Objective To evaluate the effect and safety of Yinzhihuang injection for icteric viral hepatitis. Methods We searched MEDLINE (1966 to 2005), The Cochrane Library (Issue1, 2005), CBMdisk (1978 to 2004), CMCC (1994 to 2005), CMAC (1994 to 2005), CNKI (1994 to 2005), VIP (1989 to 2004). Data were extracted by two reviewers using a designed extraction form. The quality of included trials was critically assessed. RevMan 4.2.7 was used for data analysis. Results Four randomized controlled trials were included. It showed that Yinzhihuang injection could abate jaundice better than or the same as controlled western medicine in patients with hepatitis (WMD 19.70, 95%CI 32.69 to 6.71 and WMD 1.27, 95%CI 3.08 to 0.54, respectively), but less than S-adeanosyl methionine in patients with chronic hepatitis (WMD 106.00, 95%CI 189.05 to 22.95). There may be a dose-effect relationship in Yinzhihuang injection, higher doses had better effect (WMD 11.50, 95%CI 16.53 to 6.47). No fatal side effects were reported.Conclusions It is noted that Yinzhihuang injection can abate jaundice of icteric viral hepatitis. Due to low statistical power and high risk of selection bias, performance bias and measurement bias of the included trials, these conclusions need to be treated cautiously.
Objective To evaluate the prognostic value of the level of serum neurone specific enolase (NSE) in patients with small cell lung cancer (SCLC). Methods We searched MEDLINE, EMbase, CBMdisc, and The Cochrane Central Register of Controlled Trials (1950 to December 2007). Studies meeting the eligibility criteria were retrieved and their bibliographies were checked for other relevant publications. The quality of included studies was evaluated by 2 reviewers independently. Meta-analyses were performed for the results of homogeneous studies using STATA 7.0 software. Results Nine studies involving 2 021 SCLC patients were included. About 66.0% of patients had high serum levels of NSE, according to the cut-off value defined by the authors. The hazard ratio (HR) of high levels of NSE for overall survival (OS) was 1.27 times of that of low levels of NSE for OS in SCLC patients (95% CI 1.19 to 1.35, P=0.281). Conclusion Patients with high levels of NSE appear to have a poorer OS compared with those with low levels of NSE, thus the level of NSE has a prognostic value in SCLC patients. Due to the potential publication bias, selection bias, and measurement bias among these studies, the conclusion should be interpreted carefully. More high-quality homogeneous studies are required to accurately evaluate the prognostic value of NSE.
Objective To assess the efficacy of ambroxol on acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) . Methods The randomized controlled study involving ambroxol on ALI/ARDS were searched and identified from Cochrane Library, PubMed, China Academic Journals Full-text Database, Chinese Biomedical Literature Database, WanFang Resource Database, and Chinese Journal Fulltext Database. The quality of the chosen randomized controlled studies was evaluated, and then the valid data was extracted for meta-analysis. Results Ten articles were included, all in Chinese, including 459 cases ofpatients ( 233 cases in experimental group,226 cases in control group) , with baseline comparability between the various experiments. Systematic review showed that in ALI/ARDS patients, high-dose ambroxol was in favor to improve PaO2 [ WMD =12. 23, 95% ( 9. 62, 14. 84) , P lt; 0. 0001] and PaO2 /FiO2 [ WMD = 32. 75,95% ( 30. 00, 35. 51) , P lt;0. 0001] , reduce lung injury score [ WMD = - 0. 49, 95% ( - 0. 66, - 0. 33) ,P lt;0. 0001] , decrease the duration of mechanical ventilation [ WMD = - 2. 70, 95% ( - 3. 24, - 1. 12) ,P lt;0. 0001] and the length of ICU stay [ WMD= - 2. 70, 95% ( - 3. 37, - 2. 04) , P lt;0. 0001] , and lower mortality [ OR=0. 46,95%( 0. 22, 1. 00) , P = 0. 05] . Conclusions The existing clinical evidence shows that, compared with conventional therapy, high-dose ambroxol plus can significantly improve PaO2 , PaO2 /FiO2 , lung injury score, duration of mechanical ventilation, length of ICU stay and mortality in ALI/ARDS patients. Due to the quality of research and the limitations of the study sample, there likely to exist a bias,and may affect the strength of result, so we expect more high-quality, large-scale randomized controlled clinical trial to verify.
Objective To assess the effectiveness and safety of salbutamol in the treatment of preterm labor. Methods We searched MEDLINE (1966-Jan. 2007), EMBASE (1966-Jan. 2007), Cochrane Central Register of Controlled Trials (Issue 4, 2006), CBMdisc (1978-Jan. 2007) and CNKI (1979-Jan. 2007). Randomized controlled trials (RCTs) or quasi-randomized controlled trials (quasi-RCT) involving salbutamol for preterm labor were collected. The quality of the retrieved trials was assessed using the Jadad Scale. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2 software. Results A total of 19 RCTs and quasi-RCTs were included, of which 16 were published in Chinese and 3 in English. The quality of the 16 Chinese studies was low, scored less than 3 by the Jadad Scale. None of the 16 RCTs mentioned the method of randomization, allocation concealment, double-blinding or the long-term effect. The quality of the 3 English studies was high. Compared with basic treatment, salbutamol was more effective in prolonging pregnancy over 48 hours (RR=6.30, 95%CI 3.23 to 14.32), and preventing neonatal asphyxia (RR=0.44, 95%CI 0.33 to 0.59), but the incidence of adverse events in pregnant women was higher in the salbutamol group (RR=4.57, 95%CI 1.34 to 15.54). Salbutamol was as effective as magnesium sulfate in prolonging pregnancy over 48 hours (OR=1.60, 95%CI 0.92 to 2.76), but more effective in preventing neonatal asphyxia (OR=0.29, 95%CI 0.14 to 0.61). Salbutamol was similar to atosiban in terms of prolonging pregnancy over 48 hours (OR=1.18, 95%CI 0.42 to 3.37) and preventing neonatal asphyxia (OR=1.13, 95%CI 0.30 to 4.31). Conclusion Salbutamol is effective in prolonging pregnancy over 48 hours and preventing neonatal asphyxia, but may cause more adverse events in pregnant women. Salbutamol has similar effects to other commonly-used drugs in regard to prolonging pregnancy over 48 hours, but is better than magnesium sulfate in decreasing the incidence of neonatal asphyxia. Salbutamol may lead to more adverse events compared with atosiban, but fewer adverse events than magnesium sulfate.
Objective To assess the efficacy and safety of neoadjuvant intraarterial chemotherapy in the treatment of advanced cervical cancer. Methods We searched databases including PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBMdisc, conference articles, and Ongoing Controlled Trial for Random Controlled Trials and quasi-Random Controlled Trials up to October 2009. For homogeneous studies, we performed meta-analysis. Results Fifteen studies involving 1 331 participants with advanced cervical cancer were included. Twelve studies showed that the efficacy of the NIC group was 6.72 times than that of the traditional group. Several studies showed that the survival rate of the NIC group was better than that of the traditional group. Meanwhile, the adverse events of the NIC group were fewer than those of the traditional group. Conclusions The results of this system review show that, NIC which is more effective than conventional treatments with less adverse reactions provides a new adjunct for clinical treatment of advanced cervical cancer . However, due to the current clinical treatment for the disease is the coexistence of multiple chemotherapy program status, the higher quality and more focused clinical research which will compare NIC with a variety of conventional chemotherapy are needed in the further.
ObjectiveTo systematically review the efficacy of promoting neonatal resuscitation technique in treatment of neonatal asphyxia in China. MethodsElectronical databases including WanFang Data, CNKI, VIP, Jiangsu Engineering and Technology Literature Information Center, PubMed and The Cochrane Library (Issue 5, 2016) were searched to collect studies of neonatal resuscitation technique in treatment of neonatal asphyxia up to June 1st, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of eighteen observational studies were included, involving 28 144 cases of neonatal asphyxia and 32 636 cases of control, 2 148 death cases of neonatal asphyxia and 1 679 cases of controls. The results of meta-analysis showed that neonatal resuscitation technique could reduce newborn suffocation rate compared with the control group in hospital surveys (RR=0.59, 95%CI 0.55 to 0.63, P<0.000 01) and in regional project surveys (RR=0.72, 95%CI 0.69 to 0.75, P<0.000 01). Neonatal resuscitation could also reduce neonatal asphyxia mortality rate in hospital surveys (RR=0.26, 95%CI 0.16 to 0.42, P<0.000 01) and in regional surveys (RR=0.65, 95%CI 0.55 to 0.77, P<0.000 01). ConclusionThe existing evidence shows that neonatal resuscitation technology could effectively reduce the incidence of neonatal asphyxia and mortality rate in China. Due to the limitations of the quantity and quality of present studies, we need to carry out prospective multicenter cohort studies to verify the current results.
Objective To conduct bibliometric analysis of systematic review and meta-analysis published in the Chinese Journal of Evidence-based Medicine. Methods Based on the Chinese academic periodical network as a data pool, literature on systematic reviews (involving meta-analysis) and clinical decision-making researches were retrieved in the Chinese Evidence-Based Medicine Magazine from 2001 to 2010, screened and categorized by the medical and hygienic standards of Chinese Library Classification (fourth edition), and then were counted and sorted. Results There were 425 articles about systematic reviews (involving meta-analyses) and clinical decision-making studies in the Chinese Evidence-Based Medicine Magazine, with an yearly increasing number. Basically, those articles involved all subjects such as clinical medicine, preclinical medicine, hygenics, pharmacy, and traditional Chinese medicine. Conclusion Development levels of evidence-based research in medical subjects are different, each of which has its own feature. Also, some systematic reviews do not strictly follow the Cochrane Handbook. Therefore, high-quality systematic review is still needed in each subject.
The most important difference between systematic review and traditional narrative review lies in their respective quality, namely the degree of bias control. Generally speaking, the sources of bias include the process of literature searching, study selection, data extraction and original studies. A systematic review may greatly reduce bias, as it takes effective steps such as developing search strategies, undertaking funnel plot analysis, using established criteria for study selection, and assessment of the methodology quality of studies. All these help to control, identify and, describe the possible bias.
ObjectiveTo systematically evaluate the efficacy of mirror therapy for phantom limb sensation and phantom limb pain in amputee. MethodsDatabases include PubMed, EMbase, The Cochrane Library (Issue 9, 2015), CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about mirror therapy for phantom limb sensation and phantom limb pain in amputee from inception to 1st Sept. 2015. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then metaanalysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 129 patients were included. The results of meta-analysis showed that, there was no significant difference between the mirror therapy group and the control group in relieving the phantom limb sensation and phantom limb pain in amputee (MD=-7.29, 95%CI -27.73 to 13.16, P=0.48). ConclusionMirror therapy could improve the control of phantom limb, however, there is no sufficient evidence to support the effect of mirror therapy on pain management in amputee. The long-term effect of mirror therapy is still under exploration. Due to the limited quantity and quality of the included studies, larger-sample, high quality designed RCTs are needed to verify the above conclusion.
Objective To investigate the effect of penehyclidime hydrochloride as the preanesthetic medication for general anesthesia, and also to provide evidence for clinical practice. Methods We searched The Cochrane library (2007, Issue 3), MEDLINE (1966 to 2007), EMBASE (1988 to 2007), CBM (1978 to 2007), VIP (1989 to 2007) and CNKI (1994 to 2007). Randomised trials comparing penehyclidime hydrochloride with other drugs were collected. Quality assessment and data extraction were performed. Results A total of 23 trials were included, and the quality of all studies was low. Among them, 11 trials compared penehyclidime hydrochloride with atropine, of which only 2 measured the airway secretion volume and indicated that the airway secretion volume was smaller in the penehyclidime hydrochloride group than that in the atropine group (WMD –8.00, 95%CI –8.16 to –7.85, Plt;0.000 01). Twelve trials compared penehyclidime hydrochloride with scopolamine, of which only 2 measured the airway secretion volume and revealed no significant difference between the two groups (WMD –17.07, 95%CI –45.49 to 11.35, P=0.24). Three trials compared penehyclidime hydrochloride with placebo, which showed that the airway secretion volume was smaller in the penehyclidime hydrochloride group than that in the placebo group (WMD –10.60, 95%CI –13.64 to –7.56, Plt;0.000 01). No significant adverse drug reactions were found. Conclusion Current evidence suggested that penehyclidime hydrochloride was not inferior to other drugs in decreasing airway secretion and keeping heart rate stable.