A systematic review and meta-analysis of immune-mediated liver dysfunction in non-small cell lung cancer

BackgroundImmune checkpoint inhibitors (ICIs) have been identified as validated medications in non-small cell lung cancer (NSCLC). However, they are often associated with immune-related adverse events (irAEs) including liver dysfunction. Therefore, we conducted a systematic review of the literature and performed a meta-analysis to ascertain overall incidence and risk of immune mediated liver dysfunction in NSCLC patients.MethodsPubMed, the Cochrane Library, Embase and ClinicalTrials.gov (http://clinicaltrials.gov/) were searched from inception to December 2019. Studies regarding all grade (1–5), high grade (3–5) hepatitis and ALT or AST elevation were included.ResultsA total of 11 clinical trials including 7086 patients were selected for further assessment. The overall incidence of ALT elevation, AST elevation and hepatitis for the application of ICIs was 6.18%, 4.99% and 1.09%, respectively. Compared with chemotherapy group, treatment with ICIs had a significantly higher risk of all grade (RR: 7.27, p = 0.001) and high grade (RR: 6.70, p = 0.003) hepatitis. When ICIs combined with chemotherapy, the relative risk of all grade hepatitis was higher than monotherapy group (RR: 7.89, p = 0.044 vs RR: 6.94, p = 0.008).ConclusionThe application of ICIs could result in a higher incidence and relative risk of all grade immune-induced liver dysfunction. Moreover, immunotherapy combined with chemotherapy may also increase relative risk of all grade hepatic AEs when compared with monotherapy. Prompt recognition and proper administration is required for clinicians to prevent potentially hepatic deterioration.     

Broncho-Vaxom in pediatric recurrent respiratory tract infections: A systematic review and meta-analysis

ObjectivesAssess the efficacy and safety of Broncho-Vaxom in pediatric recurrent respiratory tract infections (RRTIs).MethodsPublished randomized controlled trials (RCTs) of Broncho-Vaxom for pediatric RRTI were searched using PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang Data, and VIP databases up to January 2017. Risk of bias was evaluated in accordance to the guidelines of the Cochrane collaboration and the level of evidence was graded according to the GRADE.Results53 RCTs involving 4851 pediatric patients were included in this meta-analysis. It showed that Broncho-Vaxom was positively correlated with a reduction in the frequency of respiratory infection [MD = − 2.33, 95% CI (− 2.75, − 1.90), P < 0.00001] compared to the control group. The Broncho-Vaxom group was more effective than control groups in relation to the duration of antibiotics course, infections, fever, cough, and wheezing, increasing serum immunoglobulin levels (IgG, IgA or IgM), and T-lymphocytes subtype (CD3 +, CD4 +, or CD8 +). However, Broncho-Vaxom had higher adverse event rates [RR = 1.39, 95% CI (1.02, 1.88), P = 0.04]; these were not serious and did not influence the treatment course.ConclusionBroncho-Vaxom shows a good efficacy for pediatric RRTIs on the basis of routine therapy (e.g. anti-infection and antiviral therapy). However, the level of evidence was low and more international multicenter clinical trials are needed to explore the efficacy and safety of Broncho-Vaxom.     

Privigen® has similar pharmacokinetic properties in primary and secondary immune deficiency

PurposePrimary (PID) and secondary immune deficiencies (SID) represent diverse groups of diagnoses, yet both can be effectively treated with intravenous immunoglobulin (IVIG) replacement therapy. Guidelines for the use of IVIG in SID vary due to the paucity of data. The objective was to analyze available IVIG Privigen® (IgPro10, CSL Behring, Bern, Switzerland) data on Efficiency Index (EI) and pharmacokinetic (PK) parameters in patients with PID and SID.MethodsThree Privigen® studies (NCT00168025, NCT00322556, and the observational study IgPro10_5001) were used to identify patients with PID and SID meeting the qualifying criteria for the PK analysis. PK properties of IVIG were estimated using a population PK model based on a standard two-compartment PK model. Immunoglobulin G (IgG) EI was calculated as the gain in serum IgG level per unit external IgG dose.ResultsA similar IVIG dose-serum IgG concentration relationship was observed in patients with PID (N = 90) and SID (N = 91). IgG EI was inversely proportional to the endogenous IgG concentration and comparable in PID (slope = −1.079) and SID (slope = −2.12).ConclusionsThese findings indicate that the disposition of Privigen® is similar during IgG replacement therapy in PID and SID. The results contribute to the understanding of IVIG treatment of SID and may support an evidence-based approach for the use of IVIG in SID in the future.     

不同随访时间下细菌溶解产物胶囊预防儿童反复呼吸道感染的系统评价

目的 评估不同随访时间下细菌溶解产物胶囊预防儿童反复呼吸道感染（RRTIs），力求还原该药在RRTIs中的真实循证证据。方法 检索PubMed、the Cochrane Library、中国学术期刊全文数据库（CNKI）、万方数据库（Wanfang Data）、中国生物医学数据库（CBM）、维普全文数据库（VIP）等数据库，搜索细菌溶解产物胶囊预防儿童RRTIs的临床随机对照试验（RCT），检索时间为各数据库建库起至2021年8月。采用Cochrane协作网研发的偏倚风险评估工具评价文献质量，采用RevMan 5.3软件进行Meta分析。将研究中的呼吸道感染次数纳入主要结局指标，包括血清免疫球蛋白水平、抗菌药物使用时间、不良反应发生率等9项作为次要结局指标。结果 共纳入22项RCTs、包括2 421例患儿，其中实验组1 177例、对照组1 244例，均为服用1个疗程细菌溶解产物。结果表明，细菌溶解产物胶囊的使用与呼吸道感染的频率降低显著相关［SMD=-1.76，95% CI（-2.00，-1.52），P＜0.000 1］，但组间异质性明显，其中观察时间窗为3个月时［SMD=-2.35，95% CI（-2.72，-1.98），P＜0.000 1］，6个月时［SMD=-1.42，95% CI（-1.66，-1.18），P＜0.000 1］，12个月时［SMD=-2.39，95% CI（-2.74，-2.03），P＜0.000 1］；与抗菌药物使用天数、发热天数、咳嗽天数、喘息天数的减少呈正相关；与IgG、IgA水平的增加呈正相关，有统计学意义；与IgM水平的升高相关性不明显；不良反应发生率无明显差异。结论 细菌溶解产物胶囊的使用能够使患儿呼吸道感染次数降低，其差异主要来源于不同观察时间窗；且每个时间窗内获益可能不同，3个月时效果较为明显；远期来看，该药物对症状的控制有效，且安全性好。     

枣仁安神胶囊对比苯二氮类治疗失眠症的Meta-分析

目的 系统评价枣仁安神胶囊与苯二氮类药物对失眠症的临床疗效及安全性。方法 检索Pubmed、the Cochrane Library、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）和万方数据库中关于枣仁安神胶囊治疗失眠症的研究,检索时间自建库至2019年12月。根据纳入排除标准筛选出符合条件的随机对照试验（RCTs）,采用RevMan 5.0及Stata 12.0软件进行Meta-分析。结果 共纳入13篇RCTs,共计1 169例。Meta-分析结果显示枣仁安神胶囊与苯二氮类药物治疗失眠症的临床总有效率组间差异不具有统计学意义［RR=1.01,95%CI（0.96,1.07）,P=0.669］;枣仁安神胶囊相比于苯二氮类药物可显著降低失眠症患者不良反应的发生风险,差异具有统计学意义［RR=0.19,95%CI（0.14,0.25）,P=0.000］。结论 应用枣仁安神胶囊与苯二氮类药物治疗失眠症的临床疗效相似,而枣仁安神胶囊可明显降低不良反应的发生风险。     

万古霉素静脉滴注联用鞘内注射治疗颅内感染的Meta分析

目的 评价万古霉素静脉滴注联用鞘内注射治疗颅内感染的有效性和安全性。方法 检索2000年1月-2017年5月PubMed、中国知网（CNKI）、万方数据库、维普全文数据库（VIP）中的数据,收集万古霉素静脉滴注联用鞘内注射治疗颅内感染的临床随机对照研究（RCT）,采用RevMan 5.2软件进行Meta分析。结果 共纳入9项RCTs,469例患者。Meta分析结果显示：相对于万古霉素静脉滴注,联用鞘内注射能显著提高临床治愈率[RR=0.70,95%CI（0.61,0.81）,P < 0.001]和耐甲氧西林金黄色葡萄球菌清除率[RR=0.90,95%CI（0.81,1.00）,P=0.04],缩短治愈时间[SMD=3.26,95%CI（2.84,3.68）,P < 0.001];两组不良反应发生率无统计学差异[RR=0.73,95%CI（0.35,1.49）,P=0.38],但中枢神经根刺激症发生率较大[RR=0.05,95%CI（0.00,0.92）,P=0.04]。结论 万古霉素静脉滴注联用鞘内注射治疗颅内感染疗效确切,安全性好。     

The protective effects of silymarin nanoemulsion on 5-fluorouracil-induced gastrointestinal toxicity in rats

5-Fluorouracil (5FUra) is the third most popular chemotherapeutic component employed to treat solid tumors. In the present study, we aimed to appraise the silymarin (SM) and silymarin nanoemulsion (SMN) effect on 5FUra-induced gastrointestinal toxicity in adult male rats. A total of 30 male Wistar rats were divided into 6 groups including the control (Crl) group, and groups treated with SMN (5 mg.kg⁻¹), SM (5 mg.kg⁻¹), 5FUra + SMN (5 mg.kg⁻¹), and 5FUra + SM (5 mg.kg⁻¹) by IP injection for 14 days. And gastrointestinal toxicity was induced by a single intraperitoneal (IP) injection of 5FUra (100 mg.kg⁻¹) for the last group in the study. Treating rats with SM and SMN diminished elevating malondialdehyde (MDA) levels, and improved total antioxidant capacity (TAC) levels. Also, the intensity of mRNA expression of interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-α) caused by 5FUra in the gastrointestinal tissue tract, and macroscopic oral ulcerations decreased, ass well as weight loss was prevented, particularly in the SMN group. Moreover, in the microscopic scope, there were significant improvements in the levels of hyperemia, hyaline, and inflammatory cell infiltration in the tongue, esophagus, and intestinal tissues in the FUra + SMN and FUra + SM groups compared to 5FUra. Hence, treatment with SM and SMN reduced oxidative stress, histopathological degeneration, and gene expression of inflammatory markers in the gastrointestinal tract. According to the results, treatment with SM and SMN markedly decreases the gastrointestinal toxicity caused by 5FUra.     

益生菌制剂对儿童反复呼吸道感染的疗效和免疫功能影响的系统评价

目的 系统评价益生菌制剂防治儿童反复呼吸道感染（RRTIs）的有效性和安全性,为临床提供循证参考。方法计算机检索PubMed、EMBase、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）和万方数据库,收集益生菌制剂（试验组）防治儿童RRTIs的随机对照试验（RCT）,检索时限均为建库起至2019年3月。提取资料,用Rev Man 5.3软件进行Meta-分析。结果 共纳入12项研究,878例患者。Meta-分析结果显示,试验组在总有效率［RR=1.31,95%CI（1.22,1.41）,P<0.001］、抗菌药用药时间［MD=-4.42,95%CI（-5.92,-2.91）,P<0.001］、年呼吸道感染次数［MD=-2.30,95%CI（-2.70,-1.89）,P<0.001］、临床体征改善时间均优于对照组（P<0.05）;免疫球蛋白IgG ［MD=1.80,95%CI （1.60,2.01）,P<0.001］、IgA ［MD=0.37,95%CI（0.23,0.51）,P<0.001］、IgM［MD=0.06,95%CI（0.02,0.09）,P=0.002］,T淋巴细胞亚群CD3+［MD=4.48,95%CI（1.48,7.49）,P=0.03］、CD4⁺［MD=3.17,95%CI（1.01,5.55）,P=0.009］和CD8⁺［MD=-4.44,95%CI（-6.52,-2.36）,P<0.05］改善情况均显著优于对照组,差异均有统计学意义（P<0.05）。结论 益生菌可有效治疗儿童反复呼吸道感染,安全性较好。但由于纳入研究数量少,研究质量不统一,尚需要大样本、高质量的临床随机对照研究予以证实。     

Efficacy and safety of lorcaserin in obesity: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Background: Lorcaserin is a novel, selective 5-hydroxytryptamine 2C serotonin receptor agonist, approved for the treatment of obesity. Several phase 3 randomized controlled trials (RCTs) trials have shown a significant reduction in body weight with lorcaserin.

Research design and methods: We systematically searched the database of PubMed, Embase, The Cochrane Library and ClinicalTrials.gov up to 31 July 2019 and retrieved all the studies conducted with lorcaserin for ≥1 year that have explicitly reported the efficacy and safety outcomes versus placebo. Subsequently, we studied the effect of lorcaserin on weight reduction, FDA-defined valvulopathy, depression and suicidal risks in RCTs.

Results: The meta-analysis of four RCTs (N = 16,856) demonstrated a significant decrease in body weight (mean ? ?3.076 Kg; 95% CI, ?3.49 to ?2.66; P < 0.00001), compared to placebo. No significant difference in FDA-defined valvulopathy (RR 1.20; 95% CI, 0.89 to 1.63; P = 0.24), depression (RR 1.07; 95% CI, 0.80 to 1.43; P = 0.67) or suicidal risk (RR 1.43; 95% CI, 0.96 to 2.15; P = 0.08) has been observed with lorcaserin compared to placebo.

Conclusions: Lorcaserin reduces body weight modestly, with no obvious serious adverse side effects. The common adverse events noted with lorcaserin include nausea, dizziness, and transient headache.     

艾司氯胺酮鼻腔喷雾剂辅助治疗难治性抑郁症安全性meta分析

目的 采用meta分析全面了解艾司氯胺酮鼻腔喷雾剂辅助治疗难治性抑郁症的安全性。方法 搜索艾司氯胺酮鼻腔喷雾剂+口服抗抑郁药的随机对照试验,并进行meta分析。结果 最终5个随机对照试验,1 019例患者纳入研究。与对照组比较,试验组出现了更多的解离症状（RR=6.35,95% CI,2.84~14.23,P<0.000 01）、镇静（RR=5.47,95% CI,2.05~14.57,P=0.000 7）、嗜睡（RR=2.66,95% CI,1.30~5.44,P=0.007）、头痛（RR=1.38,95% CI,1.05~1.83,P=0.02）、眩晕（RR=5.87,95% CI,3.30~69.79,P<0.000 01）、头晕（RR=2.98,95% CI,1.33~6.68,P=0.008）、感觉迟钝（RR=10.25,95% CI,3.65~28.83,P<0.000 1）、焦虑（RR=2.01,95% CI,1.20~3.37,P=0.008）、感觉异常（RR=6.62,95% CI,2.75~15.98,P<0.000 1）、恶心（RR=4.05,95% CI,2.71~6.05,P<0.000 01）、味觉异常（RR=1.81,95% CI,1.35~2.42,P<0.000 1）。亚组分析显示,与对照组比较,艾司氯胺酮鼻腔喷雾剂28 mg组不良反应没有统计学意义;除了嗜睡、头痛、味觉异常以外,56,84 mg 2个亚组的不良反应有统计学意义。结论 艾司氯胺酮鼻腔喷雾剂辅助治疗会增加患者不良反应,但是不良反应轻微。     

Comparison of common side effects from mood stabilizers and antipsychotics between pediatric and adult patients with bipolar disorder: a systematic review of randomized,double-blind,placebo-controlled trials

Introduction: To compare common side effects of mood stabilizers (MSs) and antipsychotics in pediatric and adult bipolar disorder (BD).

Area covered: MEDLINE, EMBASE, PsycINFO was searched for randomized, double-blind, placebo-controlled trials (RCTs) in the treatment of pediatric and adult BD. Twelve RCTs for pediatric patients and 30 for adult patients were included. The risk for the discontinuation due to adverse events, ≥7% weight gain, somnolence, akathisia, nausea and vomiting from a medication relative to placebo was estimated with absolute risk increase and the number needed to harm. The relative risk of these measures in pediatric and adult patients was compared.

Expert opinion: Overall, the relative risk for ≥7% weight gain, somnolence, nausea, or vomiting was higher, and akathisia was lower in pediatric patients than in adults. The magnitude of difference among MSs and antipsychotics and between pediatrics and adults varied widely. The risk for pediatric patients could be underestimated because in most pediatric studies, doses of studied medications were lower and flexibly dosed, and titration speeds were slower than in adult studies. Clinicians should pay attention to differences in study designs to understand the risk for common side effects when prescribing a medication for BD.     

Aidi injection as adjunctive treatment to gemcitabine-based chemotherapy for advanced non-small cell lung cancer: a systematic review and meta-analysis

ContextAidi injection is one of the most commonly use antitumor Chinese medicine injections for advanced non-small cell lung cancer (NSCLC). It is made from the extraction of Astragalus, Eleutherococcus senticosus, Ginseng, and Cantharis.ObjectiveTo evaluate the efficacy and safety of Aidi injection in combination with gemcitabine-based chemotherapy (GBC) for advanced NSCLC.Materials and methodsPubMed, Embase, Cochrane Library, Chinese Biological Medicine, China National Knowledge Infrastructure, Wanfang, and VIP were searched for relevant randomised controlled trials (RCTs) comparing Aidi injection plus GBC treatment with GBC alone in NSCLC, from inception up to October 2020. The primary outcomes were objective response rate (ORR), and disease control rate (DCR). Secondary outcomes were quality of life (QOL) and adverse drug reactions (ADRs). The quality of evidence was rated using the GRADE approach. This study was registered with PROSPERO: CRD42021221225.ResultsIn total, 54 RCTs involving 4318 NSCLC patients were included in this meta-analysis. Compared with GBC alone, Aidi injection plus GBC significantly improve ORR (risk ratios [RR] = 1.38, 95% confidence interval [CI] 1.29–1.48), DCR (RR = 1.15, 95% CI 1.12–1.19), QOL (RR = 1.71, 95% CI 1.54–1.89), and reduced the risk of gastrointestinal toxicity, thrombocytopenia, neutropenia, liver injury, renal injury, and anaemia. The evaluation results of the evidence ranged from moderate to low.ConclusionsCurrent moderate evidence revealed that Aidi injection as an adjunctive treatment to GBC was associated with superior benefits in patients with advanced NSCLC and alleviate toxicities. High-quality RCTs are needed to further confirm the results.     

Efficiency and safety of desloratadine in combination with compound glycyrrhizin in the treatment of chronic urticaria: a meta-analysis and systematic review of randomised controlled trials

ContextDesloratadine, an H1 receptor antagonist, is suggested as an effective first-line drug for chronic urticarial (CU). However, the efficacy of desloratadine alone is limited, and the recurrence rate of CU is relatively high.ObjectiveWe sought to evaluate the efficacy and clinical feasibility of desloratadine in combination with compound glycyrrhizin in the treatment of CU.Materials and methodsA systematic literature search was conducted in the databases of the China National Knowledge Infrastructure Database, VIP, WanFang, PubMed, and Web of Science using subject terms: “Chronic urticaria”, “Loratadine”, and “Compound glycyrrhizin”. Randomised controlled trials (RCTs) that compared the efficiency and safety of the combination treatment with desloratadine alone starting from January 1, 2014 until February 10, 2021 were selected by two co-first authors independently, and the extracted data were analysed using Rev Man 5.3 software.ResultsFourteen RCTs were included in our meta-analysis with a total of 1501 patients. The results showed that the combination treatment yielded a better treatment effect (total response rate: RR = 1.23, 95% CI: 1.17 to 1.29, p < 0.00001; cure rate: RR = 1.50, 95% CI: 1.30 to 1.73, p < 0.00001), lower recurrence rate as well as superior immune improvement than the treatment with desloratadine alone. In addition, there was no significant difference in the safety of the two treatments.Discussion and ConclusionThe combination of desloratadine and compound glycyrrhizin is a promising treatment for CU and is associated with decreased serum IgE level and improved proportions of CD4+ T and CD8+ T cells.     

异甘草酸镁治疗抗结核药致肝损害疗效和安全性的Meta-分析

目的 系统评价异甘草酸镁治疗抗结核药物所致肝损害的疗效和安全性。方法 检索PubMed、EMbase、Cochrane图书馆、Medline、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库和维普数据库,收集国内外关于异甘草酸镁治疗抗结核药致肝损害的临床随机对照研究（RCTs）,评价纳入研究的质量并提取数据,使用RevMan 5.3软件进行Meta-分析。结果 共纳入14篇RCTs,包括1 202名抗结核药致肝损害患者。Meta-分析结果显示：异甘草酸镁在治疗抗结核药致肝损害总有效率[RR=1.38,95% CI （1.24,1.54）,P<0.000 01]、降低丙氨酸氨基转移酶（ALT）[MD=-25.98,95% CI （-34.68,-17.29）,P<0.000 01]、天冬氨酸氨基转移酶（AST）[MD=-20.21,95% CI （-24.49,-15.93）,P<0.000 01]、总胆红素（TB）[MD=-9.92,95% CI （-16.41,-3.43）,P=0.003]、碱性磷酸酶（ALP）[MD=-13.91,95% CI （-26.03,-1.79）,P=0.02]方面均优于对照组,差异有统计学意义,同时不良反应发生率低于对照组[RR=0.51,95% CI （0.27,0.96）,P=0.04]。结论 异甘草酸镁治疗抗结核药致肝损害临床疗效较好,可显著降低患者血清ALT、AST、TB和ALP水平,同时具有较高安全性,但本研究纳入文献多为较低质量的小样本研究,尚需更多高质量、大样本的随机对照试验进一步支持。     

Pharmacotherapy for acute migraines in children and adolescents

Introduction: Migraine is increasingly recognized as an extremely burdensome and disabling disorder in both children and adolescents. A proper treatment plan is needed to improve the quality of life of both children and families as well as to minimize the risk of disease progression.

Areas covered: This review focuses on the current pharmacotherapy for acute migraine in pediatric populations, taking into account specific considerations for those drugs tested in randomized, placebo-controlled trials (RCTs).

Expert opinion: A large number of RCTs have documented the efficacy, tolerability, and safety of different compounds. Triptans appears more effective than placebo but results are variable and inconsistent. Almotriptan and rizatriptan are effective as oral formulations, as well as sumatriptan and zolmitriptan as both oral and nasal spray formulations. Adding non-steroidal anti-inflammatory drugs (NSAIDs) reinforces triptan’s effectiveness. Furthermore, small RCTs have documented both the efficacy of ibuprofen and the ineffectiveness of acetaminophen. Naproxen, ketoprofen, diclofenac, and indomethacin – NSAIDs effective in acute migraines in adults – should be tested also in pediatric subjects. Furthermore, the authors suggest that dopamine receptor antagonists should be considered in cases of severe migraines. Lastly, better designed RCTs are needed to fine-tune current therapeutic resources.     

Treatment sequence network meta-analysis in Crohn’s disease: a methodological case study

Objective: Several biologic therapies are available for the treatment of mild-to-moderate Crohn’s disease (CD). This network meta-analysis (NMA) aimed to assess the comparative efficacy of ustekinumab, adalimumab, vedolizumab and infliximab in the maintenance of clinical response and remission after 1?year of treatment.

Methods: A systematic literature search was performed to identify relevant randomized controlled trials (RCTs). Key outcomes of interest were clinical response (CD activity index [CDAI] reduction of 100 points; CDAI-100) and remission (CDAI score under 150 points; CDAI < 150). A treatment sequence Bayesian NMA was conducted to account for the re-randomization of patients based on different clinical definitions, the lack of similarity of the common comparator for each trial and the full treatment pathway from the induction phase onwards.

Results: Thirteen RCTs were identified. Ustekinumab 90?mg q8w was associated with statistically significant improvement in clinical response relative to placebo and vedolizumab 300?mg. For clinical remission, ustekinumab 90?mg q8w was associated with statistically significant improvement relative to placebo and vedolizumab 300?mg q8w. Findings from sub-population analyses had similar results but were not statistically significant.

Conclusions: The NMA suggest that ustekinumab is associated with the highest likelihood of reaching response or remission at 1?year compared with placebo, adalimumab and vedolizumab. Results should be interpreted with caution because this is a novel methodology; however, the treatment sequence analysis may be the most methodologically sound analysis to derive estimates of comparative efficacy in CD in the absence of head-to-head evidence.     

Emotion regulation difficulties and social control correlates of smoking among pregnant women trying to quit

Approximately 15% of US women currently smoke during pregnancy. An important step toward providing effective smoking cessation interventions during pregnancy is to identify individuals who are more likely to encounter difficulty quitting. Pregnant smokers frequently report smoking in response to intrapersonal factors (e.g., negative emotions), but successful cessation attempts can also be influenced by interpersonal factors (i.e., influence from close others). This study examined the association between emotion regulation difficulties, positive and negative social control (e.g., encouragement, criticism), and smoking cessation-related variables (i.e., smoking quantity, withdrawal symptoms) among pregnant smokers. Data were drawn from the pretreatment wave of a smoking cessation trial enrolling low-income pregnant women who self-reported smoking in response to negative affect (N = 73). Greater emotion regulation difficulties were related to greater smoking urges (b = 0.295, p = .042) and withdrawal symptoms (b = 0.085, p = .003). Additionally, more negative social control from close others was related to fewer smoking days (b = −0.614, p = .042) and higher smoking abstinence self-efficacy (b = 0.017, p = .002). More positive social control from close others interacted with negative affect smoking (b = −0.052, p = .043); the association between negative affect smoking and nicotine dependence (b = 0.812, p < .001) only occurred at low levels of positive social control. Findings suggest that emotion regulation difficulties may contribute to smoking during pregnancy by exacerbating women's negative experiences related to smoking cessation attempts. Negative social control was related to lower smoking frequency and greater confidence in quitting smoking, suggesting that it may assist pregnant smokers' cessation efforts. Positive social control buffered women from the effects of negative affect smoking on nicotine dependence.Trial registrationClinicalTrials.gov, NCT01163864     

小儿肺热咳喘口服液联合阿奇霉素治疗支原体肺炎的Meta-分析

目的 评价小儿肺热咳喘口服液联合阿奇霉素治疗支原体肺炎的有效性和安全性。方法 中国知网（CNKI）、万方数据库（WF）、维普数据库（VIP）、中国生物医学全文数据库（CBM）、PubMed、EMbase和Cochrane Library等数据库,纳入随机对照试验（RCT）,提取有效数据进行Meta-分析。结果 共纳入12个RCT,1 234病例,试验组619例,对照组615例。Meta结果显示,小儿肺热咳喘口服液联合阿奇霉素在总有效率[RR=1.18,95% CI（1.13,1.23）,P<0.000 01],退热时间[MD=-0.85,95% CI（-1.19,-0.51）,P<0.000 01]、咳嗽消失时间[MD=-2.54,95% CI（-3.38,-1.69）,P<0.000 01]、肺部啰音消失时间[MD=-1.53,95% CI（-2.24,-0.81）,P<0.000 1]、咳痰消失时间[MD=-1.63,95% CI（-1.96,-1.30）,P<0.000 01]及减少住院天数方面均优于单用阿奇霉素,差异均有统计学意义;两组不良反应发生率（RR=0.70,95% CI（0.26,1.87）,P=0.48）,差异无统计学意义。结论 小儿肺热咳喘口服液联合阿奇霉素治疗儿童支原体肺炎的疗效优于单用阿奇霉素,且联合应用并未增加不良反应发生率。     

5种清热解毒类中成药联合奥司他韦治疗小儿流感的Meta分析

目的 系统评价5种清热解毒类中成药（抗感颗粒、板蓝根颗粒、连花清瘟颗粒、小儿牛黄清心散或小儿豉翘清热颗粒）联合奥司他韦治疗小儿流感的有效性和安全性,为临床治疗的选择提供依据。方法 检索中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据知识服务平台（Wanfang Data）、维普期刊中文数据库（VIP）、PubMed和Cochrane Library等中英文数据库,检索时间为建库至2021年1月。筛选清热解毒中成药联合奥司他韦（联合用药）对比奥司他韦单药治疗小儿流感的随机对照试验（RCT）,采用RevMan 5.3软件进行Meta分析。结果 共纳入文献24篇RCTs,包含患儿2 932名,联合用药较奥司他韦单药治疗小儿流感可以减少发热缓解时间［MD=-20.37,95% CI=（-26.32,-14.43）,P<0.05］和咳嗽缓解时间［MD=-20.45,95% CI=（-29.80,-11.10）,P<0.05］,增加C反应蛋白（CRP）下降值［MD=5.72,95% CI=（2.58,8.86）,P<0.05］,提高总有效率［RR=1.17,95% CI=（1.14,1.20）,P<0.05］,同时可以减少恶心呕吐［OR=0.44,95% CI=（0.24,0.80）,P<0.05］和腹痛［OR=0.32,95% CI=（0.12,0.85）,P=0.02］。结论 奥司他韦联合清热解毒类中成药治疗小儿流感可以减少发热缓解时间和咳嗽缓解时间,增加CRP下降值,提高总有效率,同时减少恶心呕吐和腹痛不良反应。但研究纳入例数有限、文献质量较低,需要设计严谨的多中心临床RCT增加论证强度。     

普罗布考抗动脉粥样硬化作用的meta分析

目的 通过系统评价有关普罗布考抗动脉粥样硬化作用的文献,评估普罗布考对动脉粥样硬化及预防再狭窄的有效性。方法 在Medline数据库、Embase数据库和Cochrane图书馆和中国期刊全文数据库（CNKI）、VIP、万方数据库、中国生物医学文献数据库（CBM）中检索有关普罗布考抗动脉粥样硬化的随机对照试验,并且对纳入研究进行方法学质量评价,提取文献中有效数据采用RevMan 5.3软件进行 meta分析。结果 共纳入20项随机对照试验,合计1 314例患者。Meta分析结果显示,预防PTCA 再狭窄支架管腔面积[WMD 0.80,95%CI（0.41~1.20）,P<0.000 01]、管腔直径[WMD 0.24,95%CI（0.17~0.30）,P<0.000 01]、再狭窄率[RR=0.66,95%CI（0.56~0.78）,P<0.000 01]、再狭窄程度[WMD=-11.20,95%CI（-17.02~5.38）,P=0.000 02]、临床不良事件发生率[RR=0.57,95%CI（0.48~0.67）,P<0.000 01]方面均优于对照组,差异有统计学意义。结论 普罗布考能够改善患者动脉粥样硬化状况,有效预防支架术后再狭窄。