Objective To evaluate the effectiveness of topical fluoride on prevention of enamel demineralization during the orthodontic treatment in China. Methods The Cochrane Library（Issue 9, 2012), MEDLINE (1996 to 2012.10), EMbase (1974 to 2012.10), CNKI (1994 to 2012.10), VIP (1994 to 2012.10), WanFang data (1998 to 2012.10) and CBM (1978 to 2012.10) are searched for the randomized controlled trials (RCTs) and quasi-Randomized controlled trials (qRCTs) about topical fluoride preventing enamel demineralization during the orthodontic treatment. The bibliographies of the included studies were searched, too. Two reviewers evaluated the quality of the included studies and extracted data critically and independently, and then the extracted data were analyzed using RevMan 5.2 software. Results A total of 20 studies within 19 articles were included, which involved 26 323 teeth. The results of meta-analysis results show that, the rate of enamel demineralization of the fluoride varnish group (8.4%) was lower than that of the control group (16.0%) (OR=0.44, 95%CI 0.33 to 0.59, Plt;0.000 01); the rate of enamel demineralization of the fluoride coating group (8.3%) was lower than that of the control group (17.7%) (OR=0.46, 95%CI 0.35 to 0.60, Plt;0.000 01); the rate of enamel demineralization of the fluoride toothpaste group (9.0%) was lower than that of the control group (14.5%) (OR=0.59, 95%CI 0.49 to 0.71, Plt;0.000 01); the rate of enamel demineralization of the fluoride foam group (11.6%) was lower than that of the control group (18.2%) (OR=0.48, 95%CI 0.24 to 0.96, P=0.04); the rate of enamel demineralization of other groups (12.0%) was lower than that of the control group (21.8%) (OR=0.43, 95%CI 0.30 to 0.60, Plt;0.000 01). Two outcomes were low quality in the GRADE system and the other three are very low quality. Conclusion Current domestic evidence shows that topical fluoride is effective to prevent enamel demineralization during the orthodontic treatment. However, given the low methodological quality of most included studies, this conclusion still needs to be further proved by conducting more strictly-designed, high-quality and large-scale studies.
R Software is an open, free of use and charge statistical software which has a powerful graphic capability; however, it requires more complex codes and commands to perform network meta-analysis, which causes errors and difficulties in operation. WinBUGS software is based on Bayesian theory, which has a powerful data processing capability, and especially its codes are simple and easy to operate for dealing with network meta-analysis. However, its function of illustrating statistical results is very poor. In order to fully integrate the advantages of R software and WinBUGS software, an R2WinBUGS package based on R software has been developed which builds a “bridge” across two of them, making network meta-analysis process conveniently, quickly and result illustration more beautiful. In this article, we introduced how to use the R2WinBUGS package for performing network meta-analysis using examples.
Objective To evaluate the effect of different topical fluorides for preventing dental caries in children. Methods Literature was searched according to the methods of systematic review in the following databases: CENTRAL, Medline, EMbase, CNKI, VIP, WanFang Data, CBM and Gray literature databases such as Open Grey and National Technical Information Service (NTIS) online, and the relevant journals and professional materials were also searched manually. The quality of the selected studies was appraised using Cochrane criteria, and then Meta-analysis was conducted suing RevMan 5.0, GRADEprofiler and Stata.11 software. Results 18 RCTs involving 19 359 children were included. A result of eight RCTs showed that the prevalence rate of caries of the fluoride varnish group (50.62%) was lower than that of the control group (70.89%) (OR=0.43, 95%CI 0.34 to 0.44, Plt;0.000 01). A result of four RCTs showed that the prevalence rate of caries of the fluoride ion group (32.04%) was lower than that of the control group (44.94%) (OR=0.50, 95%CI 0.45 to 0.55, P=0.02). A result of six RCTs showed that the prevalence rate of caries of the fluoride foam group (55.90%) was lower than that of the control group (67.20%) (OR=0.53, 95%CI 0.47 to 0.60, Plt;0.000 01). The quality of the above three results was low according to the GRADE analysis. Conclusion This systematic review shows topical fluoride is effective to prevent dental caries in children without side effects. But more high-quality RCTs are needed to prove this conclusion due to the low quality of the included studies.
R software is a free and powerful statistical tool, including Metafor, Meta as well as Rmeta packages, all of which could conduct meta-analysis. Metafor package provides functions for meta-analyses which include analysis of continuous and categorical data, meta-regression, cumulative meta-analysis as well as test for funnel plot asymmetry. The package can also draw various plots, such as forest plot, funnel plot, radial plot and so forth. Mixed-effects models (involving single or multiple categorical and/or continuous moderates) can only be fitted with Metafor packages. Advanced methods for testing model coefficients and confidence intervals are also implemented only in this package. This article introduces detailed operation steps of Metafor package for meta-analysis using cases.
Objective To systematically evaluate the efficacy and safety of tacrolimus and glucocorticoid for oral lichen planus (OLP). Methods The Cochrane review’s method was adopted and computer-based retrieval was performed on The Cochrane Library, MEDLINE, EMbase, CBM, and CNKI (from their establishment to November 2010) to collect randomized controlled trials (RCTs) comparing the clinical efficacy of tacrolimus in treating OLP with that of triamcinolone. The study was selected according to the inclusion and exclusion criteria, the data were collected, and the methodological quality of the included studies was evaluated. The RevMan 5.0.25 software was applied for statistical analyses. Results Four RCTs involving 164 patients were included. Two studies showed that the tacrolimus effectively reduced lesion area and alleviated pain of patients with OLP. The results of meta-analyses showed that the total effective rate of tacrolimus was not higher than that of glucocorticoid (OR=4.38, 95%CI 0.67 to 28.73), and there was no significant difference between the tacrolimus group and the glucocorticoid group in adverse events during the treatment session (OR=3.49, 95%CI 0.49 to 24.84), and there was no significant difference in recurrence rate between those two groups (OR=0.82, 95%CI 0.27 to 2.46). Conclusion Topical tacrolimus can remarkably improve the OLP sign (lesion area) and symptom (pain), which is in line with the findings of other non-RCTs. The current evidence proves that the tacrolimus is similar to glucocorticoid in terms of the total effective rate of treating OLP, the incidence of side reaction during treatment, and the recurrence rate after stopping treatment. Some studies included in this systematic review apply different assessment methods, hence more RCTs with high-quality, multi-center, and therapeutic evaluation indexes with corresponding evaluation methods are required to provide more reliable evidence.
Objective Compare and analyze the value of β-hydroxybutyrate from two kinds of blood ketone instruments (Optium Xceed blood ketone body instrument from American Abbott laboratories and TBS-1 blood ketone body instrument from Beijing Yicheng company), and provide instructions for clinical applications. Methods Select 7 children patients with epilepsy which have a response to ketogenic diet. The two kinds of blood ketone instruments were used to test blood ketone value of whole blood synchronously in five different periods, and compare the 70 results. Results The measuring results obtained from these two kinds of blood ketone body instruments have statistical difference significantly. The value acquired from TBS-1 blood ketone body instrument is lower than that from Optium Xceed blood ketone body instrument. Measurements using a paired t test, the value of t=12.14, P<0.01. The results from two kinds of blood ketone body instruments are statistically significant. Conclusion The values from 2 kinds of blood ketone instruments are different, which would influence the clinical judgment. At present, the key problem is that there is lack of special blood ketone measure technology for patients with ketogenic diet. How to improve the measure accuracy of high-level blood ketone value remains the future work.
Objective To explore the correlation between overweight, obesity and incidence of type 2 diabetes mellitus (T2DM). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CNKI, VIP, CBM and WanFang Data were searched from inception to May, 2012 to collect the cohort studies on the correlation between overweight, obesity and incidence of T2DM. The studies were screened according to the inclusion and exclusion criteria by two researchers independently, the quality was evaluated, the data were extracted, and then meta-analysis was performed using RevMan 5.1 and Stata 11.0 software. Results A total of 8 studies involving 101 864 participants were included. The results of meta-analysis showed that, compared with the normal weight population, the onset risk of T2DM was obviously higher in the overweight (RR=2.59, 95%CI 2.11 to 3.19, Plt;0.000 01), and obese (RR=6.28, 95%CI 4.99 to 7.91, Plt;0.000 01) populations. In the subgroup analysis, the onset risk of T2DM was higher in the western obese population (RR=6.91, 95%CI 5.59 to 8.56) than the eastern obese population (RR=4.19, 95%CI 2.93 to 5.99). Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), the quality of the included studies on T2DM developed by overweight and obesity was low and medium respectively. Conclusion Overweight and obesity can increase the onset risk of T2DM which is higher in the female and western obese populations than the male and eastern obese populations respectively.
Objective To evaluate the diagnostic accuracy of the aberrant methylation of genes in stool for colorectal tumor. Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, Web of Science, CNKI and WanFang Data were searched to collect the diagnostic trials on the aberrant methylation of genes in stool for colorectal tumor published from January 1990 to February 2012. QUADAS items were used to evaluate the quality of the included studies, and the meta-analysis was conducted using Meta-Disc 1.4 software. Results A total of 32 studies involving 3 951 patients were included. The results of meta-analysis showed that, for detecting the colorectal tumor, the weighted sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (SROC) curve and Q were 92% (95%CI 91% to 93%), 63% (95%CI 61% to 65%), 20.79 (95%CI 15.13 to 28.57), 0.861 9 (SE=0.020 4), and 0.792 6 (SE=0.019 8), respectively. For detecting the colorectal cancer, the weighted sensitivity, specificity and area under the curve (AUC) were 91% (95%CI 89% to 92%), 75% (95%CI 73% to 77%), and 0.900 7, respectively. For detecting the colorectal adenoma, the weighted sensitivity, specificity and AUC were 79% (95%CI 76% to 83%), 75% (95%CI 73% to 77%), and 0.845 7, respectively. Conclusion With high sensitivity (92%) and moderate specificity (63%), aberrant methylation of genes in stool can be used as an optional noninvasive method for the diagnosis of colorectal tumor.
Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
This paper is aimed to introduce the definition and application of Population Impact Measures (PIMs). The PIMs use Number Need to Treat (NNT) for reference and generalize the variables of clinical research to interest population, which then can be used to measure the effectiveness of interventions and the harmfulness of risk factors, so as to provide evidence for making public health policy. Of the PIMs, the variables used for measuring the effectiveness of interventions include Disease Impact Number (DIN), Population Impact Number (PIN) and Number of Events Prevented in your Population (NEPP); The variables used for measuring the harmfulness of risk factors include Exposure Impact Number (EIN), Exposed Cases Impact Number (ECIN), Population Impact Number (PIN), Case Impact Number (CIN) and Population Impact Number of Eliminating a Risk factor (PIN-ER-t).