Hepatitis C infection and renal cell carcinoma:A systematic review and meta-analysis

AIM To investigate the association between hepatitis C virus(HCV) infection and risk of renal cell carcinoma(RCC).METHODS A literature search was performed from inception until February 2016.Studies that reported relative risks,odd ratios,hazard ratios or standardized incidence ratio comparing the risk of RCC among HCV-infected participants vs those without HCV infection were included.Participants without HCV infection were used as comparators.Pooled odds ratios and 95%CI were calculated using a random-effect,generic inverse variance method.RESULTS Seven observational studies were with 196826 patients were included in the analysis to assess the risk of RCC in patients with HCV.A significantly increased risk of RCC among participants with HCV infection was found with a pooled RR of 1.86(95%CI:1.11-3.11).The association between RCC and HCV was marginally insignificant after a sensitivity analysis limited only to studies with adjusted analysis,with a pooled RR of 1.50(95%CI:0.93-2.42).CONCLUSION Our study demonstrated a potential association between HCV infection and RCC.Further studies of RCC surveillance in patients with HCV are required.     

Age at menopause in India: A systematic review

Background and aimsMenopause is a physiological process in nature and hence, variations in the age of menopause are not expected. Hence, the study was conducted with an objective to calculate the reliable estimates of age at menopause for India, and understand the differentials in women’s age at menopause throughout the country.MethodsA total of 202 studies of age at menopause, covering the period 2009–2020, were accessed from PubMed database and Google. Of these only ten studies met the selection criteria for this paper, which is that the data for these studies must be collected from house-to-house surveys.ResultsThe average age at menopause in India, with minimal publication bias, is 46.6 years (95% CI: 44.83, 48.44). In one study slightly above 1.96 Standard Deviation, was observed, as ascertained by Funnel Plot and Egger’s test. The mean age ranged from a minimum of 44.69 years (95% CI: 35.01, 54.37) to a maximum of 48.95 (95% CI: 42.29, 55.61) years. Furthermore, the age at menopause did not exhibit any significant variation by age at menarche, although the association was positive.ConclusionsThe age at menopause showed positive association with age at menarche. In India, during the period 2009–2020, it was 46.6 years, which significantly lower than the age in some developed countries. The differences may be methodological since no information was found regarding the distribution of age at menopause in the studies that were considered for meta-analysis.     

Sulbactam-based therapy for Acinetobacter baumannii infection: a systematic review and meta-analysis

BackgroundA number of studies have reported on the effectiveness of sulbactam-based therapies for Acinetobacter baumannii infection; however, there is little evidence that sulbactam-based therapies are more or less effective than alternative therapies. Unfortunately, there is a distinct lack of high quality data (i.e., from randomized controlled trials) available on this issue. Therefore, we conducted a systematic review and meta-analysis comparing the efficacy of sulbactam-based and non-sulbactam-based regimens in the treatment of A. baumannii infection.MethodsWe searched PubMed, MEDLINE, Biomedical Central, Google Scholar, the China National Knowledge Infrastructure, the Cochrane library, and the Directory of Open Access using the terms “sulbactam and baumannii” or “maxtam and baumannii”. Randomized controlled trials, controlled clinical studies, and cohort studies were considered for inclusion. The primary outcome was the clinical response rate for sulbactam-based therapy vs comparator therapies.ResultsFour studies (1 prospective, 3 retrospective) were included in the meta-analysis. Sulbactam was given in combination with ampicillin, carbapenem, or cefoperazone (n = 112 participants). Comparator drugs included colistin, cephalosporins, anti-pseudomonas penicillins, fluoroquinolones, minocycline/doxycycline, aminoglycosides, tigecycline, polymyxin, imipenem/cilastatin, and combination therapy (n = 107 participants). The combined clinical response rate odds ratio did not significantly favor sulbactam-based therapy over comparator therapy (odds ratio = 1.054, 95% confidence interval = 0.550–2.019, p = 0.874), nor did any of the individual study odds ratios.ConclusionsThe available evidence suggests that sulbactam-based therapy may be similarly efficacious to alternative antimicrobial therapies for the treatment of A. baumannii infection. Further research on this issue is warranted given the limited availability of data from high quality/randomized controlled trials.     

Smoking cessation reduces postoperative complications: a systematic review and meta-analysis

Objective

We aimed to review randomized trials and observational evidence to establish the effect of preoperative smoking cessation on postoperative complications and to determine if there is an optimal cessation period before surgery.

Methods

We conducted a systematic review of all randomized trials evaluating the effect of smoking cessation on postoperative complications and all observational studies evaluating the risk of complications among past smokers compared with current smokers. We searched independently, in duplicate, 10 electronic databases and the bibliographies of relevant reviews. We conducted a meta-analysis of randomized trials using a random effects model and performed a meta-regression to examine the impact of time, in weeks, on the magnitude of effect. For observational studies, we pooled proportions of past smokers in comparison with current smokers.

Results

We included 6 randomized trials and 15 observational studies. We pooled the 6 randomized trials and demonstrated a relative risk reduction of 41% (95% confidence interval [CI], 15-59, P = .01) for prevention of postoperative complications. We found that each week of cessation increases the magnitude of effect by 19%. Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04). Observational studies demonstrated important effects of smoking cessation on decreasing total complications (relative risk [RR] 0.76, 95% CI, 0.69-0.84, P < .0001, I² = 15%). This also was observed for reduced wound healing complications (RR 0.73, 95% CI, 0.61-0.87, P = .0006, I² = 0%) and pulmonary complications (RR 0.81, 95% CI, 0.70-0.93, P = .003, I² = 7%). Observational studies examining duration of cessation demonstrated that longer periods of cessation, compared with shorter periods, had an average reduction in total complications of 20% (RR 0.80, 95% CI, 3-33, P = .02, I² = 68%).

Conclusion

Longer periods of smoking cessation decrease the incidence of postoperative complications.     

Effectiveness of probiotics in irritable bowel syndrome:Updated systematic review with meta-analysis

AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013.The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials,of which 15 were eligible for meta-analysis and nine were reviewed systematically.All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement.The Jadad score was used to assess the methodological quality of trials.The quality scale ranges from 0 to 5 points,with a score ≤ 2 indicating a low quality report,and a score of ≥3 indicating a high quality report.Relative risk(RR),standardized effect size,and 95%CI were calculated using the Der Simonian-Laird method.The Cochran Q test was used to test heterogeneity with P 0.05.Funnel plots were constructed and Egger's and BeggMazumdar tests were performed to assess publication bias.RESULTS:A total of 1793 patients were included in the meta-analysis.The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96(95%CI:1.14-3.36;P = 0.01).RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43(95%CI:1.13-5.21;P = 0.02).For adequate improvement of general symptoms in IBS patients,the RR of seven included trials(six studies) comparing probiotics with placebo was 2.14(95%CI:1.08-4.26;P = 0.03).Distension,bloating,and flatulence were evaluated using an IBS severity scoring system in three trials(two studies) to compare the effect of probiotic therapy in IBS patients with placebo,the standardized effect size of mean differences for probiotics therapy was-2.57(95%CI:-13.05--7.92).CONCLUSION:Probiotics reduce pain and symptom severity scores.The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo.     

Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis

Background

Disease-management programs may enhance the quality of care provided to patients with chronic diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to assess the effectiveness of COPD disease-management programs.

Methods

We conducted a computerized search of MEDLINE, EMBASE, CINAHL, PsychINFO, and the Cochrane Library (CENTRAL) for studies evaluating interventions meeting our operational definition of disease management: patient education, 2 or more different intervention components, 2 or more health care professionals actively involved in patients' care, and intervention lasting 12 months or more. Programs conducted in hospital only and those targeting patients receiving palliative care were excluded. Two reviewers evaluated 12,749 titles and fully reviewed 139 articles; among these, data from 13 studies were included and extracted. Clinical outcomes considered were all-cause mortality, lung function, exercise capacity (walking distance), health-related quality of life, symptoms, COPD exacerbations, and health care use. A meta-analysis of exercise capacity and all-cause mortality was performed using random-effects models.

Results

The studies included were 9 randomized controlled trials, 1 controlled trial, and 3 uncontrolled before-after trials. Results indicate that the disease-management programs studied significantly improved exercise capacity (32.2 m, 95% confidence interval [CI], 4.1-60.3), decreased risk of hospitalization, and moderately improved health-related quality of life. All-cause mortality did not differ between groups (pooled odds ratio 0.84, 95% CI, 0.54-1.40).

Conclusion

COPD disease-management programs modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality. Future studies should explore the specific elements or characteristics of these programs that bring the greatest benefit.     

Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials

Context: Aldosterone blockade has been used to treat acute myocardialinfarction (MI) and chronic heart failure. Objective: The aim of this study is to summarize the evidence on the efficacyof spironolactone (SP), eplerenone (EP), or canrenoate (CAN)in patients with left ventricular dysfunction. Data sources: A search of multiple electronic databases until June 2008 wassupplemented by hand searches of reference lists of includedstudies and review articles, meeting abstracts, FDA reports,and contact with study authors and drug manufacturers. Study selection and data extraction: Studies were eligible for inclusion if they included patientswith left ventricular systolic or diastolic dysfunction, treatmentwith SP, EP, or CAN vs. control, and reported clinical outcomes.Nineteen randomized controlled trials (four in acute MI and15 in heart failure, n = 10 807 patients) were included—14of SP, three of EP, and three of CAN. Analysis was performedusing relative risks (RRs) with 95% confidence intervals (CIs)and a random effects model with statistical heterogeneity assessedby I². Data synthesis: Aldosterone blockade reduced all-cause mortality by 20% (RR0.80, 95% CI 0.74–0.87). All-cause mortality was reducedin both heart failure (RR = 0.75, 95% CI 0.67–0.84) andpost-MI (RR 0.85, 95% CI 0.76–0.95) patients. Only ninetrials reported hospitalizations, and the RR reduction was 23%(RR 0.77, 95% CI 0.68–0.87), although 98% of the outcomescame from two trials. Ejection fraction (EF) improved in theseven heart failure trials, which assessed this outcome (weightedmean difference 3.1%, 95% CI 1.6–4.5). Conclusion: We demonstrated a 20% reduction in all-cause mortality withthe use of aldosterone blockade in a clinically heterogeneousgroup of clinical trial participants with heart failure andpost-MI. In addition, we found a 3.1% improvement in EF. Furtherstudy in those with less severe symptoms or preserved systolicfunction is warranted.     

Valerian for sleep: a systematic review and meta-analysis

Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety.     

Cytokines in patients with type 2 diabetes and chronic periodontitis: A systematic review and meta-analysis

Individuals with type 2 diabetes mellitus (T2DM) and chronic periodontitis have significantly higher levels of interleukin-1 beta compared with systemically healthy individuals with chronic periodontitis. However, there was no significant difference in gingival crevicular levels of other cytokines between individuals with and without T2DM.     

替加色罗治疗肠易激综合征的系统评价

目的 评价替加色罗治疗肠易激综合征(irritable bowel syndrome,IBS)的有效性和安全性.方法 对替加色罗治疗便秘型或非腹泻型IBS的随机对照试验(RCTs)进行系统评价.结果 共纳入13项RCTs,7 189例患者.替加色罗12 mg/d和4 mg/d对总体IBS症状的改善均优于安慰剂;对腹痛/腹部不适症状的缓解与安慰剂比无显著差异;对腹胀的疗效,各研究结果不一致;腹泻发生率显著高于安慰剂,替加色罗组报道了2例缺血性心脏病,严重不良事件的发生率与安慰剂比无显著差异.结论 替加色罗能改善便秘型或非腹泻型IBS患者的总体症状;缓解腹痛/腹部不适和腹胀等症状的证据不足;腹泻是替加色罗的主要不良反应.     

替比夫定治疗慢性乙型肝炎疗效的系统评价

目的:系统评价替比夫定(LDT)治疗慢性乙型肝炎(CHB)的治疗效果.方法:应用Cochrane系统评价方法计算机检索Cochrane Library(2009年第3期)、PubMed(1966-2009.9)、EMBASE(1974-2009.9)、中国生物医学数据库(CBM,1978-2009.9)、中国期刊全文数据库(CNKI,1979-2009.9)和维普数据库(VIP,1989-2009.9),同时在临床试验注册网站及Google搜索引擎进行检索,并追查纳入研究参考文献,收集以LDT治疗CHB的所有随机对照试验(RCT)和交叉试验.根据Cochrane协作网推荐的风险评估工具进行风险偏倚评估,用RevMan5.0软件进行统计学分析.结果:最终纳入10个RCTs,共4037例患者.7篇LDT对比拉米夫定(LAM)的研究结果显示,对于HBeAg阳性患者,LDT组较LAM组更有效提高血清HBVDNA检测不到率(RR=1.50,95%CI:1.38-1.64)、ALT复常率(RR=1.10,95%CI:1.05-1.16)、HBeAg转阴率(RR=1.23,95%CI:1.08-1.40)和HBeAg血清转...     

Prevalence,trends and risk factors for the diabetes epidemic in China: A systematic review and meta-analysis

Aims

To describe the prevalence and trends of diabetes and to quantitatively assess its risk factors in mainland China.

Methods

Thirty-one epidemiological studies were identified by a systematic search of four databases. Prevalence estimates were mapped and summarized by meta-analysis in each region of China. The pooled ORs and 95% CIs of risk factors for diabetes were also calculated.

Results

There was a large geographical imbalance with regard to the prevalence of diabetes. Region-pooled prevalence was highest in the eastern region (8.0%, 95% CI: 6.1–10.0%) and lowest in the western region (4.6%, 95% CI: 3.3–6.0%), which was consistent with regional levels of economic development. The overall prevalence of diabetes has been increasing since 1980. Traditional risk factors such as age, family history of diabetes, obesity, hypertension and elevated triglycerides were found to be associated with diabetes. In addition, urban residence and being from ethnic minorities were also significantly associated.

Conclusion

Based on the meta-analyses, we found that the prevalence of diabetes is different in different parts of China but it has been increasing sharply during the last three decades. Some risk factors were quantitatively derived in the study, which are free from the diversity of a single sample.     

干扰素辅助治疗肝细胞癌随机对照试验的系统评价和Meta分析

目的 评价手术、消融、动脉栓塞化疗等治疗措施后辅助用干扰素(IFN)治疗病毒性肝炎相关性肝细胞癌的疗效和安全性.方法 检索PubMed、Embase、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,并辅以手工检索和互联网检索灰色文献,纳入符合标准的文献,并进行系统评价和Meta分析.结果 共纳入8篇随机对照试验(RCT),共计857例,其中IFN组442例,对照组415例.Meta分析结果显示,根治性治疗后辅助用IFN治疗能降低肝癌1年复发率[相对危险度(RR)=0.71,95％可信区间(CI)为0.51～0.99]、3年复发率(RR=0.86,95％CI为0.76～0.98)、4年复发率(RR=0.79,95％CI为0.68～0,91);提高患者1年生存率(RR=1.09,95％CI为1.01～1.18)、2年生存率(RR=1.25,95％口CI为1.04～1.50),且组间差异均具有统计学意义.2、5年复发率和3、4、5年生存率的差异在组间无统计学意义.一项针对晚期肝细胞肝癌患者经肝动脉化疗栓塞(TACE)术后辅助用IFN治疗的RCT结果显示,TACE-IFN联合能降低患者的肝癌复发率,改善患者2年的无疾病生存率和2年的总生存率,但1年的无疾病生存率和1年的总生存率在组间的差异无统计学意义.结论 IFN辅助治疗病毒性肝炎相关性肝细胞癌能在一定程度上降低其复发率,提高患者生存率,且患者对IFN的不良反应能较好耐受.     

Age at menarche and risk of asthma: systematic review and meta-analysis

Background: Several studies have suggested a relationship between the age at menarche and risk of asthma development. Objective: To conduct a systematic review and meta-analysis of the relationship between the age at menarche and the risk of asthma. Methods: This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pre specified literature search strategy was used to identify studies of potential relevance and independent reviews were carried out by two authors. Raw data was pooled using the software package RevMan to calculate summary odds ratios. The risk of publication bias was assessed graphically by using a funnel plot and the robustness of the overall estimate obtained was assessed by using sensitivity analyses. Results: The searches identified 61 potentially relevant articles of which seven articles, with a total of 22?859 subjects, matched the inclusion criteria for the meta-analysis. Pooling of the seven studies showed that girls with early menarche (<12 years) had an increased risk of asthma relative to girls with late menarche; random effects odds ratio?=?1.37 (1.15–1.64), (p?=?0.0005). Substantial heterogeneity was revealed (I²?=?55%). Sensitivity analysis showed that the risk estimate was not markedly changed when excluding any of the studies. The funnel plot did not indicate publication bias. Conclusions: Early menarche appears to be associated with increased risk of asthma. Hormonal, immunological, genetic and environmental factors may act in a developmental context to explain this relationship. Future studies are warranted to further determine the mechanisms responsible for this observation.     

术前减重在减重代谢手术中的作用：一项系统评价及Meta分析

目的系统评价术前减重是否可以改善减重代谢手术患者的临床疗效。 方法通过检索PubMed、Emabase、Cochrane数据库搜集关于术前减重对接受减重代谢手术治疗患者临床疗效的研究,检索时限均从建库至2020年10月。采用Review Manager 5.3软件进行Meta分析,主要评估术前合并症改善、术中腔镜中转、手术时间、住院时间、非计划二次手术、术后伤口感染、术后出血、术后早期并发症、术后合并症改善、术后体重减轻指标。 结果共纳入包括6 000名患者在内的10项研究。Meta分析显示,与常规对照组相比,术前减重组在术前合并症改善、术中腔镜中转、手术时间、术后早期并发症、术后出血、术后伤口感染、非计划二次手术、住院时间、术后合并症改善、术后6个月减轻指标、术后12个月均无明显获益,两组间差异均无统计学意义。而术前减重组在术后短期3个月内体重减轻更明显。 结论实施减重代谢手术前进行术前减重可能使患者在术后短期内体重减轻更明显,但在围手术期风险、合并症改善、住院时间、远期体重减轻等方面获益并不明显,其临床疗效仍需更多高级别循证研究证据的帮助与支持。     

Dietary calcium intake in relation to blood lipids and lipoproteins profiles: A systematic review and meta-analysis of epidemiologic studies

AimsFindings of prior investigations on the association between calcium intake and lipid profiles were inconsistent. We performed a systematic review and meta-analysis on epidemiologic studies to evaluate the relationship of dietary calcium intake with blood lipids and lipoproteins.Data synthesisA systematic search up to April 2021 was performed in different electronic databases, including MEDLINE (PubMed), Scopus, Web of Science (ISI), and Google Scholar for epidemiological studies that considered dietary calcium intake as the exposure and reported risk of dyslipidemia or blood lipids and lipoproteins concentrations (as mean ± SD or mean ± SE or median (Inter Quartile Range) as the outcomes of interest in adult populations from both genders (18 years or older), regardless of their health status. Nineteen cross-sectional studies were included in the analysis. Combining estimates from 11 studies (including 33,304 subjects) revealed that individuals in the highest category of calcium intake, compared to the lowest one, had 5.94 mg/dL lower circulating triglyceride (TG) concentration (weighted mean difference (WMD): ?5.94; 95% CI: ?8.27, ?3.62), 4.02 mg/dL lower circulating low-density lipoprotein cholesterol (LDL-c) levels (WMD: ?4.02; 95% CI: ?7.08, ?0.95), and 1.56 mg/dL higher blood high-density lipoprotein cholesterol (HDL-c) (WMD: 1.56; 95% CI: 0.81, 2.30). Although meta-analysis on 13 studies (including 38,714 participants) did not reveal a significant relationship between dietary calcium intake and odds of dyslipidemia or hyperlipidemia in the whole population, the highest vs. lowest level of calcium intake was related to 42% decreased odds of low blood HDL-c levels in females (95% CI: 0.40, 0.84) and 41% increased odds in males (95% CI: 1.21, 1.65).ConclusionsThis meta-analysis demonstrated that individuals with the highest dietary calcium intake might have lower blood TG, LDL-c, and higher HDL-c concentrations as compared to those with the lowest calcium intake. However, the linkage between dietary calcium intake with odds of hyperlipidemia or dyslipidemia was not significant. Because of the cross-sectional nature of included studies, causality could not be proven. Further prospective studies are needed to affirm these findings.     

Outcomes of robotic vs laparoscopic hepatectomy: A systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria: (1) studies comparing robotic and laparoscopic liver resection; (2) studies reporting at least one perioperative outcome; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time (MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.     

Water intake and risk of type 2 diabetes: A systematic review and meta-analysis of observational studies

Background and aimsThe association of water intake with type 2 diabetes mellitus (T2DM) is still unclear. Therefore, the aim of this systematic review and meta-analysis was to synthesize the knowledge about the relationship between water intake and the risk of T2DM.MethodsWe conducted a systematic search in PubMed and Scopus up to June 2018 for observational studies. Risk ratios (RR)s and 95% confidence intervals (95% CI)s were calculated and fixed effects models were used.ResultsOverall, 6 studies were included in the meta-analyses. There was an inverse relationship between water intake and risk of T2DM (RR: 0.94; 95% CI: 0.91–0.97, P < 0.001) with low heterogeneity (I2 = 24%, P = 0.24).ConclusionOur findings indicated that the intake of water was correlated with reduced risk of type 2 diabetes in women and men. These results support the current recommendations of water intake as an inseparable part of a diet with the lowest risk of diabetes mellitus.     

Effects of neutrophil elastase inhibitor in patients undergoing esophagectomy:A systematic review and meta-analysis

AIM: To evaluate the benefit and safety of sivelestat(a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy. METHODS: Online databases including Pub Med, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases(Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-qualitycomparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio(RR) was used to express the effect size of dichotomous outcomes, and mean difference(MD) or standardized mean difference was used to express the effect size of continuous outcomes.RESULTS: Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I2 = 76.3%, SMD =-1.41, 95%CI:-2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery(I2 = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever. CONCLUSION: A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect.