Objective To review the clinical evidence of Pingxiao Capsule for tumor adjuvant treatment so as to provide some decision-making references for clinical practice. Methods We electronically searched CBM, CNKI, VIP, WanFang Data and MEDLINE (from inception to Feb, 2013) to collect the randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) about Pingxiao Capsule for tumor adjuvant treatment. Then, the included studies were summarized and evaluated according to the classification of diseases. Results 1 097 potential relevant articles were searched. We included 41 RCTs and 15 non-RCTs. The results showed that Pingxiao Capsule used as an adjuvant therapy in treating tumor improved the efficacy and reduced the side effects of radiation and chemotherapy, and also improved the quality of survival. Conclusion Current evidence showed that the effectiveness and safety of Pingxiao Capsule combined with radiation or chemotherapy in the tumor treatment is superior to radiation monotherapy or chemotherapy monotherapy. But due to the limited quality of the included studies, the results needed to be further verified by high-quality studies.
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
To evaluate the effectiveness and safety of anticoagulants in ischaemic stroke primary or secondary prevention and treatment, we searched The Cochrane Library and MEDLINE to find high quality evidence and summarized the available evidence. The results showed that routine immediate anticoagulant therapy in patients with acute ischaemic stroke should not be recommended because it increased the risk of hemorrhage with ineffective reduction to the risk of death or disability. For the high risk group with cardiogenic embolism, anticoagulant therapy could safely and effectively reduce the incidence of stroke or other vascular events. However, for non-cardiogenic embolism group, anticoagulant therapy was hard to balance the benefits and harms.
现有预防非妊娠期妇女膀胱炎复发的临床证据如下:①连续预防性使用抗生素:一系列随机对照试验研究表明,连续预防性使用抗生素(甲氧苄氨嘧啶、复方磺胺甲噁唑、呋喃妥英、头孢克洛或一种喹啉)6～12个月可以减少复发性膀胱炎的发生率,但各种不同用药方案间未发现感染率有差异.一个比较持续性每日使用抗生素与性交后使用抗生素的随机对照试验表明,1年后尿培养阳性率差异无统计学意义.②性交后预防性使用抗生素(复方磺胺甲噁唑、呋喃妥英或一种喹啉):4个随机对照试验研究表明,性交后2 h内使用复方磺胺甲噁唑、呋喃妥英或喹啉较安慰剂能显著降低膀胱炎发生率.一个关于性交后预防性使用抗生素和每日连续使用抗生素的随机对照试验发现,1年后二者的膀胱炎发生率的差异无统计学意义.③一次性使用复方磺胺甲噁唑:一个小样本随机对照试验发现,连续每日预防性使用复方磺胺甲噁唑与在膀胱炎症状出现后一次性使用复方磺胺甲噁唑相比,前者能显著降低膀胱炎发生率.但由于证据太有限,不能得出肯定结论.④酸果蔓汁(cranberry juice)和酸果蔓制品:一个系统评价发现,酸果蔓汁及其制品能预防复发性膀胱炎的证据不足.⑤用马尿酸乌洛托品预防:缺乏研究马尿酸乌洛托品的可靠的随机对照试验.
现有治疗排卵功能障碍性不孕的临床证据如下,①克罗米酚.1个系统评价结果表明,对不规则排卵妇女,克罗米酚与安慰剂相比,明显提高了妊娠率.另外4个克罗米酚和他莫昔芬的研究表明,这两种药物对排卵率和妊娠率的影响无统计学差异.1个随机对照试验(RCT)表明,6个月疗程的克罗米酚加二甲双胍比单用克罗米酚可明显提高妊娠率.②环芬尼:1个RCT表明,环芬尼与安慰剂相比,对妊娠率的影响无统计学差异.③促性腺激素(HMG):1个系统评价表明,HMG治疗与尿促卵泡素(urofollitropin)治疗相比,两者妊娠率无统计学差异.2个RCT表明,重组的促滤泡素和尿促卵泡素治疗相比,两者的持续妊娠率和活产率无统计学差异.以往的研究发现,虽然仅限于那些没有配合使用GnRHa的妇女,但HMG与尿促卵泡素治疗相比,发生卵巢过度刺激综合征的危险性较小.观察性研究证据表明,促性腺激素使用可能使卵巢非侵袭性肿瘤发病及多胎妊娠发生增加.④腹腔镜下卵巢打孔:1个系统评价和其后的1个小样本RCT表明,促性腺激素治疗和卵巢打孔治疗相比,对妊娠率影响的无统计学差异,但卵巢打孔术后多胎妊娠的发生率明显较低.促性腺激素脉冲疗法:有1个系统评价结果,但没有发现促性腺激素脉冲疗法有效.
临床证据检索和评价截止至2002年3月.结果: ⑴硬化性苔癣: ①口服视黄醛(阿维A): 1个小样本RCT经过20～22周随访发现,阿维A与安慰剂相比,能显著减轻瘙痒和减小病变程度,但与严重的脱皮、脱发有关.②外科手术:我们未找到手术治疗妇女硬化性苔癣疗效的充足证据.③局部用0.05%丙酸氯倍他索(又名氯氟美松):1个小样本RCT经过3个月的治疗发现,局部用丙酸氯倍他索比局部用丙酸睾丸酮或矿物油软膏能更有效地控制症状.高质量的前瞻性观察性研究发现,丙酸氯倍他索用于维持治疗时副作用轻微.④局部用睾丸酮:2个小样本RCT认为,不管是用于12个月的初始治疗,还是在用了丙酸氯倍他索16周后的继续治疗,都没有证据证明丙酸睾丸酮比矿物油软膏更能缓解症状.丙酸睾丸酮与男性化有关.⑵外阴上皮内瘤样病变:我们发现,外阴上皮内瘤样病变的外科手术治疗效果和局部应用α-干扰素治疗效果,目前临床证据不足.
Objective To define an evidence-based conclusion concerning ultrasound screening for fetal genital system malformations during pregnancy. Methods In order to assess whether or not ultrasound screening for fetal genital system malformations is effective and feasible, we searched The Cochrane Library (Issue 3, 2009), MEDLINE (1981 to 2009), ACP Journal Club (1991 to 2008), and BMJ Clinical Evidence (1999 to 2008) for systematic reviews, randomized controlled trials (RCTs), cohort studies, and controlled clinical trials. Results Five cohort studies and three crosssectional studies were retrieved. The results showed ultrasound screening detected fetal sex determination by the contour of the rump and the angle of the genital tubercle to a horizontal line through the lumbosacral skin surface in the first trimester. Scrotal size and penile length increases with gestational age for male fetuses, and by 32 weeks, bilateral testicular descent was observed in most cases. Ultrasonographic scans, fetal genetic studies, and hormonal assays of amniotic fluid can diagnosis certain diseases, fetal sex differentiation disorders, fetal endocrinal disorders, and chromosome abnormality. Conclusion The findings of this study should reassure physicians and parents alike that ultrasound screening is an reliable option for the prenatal diagnosis of fetal genital system malformations, but more randomized controlled trials are needed to further supply relevant evidence.
Objective To summarize the available clinical evidence on the treatment of non-proliferative diabetic retinopathy (NPDR). Methods Based on the basic methods and principles of evidence-based medicine, we searched and evaluated the NPDR-related evidence from the Cochrane Library(Issue 3,2007), PubMed (1966 to June 2007) and CBM(1979 to June 2007) Results We finally identified 1 systematic review and 20 randomized controlled trials. Clinical evidence showed that critical glycemic control and blood pressure control were essential in the treatment of NPDR, which might delay the progression of retinopathy. The effectiveness of other therapeutic measures needed to be further investigated. Conclusion NPDR is the early stage of diabetic retinopathy (DR). Relevant systematic reviews and high-quality randomized controlled trials have confirmed the effectiveness of critical control of blood glucose and blood pressure for NPDR. The effectiveness of other therapeutic measures needs to be confirmed by systematic reviews of high quality and rigorously designed randomized, multi-center and large-scale trials.
Objective To investigate an evaluation method of medical literature applicability to clinical work， and provide a convenient way for physicians to search for the best evidence. Methods Delphi method was used to choose appropriate evaluating indexes， analytic hierarchy process was performed to determine the weighing of each index， and the formula to calculate medical literature applicability was formed. The practicability of this formula was evaluated by consistency checking between the formula’s results and experts’ opinions on literature applicability. Results Five evaluating indexes were determined， including literature’s publishing year （X1）， whether the target questions were covered （X2）, sample size （X3）， trial category （X4）， and journal level （X5）. The formula to calculate medical literature applicability was Y=3.93 X1＋11.78 X2＋14.83 X3＋44.53 X4＋24.93 X5. The result of consistency checking showed that the formula’s results were highly consistent with experts’ opinions （Kappa=0.75， P＜0.001）. Conclusion The applicability formula is a valuable tool to evaluate medical literature applicability.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.