Objective To systematically evaluate the effects of psychotherapy for cancer patients with depression. Methods We searched The Cochrane Library, PubMed, EMbase, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database up to October 2010 to identify randomized controlled trials (RCTs) comparing psychotherapy plus conventional treatment with conventional treatment alone. The data were analyzed by using RevMan 5.0 software. Results Eleven RCTs involving 1 670 participants were included. The results of meta-analyses showed: (1) A significant difference was found between psychotherapy plus conventional treatment and conventional treatment alone in decrease of depression score (SMD= – 0.40, 95%CI – 0.70 to – 0.11); (2) No difference was observed between the two groups in decrease of anxiety score (SMD= – 0.68, 95%CI – 1.37 to 0.01), but the result was changed when a sensitivity analysis was done (SMD= – 0.30, 95%CI – 0.52 to -0.08). Conclusion Compared with conventional treatment alone, psychotherapy combined with conventional treatment could improve depressive states in cancer patients, but the result still needs to be confirmed by high-quality and large-sample RCTs.
ObjectiveTo systematically review the efficacy and safety of totally thorascopic (TT) and median sternotomy (MS) approaches for atrial septal defect repair (ASDR). MethodsDatabases including The Cochrane Library (Issue 2, 2016), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that: The TT group had shorter postoperative ventilation time (MD=-1.49, 95%CI -2.27 to -0.71, P=0.000 2), postoperative ICU stay time (MD=-7.30, 95%CI -12.07 to -2.53, P=0.003), hospital stay time (MD=-2.06, 95%CI -2.80 to -1.32, P<0.000 01) and less postoperative drainage (MD=-199.83, 95%CI -325.96 to -73.70, P=0.002) than the MS group. But the bypass time (MD=9.42, 95%CI 1.55 to 17.30, P=0.02) and aortic clamping time (MD 6.78, 95%CI 3.48 to 10.07, P<0.000 1) of the TT group were significantly longer than those of the MS group. ConclusionCompared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.
ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
ObjectiveTo systematically evaluate the efficacy of steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment of children with epileptic electrical status during sleep to provide evidence-based medical basis for its treatment.MethodsElectronic searches were maded in PubMed, Embase database, Cochrane Library, CNKI, Wanfang and the Chinese biomedical literature database for the literature about steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment, and retrieval time is from January 1990 to October 2020. Two evaluators independently screened literature, extracted data, evaluated literature quality and risk of bias and checked each other. Meta analysis was performed by stata16.0 software.ResultsA total of 679 children with ESES were included in 10 studies, including 9 randomized controlled trials and 1 retrospective cohort study. Meta analysis results showed that there were statistically significant differences in clinical improvement rate [RR=1.31, 95%CI (1.21, 1.42), P<0.01], electroencephalogram discharge improvement rate [RR=1.35, 95%CI (1.25, 1.46), P<0.01] and cognitive intelligence score [SMD=1.19, 95%CI (0.80, 1.57), P<0.01] between steroids combined with antiepileptic drugs group and alone antiepileptic drugs group after 6 months follow-up. The incidence of adverse reactions in steroids combined with antiepileptic drugs group was higher than that in alone antiepileptic drugs group, and the difference was statistically significant [RR=4.13, 95%CI (1.06, 16.13), P<0.01]. All adverse reactions improved or disappeared after drug withdrawal.ConclusionCompared with alone antiepileptic drugs, steroids combined with antiepileptic drugs group has advantages in controlling epileptic seizures, improving electroencephalogram abnormalities and improving cognitive ability, and it is relatively safe.
ObjectiveTo investigate the short-term efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity with type 2 diabetes mellitus (T2MD) in China. MethodsClinical randomized controlled trial literatures about domestic LSG treatment of obesity with T2MD were obtained from Wanfang Data, China Knowledge Resource Integrated Database, PubMed and Web of Science English Data. The literatures were selected according to the inclusive and exclusive criteria, then evaluated. Methodological quality assessment and meta analysis were evaluated according to the data extracted from those literatures. The short-term efficacy (fasting blood glucose or glycosylated hemoglobin) was evaluated after operation. ResultsOne hundred and seven patients performed LSG were retrieved from 7 literatures. The levels of fasting blood glucose and glycosylated hemoglobin on the postoperative 6 months were all obviously decreased as compared with the levels before operation (fasting blood glucose:MD=2.99, 95% CI 2.39-3.60, P < 0.000 01; glycosylated hemoglobin:MD=2.24, 95% CI 1.43-3.04, P < 0.000 01), which on the postoperative 12 months were all obviously decreased as compared with the levels on the postoperative 6 months (fasting blood glucose:MD=0.56, 95% CI 0.16-0.95, P=0.006; glycosylated hemoglobin:MD=0.52, 95% CI 0.22-0.81, P=0.000 6). The postoperative fasting blood glucose and glycosylated hemoglobin levels in patients accepted LSG showed a downward trend. ConclusionsLSG on obesity with T2MD has an obvious short-term curative effect. But its long-term efficacy still needs to be supported by large samples randomized controlled clinical research data.
Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
ObjectivesTo systematically review the risk of arterial ischemic and metabolic adverse events in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect clinical trials, observational studies and case reports of adverse events in CML patients treated with TKIs from inception to February 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 22 studies involving 4 223 patients were included. The incidence rates of ischemic heart disease in any grade were 2 per 100 patient-years (95%CI 2 to 3) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 3) for imatinib. The incidence of ischemic heart disease in grade 3 or 4 was 1 per 100 patient-years (95%CI 0 to 2) for nilotinib. The incidence of peripheral arterial occlusive disease in any grade was 2 per 100 patient-years (95%CI 0 to 14) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 2) for imatinib. The incidence of hypertension in any grade was 1 per 100 patient-years (95%CI 0 to 3) for nilotinib, and 44 per 100 patient-years (95%CI 27 to 71) for ponatinib. The incidence of hypertension in grade 3 or 4 was 2 per 100 patient-years (95%CI 0 to 15) for nilotinib, and 22 per 100 patient-years (95%CI 8 to 58) for ponatinib. The incidence of hyperlipidemia in any grade was 17 per 100 patient-years (95%CI 5 to 59) for nilotinib. The incidence of hyperglycemia in any grade was 11 per 100 patient-years (95%CI 9 to 15) for nilotinib, 2 per 100 patient-years (95%CI 1 to 4) for imatinib, 1 per 100 patient-years (95%CI 0 to 5) for dasatinib, and 19 per 100 patient-years (95%CI 19 to 20) for bosutinib. The incidence of hyperglycemia in grade 3 or 4 was 4 per 100 patient-years (95%CI 3 to 5) for nilotinib, and 1 per 100 patient-years (95%CI 1 to 2) for bosutinib.ConclusionsPatients treated with nilotinib have a greater possibility of ischemic heart and peripheral arterial occlusive disease compared with patients treated with imatinib. Patients treated with ponatinib have a high incidence rate of hypertension, and patients treated with nilotinib have a high incidence rate of hyperlipidemia. Patients treated with bosutinib and nilotinib have higher risk of hyperglycemia compared with patients treated with imatinib or dasatinib.
Objective To compare the long-term outcome between breast-conserving therapy with mastectomy therapy for early stage invasive breast cancer through a Meta analysis of the randomized controlled trials published worldwide. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and so on. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicators for assessment including death number at the end of follow-up, locoregional and total recurrence. The results were analyzed with RevMan 4.2.2 software. Results Six articles were involved in the Meta analysis with total 3 933 patients. No statistical difference was found in the death at the end of follow-up between breast-conserving therapy group and mastectomy therapy group (OR=1.05, 95% CI=0.93—1.19， P=0.45). Locoregional and total recurrence rate of breast-conserving therapy group were statistical higher than those in mastectomy therapy group (OR=1.64, 95% CI: 1.10—2.44， P=0.01； OR=1.42, 95% CI: 1.22—1.64， Plt;0.01). Conclusions Breast-conserving therapy and mastectomy therapy have comparable effects on mortality in patient with early stage invasive breast cancer, even after long-term follow up. However, breast-conserving therapy is associated with significantly greater risk of locoregional recurrence.
ObjectiveTo evaluate the efficacy and safety of all kinds of hemocoagulase on operative incisions. MethodsDatabases including Web of Science, MEDLINE, EMbase, EBSCO, PubMed, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials (RCTs) about hemocoagulase on operative incisions from the inception to June 20th, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 867 patients were included. The results of meta-analysis showed that, compared with the control group, the hemostatic time (MD=-37.84, 95%CI -52.72 to -22.96, P<0.000 01), blood loss volume per unit area (MD=-0.09, 95%CI -0.10 to -0.07, P<0.000 01), PT of the first postoperative day (MD=-0.37, 95%CI -0.65 to -0.09, P=0.009) were significantly shorter in the hemocoagulase group. However, no significant differences were found in APTT, TT and FIB between two groups. ConclusionHemocoagulase can reduce hemostatic time and blood loss volume in surgical incisions. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.