Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
ObjectiveTo compare the effectiveness of antecolic duodenojejunostomy (ADJ) and retrocolic duodenojejunostomy (RDJ) after pylorus-preserving pancreaticoduodenectomy (PPPD). MethodsRandomized controlled trials (RCTs) of ADJ versus RDJ after PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and Wanfang database from inception to April 2014, as well as Google. After quality assessment of RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version, Meta analysis was performed by RevMan 5.1 software. ResultsFour RCTs of 462 patients in total were included in this Meta-analysis. The results of Meta-analysis showed that, there were no significant differences in the operation time (MD=14.02, 95% CI:-41.42-69.46, P=0.62), incidence of postoperative complications (RR=1.09, 95% CI:0.81-1.48, P=0.56), incidence of delayed gastric emptying (RR=0.63, 95% CI:0.31-1.28, P=0.20), incidence of pancreatic fistula (RR=1.13, 95% CI:0.72-1.75, P=0.60), incidence of abdominal abscess (RR=0.92, 95% CI:0.54-1.58, P=0.77), and mortality (RR=0.61, 95% CI:0.24-1.60, P=0.32) between ADJ group and RDJ group. ConclusionsThe effectiveness of ADJ is similar with RDJ after PPPD, so the reconstruction way after PPPD can be routed according to the surgeon's preference.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
ObjectivesTo systematically review the risk of arterial ischemic and metabolic adverse events in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect clinical trials, observational studies and case reports of adverse events in CML patients treated with TKIs from inception to February 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 22 studies involving 4 223 patients were included. The incidence rates of ischemic heart disease in any grade were 2 per 100 patient-years (95%CI 2 to 3) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 3) for imatinib. The incidence of ischemic heart disease in grade 3 or 4 was 1 per 100 patient-years (95%CI 0 to 2) for nilotinib. The incidence of peripheral arterial occlusive disease in any grade was 2 per 100 patient-years (95%CI 0 to 14) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 2) for imatinib. The incidence of hypertension in any grade was 1 per 100 patient-years (95%CI 0 to 3) for nilotinib, and 44 per 100 patient-years (95%CI 27 to 71) for ponatinib. The incidence of hypertension in grade 3 or 4 was 2 per 100 patient-years (95%CI 0 to 15) for nilotinib, and 22 per 100 patient-years (95%CI 8 to 58) for ponatinib. The incidence of hyperlipidemia in any grade was 17 per 100 patient-years (95%CI 5 to 59) for nilotinib. The incidence of hyperglycemia in any grade was 11 per 100 patient-years (95%CI 9 to 15) for nilotinib, 2 per 100 patient-years (95%CI 1 to 4) for imatinib, 1 per 100 patient-years (95%CI 0 to 5) for dasatinib, and 19 per 100 patient-years (95%CI 19 to 20) for bosutinib. The incidence of hyperglycemia in grade 3 or 4 was 4 per 100 patient-years (95%CI 3 to 5) for nilotinib, and 1 per 100 patient-years (95%CI 1 to 2) for bosutinib.ConclusionsPatients treated with nilotinib have a greater possibility of ischemic heart and peripheral arterial occlusive disease compared with patients treated with imatinib. Patients treated with ponatinib have a high incidence rate of hypertension, and patients treated with nilotinib have a high incidence rate of hyperlipidemia. Patients treated with bosutinib and nilotinib have higher risk of hyperglycemia compared with patients treated with imatinib or dasatinib.
Objective To analyze the relationship between helicobacter pylori (HP) and gastric cancer. Methods We searched CNKI (Jan.1995-Dec.2005) and Wangfandatabase (Jan.1995-Dec.2005). Case-control studies on relationship of helicobacter pylori infection and gastric cancer were collected. Meta-analysis method was used to sum up the odds ratio (OR) and 95%CI of these studies.Results We identified 14 case-control studies with 11 studies of healthy adults versus gastric cancer patients and 4 studies of gastritis versus gastric cancer patients. The results of subgroup analyses based on patients resource showed: statistical difference was founded between healthy adults and gastric cancer patients with pooled OR 2.00 and 95%CI 1.25 to 3.20; no statistical difference was founded between gastritis patients and gastric cancer patients with pooled OR 1.54 and 95%CI 0.68 to 3.50. The results of subgroup analyses based on locations of gastric cancer showed: statistical difference was founded between the non-cardiac gastric cancer patients and the control with pooled OR 3.60 and 95%CI 1.25 to 10.36; no statistical difference was found between cardiac gastric cancer patients and control with pooled OR 0.88 and 95%CI 0.56 to 1.39.Conclusion HP infection can be associated with gastric cancer, and the different conclusions of the 14 reports may be attributed to the locations of gastric cancer and the selection of controls.
Objective To estimate the effect of desensitizing toothpaste containing arginine on dentine hypersensitivity. Methods Such databases as CNKI, PubMed, Web of Science and Cochrane Trials Register (Issue 4, 2008) were retrieved, and Google was used as a supplementary tool to search the information up to March 2010. Randomized controlled trials (RCTs) of treating dentine hypersensitivity with arginine-containing toothpaste were included, and the relevant information was extracted and the quality evaluation was undertaken. Meta-analyses were performed with RevMan 5.0 software. Results Five RCTs with 397 patients were included. The results of meta-analyses showed that at 8 weeks, arginine-containing toothpaste was significantly different from potassium-containing toothpaste in terms of tactile sensitivity test (SMD=1.32, 95%CI 0.68 to 1.96) and air blast test (SMD= –0.77, 95%CI –1.22 to 0.32) with a better therapeutic effect. Conclusion Current literature evidence shows that the arginine-containing toothpaste is effective for the dentine hypersensitivity. However, this study is based on a small number of RCTs and samples, so further studies with high-quality and large-sample RCTs are needed.
ObjectiveTo investigate the short-term effect of laparoscopic sleeve gastrectomy (LSG) in treatment of obesity in China. MethodsLiteratures about the effect of LSG in treatment of obesity were searched from WanFang, CNKI, PubMed, and Web of Science, then these literatures were filtered according to the inclusive and exclusive criteria and evaluated. Meta analysis was performed based on data extracted from these literatures. ResultsThree hundreds and eighty three cases of LSG were retrieved from 12 literatures. Compared with the preoperative, the body mass index (BMI) was lower in 6 months after LSG (MD=7.56, 95% CI: 5.77-9.34, P < 0.000 01), and compared with 6 months after LSG, the BMI was lower in 12 months after LSG (MD=3.19, 95% CI: 2.20-4.18, P < 0.000 01). Compared with 1 months after LSG, the excess weight loss (EWL%) was higher in 6 months after LSG (MD=-42.77, 95% CI:-45.77--39.77, P < 0.000 01), and compared with 6 months after LSG, EWL% was higher in 12 months after LSG (MD=-19.71, 95% CI:-25.54--13.87, P < 0.000 01). After the LSG, BMI decreased, but EWL% increased over time. ConclusionsIn China, LSG has obviously short-term curative effect in the treatment of obesity.
Objective To determine the effectiveness and safety of weekly versus three weekly regimens of taxanes for non-small cell lung cancer (NSCLC). Methods We searched The Cochrane Library (Issue 1, 2008), PubMed (1966 to May 2008), EMbase (1974 to May 2008), and CBM (1978 to May 2008) to identify randomized controlled trials (RCTs) which compared weekly and three weekly regimens of taxanes for NSCLC. Data collection was undertaken by two reviewers independently; the methodological quality was assessed according to the Cochrane Handbook 4.2.6; and the meta-analyses were performed using RevMan 5.0 software. Results Nine RCTs involving 1 438 patients were included. The results of meta-analyses showed: (1) There were no significant differences in the efficacy between weekly and three weekly regimens of taxanes regarding the one-year survival rate (paclitaxel: RR=1.24, 95%CI 0.83 to 1.86; docetaxel: RR=0.80, 95%CI 0.51 to 1.23) and the overall response rate (paclitaxel: RR=1.03, 95%CI 0.72 to 1.49; docetaxel: RR=0.98 95%CI 0.64 to 1.49). (2) The incidence of neutropenia was less serious in the weekly group (paclitaxel: RR=0.74, 95%CI 0.56 to 0.97; docetaxel: RR=0.22, 95%CI 0.16 to 0.30), while no significant differences existed in other adverse effects such as anemia and nausea/vomiting. Conclusion The efficacy of weekly and three weekly regimens of taxanes for the treatment of NSCLC is similar. The incidence of neutropenia is lower in the weekly group while other toxicities show no differences.
Objective To evaluate the clinical effectiveness of laparoscopic and open appendectomy. Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed，Wiley Online Library，Medline，Embase，Cochrane，CNKI，VIP，CBM databases were extracted，and methodological quality was evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analysis. The wound infection，hospitalization time，operation time，hospitalization expenses，and peritoneal abscess were compared between laparoscopic and open appendectomy. Results Eight published reports of eligible studies were extracted. Compared with the open appendectomy， laparoscopic appendectomy had significant differences in lower wound infection rate 〔OR=0.19，95%CI （0.09，0.38），P＜0.000 01〕， longer operation time 〔WMD=3.66，95%CI （0.50，6.82），P=0.02〕，and more hospitalization expenses〔WMD=503.96，95%CI （337.23，670.70），P＜0.000 01〕.But there were no significant differences in hospitalization time〔WMD=-0.11，95%CI （-3.64，3.43），P=0.95〕 and incidence rate of peritoneal abscess 〔OR=1.40，95%CI （0.23，8.64），P=0.71〕 between laparoscopic and open appendectomy. Conclusions The wound infection rate is lower，but the operation time is longer，the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy. There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.