As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine(EBM),which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking . Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis). MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software. ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis. ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
ObjectiveTo systematically review the efficacy and safety of crizotinib in the treatment of non-small cell lung cancer (NSCLC).MethodWe electronically searched databases including the Cochrane Library (Issue 5, 2017), PubMed, Embase, China Biology Medicine Database, China National Knowledge Internet Database, VIP Database and Wangfang Data from the establishment to May 2017. The randomized controlled trials (RCTs), non-RCTs, case series and case reports on crizotinib for NSCLC were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the methodological quality of included studies, then make Meta-analysis and descriptive analysis.ResultA total of 15 studies were included, including 4 RCTs, 1 non-RCT, 4 case series and 6 case reports. The results indicated that the progression-free survival time of crizotinib group was 8 months, which was better than chemotherapy group (4.6 months). The results of Meta-analysis showed that the response rate in the crizotinib group was higher than that in the chemotherapy group [RR=2.35, 95%CI (1.59, 3.46), P<0.000 1]. The one year survival rate in the crizotinib group was 74.5%-78.6%. The incidences of adverse reactions including dysopsia, dysgeusia, diarrhea, vomiting, constipation, transaminase lifts, upper respiratory tract infection, edema and dizziness in the crizotinib group were higher than those in the chemotherapy group (P<0.05), while the incidences of adverse reactions including leukopenia, thrombocytopenia, alopecia and fatigue in crizotinib group were lower than those in the chemotherapy group (P<0.05). Subgroup analysis under precision treatment showed the progression-free survival time of anaplastic lymphoma kinase (ALK)-positive group was 8 months, and it was longer than ALK-negative group of 4 months.ConclusionsBased on current evidence, crizotinib is better than chemotherapy for NSCLC. Due to limited quality of the included studies, the above conclusion needs to be verifed by more high quality studies.
Perineal care is a classic topic for obstetrics. After thousands of years of practice, we have accumulated some experience and meanwhile, we are also taking some attempts. The effectiveness and reliability of these methods need evaluation. Nowadays, the best evidence comes from randomized controlled trials (RCT) and systematic reviews (SR). We searched The Cochrane Library (Issue 3, 2007), MEDLINE (Jan. 1980 to May 2007) databases and CBM-disc (Jan. 1980 to May 2007) to obtain current best evidence for perineal care.
Objective To systematically review the current situation of health economics evaluation of gastric cancer screening. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect the health economics evaluation studies on gastric cancer screening from January 1st, 1975 to September 30th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Then, qualitative analysis was performed. Results A total of 44 studies were included. Most of the targeted populations of the study were high-risk groups in areas with a high incidence of gastric cancer. Screening methods such as endoscopy and Helicobacter pylori infection detection were mainly evaluated in those studies. According to the results, about 47% of the studies evaluated a single screening method. A total of 35 studies showed that they established models, however, only a few calibrated the models. Conclusion Most studies of gastric cancer screening reviews neither calibrate the results nor consider the effect of smoking on the progression of gastric cancer. Those evaluated screening programs are limited.
Objective To evaluate the efficacy, safety and economics of digestive enzyme for dyspepsia. Methods Electronic databases such as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, VIP and CNKI were searched from establishment dates of databases to June 2010 to identify the randomized controlled trials (RCTs) of digestive enzyme for dyspepsia. Then studies were identified according to predefined inclusion and exclusion criteria, and their quality was evaluated. The meta-analysis was performed using RevMan 5.0 software. Results Eight studies involving 1 092 patients were included, 3 of which were Grade B while the rest were Grade C. The results of the meta-analysis showed that the total efficacy rate of oryz-aspergillus enzyme and pancreatin tablet, compound digestive enzymes capsule, and compound azintamide enteric-coated tablet for dyspepsia were better than either placebo or blank intervention, with the results as (OR=49.70, 95%CI 17.16 to 143.96), (OR=7.71, 95%CI 3.88 to 15.33) and (OR=16.27, 95%CI 6.85 to 38.66), respectively. The efficacy for treating loss of appetite, abdominal distension, abdominal pain, diarrhea and belching was superior to either placebo or blank intervention. Oryz-aspergillus enzyme and pancreatin tablet was inferior to compound digestive enzyme capsule in treating dyspepsia following cholecystectomy. No significant difference was observed in treating dyspepsia following chronic pancreatitis between compound azintamide enteric-coated tablet and compound digestive enzymes capsule. Drug-related adverse reactions as well as economic evaluation were not reported in included studies. Conclusion Digestive enzyme is effective for dyspepsia caused by various diseases. The OR of digestive enzyme versus the placebo/blank-control group shows that oryz-aspergillus enzyme and pancreatin tablet is better than other digestive enzyme drugs.
ObjectiveTo systematically review the incidence of social isolation in Chinese elderly population. MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and CENTRAL databases were electronically searched to collect studies on the incidence of social isolation in China from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, meta-analysis was performed by using Stata 15.1 software. ResultsA total of 20 studies involving 86 111 subjects were included. Meta-analysis results showed that the incidence of social isolation among the elderly in China was 27.54% (95%CI 22.15% to 57.74%). The results of subgroup analysis showed that gender, age, educational level, marital status, self-assessment of health, living style, year of publication, and region surveyed were all influential factors of the incidence of social isolation among the elderly in China. ConclusionCurrent evidence shows that the incidence of social isolation among the elderly in China is relatively high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To assess the benefits and harms of traditional Chinese medicine in the treatment of postmenopausal osteoporosis. Methods We electronically searched MEDLINE (1966-2003), EMBASE (1974-2003), Controlled Trials Register and The National Research Register, The Cochrane Library Issue 4, 2003, CBM disc, VIP, CNKI, and CMCC. We also handsearched some related journals. The search was conducted in Nov., 2003. The quality of included randomized controlled trials was evaluated and meta-analysis was conducted by RevMan 4.2.2. Results We identified 33 studies including 2 337 patients and 27 traditional Chinese medicines. Some traditional Chinese medicines alone or integrated Chinese and Western medicine may be effective for improving patients’ bone mineral density, serum oestradiol and serum calcium. For example, Compared with placebo, Bushen Yigu soft extraction with WMD 0.76, 95% confidence interval 0.65 to 0.87, Bushen Qianggu capsule with WMD 39.94, 95% confidence interval 35.12 to 44.76 were effective for improving the level of serum oestradiol.There were no confirmed results of the other traditional Chinese medicines because of the small number of studies or inconsistent conclusions among studies. We didn’t find obvious side effects. Conclusions Some traditional Chinese medicines may be effective for treating postmenopausal osteoporosis. Due to the limited evidence identified, we can not draw a firm conclusion. More randomised controlled trials of high quality are needed for ber evidence.