ObjectiveTo systematically review the impact of side-to-side esophagogastric anastomosis on postoperative anastomostic leak, fibrosis stricture and stroesophageal reflux. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 4 2015), Web of Science, CNKI, CBM, Wanfang Database and VIP up to April 2015. Randomized controlled trials involving the complications after side-to-side esophagogastric anastomosis were included. Data were extracted and methodological quality was evaluated by two reviewers independently with a designed extraction form. Then RevMan 5.3 software was used for meta-analysis. ResultsA total of 7 studies involving 684 patients were included. The results of meta-analysis showed that comparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidence of fibrosis stricture with RR=0.20 and 95% CI 0.11 to 0.36 (P<0.000 01). There was no statistical difference in incidence of postoperative anasotmostic leaks with RR=0.71 and 95% CI 0.43 to 1.19 (P=0.19) or stroesophageal reflux with RR=0.74 and 95% CI 0.50 to 1.11 (P=0.15) between the two groups. ConclusionComparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidences of fibrosis stricture, but there is no statistical difference in anastomostic leak or stroesophageal reflux.
Objective To determine the efficacy and safety of external fixation versus intramedulllary nailing in the treatment of adult tibial shaft fracture. Methods We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscule Trauma Group, The Cochrane Library (CENTRAL), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) and PUBMED (1966 to March 2006). We also handsearched some Chinese orthopedic journals. Randomized controlled trials (RCTs) and quasi-randomized trials (quasi-RCTs) comparing external fixation versus intramedullary nailing for tibial shaft fractures in adults were included. The quality of these trials was critically assessed. We used the Cochrane Collaboration’s RevMan 4.2.8 for data analyses. Result Three RCTs and two quasi-RCTs involving a total of 279 patients were included. The results of meta-analyses showed that external fixation for tibial shaft fractures in adults may increase the infection rate [RR 2.45, 95%CI (1.31,4.61), P=0.005], and the malunion rate [RR 2.85, 95%CI (1.20,6.79), P=0.02] but may reduce the duration of hospitalization [RR –5.50, 95%CI (–6.99,–4.01)]. The nonunion rate, delayed healing rate, and healing time, were comparable between external fixation and intramedulllary nailing. Conclusion The trials available for this systematic review are too few and small for reliable estimates of the relative effects of external fixation and intramedulllary nailing. Further studies are needed to determine these effects , especially for patients who have GustiloШ C fractures.
Objective To assess the efficacy and safety of Chinese herbal medicine for the treatment of functional dyspepsia (FD) and compare the difference of efficacy between Chinese herbal medicine and western medicine. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, CBMdisc and CNKI from inception to Dec. 2008. And we also handsearched relevant journals and conference proceedings. We evaluated the risk of bias in the included randomized controlled trials(RCTs) according to the Cochrane Handbook for Systematic Reviews. The Cochrane Collaboration’s software RevMan 4.2.8 was used for meta-analysis. Results Seven studies involving 981 patients were identified. The results of meta-analysis showed that: (1) There was no significant difference between Dalitong granule and cisaprid in effective rates (RR=1.03, 95%CI 0.97 to 1.09, P=0.36), piman syndrome (RR=1.06, 95%CI 0.96 to 1.18, P=0.23), gastric emptying function (RR=1.05, 95%CI 0.76 to 1.45, P=0.78), syndromes of TCM (WMD=0.41, 95%CI –1.05 to 1.87, P=0.58), pulse and tongue picture (RR=1.00, 95%CI 0.69 to 1.45, P=0.98), and adverse reaction (RR=1.00, 95%CI 0.69 to 1.45, P=0.46). (2) There was no significant difference between Weishuan pellet and cisaprid on effective rates (RR=1.02, 95%CI 0.96 to 1.07, P=0.53), piman syndrome (RR=1.06, 95%CI 0.97 to 1.15, P=0.19), gastric emptying function (RR=1.05, 95%CI 0.86 to 1.28, P=0.63), syndromes of TCM (WMD=0.70, 95%CI 0.11 to 1.29, P=0.02) and adverse reaction (RR=0.33, 95%CI 0.02 to 5.28, P=0.44). (3) There was no significant difference among Jianpiyiqi prescription (RR=1.16, 95%CI 1.00 to 1.34, P=0.05), Liqifuwei oral liquid (RR=1.00, 95%CI 0.91 to 1.11, P=0.94) and Jianpixiaozhang granules (RR=0.88, 95%CI 0.76 to 1.00, P=0.06) compared with cisaprid in effective rates (Pgt;0.05). (4) There was no significant difference between Hewei Xiaopi Capsule and domperidone on effective rates (RR=1.11, 95%CI 0.87 to 1.41, P=0.42) and piman syndrome (RR=1.07, 95%CI 0.93 to 1.24, P=0.35). Conclusion Chinese herbal medicine has a better clinical cure rate and marks of TCM syndrome on FD than western medicine. But we have no adequate evidence to confirm whether western medicine can be substituted by Chinese herbal medicine for the treatment of FD. Therefore, we need more high quality RCTs to confirm this conclusion.
Objective To systematically evaluate the effectiveness and safety of itopride vs. mosapride in patients with functional dyspepsia, so as to provide references for clinical practice. Methods According to strict inclusive and exclusive criteria, relevant randomized controlled trials (RCTs) on itopride vs. mosapride for functional dyspepsia were searched in CENTRAL, Medline, Embase, ISI, OVID, CBM, VIP, WanFang Data and CNKI from the date of their establishment to November 2011. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Meta-analyses were conducted using Revman 5.1 software. Results A total of 4 trials involving 363 patients were included and data were coped with meta-analysis. a) About the improvement of overall symptoms: itopride was not superior to mosapride, with no significant difference (OR=1.62, 95%CI 0.53 to 4.93, P=0.4); b) About the improvement of single symptom: itopride was not superior to mosapride in improving single symptom as follows: postprandial fullness, upper abdominal distention, poor appetite, and upper abdominal pain, with no significant difference; and c) About the incidence of adverse events: itopride was similar to mosapride (OR=0.63, 95%CI 0.31 to 1.29, P=0.21). Conclusion Current evidence shows that itopride is similar to mosapride in effectively improving overall symptoms and single symptom, and it has fewer side effects than mosapride does. Due to the low quality of most included studies, more strictly-designed and large-scale RCTs are needed to provide reasonable proofs for clinic.
Objective To assess the efficacy and safety of sevoflurane versus ketamine in the anesthesia of child short period surgery. Methods Such databases as EMbase, PubMed, The Cochrane Library, CNKI, VIP, CBMdisc, Ongoing Controlled Trial and Conference Articles were searched from their establishment to April 2011 to collect randomized controlled trials (RCTs) and the quasi-RCTs. The quality of those studies meeting the inclusive criteria was assessed, the data were extracted and the meta-analysis was conducted by using RevMan 5.1.1 software. Results Ten studies involving 600 participants were included. Seven studies showed that the intraoperative heart rate of the sevoflurane group was lower than that of the ketamine group (MD= –11.85, 95%CI –16.47 to –7.23, Plt;0.000 01). Nine studies showed that the revival time of the sevoflurane group was shorter than that of the ketamine group (MD= –29.05, 95%CI –37.98 to –20.12, Plt;0.000 01). Three studies showed that the anesthesia induction time of the sevoflurane group was shorter than that of the ketamine group (MD= –208.45, 95%CI –359.22 to –57.68, P=0.007). Six studies showed that the influence on mean arterial pressure (MAP) had no significante difference (MD= –4.86, 95%CI –10.02 to 0.29, P=0.06). Meanwhile, seven studies showed that the adverse events of the sevoflurane group were fewer than those of the ketamine group (Peto OR=0.29, 95%CI 0.20 to 0.40, Plt;0.000 01). Conclusion The results of this system review show that sevoflurane is more effective than ketamine with fewer adverse reactions, and it provides a new choice for clinical anesthesia for child short period surgery. However, ketamine is still the main drug in clinical anesthesia for the child short period surgery at present, so high quality studies are needed for further clinical researches.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
Objective To assess the efficacy and safety of adalimumab on plaque psoriasis. Methods We searched the MEDLINE (1966 to December 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 12, 2009), EMbase (1980 to December 2009), CBM (1978 to December 2009), and CNKI (1979 to December 2009) to collect randomized controlled trials (RCTs) of adalimumab for plaque psoriasis. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 1?630 patients with chronic moderate or severe plaque psoriasis were included and assessed. At the end of 4th, 8th, 12th and 16th week, the PASI 75s of subcutaneous injection every other week in adalimumab (EOW) group were obviously higher than that of placebo group and methotrexate group. While at the end of 24th week and 60th week, the PASI 75s showed no difference between adalimumab EOW and placebo group. Twelve weeks after subcutaneous injection each week with adalimumab (QW), PASI 75 was obviously higher than those of placebo and EOW groups. However, at the end of 24th week and 60th week, there was no significant difference between adalimumab QW and placebo followed by adalimumab EOW. At end of week 12-16, there was no difference between adalimumab EOW group and placebo group in the incidence of adverse effects, with the exception of pain on injection site and upper respiration viral infection. At week 12-60, there was no difference between adalimumab QW and EOW groups in the incidence of adverse effects, with the exception of all serious adverse effects. Conclusion The limited evidence indicates that subcutaneous injection of adalimumab every other week for 12-16 weeks is safe and efficient for patients with moderate or severe plaque psoriasis. The efficacy can’t be enhanced when the treatment is prolonged to 24 weeks. The once-a-week protocol has no obvious advantage over every other week protocol. More RCTs are required to verify these conclusions owing to the limitations of the present study.
Objective To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.
Objective To assess the effects and possible adverse reactions of traditional Chinese medicine (TCM) in treating arteriosclerosis obliterans. Methods Materials were collected with both electronic retrieval including EMbase (1978 to October 2009), OVID-MEDLINE (1950 to October 2009), Cochrane Controlled Trials Register (Issue 3, 2009), Current Controlled Trials, The National Research Register, CBM (1983 to September 2009), CNKI (1995 to September 2009), Wanfang Data (1994 to 2009), and VIP Data (1989 to 2009), and manual retrieval of related journals. All the retrievals were published before November 10, 2009 without limitation of languages. The quality of included studies was evaluated, and meta-analysis was conducted with RevMan 5.0.2 software. Results A total of 10 included studies were all randomized controlled trials, including 837 patients, and the sample size of each study was from 36 to 260 cases. Because both Chinese medicines and control drugs used in studies were different from each other, the effect size of each study can only be singley described and newly calculated. Most included studies showed that, the effects of TCM on cure rate, total effective rate and decrease of TC and TG were similar to that of aspirin, acipimox, prostaglandin E1; a few studies showed the effect of TCM was much better; one study on side effect showed that, TCM was less than western medicine. Conclusion The evidences of TCM effects in treating arteriosclerosis obliterans is quite limited, which has to be strengthened by more studies of high quality.
Objective To assess the clinical effectiveness, safety and cost-effectiveness of adjuvant radiotherapy(RT) for endometrial cancer compared to other treatmen. Method The following electronic databases were searched: MEDLINE, EMBAS, CancerLit, CBMdisc, CNKI. The Cochrane Library (Issue 3, 2007). Correlative websites, such as ‘google’, were searched by hand. The studies included in the references of eligible studies were additionally searched RCTs of adjuvant radiotherapy before March, 2007 comparing adjuvant radiotherapy with other treatment for endometrial cancer were included. Eligible RCTs were assessed for quality by two reviewers independently: criteria of concealment of treatment, blinding, standard validity and reliability of outcome measures, withdraw rate, intention-to-treat analysis and homogeneity between centers were analyzed for each study. All data were performed by a meta-analysis. Result Seven RCTs met the inclusion criteria/ Methodological quality was level B. Five RCTs were compared adjuvant radiotherapy (external beam radiotherapy (EBRT) and /or intracavitary radiotherapy (ICRT) with other treatment, Two RCTs including one RCT was compared two different fractionation schedules for postoperative vagina high-dose-rate(HDR) irradiation in endometrial carcinoma the other RCT was compared two different radiotherapy method (pelvic radiotherapy and vagina radiotherapy vs vagina radiotherapy) for endometrial carcinoma. No survival different were identified; none of the studies was powered enough to show a survival benefit. But who received RT had fewer local (pelvic and/or vagina) recurrences compared to women not receiving RT. Adverse effects is found more often in RT than in not RT, there is less localrecurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vagina radiotherapy. lowdose vagina radiotherapy had few vagina shortening than high-dose radiotherapy, there are the same 5-overall surviva, local recurrences and distant recurrences. Conclusions Adjuvant radiotherapy for endometrial can cer can better control local recurrences than observation for postoperative endometrial cancer. Effects about overall survival, distant recurrences and disease-free survival are similar; low-dose vagina radiotherapy has few vagina shortening than high-dose radiotherapy, there are the same 5-years overall survival, local recurrences and distant recurrences for endometrial cancer, there is less local recurrences in combined radiotherapy (pelvic radiotherapy plus vagina radiotherapy) than in vagina radiotherapy for endometrial cancer; postoperative high-dose brachytherapy can get good cost-effectiveness; Effect of adjuvant radiotherapy for overall survival and disease-free survival of endometrial carcinoma are needed to further assessed by rigorously designs, randomized, double-blind, placebo-controlled trials adjuvant radiotherapy for endometrial carcinoma.