清热利湿类中药复方治疗慢性前列腺炎的系统评价

目的:评价清热利湿类中药复方治疗慢性前列腺炎的疗效和安全性。方法:制定高敏感检索策略,全面检索截止2006年6月清热利湿类中药复方治疗慢性前列腺炎的临床对照研究文献,运用改良后Jadad量表评价纳入文献的方法学质量并提取有效数据进行Meta分析,用RevMan4.2软件完成统计和系统评价。结果:共44篇文献包含5746例患者符合纳入标准。3篇被评为高质量,其余为低质量。Meta分析表明,清热利湿类中药复方优于男康片(RR1.22,95%CI1.10~1.35)、舍尼通(RR1.26,95%CI1.13~1.41);亚组分析显示,该类复方优于前列康(RR1.32,95%CI1.19~1.45)、喹诺酮类抗生素(RR1.34,95%CI1.15~1.57);清热利湿中药对照α受体阻滞剂、普乐安片,以及清热利湿中药与合用喹诺酮类抗生素对照单用该类抗生素比较差异无显著性(P<0.01)。18篇文献报道了不良事件的结局,未见严重不良反应的报道。结论:清热利湿类中药复方在改善慢性前列腺炎症状或体征、生活质量、前列腺液指标等可能优于男康片、舍尼通、前列康和喹诺酮类抗生素。然而,由于现有试验的方法学质量普遍较低且该类复方使用的变异性大,目前尚无足够证据支持其治疗应用,需更多高质量的随机对照试验。     

补肾活血类中药复方治疗良性前列腺增生的系统评价

目的 :系统评价补肾活血类中药复方治疗良性前列腺增生 (BPH)的疗效和不良反应 ,以期指导临床决策。方法 :采用循证医学的方法 ,全面检索国内 1978年 1月～ 2 0 0 3年 2月中医药治疗BPH的临床研究文献 ,依据JADAD量表和试验分配的隐藏方案评价文献的质量。对纳入的文献进行资料合并的累加分析 (META分析 ) ,用Revman 4 .2软件进行统计和系统评价。　结果 :补肾活血类中药复方治疗BPH比前列康有效 (P <0 .0 0 0 0 1) ;与保列治相比疗效无差异 (P =0 .15 ) ;补肾活血类中药复方合用外科治疗与单纯外科治疗相比疗效无差异 (P =0 .0 7)。 4篇文献报道了不良反应 ,包括腹部不适、恶心腹胀、腹痛腹泻、鼻干。　结论 :应该进行大规模、多中心、随机对照的临床试验 ,并以客观指标为疗效评价标准来研究中医药治疗BPH的有效方法 ,评价药物不良反应。     

系统评价再评价在中药治疗绝经后骨质疏松症中的应用

目的 运用AMSTAR 2方法质量评分和PRISMA报告质量评分定性定量再评价中药治疗绝经后骨质疏松症的系统评价/Meta分析,以期为临床决策者提供科学的参考证据.方法 运用计算机检索国内外8大中英文数据库:中国知网(CNKI)、维普(VIP)、中国生物医学文献数据库(CBM)、万方数据库、The Cochrane L...     

中药口服治疗肾纤维化随机对照试验的系统评价

目的：系统评价中药口服治疗肾纤维化的临床疗效。方法：计算机检索The Cochrane library（2013年第10期）、Pub Med、EMbase、VIP、万方、CNKI、CBM中关于中药口服治疗慢性肾病肾纤维化的随机对照试验（RCT）,检索时限均为从建库至2014年3月。由两名研究者按照纳入和排除标准独立进行文献筛选、资料提取、质量评价并交叉核对,采用RevMan 5.2软件进行meta分析。结果：最终纳入12个RCT,共828例患者。与对照组相比,在常规西药治疗的基础上加用中药口服,可明显降低Scr与BUN含量（P〈0.05）;并可降低血清PCⅢ、Ⅳ-C、LN、HA及尿CTGF、TGF-β1等肾纤维化指标（P〈0.05）,且现有研究无不良反应报道。结论：现有证据表明,在西医常规药物的基础上加用中药口服治疗慢性肾病肾纤维化,其效果明显优于单纯常规西药治疗。常用的口服中药为补益活血化瘀类。因纳入研究存在一定的方法学问题,上述结论尚需今后开展更高质量的相关研究加以验证。     

生精胶囊治疗男性不育症安全性和有效性探讨

目的探讨生精胶囊治疗男性不育症患者的有效性和安全性。方法将在上海仁济医院男科门诊就诊的100名男性不育患者分为治疗组(70名)和对照组(30名),治疗组给予生精胶囊口服每次4片t.i.d、vitE 100mg/d、ATP 40mgb.i.d口服;对照组给予vitE 100mg/d、ATP 40mgb.i.d口服,疗程为3月。结果治疗组精子密度、活力[(a b)级]明显优于对照组(P<0.05),治疗组在随访期间3例怀孕,对照组无怀孕病例。治疗组中除2例胃部不适外,无其他副作用。结论生精胶囊治疗男性不育是有效、安全的。     

补肾类中医药治疗男性不育症随机对照试验的系统评价

目的:系统评价补肾类中医药治疗男性不育症的有效性和安全性。方法:检索中国期刊全文数据库(CNKI)、维普资源系统(VIP)以及万方数据库等,检索年限均从建库至2012年12月,收集数据库中关于补肾类中医药治疗男性不育症的随机对照试验(RCT),制定相关的文献纳入和排除标准及检索策略,并对纳入文献进行数据提取和质量评价,采用Rev Man5.2软件进行统计分析。结果:纳入20个随机对照试验,合计2 272例患者,单个研究样本量60~270例。Jadad评分所有研究得分均不超过3分,属低质量文献。Meta分析结果显示,中药与西药对照亚组总有效率的相对危险度(RR值)(95%CI)为1.71[1.19,2.47],中西医结合与西药对照亚组总有效率的相对危险度(RR值)(95%CI)为1.15[1.01,1.30]。补肾中药单独或联合西药均能提高配偶妊娠率,其疗效优于西药,且无严重不良反应。结论:由于纳入研究的方法学质量低下及异质性较大,补肾类中医药治疗男性不育症的有效性及安全性证据仍十分有限,尚需标准设计的高质量RCT研究加以证实。     

遗传性病因致男性不育的研究进展

据统计,约15%的高龄夫妇受不育症困扰[1].其中遗传性因素是导致不育的重要原因之一,大约有15%的男性不育症是由遗传性因素引起,包括染色体异常和单基因突变.估计在男性不育症患者中染色体异常占2%～8%,平均5%[2].     

中药箍围法治疗糖尿病足溃疡随机对照试验的系统评价

目的 系统评价中药箍围法治疗糖尿病足溃疡（DFU）的临床疗效与安全性。方法 计算机检索中国知网、维普中国科技期刊数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science数据库,检索时间为建库至2022年10月1日,并手工检索相关内部报告、会议论文及相关主题的灰色文献,纳入中药箍围法治疗DFU的随机对照试验（RCT）,由2名研究成员进行数据提取及质量评价,采用RevMan5.4.1软件进行Meta分析。结果 共纳入8篇文献632例患者,方法学质量评价较差。Meta分析结果显示,中药箍围法对糖尿病足创面面积和局部症状改善的总有效率高于西医外治疗法,差异有统计学意义（RR=1.14,95%CI:1.07～1.22,P<0.01）。仅1篇文献在中药箍围法干预过程中出现了创面及创周的轻度瘙痒及斑疹等过敏症状,停药后自行缓解,其他文献均未报道与中药箍围法相关的不良反应。结论 与西医外治疗法相比,中药箍围法在治疗DFU疗效与安全性方面存在优势,但因本研究系统评价纳入的研究证据强度不高、样本量小,故仍需要大样本、高质量的临床试验给予...     

男性不育基础研究的现状及可能性途径

男性不育是一种多病因引起的疾病,如各种与精子发生相关基因调控异常引起的生精功能障碍,也可以是一些与精子成熟有关基因的突变最终导致精子成熟受阻等.另外,它还与其它一些因素如精索静脉曲张、生殖管道阻塞、精囊腺发育不良、激素分泌不足、感染、重金属中毒、热环境因素、免疫因素、氧化应激等相关.     

中药溻渍法治疗糖尿病足溃疡的系统评价和Meta分析

目的 系统评价中药溻渍法应用于糖尿病足溃疡的临床疗效。方法 通过计算机系统性检索中国知网、维普、SinoMed、PubMed、the Cochrane Library、Embase等数据库中公开发表的关于中药溻渍法治疗糖尿病足溃疡临床疗效的随机对照研究,检索时限从建库至2021年3月5日,提取相关数据并评价纳入研究的偏倚风险,应用Review Manager 5.3软件进行Meta分析和系统评价。结果 共纳入16篇文献,包括1325例糖尿病足溃疡患者,其中,试验组673例,对照组652例。Meta分析结果显示,试验组患者的伤口显愈率明显高于对照组患者,差异有统计学意义（OR=0.25,95%CI:0.19～0.31,P<0.01）;有效率明显高于对照组患者,差异有统计学意义（OR=4.27,95%CI:2.94～6.22,P<0.01）;创面愈合时间明显短于对照组患者,差异有统计学意义（RR=-8.82,95%CI:-13.88～-2.56,P=0.004）;C反应蛋白水平明显低于对照组患者,差异有统计学意义（RR=-3.19,95%CI:-4.15～-2.24,P<...     

Double versus single homologous intrauterine insemination for male factor infertility: a systematic review and meta-analysis

Male factor infertility affects 30%–50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination (IUI), a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner''s sperm in couples with male factor infertility. An odds ratio (OR) of 95% confidence intervals (CIs) was calculated for the pregnancy rate. Outcomes were analysed by using the Mantel–Haesel or DerSimonian–Laird model according to the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI (OR: 2.0; 95% CI: 1.07–3.75; P<0.03). Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles (OR: 1.58; 95% CI: 0.59–4.21), but without statistical significance (P=0.20). Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence to guide current clinical practice.     

Clinical significance of subclinical varicocelectomy in male infertility: systematic review and meta‐analysis

Recent meta‐analysis by the Cochrane collaboration concluded that treatment of varicocele may improve an infertile couple's chance of pregnancy. However, there has been no consensus on the management of subclinical varicocele. Therefore, we determine the impact of varicocele treatment on semen parameters and pregnancy rate in men with subclinical varicocele. The randomised controlled trials that assessed the presence and/or treatment of subclinical varicocele were included for systematic review and meta‐analysis. Random effect model was used to calculate the weighted mean difference of semen parameters and odds ratio of pregnancy rates. Seven trials with 548 participants, 276 in subclinical varicocelectomy and 272 in no‐treatment or clomiphene citrate subjects, were included. Although there was also no statistically significant difference in pregnancy rate (OR 1.29, 95% CI 0.99–1.67), surgical treatment resulted in statistically significant improvements on forward progressive sperm motility (MD 3.94, 95% CI 1.24–6.65). However, the evidence is not enough to allow final conclusions because the quality of included studies is very low and further research is needed.     

Chinese herb formulae for treatment of erectile dysfunction: a systematic review of randomised controlled clinical trials

To assess the beneficial and adverse effects of orally therapies of Chinese herb formulae (CHF) for erectile dysfunction (ED), four electronic databases were searched until 23 June 2012. Randomised clinical trials testing CHF or combined with Western medicine therapy (WMT) against placebo, another different CHF and WMT were included. Study selection, data extraction, assessing of bias risk and data analysis were conducted according to the Cochrane handbook. Twenty‐one randomised controlled clinical trials (involving 2253 patients) were included, and the bias risks were not low. Funnel plots of comparing CHF to another CHF on the clinical comprehensive effectiveness were asymmetrical. The compositions of CHF used were greatly complex. The analyses showed that some CHF or combined with WMT had significant effects on cure rate, total clinical effective rates, IIEF‐5 scores, erectile quality scores, erection angles of penis and recovery times of erection compared with the controls. Eight trials reported mild adverse drug reactions, mostly involving gastrointestinal symptoms. It was concluded that some therapies of CHF may be more effective than the controls for treatment of ED. However, because of the generally not low risks of bias, CHF are not recommended for ED. Further research that demonstrates their mechanisms of action and meaningful efficacies must be carried out by rigorously designed, randomised controlled trials.     

Y-microdeletions: a review of the genetic basis for this common cause of male infertility

The human Y-chromosome contains genetic material responsible for normal testis development and spermatogenesis. The long arm (Yq) of the Y-chromosome has been found to be susceptible to self-recombination during spermatogenesis predisposing this area to deletions. The incidence of these deletions is estimated to be 1/4,000 in the general population but has been found to be much higher in infertile men. Currently, Y-microdeletions are the second most commonly identified genetic cause of male infertility after Klinefelter syndrome. This has led to testing for these deletions becoming standard practice in men with azoospermia and severe oligospermia. There are three commonly identified Y-microdeletions in infertile males, termed azoospermia factor (AZF) microdeletions AZFa, AZFb and AZFc. With increased understanding and investigation of this genetic basis for infertility a more comprehensive understanding of these deletions has evolved, with several other deletion subtypes being identified. Understanding the genetic basis and pathology behind these Y-microdeletions is essential for any clinician involved in reproductive medicine. In this review we discuss the genetic basis of Y-microdeletions, the various subtypes of deletions, and current technologies available for testing. Our understanding of this issue is evolving in many areas, and in this review we highlight future testing opportunities that may allow us to stratify men with Y-microdeletion associated infertility more accurately     

Music therapy and music medicine interventions with adult burn patients: A systematic review and meta-analysis

BackgroundPain is one of the most common and most difficult symptoms to manage in adult burn patients in the Intensive Care Unit (ICU). Insufficient or unsuccessful pain management can negatively affect physiological, psychological, and social health in burn patients, both during and after hospitalization. Music therapy and music medicine interventions have been shown to positively affect pain and mental health in this population. This systematic review and meta-analysis provide an update of Randomized Controlled Trials (RCTs) using music therapy or music medicine interventions in adult burn patients.MethodsA variety of databases were searched from their beginning to June 2020, including PsycINFO and PsycArticles (via APAsycNET), PubMed and MEDLINE (via OvidSP), Scopus, Web of Science, and the Cochrane Library. Data of all articles meeting the inclusion criteria were extracted, organized, and processed according to the PRISMA guidelines. Statistical analysis was performed using Q-test and I2 statistics.Results10 RCTs with a total of 1061 participants were included. The results of the meta-analysis showed a statistically significant reduction of pain (I² = 96.03%, P < 0.001), anxiety (I² = 98.85%, P < 0.002), and improved relaxation (I² = 87.19%, P < 0.001) favoring music interventions compared to control groups.ConclusionsThis review provides preliminary evidence for the effectiveness of music interventions for adult burn patients. However, more high-quality RCTs are needed to safely establish guidelines for music therapists and other health care professionals in using music for health purposes with this population.     

Efficacy and safety of acupuncture for the treatment of oligoasthenozoospermia: A systematic review

Oligoasthenozoospermia is a common factor leading to male infertility. Acupuncture has been applied for treating male infertility for several thousand years in China, but clinical evidence of its efficacy and safety in treating oligoasthenozoospermia is yet to be established. This review aimed to systematically assess the evidence on the effect of acupuncture in males with oligoasthenozoospermia. Databases (PubMed, EMBASE, SINOMED, CNKI, Wanfang database and Cochrane Library) were searched to identify related studies published before 30th June 2019. The Cochrane risk of bias tool and Jadad score was adopted to assess the methodological quality of included studies. Twelve randomised controlled trials (RCTs) with 1,088 participants were included in this review. The aim of this study was to perform a meta-analysis, but it was not possible due to considerable clinical heterogeneity among the included studies. According to the narrative analysis, acupuncture or acupuncture combined with another intervention was effective in improving the semen quality based on the included studies. However, this result should be interpreted with caution due to high risk. The methodological quality of most included studies was low. The current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a solid conclusion due to the poor methodological quality. Rigorous full-scale RCTs are needed to validate the therapeutic efficacy and safety of acupuncture in treating oligoasthenozoospermia.     

Targeted therapy for advanced renal cell cancer (RCC): a Cochrane systematic review of published randomised trials

What's known on the subject? and What does the study add? Targeted agents have greatly changed the therapeutic landscape in RCC. A substantial number of trials have been published in recent years. The current review summarises and analyses the available data to date.

OBJECTIVE

• ? To estimate the effects of drugs with molecular targets on patients with advanced renal cell cancer (RCC).

PATIENTS AND METHODS

• ? MEDLINE, EMBASE, and the Cochrane Collaboration Library were systematically searched on‐line through to June 2011 to identify eligible randomised trials. We also searched abstract reports from major oncology and urology meetings.
• ? We included randomised trials that tested a targeted agent and reported at least one outcome by allocation on an intent‐to‐treat basis. Completeness of ascertainment and risk of bias were assessed.
• ? Our primary outcome was progression‐free survival (PFS).

RESULTS

• ? In all, 28 studies met our inclusion criteria and 10 were placebo‐controlled. Two studies were too small to assess, and five early studies used nonspecific anti‐angiogenic agents with poor activity. In all, 15 studies, in 5587 patients, tested anti‐vascular epithelial growth factor (VEGF) agents: bevacizumab (BEV), sorafenib, sunitinib, pazopanib, tivozanib, or axitinib. Three studies, in 1147 patients, tested the mammalian target of rapamycin (mTOR) inhibitors, temsirolimus or everolimus. Two studies included epidermal growth factor receptor (EGFR) inhibitors, and one tested the combination of temsirolimus plus BEV.
• ? In treatment‐naive patients with mostly good–moderate prognostic risk, in separate trials oral sunitinib (one trial) and intravenous BEV plus subcutaneousinterferon‐α (two trials) improved PFS compared with the previous standard of care interferon‐α within randomised phase III trials. Sorafenib did not improve PFS over interferon‐α in the first‐line setting and the addition of cytokines did not improve sorafenib efficacy. In poor‐risk patients, the mTOR inhibitor temsirolimus improved PFS and overall survival (OS). The studies of other VEGF inhibitors have used placebo controls no longer appropriate in this setting, although pazopanib is an approved option.
• ? Several trials examined agents in the second‐line setting. After cytokine therapy, sorafenib (one study) and pazopanib (one study) prolonged PFS over placebo. A preliminary report of the investigational VEGF receptorinhibitor axitinib gave superior PFS to sorafenib after either prior cytokine or prior sunitinib treatment. After cancer progression ≤6 months of sunitinib and/or sorafenib therapy, everolimusprolonged PFS.
• ? OS was marginally improved in several studies. A more substantial effect on OS may have been diluted by crossover from control therapy to the investigational arm and/or by other anti‐angiogenic agents after trial closure. Patient‐reported outcomes were considered unreliable in trials without ‘blinding’.
• ? A clear cell RCC (ccRCC) component was required for most trials, and information for non‐ccRCCs is consequently limited

CONCLUSIONS

• ? Agents targeting VEGF and mTOR pathways improve PFS in both first‐line and second‐line settings. These treatments rarely yield complete responses and thus are not curative.
• ? No placebo‐controlled trial has reported a health‐related quality of life benefit.