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.
ObjectiveTo systemically evaluate the efficacy and safety of cyclooxygenase-2 (COX-2) signal pathway inhibition in treating advanced non-small cell lung cancer (NSCLC). MethodsA systematic literature search in PubMed, EMbase, Cochrane Library, ASCO databases, CNKI and Wanfang database was conducted to identify relevant randomized controlled trials (RCTs) from the time of database establishment to June 2015. RCTs of COX-2 inhibitors treating advanced NSCLC were included. We assessed the methodology quality of the included studies by using Jadad's scale, and performed this meta-analysis by using stata12.0 software. ResultsTwelve RCTs involving three different COX-2 inhibitors with a total of 1 828 patients were identified including 8 studies of high quality and 4 studies of low quality. We found that COX-2 signal pathway inhibition could significantly increase overall response rate at RR=1.27 with 95%CI1.10 to 1.46 (P=0.001). While our present data could not confirm the efficacy of COX-2 inhibitors in improving progression-free survival (PFS) at HR=0.93 with 95%CI0.81 to 1.08 (P=0.334), overall survival (OS) at HR=0.95 with 95%CI0.84 to 1.08 (P=0.461), or one-year survival rate at RR=1.08 with 95%CI0.90 to 1.24 (P=0.29). As for toxicities, only increased risk of thrombocytopenia at RR=1.28 with 95%CI 1.03 to 1.85 (P=0.03) was observed in the patients treated with COX-2 inhibitors. ConclusionCOX-2 signal pathway inhibition is effective in improving the overall response rate of the patients with advanced NSCLC, and is well tolerated. Whether COX-2 signal pathway inhibition is effective in improving long-term survival of the patients with advanced NSCLC still needs to be confirmed via further clinical trials.
ObjectiveTo systemically evaluate the advantage of simplified single-patch technique used in complete atrioventricular septal defects. MethodsA systematic literature search was conducted in PubMed, Annual Reviews, CNKI, Wanfang Data Libraries and Read Show Academic Search, and the retrieval date was March 2016. The literatures were screened and assessed according to inclusion criteria, and analyzed by meta-analysis STATA 11.0 software. The results were represented in standard mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI). ResultsCompared with the two-patch technique group, in the simplified single-patch technique group cardiopulmonary bypass time, aortic clamping time, the length of hospital stay and the ICU stay as well as the mortality rate were satistically less (SMD=-0.93, 95% CI -1.24, -0.61, P=0.000; SMD=-1.02, 95% CI -1.39, -0.66, P=0.000; SMD=-0.10, 95% CI -0.43, -0.23, P=0.035; SMD=-0.12, 95% CI -0.29, -0.05, P=0.555; RR=0.93, 95% CI 0.66, 1.30, P=0.031, respectively). While there was no statistical difference in the reoperation rate (RR=0.87, 95% CI 0.65, 1.17, P=0.398). ConclusionSimplified single-patch technique has dominant superiority in operation time, ICU stay, mortality rate, and correlative complications induced by extracorporeal circulation. However, difference in reoperation rate is not significant.
Objective To evaluate the efficacy and safety of Chinese medicine for the treatment of angina pectoris. Methods PubMed, EMbase, The Cochrane Library (Issue 11, 2015), VIP, WanFang Data and CNKI databases were used to evaluate the curative effect and safety of proprietary Chinese medicine in the treatment of angina pectoris. The retrieval time was up to November 2015. Two reviewers screened literatures, extracted data and assessed the methodological quality of included studies, and then the GRADE evaluation system was used to assess the quality of evidence. Results A total of 42 systematic reviews/Meta-analysises were included in the study. There were 15 kinds of proprietary Chinese medicines, and the drugs published most were compound composite salvia. AMSTAR evaluation results showed that the quality of all studies were low. The main problems were: ① no consideration was given to the publication of the inclusion criteria (eg, gray literature); ② only the list of articles included in the study literature was not available; ③ all articles did not describe the relevant conflicts of interest. The results of GRADE systems showed that: ① as to the total effective rate: musk pills (RR=3.44, 95%CI 2.99 to 3.96,P=0.08) and suxiaojiuxin Pills (RR=4.25, 95% CI 3.31 to 5.47,P<0.01) were superior to Western medicine, and the level of evidence was very low. ② As to the ECG changes efficiency rate: Puerarin (RR=3.61, 95% CI 2.95 to 4.42,P=0.05), Musk pill (RR=2.48, 95%CI 2.12 to 2.91,P<0.01) and Shuxuening (RR=1.62, 95% CI 1.33 to1.97,P<0.01) were superior to Western medicine, and the evidence level was low. The level of evidence was low for the remaining effective rate of proprietary Chinese medicine; ③ as to the adverse reactions: the musk Baoxin pill (RR=0.05, 95% CI 0.01 to 0.37,P=0.04) was less than Western medicine, and the evidence level was low. Conclusion Although the number of systematic reviews of published proprietary Chinese medicines for angina pectoris is high, but the methodological quality and evidence level are low. There are serious defects in the low quality of the original research literature and the systematic evaluation method. We suggest future studies to improve for two aspects: ① reasonable design to reduce the selective bias, to carry out the required clinical trials to reduce the implementation bias, the implementation of multi-center, the sample size of sufficient randomized controlled clinical trials to reduce the number of patients into the group less resulting in the loss of bias, strict implementation of the standard data collection methods to reduce the occurrence of measurement bias; ② in accordance with the requirements of clinical trials to report to improve the report quality of the literature.