Objective To evaluate the effectiveness and safety of doxepin in the treatment of primary insomnia. Methods We searched The Cochrane Library (Issue 4, 2009), PubMed (1966 to December 2009), EMbase (1974 to December 2009), ISI (1961 to December 2009), CNKI (1979 to December 2009), VIP (1989 to December 2008), CBM (1978 to December 2009), and WANFANG Data (1998 to December 2009). We also searched the correlated grey literature and conference literature for complement. Data were extracted, methodologically evaluated, and cross-checked by two reviewers independently. RevMan 5.0 was used for statistical analysis. Results One randomized controlled trial and three cross trials involving 171 patients were included. The results of meta-analyses showed that total sleep time (TST), wake time during sleep (WTDS), wake time after sleep (WTAS), and sleep efficiency (SE) were improved by low and medium dosage of doxepin (1-25 mg) with statistically significant difference compared with placebo. On the contrary, most indicators of sleep quality had no statistically significant difference between high dose doxepin (50 mg) and placebo. While the sleeping structural indicators of rapid eye movement sleep (REM), rapid-eyemovement latency (REM-L), and sleep stage II (St.II) were changed by high and medium dosage of doxepin (25-50 mg) with statistically significant difference. Conclusions Low and medium dosage of doxepin (1-25 mg) is effective in improvement of the sleep quality in patients with primary insomnia, but it is necessary to concern the side effects and the effects on sleep structure when treating primary insomnia with medium dosage of doxepin (25 mg). High dosage of doxepin (50 mg) is not recommended to treat primary insomnia. However, this conclusion still needs clinical trials to be further validated.
Objectives To evaluate the effect of metrinidazole treatment after conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Methods We searched the Cochrane Library (Issue 1 2009), PubMed (1966 to March 2009), EMbase (1974 to March 2009), SCI (1974 to March 2009), CBM (1978 to March 2009), CNKI (1994 to March 2009), and VIP (1989 to March 2009) to identify randomized controlled trials or quasi- randomize controlled trials of metronidazole versus placebo for treating post hemorrhoidectomy pain. We evaluated the quality of the included studies by using the Handbook 4.2.6 recommend standards and analyzed data using the Cochrane Collaboration’s RevMan 4.2.10. Results We included seven randomized controlled trials or quais-randomized controlled trials (n=553). Meta-analyses showed that there were statistical differences between metronidazole and placebo in pain after hemorrhoidectomy and the use of an additional dose of analgesia. Conclusions The current evidence shows that metronidazole relieves the pain after conventional hemorrhoidectomy and reduces the additional used of analgesics. Further high quality, large sample randomized controlled trials should be carried out.
Objectives To assess the efficacy and safety of metformin plus rosiglitazone in treating type 2 diabetes mellitus. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the CochraneLibrary (2008, 4 issue), PubMed (1966 to October 19, 2008), Embase (1974 to October 19, 2008), China BiomedicalLiterature Database (1978 to October 12, 2008), China Journal Fulltext Database (1994 to October 12, 2008), ChineseScientific Journals Full text Database (1989 to October 12, 2008). Randomized controlled trials (RCTs) of Metforminplus roziglitazone versus metformin for type 2 diabetes were included. We assessed the quality of the included RCTsaccording to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Twelve RCTs totaling 3020 patients were included. Metaanalysis showed that Glycosylated hemoglobin levels [WMD= – 0.48%, 95%CI (– 0.74, – 0.22), P=0.000 3], fasting plasma glucose levels [WMD= – 1.03mmol/L, 95%CI (– 1.85, – 0.75), Plt;0.000 01], insulin sensitivity, and β-cell function improved significantly with metformin plus rosiglitazone therapy. Compared with the metformin monotherapy group, patients treated with metformin plus rosiglitazone had more edema events [RR= 3.27, 95%CI (1.80, 5.91), Plt;0.000 1] and lower gastro-intestinal events [RR= 0.82, 95%CI (0.71, 0.94), P=0.004]. We found no statistically significant effect on body weight, the percentage of patients with at least one adverse event, and hypoglycemia events. Conclusions Current evidence demonstrates that combination treatment with metformin plus rosiglitazone improves glycemic control, insulin sensitivity, and cells function more effectively than with metformin monotherapy. Side effects of two types of therapy have differences in performance.
Objective To evaluate the diagnostic value of MR imaging for anterior cruciate ligament. Methods We searched PubMed, EMBASE, CBM, CSJD and CJFD to find all diagnostic tests about MR imaging in anterior cruciate ligament. QUADAS items were used to evaluate the quality of the included studies. We used Meta-disc software for data collection, and sensitivity, specificity and SROC curves were calculated to assess the diagnostic value of individual diagnostic tests. Results Twenty-nine studies met the eligibility criteria and were included. Compared with arthroscope, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and SROC curve of MR imaging were 93%, 93%, 9.85, 126.39, and 0.971 4, respectively. Conclusion MR imaging can be regarded as an effective and feasible method for ACL tears diagnosis and screening clinically, based on the results of this systematic review.
Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults. Methods A fully recursive literature search was conducted in PubMed (2002 to September, 2009), EMBASE (2002 to September, 2009), Cochrane Central Register of Controlled Trials (Issue 3, 2009), CBM (2002 to September, 2009) , CNKI and VIP Chinese Scientific Journals Full-text Database (2002 to September, 2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion. The four analyzed outcome variables were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan 5.0 software. Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53, 95%CI (1.00 to 2.34), P=0.05] and postoperative complication rate [OR 0.74, 95%CI (0.52 to 1.05), P=0.09], and had lower tendency chronic pain [OR 0.45, 95%CI (0.34 to 0.59) , Plt;0.000 01] with statistical significance. There were significant differences in intraoperative complications between the two groups [OR 2.15, 95%CI (1.32 to 3.53), P=0.002]. Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain .There is no significant difference in long-term recurrence rate and postoperative complications between the two methods. More studies are needed for intraoperative complications and other long-term postoperative complications.
Objective To assess the clinical effectiveness of vacuum-formed versus Hawley retainers in the period of retention. Methods PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP, and WanFang Data were searched from the date of their establishment to December 31, 2011, to collect the randomized controlled trials (RCTs) about the clinical effectiveness of vacuum-formed versus Hawley retainers. The quality of the included studies was evaluated by two reviewers independently, and meta-analysis was performed by using RevMan 5.1.4 software. Results Six RCTs including 935 patients were identified. The results of meta-analyses showed significantly fewer changes in irregularity of the maxillary incisors (MD=0.13, 95%CI 0.04 to 0.21) and mandibular incisors (MD=0.29, 95%CI 0.24 to 0.33) in the vacuum-formed group than in the Hawley group. There were no significant differences between the two groups in maxillary intercanine width (MD=?–0.01, 95%CI –0.03 to 0.01), mandibular intercanine width (MD=0.04, 95%CI –0.02 to 0.10), maxillary intermolar width (MD=?–0.01, 95%CI –0.03 to 0.00) and mandibular intermolar width (MD=?–0.02, 95%CI –0.08 to 0.04). The results of qualitative analysis were consistent with the results of meta-analysis and there were no significant differences in overjet and overbite. Conclusion Vacuum-formed retainers are more effective than Hawley retainers at maintaining position of incisors in the period of retention. In other aspects, they are similar. In consideration of the factors such as the limited quality and incomplete measure index of primary studies, RCTs of higher methodological quality are needed.
ObjectiveTo analyze the trend of disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021 and predict its future changes. MethodsData was extracted from the Global Burden of Disease Database 2021 to analyze the disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021. The Joinpoint regression model was used to analyze the temporal trends. The BAPC model was employed to predict the future disease burden of tracheal and bronchial lung cancer in China. ResultsIn 2021, the standardized incidence rate, standardized prevalence, standardized mortality rate, and standardized DALYs rate of tracheal and bronchial lung cancer in China were 44.01/100 000, 57.95/100 000, 38.98/100 000, and 878.25/100 000, all of which showed an upward trend compared to 1990, with the standardized prevalence increasing the fastest at 71.75%, followed by the standardized incidence rate, which increased by 32.93%. BAPC prediction results indicated that the standardized incidence and prevalence rates of tracheal and bronchial lung cancer in the Chinese population will show an upward trend, while the standardized mortality rate will show a downward trend, and the standardized DALYs rate will remain relatively stable from 2022 to 2035. The standardized incidence rate is expected to rise from 46.18/100 000 in 2022 to 50.32/100 000 in 2035, the standardized prevalence rate is expected to rise from 60.47/100 000 in 2022 to 73.49/100 000 in 2035, the standardized mortality rate is expected to decrease from 39.75/100 000 in 2022 to 36.53/100 000 in 2035, and the standardized DALYs rate is expected to rise from 903.25/100 000 in 2022 to 916.38/100 000 in 2035. ConclusionFrom 1990 to 2021, the disease burden of tracheal and bronchial lung cancer in China showed an upward trend. Although the disease burden among the elderly and males is more prominent, the rate of increase among females in the past decade has been rapid and shows a trend towards younger ages. Comprehensive prevention and control measures should be taken. It is predicted that the situation of tracheal and bronchial lung cancer incidence and prevalence in China will remain very serious from 2022 to 2035.
Objective To evaluate the efficacy and safety of mifepristone for perimenopause dysfunctional uterine bleeding (PDUB). Methods Such databases as VIP, CNKI, Wanfang and CBM were retrieved for collecting randomized controlled trials (RCTs) on mifepristone for PDUB. The quality of included studies was evaluated and Meta-analysis was performed according to the Cochrane methods. Results Forty RCTs involving 3 850 PDUB patients were included. The control group was divided into two sub-groups according to the features of intervention drugs: the sub-group of diagnostic curettage plus progestational hormone, and the sub-group of diagnostic curettage plus antiestrogenic drugs. The Meta-analysis indicated that compared with the sub-group of diagnostic curettage plus progestational hormone, the diagnostic curettage plus mifepristone group was more effective to increase the total effective rate, such as improving symptoms and signs of PDUB (RR=1.11, 95%CI 1.06 to 1.16, Plt;0.000 01), and to reduce recurrence (RR=0.44, 95%CI 0.36 to 0.52, Plt;0.000 01). But no differences were found between the two groups in the change of endometrial thickness, contents of hemoglobin, and serum level of FSH, LH, E2 and P hormone. Both the intervention and control groups appeared mild adverse reactions, such as rashes, tidal fever, nausea, anorexia, vomiting and breast distending, but with no liver and kidney damages. The long-term safety failed to be evaluated due to short follow-up time. Conclusion Based on this review, diagnostic curettage plus mifepristone shows certain advantage in the treatment of PDUB including the total effective rate and reducing recurrence. But there is no difference in regulating sex hormone level, inhibiting endometrial proliferation and improving anemia compared with the group of diagnostic curettage plus progestational hormone. However, this evidence is not b enough due to the low quality of included trials, possible bias risk, and failure of evaluating its long-term safety.
Objective To systematically evaluate the clinical effectiveness and safety of capecitabine plus docetaxel in the treatment of patients with metastatic breast cancer where anthracycline has failed as a treatment. Methods We electronically searched PubMed, EMBASE, the Cochrane Library (2008, issue 4), and CBM to Sept. 2008. Randomized controlled trials (RCTs) and quasi-RCTs about capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with metastatic breast cancer were identified. Study selection and analyses were undertaken according to the Cochrane Handbook, and RevMan 5.0 was applied for statistical analyses. The following was studied: total survival time, the development time of disease, reaction rate, the mid-survival time, adverse events and quality of life. Results Three RCTs involving 672 patients with metastatic breast cancer were included. The results of meta-analyses showed that the overall survival (MD=3.00, 95%CI 1.64 to 4.36), disease time to progression (MD=1.85, 95%CI 1.15 to 2.55), and the response rate (RR=1.29, 95%CI 1.09 to 1.52) were superior in the combination arm to the docetaxel alone arm. Conclusion The current evidence available shows that the combination of capecitabine and docetaxel may significantly improve the short-term efficacy comparing with docetaxel alone. However, adverse events and long-term efficacy are not clear; more high-quality RCTs should be conducted.
Objectives To evaluate the clinical efficacy and safety of coronary artery drug injection for slow flow/no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), PubMed, EMbase, CBM, CNKI, VIP, and WanFang databases from their inception to April 2009. Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed by RevMan 5.0 software. Results Eight randomized controlled trials (RCTs) involving 593 patients were included. The results of meta-analyses showed that urokinase, adenosine, and anisodamine could significantly improve the thrombolysis in myocardial infartion (TIMI) flow. In addition, anisodamine could improve the coronary blood pressure. Urokinase significantly reduced the incidence of malignant ventricular arrhythmias and non-fatal of heart failure during hospitalization, but it could not change the mortality and the incidence of unstable angina, recurrence of myocardial infarction, and ischemic target revascularization. Conclusion Evidence shows that anisodamine, urokinase, urapidil and adenosine can improve TIMI flow and improve myocardial perfusion on the no-reflow patients post coronary stent implantation and urokinase can significantly reduce the incidence of main adverse cardiovascular events. Their clinical application is worthy to be advocated.