道反应较高,有限的证据表明非类固醇类抗炎药和安慰剂组在髋关节疼痛缓解和躯体功能改善方面无显著性差异,7 Gy放疗组在降低异位骨形成发生率方面优于非类固醇类抗炎药组.     

Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis

ABSTRACT: INTRODUCTION: Critical illness is characterized by oxidative stress, which is a major promoter of systemic inflammation and organ failure due to excessive free radical production, depletion of antioxidant defenses, or both. We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes. METHODS: We searched computerized databases, reference lists of pertinent articles and personal files from 1980 to 2011. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated relevant clinical outcomes with antioxidant micronutrients (vitamins and trace elements) supplementation versus placebo. RESULTS: A total of 21 RCTs met inclusion criteria. When the results of these studies were statistically aggregated (n = 20), combined antioxidants were associated with a significant reduction in mortality (risk ratio (RR) = 0.82, 95% confidence interval (CI) 0.72 to 0.93, P = 0.002); a significant reduction in duration of mechanical ventilation (weighed mean difference in days = -0.67, 95% CI -1.22 to -0.13, P = 0.02); a trend towards a reduction in infections (RR= 0.88, 95% CI 0.76 to 1.02, P = 0.08); and no overall effect on ICU or hospital length of stay (LOS). Furthermore, antioxidants were associated with a significant reduction in overall mortality among patients with higher risk of death (>10% mortality in control group) (RR 0.79, 95% CI 0.68 to 0.92, P = 0.003) whereas there was no significant effect observed for trials of patients with a lower mortality in the control group (RR = 1.14, 95% 0.72 to 1.82, P = 0.57). Trials using more than 500 μg per day of selenium showed a trend towards a lower mortality (RR = 0.80, 95% CI 0.63 to 1.02, P = 0.07) whereas trials using doses lower than 500 μg had no effect on mortality (RR 0.94, 95% CI 0.67 to 1.33, P = 0.75). CONCLUSIONS: Supplementation with high dose trace elements and vitamins may improve outcomes of critically ill patients, particularly those at high risk of death.     

The influence of sertraline on depressive disorder after traumatic brain injury: A meta-analysis of randomized controlled studies

BackgroundSertraline showed some potential in alleviating depressive disorder after traumatic brain injury. This systematic review and meta-analysis was conducted to investigate the efficacy of sertraline on the treatment of depressive disorder after traumatic brain injury.MethodsThe databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of sertraline for traumatic brain injury.ResultsThis meta-analysis included five RCTs. The initial use of sertraline was within 8 weeks after traumatic brain injury. Compared with control group for traumatic brain injury, sertraline treatment showed no significant improvement on Hamilton Depression Rating Scale (HAM-D) (standard mean difference (Std. MD) = ?0.08; 95% confidence interval (CI) = ?0.45 to 0.28; P = 0.65), anxiety score (Std. MD = 0.08; 95% CI = ?0.32 to 0.48; P = 0.69), aggression score (Std. MD = ?0.12; 95% CI = -0.56 to 0.32; P = 0.59), or quality of life (QOL) score (Std. MD = ?0.06; 95% CI = ?0.49 to 0.37; P = 0.78). There was no statistical difference of diarrhea (risk ratio (RR) = 0.85; 95% CI = 0.92 to 3.71; P = 0.08), dizziness (RR = 1.15; 95% CI = 0.57 to 2.31; P = 0.70), dry mouth (RR = 2.44; 95% CI = 0.43 to 13.89; P = 0.32), nausea or vomiting (RR = 1.17; 95% CI = 0.37 to 3.70; P = 0.79) between sertraline group and control group.ConclusionsSertraline showed no obvious benefits for the relief of depressive disorder after traumatic brain injury.     

Use of NSAIDs for the chemoprevention of colorectal cancer

OBJECTIVE: To discuss the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the chemoprevention of colorectal cancer. DATA SOURCES: A MEDLINE search (1966-May 2003) was performed to identify key literature. Search items included, but were not limited to, NSAIDs, colorectal cancer, chemoprevention, cyclooxygenase-2 (COX-2)-specific inhibitors, and familial adenomatous polyposis (FAP). STUDY SELECTION AND DATA EXTRACTION: The search included experimental (in vitro and animal models) and clinical studies evaluating the use of NSAIDs for the chemoprevention of colorectal cancer. The MEDLINE search was supplemented by references from selected articles. DATA SYNTHESIS: Numerous experimental, epidemiologic, and clinical studies suggest that NSAIDs have promise as anticancer agents. The mechanism by which NSAIDs lead to decreased colon carcinogenesis is not fully understood, but may involve restoration of apoptosis and inhibition of prostaglandin-mediated angiogenesis. Compelling evidence from many observational studies has consistently documented a 40-50% reduction in the risk of adenomatous polyps, colorectal cancer incidence, and mortality in patients using NSAIDs. Recent randomized, controlled trials have demonstrated a benefit with aspirin in reducing the rate of development of new or recurrent adenomas in high-risk patients. In addition, randomized studies using sulindac and celecoxib in patients with FAP have documented significant regression of existing adenomatous polyps. CONCLUSIONS: Inhibition of COX-2 is an example of a targeted approach to the chemoprevention of colorectal cancer. However, controversy exists about the safety, efficacy, and optimal treatment regimen of NSAIDs as long-term chemopreventive agents in the general population. Ongoing studies in high-risk patients with both selective and nonselective COX inhibitors will provide important information in the area of colorectal chemoprevention, but clinical trials' use of adenomas as surrogate markers for chemoprevention trials makes their application to the general population limited.     

Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis

Objective  To assess the efficacy of supplemental perioperative oxygenation for prevention of surgical site infection (SSI).
Data sources  Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles.
Study selection  Randomized, controlled trials evaluating efficacy of supplemental perioperative oxygenation versus standard care for prevention of SSI in patients' undergoing colorectal surgery.
Data synthesis  Data on incidence of SSI were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence interval (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I².
Results  Four randomized controlled trials met the inclusion criteria. Supplemental perioperative oxygenation resulted in a reduced incidence of SSI [RR 0.70 (95% CI 0.52–0.94), P  = 0.01], using a fixed effects model. Using the more conservative random effects model, the point estimate was similar [RR 0.74 (95% CI 0.39–1.43), P  = 0.37], but the results failed to achieve statistical significance. The I² test showed moderate heterogeneity.
Conclusions  Our analysis showed that supplemental perioperative oxygenation is beneficial in preventing SSI in patients undergoing colorectal surgery. Because of heterogeneity in study design and patient population, additional randomized trials are needed to determine whether this confers benefit in all patient populations undergoing other types of surgery. Supplemental perioperative oxygenation is a low-cost intervention that we recommend be implemented in patients undergoing colorectal surgery pending the results of further studies. Further research is needed to determine whether or not supplemental hyperoxia may cause unanticipated adverse effects.     

扩髓与不扩髓条件下髓内钉置入内固定治疗成人股骨干骨折的系统评价

背景:髓内钉扩髓与不扩髓治疗股骨干骨折仍存在争议.目的:比较扩髓与不扩髓髓内钉治疗股骨干骨折的临床效果,评价两种治疗方法的疗效差异.方法:计算机检索Cochrane图书馆(2011年第9期)、MEDLINE(1966-01/2011-09)、EMbase(1984-01/2011-09)、CNKI(1979-01/2011-09)等数据库,收集比较扩髓和不扩髓治疗股骨干骨折的随机对照试验,利用Cochrane 协作网提供的RevMan5.1.2软件对纳入研究结果进行Meta 分析,使用GRADEpro version3.2.2软件对纳入研究进行证据评级.结果与结论:纳入10个随机对照试验,共1 360例股骨干骨折患者,其中扩随组 656例,不扩髓组704例.Meta分析表明,与不扩髓髓内钉相比,扩髓髓内钉固定能降低成人股骨干骨折不愈合率(RR = 0.20,95%CI 0.07～0.82,P=0.02)、再次手术率(RR=0.25,95%CI 0.11～0.59,P=0.002)、延迟愈合率(RR = 0.30,95%CI 0.14～0.64,P=0.002)等,对于内固定失败率(RR=0.68,95% CI 0.28～1.70,P = 0.41)、病死率(RR 0.94,95% CI 0.19～4.58,P=0.94)、呼吸窘迫综合征发生率(RR 1.53,95% CI 0.37～6.32,P=0.78)差异无显著性意义.结果提示扩髓髓内钉比不扩髓髓内钉治疗成人股骨干骨折有较好的临床疗效.     

Efficacy and tolerability of frovatriptan in acute migraine treatment: systematic review of randomized controlled trials

OBJECTIVE: To evaluate the efficacy and tolerability of frovatriptan in acute migraine treatment. METHODS: Systematic review and meta-analysis of randomized controlled trials. Clinical trials of frovatriptan were systematically identified through electronic searches and historical searches up until February 2005. Studies were included if they were (i) double-blind, randomized, placebo controlled trials that evaluated frovatriptan 2.5 mg in acute migraine treatment and (ii) reporting the efficacy data in terms of pain-free, headache response, headache recurrence, or relief of migraine-associated symptoms. Two authors extracted data independently. Disagreements were resolved through discussion. The efficacy was estimated using risk ratio (RR), risk difference, and number needed to treat together with 95% confidence intervals. RESULTS: Five trials involving a total of 2,866 patients were included. Frovatriptan 2.5 mg was more effective than placebo in rendering patient pain-free (RR 3.70, 95% CI 2.59-5.29, P < 0.0001 at 2 h and 2.67, 95% CI 2.21-3.22, P < 0.0001 at 4 h post-dose). It was also superior to placebo in reducing headache severity. The pooled RR was 1.66 (95% CI 1.48-1.88, P < 0.0001) and 1.83 (95% CI 1.66-2.00, P < 0.0001), respectively, at 2 and 4 h after treatment. In those whose headache was relieved at 4 h, the risk of headache recurrence within 24 h was reduced by 26% with frovatriptan (RR 0.74, 95% CI 0.59-0.93, P = 0.009). Frovatriptan was also superior to placebo in improving symptoms associated with migraine. At 2 h after dosing, frovatriptan reduced the risk of nausea by 14% (95% CI 6-20%, P = 0.0005), photophobia 17% (95% CI 12-22%, P < 0.0001), and phonophobia 14% (95% CI 17-20%, P < 0.0001). The corresponding numbers at 4 h after dosing were 37% (95% CI 30-43%, P < 0.0001), 34% (95% CI 29-39%, P < 0.0001) and 30% (95% CI 23-36%, P < 0.0001), respectively. Frovatriptan caused more adverse events than did placebo (RR 1.31, 95% CI 1.07-1.62, P = 0.01). CONCLUSION: The available evidence suggests that frovatriptan is more effective but may cause more adverse events than placebo in the treatment of acute moderate to severe migraine. It is effective in providing pain relief and reducing the risk of recurrence. However, its effectiveness relative to other more established agents needs to be better defined by appropriate head to head trials.