Probiotics’ Preventive Effect on Pediatric Food Allergy：A Meta-analysis of Randomized Controlled Trials

Objective To investigate the preventive effect of probiotics on pediatric food allergy. Methods From MEDLINE bibliographical database, we searched and reviewed all randomized controlled trials on the preventive effects of probiotics on pediatric food allergies up to September 2013 and excluded the studies that do not meet inclusion criteria and extracted the data. Meta-analysis for the results of homogenous studies was performed using RevMan 5.0 and the co-effect was pooled by using fixed-effects model of relative risk （RR） ratios. Results Ten trials published between 2007 and 2012 including 2701 cases were included. Meta-analysis based on included data showed that the preventive effect of prenatal and postnatal probiotic supplementation on food allergies was not significant with the RR=0.88 （95% CI： 0.76-1.03）. Conclusion Present evidences cannot show in unequivocal terms that prenatal and postnatal probiotic supplementation will prevent food allergic diseases.     

急性冠脉综合征常规或选择性侵入性治疗策略：RCT Meta分析

为评价急性冠脉综合征患者常规和选择性侵入性治疗策略的利弊。Shamir R．Mehta等从MEDLINE和Cochrane数据库(1970年-2004年6月)检索涉及常规或选择性侵入性治疗急性冠脉综合征的随机对照试验，并人工检索相关文章和评论的参照，选取已公开发表且主要观察结果为入院至随访期结束的死亡率和MI发病率的者，进行了一项随机试验的：Meta分析。     

Effect of statins use on the prevention of venous thromboembolism： a meta-analysis

ObjectiveTo estimate the effect of statins use on the prevention of venous thromboembolism (VTE).MethodsWe systematically searched MEDLINE (1980-June 2012), EMBASE (1980-June 2012), Google Scholar, Cochrane Library, and ISI Web of Science, manually reviewed references, and contacted experts. Case-control studies and cohort studies that compared any dose of statin with no statin or placebo are included. Data extraction and study quality evaluation were independently conducted in duplicate.Results12 studies including four cohort studies and eight case-control studies were identified and eligible for meta-analysis. Upon meta-analysis, statin use was associated with a statistically significant reduction in the odds of developing VTE (OR 0.91, 95% CI 0.86–0.96).ConclusionThis meta-analysis of current and available literature suggests that statins can reduce patient's risk of developing VTE. Due to the limitations of observational study, this conclusion should be considered with caution, and additionally, specifical well-designed trials are needed.     

Therapeutic Effect and Safety of Ustekinumab for Plaque Psoriasis:A Meta-analysis

Objective To evaluate the efficacy and safety of ustekinumab in the therapy of plaque psoriasis. Methods Literatures published up to November 2013 were collected from Cochrane library, MEDLINE, and PubMed which were related with ustekinumab for plaque psoriasis. The efficacy was estimated using relative risk of Psoriasis Area and Severity Index （PASI） 75 response rate at the week 12 endpoint in clinical trials, and adverse effects were also analyzed. Meta-analysis was carried out by using Review Manager 5.1. Results Six randomized control trials consistent with the inclusion criteria were selected and reviewed. Ustekinumab 45 mg group and 90 mg group could get better therapeutic effect compared with the placebo group （all P〈0.00001）. Furthermore, ustekinumab 90 mg group was more effective than ustekinumab 45 mg group （P=0.01）. Adverse effects in the 6 trials were mentioned including headache, upper respiratory tract infection, nasopharyngtis, infection, serious infection, cardiovascular events, and malignant tumors. There were no statistically significant differences of these adverse effects among three groups （all P〉0.0S）, except that infection rate in ustekinumab 45 mg group was higher than the placebo group （P=0.02）. Conclusions Ustekinumab is an effective and safe therapeutic method for plaque psoriasis. However, further longer time analysis of safety is needed.     

Effect of Tumor Necrosis Factor-α Antagonism in Asthma： a Meta-analysis of the Published Literature

It remains controversial whether tumor necrosis factor(TNF)-α antagonism is effective for asthma.This meta-analysis was performed to evaluate efficacy of TNF-α antagonism in treatment of patients with asthma.MEDLINE,EMBASE,LILACS,and CINAHL databases were searched for English-language studies published through January 3,2010.Randomized-controlled trials comparing TNF-α antagonism with control therapy were selected.For each report,data were extracted in relation to the outcomes analyzed:asthma exacerbation,asthma quality of life questionnaire scores,and forced expiratory volume in 1 second.Four assessable trials were identified including 641 patients with asthma.TNF-α antagonism therapy was superior to control therapy in preventing exacerbations in asthmatics [pooled odds ratio 0.52(95% confidence interval 0.29-0.88),P=0.02];however,there was a nonsignificant reduction in asthma quality of life questionnaire scores [0.23(0 to 0.47),P=0.05],forced expiratory volume in 1 second [0.03,(-0.14 to 0.10),P=0.74] when analyzed using standardized mean differences.TNF-α antagonism was superior to control chemotherapy in terms of asthma exacerbation,but not asthma quality of life questionnaire scores or forced expiratory volume in 1 second.     

Reduced dose of Bacillus Calmette-Guérin versus full dose of Bacillus Calmette-Guérin for non-muscle-invasive bladder cancer after transurethral resection bladder tumor： a meta-analysis of randomized controlled trials

Background Bladder cancer is widely known as the most common malignant tumor in the urinary tract,with 75％-85％ of patients suffering from nonmuscle invasive bladder cancer （NMIBC）.However,the optimal dose of Bacillus Calmette-Guérin （BCG） remains controversial.The aim of this study was to compare the therapeutic efficacy of full dose （FD） with the reduced dose （RD） of BCG.Methods Randomized controlled trials （RCTs） were selected through the Cochrane Library,PubMed and Embase and were supplemented by hand searching of bibliographies.The end points include overall survival rate,recurrence rate,progression rate and side effects.Results Five RCTs that included a total of 1 473 patients （727 in the reduced dose group vs 746 in the full dose group）,with a median follow-up period from 33.5 month to 7.1 year.Disease in 80 of 687 （11.6％） patients assigned to the RD group progress to the muscular layer or distant metastasis,compared with 81 of 698 （11.6％） patients assigned to the FD group （RR=1.02; 95％ CI,0.77-1.36; P=0.89）.The incidence of recurrence at three year was reported in all five studies to be 41.1％ （299 of 727） and 36.1％ （269 of 746） in the RD and FD groups,respectively （RR=1.13; 95％ CI,1.00-1.29; P=0.05）.The 5-year survival rate was 75.9％ （502 of 662） in the RD group,and 75.8％ （510 of 673） in the FD group.In the RD group 41 of 655 （6.3％） patients and 56 of 663 （8.7％） patients in the FD group did not complete the treatment due to systemic or local side effects （RR=0.75; 95％ CI,0.51-1.10; P=0.14） Conclusions In general,the results of our study demonstrate a trend towards a reduction of the toxicity in reduced dose group without affecting the efficacy of treatment when compared with full dose.More trials with large sample size are still necessary to explore the prognosis of the patients with high risk of tumor in different dose group.     

阿维A联合中药治疗银屑病随机对照试验的Meta分析

目的:对阿维A联合中药治疗银屑病的临床研究进行系统分析,以期对其疗效作出客观、可信的评价.方法:采用Cochrane系统评价方法,计算机检索维普中文科技期刊数据库(1987～2008年)、中国知识总库(1997～2008年)和万方数据库(1997～2008年)发表的关于阿维A联合中药治疗寻常型银屑病随机对照试验,质量评价按照Cochrane系统评价员手册4.2.2版推荐的质量评价标准评价纳入研究质量,并对同质研究进行Meta分析,用比值比(OR)和95%可信区间(95%Cl)作为疗效分析统计量.结果:符合纳入标准的有7篇随机对照试验文献.结果显示:(1)阿维A联合中药治疗组疗效优于单用阿维A[OR=3.13,95%CI(1.77,5.55)]和单用中药[OR=5.09,95%CI(2.95,8.78)]的对照组.(2)单用阿维A疗效优于单用中药[OR=1.62,95%CI(1.03,2.55)].结论:阿维A联合中药治疗银屑病疗效肯定,但由于纳入试验的方法学质量较低,期待科学设计临床研究方案,进行严格的多中心、大样本的随机双肓对照试验提供高质量的科学文献.     

Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis

Background Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction （duct-to-mucosa versus invagination）, by meta-analysis and assessment of evidence quality. Methods Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials （RCTs） comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio （RR） or mean difference. Results From 321 identified abstracts, four RCTs （467 patients; duct-to-mucosa： 232; invagination： 235） were included. Pancreatic fistula rate （RR, 0.74; 95% confidence interval （C/）： 0.24-2.28; P=0.60）, mortality （RR, 1.18; 95% CI： 0.39- 3.54; P=0.77）, morbidity （RR, 0.91; 95% CI： 0.69-1.21; P=0.53）, reoperation （RR, 1.09; 95% CI： 0.54-2.22; P=-0.81） and hospital stay （mean difference, -1.78; 95% CI： -4.60-1.04; P=0.22） were similar between techniques. Conclusions Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.     

单孔与传统腹腔镜阑尾切除术治疗成人急性阑尾炎的比较：随机对照试验的Meta 分析

目的：评价单孔腹腔镜阑尾切除术( single-incision laparoscopic appendectomy,SILA)与传统腹 腔镜阑尾切除术(conventional laparoscopic appendectomy,CLA)的安全性和有效性。方法：计算机检索各数 据库中有关SILA与CLA的前瞻性随机对照试验。检索时限均为建库至2014年5月。按Cochrane系统评价员手册 对纳入文献的方法学质量进行评价后提取数据,采用RevMan5.1统计软件行Meta分析。结果：筛选后最终纳入 10项研究,共1 183例患者,其中SILA组582例,CLA组601例。Meta分析结果显示,手术中转率SILA组高于CLA 组(RR=4.38,95% CI 1.96~9.79,Z=3.59,P=0.0003),手术时间SILA组长于CLA组(RR=4.83,95% CI 1.57~8.09, Z=2.90,P=0.004),住院时间SILA组短于CLA组(WMD=−0.11,95% CI −0.21~−0.01,Z=2.02,P=0.04),术后切口外 观评分SILA组优于CLA组(WMD=0.94,95% CI 0.49~1.40,Z=4.06,P<0.001);术后并发症和术后疼痛评分两组间差 异无统计学意义(RR=1.03,95% CI 0.74~1.45,Z=0.18,P=0.86;WMD=−0.19,95% CI −0.59~0.20,Z=0.95,P=0.34)。 结论：在有条件的医院经严格选择病例,SILA是一项安全有效的手术方式,尤其适用于对切口外观有强烈要求的 病人。     

中西医结合治疗类风湿关节炎疗效的Meta分析

目的：探讨中西医结合治疗类风湿关节炎（rheumatoid arthritis,RA）的疗效,为中西医结合治疗RA方案的优化提供佐证。方法：以＂类风湿关节炎＂、＂历节＂、＂久痹＂、＂尪痹＂及＂rheumatoid arthritis＂、＂arthritis＂、＂rheumatic dis-eases＂为检索词,从重庆维普库（VIP）、中国期刊全文数据库（CNKI）、万方数据库（WANFANG）、中国生物医学期刊引文数据库（CMCI/CMCC整合版）以及MEDLINE、ScienceDirect、SpringerLink等全文数据库中检索,以中西医结合治疗RA的随机对照试验为研究对象,采用Cochrane协作网提供的最新版Revman 5.0软件进行统计分析,采用优势比作为效应合并指标。结果：共12篇文献纳入研究,治疗组和对照组的总有效人数分别为488/540（90.37%）和354/475（74.52%）。OR值为3.33,95%CI为2.32、4.76,整体效果检验Z=6.57（P〈0.000 01）。结论：中西医结合治疗RA的疗效优于单纯西药治疗,且明显减轻了单纯西药治疗的毒副作用,增强了用药的耐受性。     

Position and complications of pedicle screw insertion with or without image-navigation techniques in the thoracolumbar spine：a meta-analysis of comparative studies

Computer-navigated pedicle screw insertion is applied to the thoracic and lumbar spine to attain high insertion accuracy and a low rate of screw-related complications.However,some in vivo and in vitro studies have shown that no advantages are gained with the use of navigation techniques compared to conventional techniques.Additionally,inconsistent conclusions have been drawn in various studies due to different population characteristics and methods used to assess the accuracy of screw placement.Moreover,it is not clear whether pedicle screw insertion with navigation techniques decreases the incidence of screw-related complications.Therefore,this study was sought to perform a meta-analysis of all available prospective evidence regarding pedicle screw insertion with or without navigation techniques in human thoracic and lumbar spine.We considered in vivo comparative studies that assessed the results of pedicle screw placement with or without navigation techniques.PubMed,Ovid MEDLINE and EMBASE databases were searched.Three published randomized controlled trials（RCTs） and nine retrospective comparative studies met the inclusion criteria.These studies included a total of 732 patients in whom 4,953 screws were inserted.In conclusion,accuracy of the position of grade I,II,III and IV screws and complication rate related to pedicle screw placement were significantly increased when navigation techniques were used in comparison to conventional techniques.Future research in this area should include RCTs with well-planned methodology to limit bias and report on validated,patient-based outcome measures.     

中医药治疗帕金森病疗效系统评价

目的:系统评价中药联合帕金森病基础西药与西药比较以及单纯中药疗法与西药比较治疗帕金森病的有效性与安全性。方法:通过检索Cochrane Database、EMbase、PubMed、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数据库,全面收集中药联合帕金森病基础西药以及单纯中药疗法治疗帕金森病的中英文随机对照试验(RCT),检索时限截至2012年12月。由2名评价者独立评价并交叉核对纳入研究质量后,对同质研究采用RevMan 5.0.20软件进行Meta分析。结果:共纳入17项随机对照试验(RCT)研究,包括1461例患者,Meta分析结果显示:(1)UPDRS评分变化:13项研究在治疗末应用UPDRS进行评分,UPDRS总分[WMD=5.95,95%CI(4.37~7.42)]、UPDRS II[WMD=2.13,95%CI(1.62~2.64)]、UPDRS III[WMD=1.95,95%CI(0.81~2.42)]和UPDRS IV[WMD=0.64,95%CI(0.32~0.97)]分值相对于基线评分,中药联合帕金森病基础西药组均较对照组明显下降,两组之间差别有统计学意义;4项研究评价单纯中药疗法,治疗末应用UPDRS量表总分和UPDRSⅢ进行评分,中药治疗组与西药组比较在总体疗效、运动症状改善方面,差异无统计学意义。(2)治疗有效率:4项研究采用UPDRS减分率计算有效率的Meta分析结果显示,中药联合帕金森病基础西药组治疗有效率优于对照组[RR=1.52,95%CI(1.28~1.82)]。2个研究采用UPDRS减分率计算有效率的Meta分析结果显示,中药组与西药组的治疗有效率比较,差异无统计学意义[RR=1.01,95%CI(0.86~1.18)]。(3)不良反应:共7个试验报道了药品不良事件,无严重不良事件发生。结论:中医药治疗帕金森病安全、有效。中药联合帕金森病基础西药可能优于单用西药;对于早期帕金森病患者,采用单纯中药治疗与西药(美多巴)疗效相当。但因纳入文献数量有限且部分研究质量较低,上述结论需更多高质量的RCT研究进一步证实。     

HBV X-gene： A new serum marker for anti-HBV therapy monitoring

Objective： To address HBV serum nucleic acid markers for stages without apparent replica- tion. Methods： DNA and RNA sequence segments from the X, C and pre C/C regions produced succes- sively during replication were used as targets for quantitative PCR and RT/PCR. Results： The assays con- firmed the preferential formation of intermediates blocked at early stages. They persisted as the only de- tectable type of serum HBV DNA even after one year of therapy. At reentry into viral replication due to e- mergence of drug resistant mutants, lamivudine resistance produced exclusively incomplete DNA minus strands, whereas the wild type virus immediately synthesized complete DNA minus strands. Conclusion.. PCR assays used for monitoring complete suppression of HBV replication must target the X gene region.     

溃疡性结肠炎的循证治疗

目的 借助于循证医学的方法为溃疡性结肠炎患者选择药物治疗提供依据,并确定治疗目标及治疗方案.方法 在充分评估病人的情况后,提出临床问题,从Cochrane Library、PubMed、http://sumsearchuthscsa.edu/searchform4.htm、万方数据库检索相关证据,检索时间为2000-2...     

两种剂量福美司坦治疗晚期乳腺癌系统评价Meta分析

目的:评估两种剂量福美司坦治疗晚期乳腺癌的有效性和安全性。方法:计算机检索Springer、Pubmed、中国生物医学文献数据库、万方数据库、中国知网数据库和维普中文期刊数据库,进行检索。所有数据库检索时间截止到2013年5月。根据Cochrane 4.2.6系统评价干预手册,并使用Cochrane协作网RevMan5.2软件进行Meta分析。结果:此次研究检索到符合纳入标准的英文文献3篇(329例患者)。文献质量评价结果2篇为B级外,1篇为C级,文献质量偏低。Meta分析结果显示:500mg FOR可以有效治疗晚期乳腺癌(P=0.009);也可以有效的治疗晚期乳腺癌软组织疼痛(P=0.006),骨骼疼痛(P=0.02)和肺脏组织疼痛(P=0.0005),与250mg FOR相比有统计学意义。结论:500mg FOR与250mg FOR相比,可以有效的提高晚期乳腺癌病人的治疗率,对晚期乳腺癌软组织疼痛、骨骼疼痛和肺脏疼痛也有很好的疗效。因为试验的方法学质量普遍较低,需要更多设计合理、严格执行的大样本随机双盲对照试验来提供高质量的证据,为FOR治疗晚期乳腺癌有效治疗提供依据与指导。     

痛风及高尿酸血症的循证治疗

在痛风急性期的治疗药物中，秋水仙碱、NSAIDS、糖皮质激素以及Etroricoxib四种药物，都有A级证据证明其安全有效性，但尚缺乏大型临床试验比较秋水仙碱、NSAIDS、糖皮质激素以及Etrorlcoxib四种药物。在痛风缓解期的治疗药物中，Febuxostat及维生素C均有A级证据证明其安全有效性，而苯溴马龙、别嘌醇及氯沙坦的安全有效性需要大型临床试验提供更有力的证据。     

早期胃癌患者的循证治疗

目的借助循证医学的方法为1例早期胃癌患者确定治疗目标及治疗方案。方法在充分评估患者情况后,提出临床问题,从Cochrane图书馆（网络版2000-2009年）、PubMed和EMBASE（2000-2009年）上进行检索。检索的主题词为：stomach cancer,early cancer,therapy,preoperative treatment,postoperative treatment,lymph node metastasis,invasive therapeutic technique,postoperative complication,postoperative hemorrhage,metaanalysis,systematic review,randomized controlled trial（RCT）,practice guideline。结果共检出与不同问题相关的指南、系统评价或Meta分析14篇,随机对照试验5篇,非随机对照研究7篇。通过对检索结果进行分析,结合患者意愿,为患者制定了合理的治疗方案。结论采用循证治疗的方法,为1位诊断为早期胃癌患者确定合理的治疗方案,可以有效提高治疗效果,提高患者生存质量。     

手术与保守治疗急性闭合性跟腱断裂的Meta分析

目的对手术与保守治疗急性闭合性跟腱断裂的疗效进行系统评价。方法计算机检索MEDLINE(1966年至2012年3月)、EMBASE(1966年至2012年3月)、Cochrane图书馆(2012年1月)及中国生物医学文献数据库(1979年至2011年12月),并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,按照Cochrane协作网推荐的方法对跟腱断裂治疗后的再断裂率、并发症发生率及伤口感染率进行评价。结果分析显示:(1)再断裂率:开放手术显著低于保守治疗,开放手术与经皮缝合差异无统计学意义,术后石膏固定与术后功能治疗差异无统计学意义,保守石膏固定与保守功能治疗差异无统计学意义。(2)并发症发生率:保守治疗与经皮缝合显著低于开放手术,术后功能治疗显著低于术后石膏固定,保守石膏固定与保守功能治疗差异无统计学意义。(3)伤口感染率:保守治疗与经皮缝合显著低于开放手术,术后石膏固定与术后功能治疗差异无统计学意义。结论开放手术再断裂发生率低于保守治疗,但并发症发生率和伤口感染率高于经皮缝合与保守治疗。术后功能治疗的并发症发生率显著低于术后石膏固定。但因研究质量的局限性,经皮手术与保守治疗的关系有待进一步研究。     

蟾酥制剂辅助治疗肿瘤的疗效及安全性系统综述和Meta分析

目的：系统评价肿瘤患者进行化疗或放疗时,采用蟾酥制剂进行辅助治疗的有效性和安全性。方法：采取Cochrane系统综述方法,检索Cochrane图书馆及其对照试验注册资料库（CENTRAL）、PubMed、Nature、EMbase、CNKI、万方数据库、VIP以及手工检索《中华肿瘤杂志》等。按照纳入排除标准选择文献、提取资料和进行质量评价后,采用Cochrane协作网提供的RevMan5．0．24软件进行Meta分析。结果：共纳入6篇研究文献,包括369例患者（治疗组192例,对照组177例）。Meta分析结果表明：蟾酥制剂中的有效成分对肿瘤患者KPS功能状态评分增加率影响的效应统计量风险比（riskratio,RR）及其95％可信区间（cI）为1．92[1．29,2．85]、临床证候改善率影响的效应统计量RR及其5％CI为1．43[1．08,1．89],放化疗毒性作用影响的效应统计量RR及其95％CI为0．35[0．24,0．52],上述各指标比较,差异均有统计学意义。但肿瘤患者的疾病缓解率影响的效应统计量RR及其95％CI为1．25[0．97,1．63],此差异无统计学意义。治疗期间,该药调整了抑制性和辅助性T淋巴细胞使趋向合理比例,并提高了NK细胞活性、免疫球蛋白及补体等指标,以上次要指标的差异均有统计学意义。该药物相关不良反应报道较少,仅存在2例心律失常及1例皮疹,且两者皆无统计学意义。结论：蟾酥制剂作为辅助治疗肿瘤的药物,对提高患者KPS功能状态评分增加率、改善临床证候、减轻化疗放疗毒性、增强机体免疫功能具有一定效果,但鉴于纳入研究样本量小且质量受限,上述结论尚需更多高质量的研究来加以证实。     

Meta analysis of non-penetrating trabecular surgery versus trabeculectomy for the treatment of open angle glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration’s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P<0.00001). There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92, P<0.00001). Difference in the success rate was also found between the two surgeries (Z=3.82, P=0.0001). It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.