Serum folic acid levels and erectile dysfunction: A meta-analysis and systematic review

The aim of this study was to assess the relationship between serum folic acid (FA) levels and erectile dysfunction (ED) through a meta-analysis. A research was conducted in MEDLINE via PubMed, Cochrane Library, EMBASE and Web of Science up to 22 November 2020 to identify studies related to FA and ED. Two authors independently screened the literature, evaluated methodological quality and extracted the data. We used RevMan5.3 and STATA 14.0 for meta-analysis. A total of six studies including 1,842 participants were included, and the results showed that the FA levels in the non-ED group were significantly higher than those in the ED group (MD = 3.37, 95% CI 1.49–5.52, p = 0.004). Subgroup analysis indicated that with the increase in ED severity, the difference in FA levels between groups was more obvious (MD: 1.99 vs. 4.63 vs. 5.63). The differences in FA levels between groups seem more significant in the younger group (MD = 4.87, 95% CI 2.58–6.89, p < 0.001) than in the older group (MD = 3.15, 95% CI 2.21–4.08, p < 0.001). In conclusion, FA deficiency is closely related to ED, and the degree of FA deficiency may reflect the severity of ED. In addition, the association seems to be more pronounced in the younger group.     

Comparison of efficacy and safety of daily oral L-arginine and PDE5Is alone or combination in treating erectile dysfunction: A systematic review and meta-analysis of randomised controlled trials

The meta-analysis was performed to assess the efficacy and safety of daily oral L-arginine and phosphodiesterase type 5 inhibitors (PDE5Is) alone or combination in treating patients with erectile dysfunction (ED). We performed a search of randomised controlled trials in the following databases: PubMed, EMBASE and Cochrane Library databases. Four articles including 373 patients were studied. Erectile functions were significantly improved in three therapy groups compared with baseline. Patients who received the combination of L-arginine and PDE5Is showed significant improvement compared to those treated with L-arginine and PDE5Is alone, as assessed by sexual function index (p <0.00001 and p =0.005, respectively) and total testosterone (p <0.00001 and p =0.0007, respectively). Furthermore, patients who treated with PDE5Is alone exhibited the better efficacy than those treated with L-arginine alone in respects of sexual function index (p <0.00001) and total testosterone (p =0.0001). However, the combination of L-arginine and PDE5Is had no obvious difference relative to PDE5Is alone in terms of various adverse events (AEs). Conclusively, compared with monotherapy, the combination of L-arginine and PDE5Is showed a greater improvement of sexual function and total testosterone, and did not significantly increase the AEs. Besides, PDE5Is alone revealed a better effect than those treated with L-arginine alone for patients with ED.     

不同中国肝癌分期肝癌根治性切除术后的临床效果及预后因素分析

目的探讨不同中国肝癌分期(CNLC)肝癌接受根治性切除术后的临床效果及长期生存的预后因素。方法回顾性分析2010年1月至2019年12月南京医科大学第一附属医院肝胆中心单一治疗组收治的行肝癌根治术的549例肝细胞癌(HCC)患者的临床病理学资料。男性462例(84.2%),女性87例(15.8%);中位年龄57岁(范围:21~84岁)。观察患者的术前变量、术中及术后情况、术后病理学检查结果等。采用门诊与电话相结合的方式进行随访。采用寿命表法进行生存率的估计,采用Kaplan-Meier法绘制总体生存和无瘤生存曲线,采用Log-rank检验比较不同组别生存过程的差异,采用多因素Cox回归模型分析影响预后的主要因素。结果 549例HCC患者中,CNLC Ⅰa期200例(36.4%),CNLC Ⅰb 期148例(27.0%),CNLC Ⅱa期49例(8.9%),CNLC Ⅱb期32 例(5.8%),CNLC Ⅲa期101例(18.4%),CNLC Ⅲb期19例(3.5%)。患者1、3、5、10年总体生存率分别为83.8%、69.0%、54.2%、37.7%,1、3、5年无瘤生存率分别为61.0%、44.2%、36.0%。CNLC Ⅰa期患者的1、3、5年总体生存率和无瘤生存率分别为97.3%、90.6%、80.5%和83.9%、65.0%、54.0%;CNLC Ⅰb期患者的1、3、5年总体生存率和无瘤生存率分别为87.9%、71.0%、47.7%和58.4%、42.3%、33.4%;CNLC Ⅱa和Ⅱb期患者的5年总体生存率(Ⅱa期:37.2%,Ⅱb期:44.3%)与CNLC Ⅰb期类似。CNLC Ⅲb期患者 1、3、5年总体生存率和无瘤生存率分别为35.3%、13.2%、0和23.5%、0、0。单因素分析结果显示,术前合并症状、术前甲胎蛋白水平、术前总蛋白水平、术前AST水平、术前总胆红素水平、术中出血量、术中或术后输血、术后并发症、肿瘤最大径和数目、微血管侵犯、大血管侵犯、肿瘤分化程度是HCC患者长期生存(≥5年)的预后因素(P值均<0.05)。多因素分析结果显示,术前AST水平、术中出血量、肿瘤数目、肿瘤最大径、大血管侵犯和肿瘤分级是HCC患者长期生存的独立预后因素(P值均<0.05)。结论不同CNLC的HCC患者具有不同的复发模式及预后。经过严格术前评估的CNLC Ⅱa~Ⅲb期HCC患者可从外科根治切除术中获得生存获益。术前AST水平、术中出血量、肿瘤数目、肿瘤最大径、大血管侵犯和肿瘤分化程度是影响HCC患者长期生存的独立预后因素。     

Comparing the cost of non-metastatic breast cancer care in a low-income vs a high-income country: A plea for an optimal allocation of health resources in Sub-Saharan Africa

Breast cancer incidence is rising in low-income countries, but there is limited information regarding health resource allocation for its care. We assessed the cost of care during the first three years after diagnosis in a low-income country (Mozambique; n = 162 women) and compared it with a high-income country (Portugal, n = 703 women). Local currency prices were converted to 2019 international dollars (Int$). In Mozambique, the median cost was lower than in Portugal (2888 vs 18,533 Int$, respectively) and did not vary across stage or tumor subtype. These findings may help improving resource allocation for breast cancer care in Sub-Saharan Africa, despite reflecting an underfunding of treatment in this setting.     

中药治疗肝肾阴虚证绝经后骨质疏松的Meta分析

目的系统评价中成药和汤剂治疗肝肾阴虚证绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的疗效及安全性。方法计算机检索CNKI、CBM、VIP、万方数据库、PubMed、Embase、Cochrane图书馆,检索自建库以来至2019年9月23日的文献,按照纳排标准,收集调补肝肾法治疗PMOP的临床对照试验,依据Cochrane Handbook for Systematic Reviews of Interventions(version 5.35)进行质量评估,并使用RevMan5.3软件进行Meta分析。结果纳入9篇文献,9个研究。与常规治疗的中成药和西药相比,在降低中医证候积分[分别为MD=-3.74,95%CI(-4.86,-2.62),P<0.01;MD=-2.05,95%CI(-2.26,-1.84),P<0.01]、提高血清雌激素[分别为SMD=0.69,95%CI(0.21,1.17),P<0.01;SMD=0.37,95%CI(0.01,0.74),P=0.04]方面,单用调补肝肾法可能优于常规治疗;在临床症状疗效有效率[分别为RR=1.03,95%CI(0.90,1.17),P=0.68;RR=1.24,95%CI(0.94,1.63),P=0.13]、提高腰椎骨密度[分别为MD=0.01,95%CI(-0.03,0.05),P=0.65;MD=0.03,95%CI(-0.01,0.07),P=0.12]指标方面,与常规治疗组相比,无显著性差异。无纳入文献提示单用或联合应用以调补肝肾为治法选用的中成药和汤剂出现不良反应。结论中成药和汤剂在改善肝肾阴虚PMOP患者腰脊疼痛、腰膝酸软无力等的症状及提高血清雌激素方面,具有一定的治疗作用,具有较好的安全性。