Objective To assess the safety and effectiveness of direct stenting (DS) versus conventional stenting (CS) with predilation in clinical practice. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2011), CBM, VIP and CNKI were searched from the date of their establishment to April 2011, to collect the randomized controlled trials (RCTs) on DS vs. CS. The quality of RCTs was critically appraised, and the data were extracted and cross-checked by two reviewers independently. Meta-analyses were conducted using RevMan 5.0 software. Results A total of 24 RCTs involving 6 666 patients were included. The results of Meta-analyses showed that DS took shorter operative time compared with CS (MD=–3.36, 95%CI –4.41 to –2.30, Plt;0.000 01) with acute gain (luminal diameter) during operation (MD=–0.01, 95%CI –0.04 to 0.02, P=0.64). But there were no significant differences in the incidence of major adverse cardiac events during six-month follow-up (OR=0.89, 95%CI 0.69 to 1.14, P=0.35) and restenosis (OR=1.02, 95%CI 0.82 to 1.26, P=0.88). Conclusion Current evidence shows that DS is not superior to CS. This conclusion still needs to be further proved by well-designed and large scale RCTs with longer follow-up duration.
Objective To assess the diagnostic value of MRI and Bone Scan (BS) for osseous metastases in patients with breast cancer. Methods The trials were searched from PubMed, EMBASE, Cochrane Library, CBM, CNKI and VIP; the Criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis; and the area under curve (AUC) of SROC was calculated. Results A total of 5 researches involving 329 patients were included. The sensitivity of MRI and BS were 0.99 (0.97, 1.00) and 0.93 (0.88, 0.97) respectively; the specificity for MRI and BS were 0.99 (0.95, 1.00) and 0.86 (0.79, 0.92) respectively; and the AUC of SROC curve for MRI and BS were 0.993 6 and 0.967 5 respectively. Conclusion MRI can be regarded as an effective and feasible method for osseous metastases in breast cancer.
Objective To assess the affect of problem-based learning (PBL) versus literature based learning(LBL) in clinical medicine students. Methods Computer retrieval was conducted to search for controlled studies comparing PBL with LBL. The quality of included studies was critically evaluated and data was analyzed by using The Cochrane Collaboration’s RevMan 5.0 software. Results Finally 11 articles were included in the review, but most of them were of low quality.There are clinical heterogeneity between different studis which cause descriptive results. The PBL tended to be superior to LBL in the analysis-skill, self-directed learning skill, data-searching skill, and original skill.Conclusion PBL tends to be associated with better learning results among clinical medicine students compared withLBL methods. We need large-scale, randomized controlled trials of higher quality to confirm this.
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 provide a reference for the best evidence-based medicine (EBM) education modelby retrospective analysis and summary the EBM education model of the EBM center of Lanzhou University for medicalpostgraduates. Methods To utilize students’ spare time we changed the traditional teaching method, and instead used problem based learning and academic discussions to teach postgraduates how to design and apply research. Results Sixtytwo postgraduates were trained and completed 73 research papers and registered 33 Cochrane systematic reviews. Twentythree papers were published in foreign journals (SCI) as first authors, 34 papers were published in domestic journals. Five students received awards in the academic conference of Lanzhou University. Conclusion Medical students will benefit from taking part in EBM research. This education model will help them not only understand the methods of clinical research and EBM and improve the quality of their research and their cooperative skills, but also master related clinical knowledge.
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.
Objective To systematically review the efficacy of ambroxol for lung protection in perioperative period. Methods We followed the Cochrane Collaboration methodology to conduct systematic reviews. We searched relevant randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, CBM, CNKI and VIP. We assessed the methodological quality for each outcome by grading the quality, and used RevMan5.0.0 to perform meta-analysis. Results Eight RCTs were eligible and included 669 patients. All of these trials used randomization but the quality scales were B. Compared to the control group, the ambroxol group had a statistically significant benefit in atelectasis, pulmonary complications, cough and expectoration degree. The RR (95%CI) were 0.44 (0.25, 0.78), 0.51 (0.34, 0.75), 0.39 (0.16, 0.94) and 0.22 (0.09, 0.53), respectively. The ambroxol group was also better than the control group in sputum volume, sputum characteristics, rales and pulmonary surfactant. Conclusion Ambroxol can improve respiratory system symptoms post-operatively, reduce pulmonary complications, and prevent pulmonary surfactant from decreasing during operation. Ambroxol has a satisfactory lung protective effect in the preoperative period, but we can’t define a proper dose and usage time.
Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI). Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02). Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.
Objective To evaluate the clinical efficacy and safety of nicorandil injection for preventing slow-flow/ no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2009), PubMed, MEDLINE, EMbase, CBM, CNKI, VIP, Wanfang database, etc. from their inception to April 2009. Some relevant journals were handsearched as well. Two reviewers independently evaluated the quality of included studies and extracted the data. Meta-analysis was performed by RevMan 5.0 software. Results Seven randomized controlled trials (RCTs) involving 630 patients were included. The results of meta-analyses showed that intracoronary and intravenous nicorandil could reduce the incidence of no-reflow/ low-flow, reduce Corrected TIMI Frame Count (CTFC), and improve left ventricular ejection fraction (LVEF). Intravenous nicorandil could reduce the incidence of ventricular tachycardia/ventricular fibrillation (VT/VF), pericardial effusion, heart failure, but couldn’t reduce the incidence of death and recurrent myocardial infarction (MI) death. Conclusion Evidence shows that intracoronary nicorandil could prevent no-reflow/ slow-flow, reduce CTFC, improve LVEF, and reduce adverse reaction in patients after coronary stent implantation. However, there is a moderate possibility of selection bias, performance bias and publication bias in this review because of the small number of the included studies, which weakens the strength of the evidence of our results. More large sample size, high-quality RCTs are needed.
Objective To assess the efficacy and safety Losartan for essential hypertension associated withhyperuricemia. Methods Included randomized controlled trials of Losartan versus Valsartan. Electronic searchconducted in CENTRAL, the Cochrane Library (until 2008, Issue 4), PubMed, EMBASE, Chinese Biomedicine database,Chinese Scientific Journals Full-text Database, and China Journal Full-text Database (until 2008, Issue 10). Two reviewers extracted data independently. RevMan 5.0 software developed by the Cochrane Collaboration was used for Metaanalysis.Results Only 7 trials with 1 136 eligible patients were included in the systematic review. Meta-analysis showedno significant difference in reductions of systolic blood pressure, diastolic blood pressure, and adverse events betweenLosartan and Valsartan groups. However, a significant difference of serum uric acid reduction was observed betweenLosartan and Valsartan group. Losartan play a significant role of decreased serum uric acid levels. Conclusions Based on this systematic review, Losartan is effective and well tolerated in reducing BP and serum uric acid levels. Further large randomized, double blind, placebo controlled trials are needed in long-term safety and efficacy and different subgroups of Losartan.