Objective To assess the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of colorectal neoplasia. Methods A systematic review of all relevant randomized controlled trials and quasi-randomized controlled trials of NSAIDs for prevention of colorectal neoplasms was performed by using The Cochrane Collaboration recommended methods. Results Nine trials were included and assessed. There was sufficient evidence for aspirin to prevent the development of colorectal adenomas compared with placebo in three trials of high quality and large sample size with relative risk (RR) 0.81, 95% confidence interval (CI) 0.72 to 0.91 and P=0.000 5 . No adequate evidence supported aspirin in the prevention of development of colorectal cancer (RR 0.97, 95% CI 0.79 to 1.20, P= 0.79). However, there was no evidence to support sulindac and celecoxib curing or preventing colorectal adenomas or familial adenomatous polyposis (RR 0.71, 95% CI 0.49 to 1.03, P= 0.07 and RR 0.90, 95% CI 0.76 to 1.07, P=0.23). No evidence on the dose of NSAIDs was used for prevention of colorectal adenomas at present. No significant difference was seen in the number of adverse events between patients taking NSAIDs and those taking placebo (P=0.9). Conclusions Aspirin may prevent the development of colorectal adenomas and may avoid polypectomy for 1 in every 10 to 18 persons but we don’t know whether aspirin can be substituted for endoscopically removed colorectal polyps. However, the true clinical benefit for prevention of colorectal neoplasia of NSAIDs should be considered.
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.
ObjectiveTo systematically evaluate the effect of hyperbaric oxygen therapy on delayed encephalopathy caused by carbon monoxide poisoning.MethodsChina National Knowledge Infrastructure, Wanfang Data, CQVIP data, China Biology Medicine Database, PubMed, Embase, and Cochrance Library were searched by computer for randomized controlled trials on hyperbaric oxygenation for delayed encephalopathy caused by carbon monoxide poisoning which were published in English or Chinese from the dates of establishment of the databases to March 31st, 2019. After literature including, excluding, and screening, RevMan 5.2 software was used to conduct a meta-analysis.ResultsA total of 25 studies were included, including 1 797 patients, 924 in the hyperbaric oxygen therapy group (the trial group) and 873 in the control group. The clinical effective rate [relative risk (RR)=1.24, 95% confidence interval (CI) (1.19, 1.30), P<0.000 01], the normal rate of electroencephalogram [RR=2.10, 95%CI (1.18, 3.75), P=0.01], the Mini-Mental State Examination score [standard mean difference (SMD)= 3.19, 95%CI (2.06, 4.32), P<0.000 01], and the Activities of Daily Living score [SMD=1.46, 95%CI (1.02, 1.90), P<0.000 01] were all higher in the trial group than those in the control group.ConclusionHyperbaric oxygen therapy for delayed encephalopathy caused by carbon monoxide poisoning can improve symptoms.
Objective To evaluate the effectiveness and safety of foscarnet sodium in the treatment of chronic hepatitis B. Methods We searched MEDLINE, EMbase, The Cochrane Library and CNKI from 1978 to June 2006. Randomized controlled trials of foscarnet sodium versus other drugs or no drugs in the treatment of chronic hepatitis B were identified. The quality of the included trials was evaluated by two reviewers independently. Meta-analysis was done using The Cochrane Collaboration’s RevMan 4.2.7. Results Seven studies (337 patients) were included; one compared foscarnet sodium versus interferon, and the other six compared foscarnet sodium versus no drugs. All the included studies were graded in terms of the quality of randomization, allocation concealment and blinding. All 7 studies were graded as level C. The meta-analysis showed that: ① foscarnet sodium was not significantly different from interferon in clinical efficacy, liver function, negative-conversion rate of virological markers and side effects. ② compared with the no drugs group, the negative-conversion rate of virological markers was significantly higher for the foscarnet sodium group, HBeAg (RR 6.20, 95%CI 1.76 to 21.79) and HBV-DNA (RR 4.13, 95%CI 1.32 to 12.86); but there were no significant differences in clinical efficacy, liver function and side effects. Conclusions Available evidence shows that: in the treatment of chronic hepatitis B the effectiveness and safety of foscarnet sodium are not significantly different from interferon, but only one trial is included in this review, so the evidence is weak. Compared with no drugs, foscarnet sodium significantly improves the negative-conversion rate of virological markers, but the evidence is insufficient to show whether foscarnet sodium could improve clinical efficacy and liver function, as well as reduce side effects.
Objective To assess the efficacy of naloxone for cardio-pulmonary-cerebral resuscitation (CPCR). Methods Randomized controlled trials (RCTs) involving naloxone for CPCR were identified from MEDLINE (1966 – Jun.2006), EMbase (1974 - Jun.2006), PubMed, The Cochrane Library (Issue2,2006), CBM(1978 - Jun.2006) and CNKI (1994 - Jun.2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis. Results Ten RCTs were included. The quality of included RCTs was low. All the patients were in-patients or out-patients receiving CPCR due to cardial arrest at the age of 18-75 years. Meta-analysis indicated that the resuscitation rate in naloxone group was significantly higher than the placebo group (Plt;0.00001). And the recovery of the brain function in naloxone group was better than in the placebo group(Plt;0.00001) Conclusions Naloxone is effective for CPCR and it may ameliorate its prognosis. Because of the low quality of included trials and the small sample size, more RCTs are required to assess the efficacy of naloxone for CPCR.
Objectives To assess the effectiveness and safety of additional bedtime H2-receptor antagonists (H2RAs) in suppressing nocturnal gastric acid breakthrough (NAB). Methods We identified eligible trials by searching The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase and CINAHL. We handsearched the data from the proceedings of correlated conferences, eight kinds of important Chinese journals and references of all included trials. All randomized controlled trials evaluating H2RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. Results Only two randomized crossover studies including 32 participants met the inclusion criteria. Because the design, dosage and duration of the treatment were different between the studies, it was impossible to conduct Meta-analysis. There was no consistent conclusion between the two included studies in evaluating H2RAs for the control of NAB. Conclusion We can not conclude any implications for practice at this stage. Appropriately designed large-scale randomized controlled trials with long-term follow-up are needed to decide the effects of additional bedtime H2RAs in suppressing NAB.
ObjectiveTo compare the therapeutic effect of dual-chamber pacing (DDD) and ventricular single-chamber pacing (VVI) on arrhythmia via systematic evaluation. MethodsWith the method of Cochrane system evaluation, we searched Medline, Embase, CNKI, PubMed and Wanfang database (the searching time was up to June 30, 2016) for randomized controlled trials comparing DDD with VVI treatingcardiac arrhythmias. Meta analysis was performed using RevMan5.3 software. ResultsWe collected 12 randomized controlled trials of DDD and VVI pacing treating cardiac arrhythmia including 1 704 patients, but the quality of the studies were not good. The results of Meta analysis showed that:compared with VVI pacing mode, DDD pacing mode reduced the risk of atrial fibrillation[RR=0.36, 95%CI (0.22, 0.59), P < 0.000 1]; besides, it reduced the left atrial diameter[SMD=-0.43, 95%CI (-0.68, -0.17), P=0.001], the left ventricular end diastolic dimension[SMD=-0.33, 95%CI (-0.61, -0.05), P=0.02] and increased the left ventricular ejection fraction[SMD=1.03, 95%CI (0.49, 1.57), P=0.000 2]. ConclusionsComparing DDD with VVI on the treatment of cardiac arrhythmia in patients with cardiac arrhythmia, DDD pacing can reduce the incidence of atrial fibrillation and thrombosis, enhance heart function and improve blood supply. But because of the low quality of the included studies, the curative effect cannot be confirmed, and more randomized controlled trials with high quality needs to be carried out in the future.
ObjectiveTo systematically review the efficacy and safety of Molnupiravir in the treatment of COVID-19. MethodsThe CNKI, VIP, WanFang Data, PubMed, Web of Science, Cochrane Library, and Epistemonikos COVID-19 L·OVE databases were electronically searched to collect randomized controlled trials (RCTs) related to Molnupiravir therapy for COVID-19 from inception to July, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 9 RCTs involving 32 086 patients were included. The meta-analysis results revealed that no significant differences were observed in the 28-29 day hospitalization rate, the 28-29 day mortality rate, 14-15 day PCR test conversion rate, or adverse event incidence between the two groups. However, there was a significant increase in adverse events related to four types of systemic organ diseases in the Monolaurin group. Conclusion Current evidence shows that the safety profile of Monolaurin and its potential benefits for COVID-19 patients with a high risk of progressing to severe illness is unclear. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To assess the effectiveness and safety of Chinese medicinal herbs for female immune-caused subfertility. Methods Databases included: MEDLINE (1966-2002.2), EMBASE (1984-2002.2), CBM (1978-2002.2) and Cochrane Controlled Trial Register, CCTR (Issue 1, 2002). Reference lists of trials were handsearched. Published randomized controlled trials (RCTs) whether blind or unblind, any languages and length of follow up were included. Treatments included Chinese medicinal herbs (single or compound). Controls were placebo and western medicine, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2. Results Six RCTs were included, all of which were poor in methodological quality. Because of different therapies in the treatment and control groups, we did not perform meta-analysis. The No.1 anti-immune tablet was more effective than corticosteroid plus condom during intercourse both in the pregnancy rate (RR 3.75, 95%CI 1.61 to 8.75, P=0.002) and AsAb negative rate (RR 1.66, 95%CI 1.23 to 2.22, P=0.000 8). Bushen Xiezhuo Soup was more effective than antibiotic in the pregnancy rate (RR 2.97, 95%CI 1.60 to 5.50, P=0.000 6) and antisperm antibody (AsAb) negative rate (RR 2.33, 95%CI 1.54 to 3.54, Plt;0.000 1)。Zhenqi Zhuanyin Soup was as effective as IUI in pregnancy rate (RR 1.80, 95%CI 0.58 to 5.60, P＝0.31) but more effective than IUI in AsAb negative conversion rate (RR 9.61, 95%CI 3.22 to 28.67, Plt;0.000 1), Zhenqi Zhuanyin Soup combined with IUI was more effective than IUI in pregnancy rate (RR 3.60, 95%CI 1.32 to 9.85,P=0.01) and AsAb negative rate (RR 8.92, 95%CI 2.98 to 26.75, Plt;0.000 1). Conclusions Some Chinese medicinal herbs may work well in subfertility treatment. However, the evidence is too weak to draw a conclusion for there are deficiencies in strict randomization, blinding and follow-up.More strictly designed, randomized, double-blind, placebo-controlled trials are required.
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.