ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72). ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.
ObjectiveTo systematically review the accuracy of T-cell receptor excision circles (TRECs) in screening newborns for severe combined immunodeficiency (SCID). MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CBM, WanFang Data and CNKI databases were electronically searched to collect the diagnostic accuracy studies related to the objects from inception to October 26, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies using the QUADAS-2 scale. Meta-analysis was performed using Stata 15.0 and Meta-Disc 1.4 software. ResultsA total of 18 studies involving 6 243 718 neonates were included. The results of meta-analysis showed that the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnosis odds ratio (DOR) were 0.97 (95%CI 0.92 to 0.99), 1.00 (95%CI 1.00 to 1.00), 1447.05 (95%CI 528.49 to 3962.11), 0.13 (95%CI 0.08 to 0.22) and 11698.21 (95%CI 2853.44 to 47958.98), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.97. ConclusionThe application of TRECs in screening neonatal SCID has high accuracy, which is helpful for early diagnosis of SCID. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus (GDM) and their correlations with maternal insulin resistance (IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. ResultsA total of 19 studies were included, comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein 4 (RBP4) [standard mean difference=2.11, 95% confidence interval (CI) (1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1B (PTP1B) [relative risk (RR)=1.56, 95%CI (1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1 (IRS-1) [RR=0.69, 95%CI (0.60, 0.78), P<0.000 01] was down-regulated. The protein expression levels of RBP4 (P<0.000 01) and PTP1B (P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR), while the protein expression levels of IRS-1 (P<0.000 01) and APN (P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4 (GLUT 4) was not correlated with HOMA-IR (P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines (leptin, resistin), oxidative stress markers (xanthione oxidase, malondialdehyde, 8-isoprostaglandin),inflammatory factors (tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor),fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3a and estrogen receptor α in GDM placenta were up-regulated and all were positively correlated with HOMA-IR. The expression levels or positive rates of insulin signaling pathway proteins [phosphoinositide 3-kinase (PI3K), protein kinases B (AKT), phospho-protein kinases B (p-AKT), GLUT 4] were down-regulated, PI3K and AKT were negatively correlatedwith HOMA-IR, while p-Akt had no correlation with HOMA-IR. ConclusionsThe dysregulation of placental protein expressions may mediate maternal IR exacerbation, thus promote the occurrence and development of GDM and other pregnancy complications. The causal relationship and regulatory mechanism are still unclear, which need to be further studied.
Objective To calculate the typical time taken to complete protocols and reviews, to track how often reviews are updated and compare with Collaboration policies, to feed back any gaps in documentation of dates to individual Cochrane Collaborative Review Groups, and to suggest changes to presentation of reviews and to editorial processes.Methods Data were extracted either from The Cochrane Library or a specially constructed database to calculate the age of reviews and protocols, and the frequency of updating of reviews. Issue 1, 2003, with 1 596 reviews and 1 200 protocols, was used as the index issue.Results Median number of issues between a protocol and its completed review being published on The Cochrane Library is 5 (1.25 years). 65% of protocols have appeared on The Cochrane Library for no longer than two years, but the number of protocols more than two years old is probably increasing. One-third of reviews have been substantively updated, but generally only once and often within several months of the first publication of the review. The number of out-of-date reviews is probably increasing. Conclusions While the stage between publishing a protocol and the completed review is usually completed in no longer than two years, the number of out-of-date reviews and protocols requires continuing attention. How up-to-date a review is depends on when the evidence base was last searched and when additional relevant evidence has been integrated into the review. This needs to be reflected in the information provided to readers of Cochrane Reviews and some alternative ways of presenting the components of this information are given. More accurate and complete reporting will also allow the Collaboration to track progress against policy.
ObjectiveTo systematically review the efficacy and safety of cisplatin combined with etoposide versus other platinum combined with etoposide in the treatment of small cell lung cancer (SCLC). MethodsWe searched PubMed, The Cochrane Library (Issue 8, 2013), MEDLINE (Ovid), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) concerning the efficacy and safety of cisplatin combined with etoposide (the cisplatin group) versus other platinum combined with etoposide (the control group) for SCLC. The search was up to August 2013. Two reviewers screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. And then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 6 RCTs involving 684 patients were included. The results of meta-analysis showed that there were no significant differences in disease control rate (DCR) (RR=1.03, 95%CI 0.91 to 1.17, P=0.63), overall response rate (ORR) (RR=1.04, 95%CI 0.97 to 1.11, P=0.33), occurrence of leukocytopenia (RR=0.97, 95%CI 0.81 to 1.17, P=0.77), decreased hemoglobin (RR=0.89, 95%CI 0.61 to 1.31, P=0.56) between the cisplatin group and the control group. Occurrence of thrombocytopenia was lower (RR=0.49, 95%CI 0.38 to 0.63, P<0.000 01) while occurrence of nausea and vomiting was higher (RR=1.80, 95%CI 1.40 to 2.31, P<0.000 01) in the cisplatin group. ConclusionCurrent evidence shows that the clinical efficacy of cisplatin combined with etoposide for SCLC is equal to other platinum combined with etoposide, but it has a certain advantage in decreasing the aggregative rate of platelets, while the gastrointesnial reaction patients should avoid using cisplatin combined with etoposide.
Objective To systematically review the impact of Beijing's comprehensive reform of medical consumption linkage on medical expenses, hospital services, and hospital income. Methods Databases including CNKI, WanFang Data, VIP, CBM, PubMed, and Web of Science were searched to collect empirical research on evaluating the impact of Beijing's comprehensive reform of medical consumption linkage on patient medical expenses and hospital operation (service volume and income structure) from June 15th, 2019 to August 15th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature and extracted data. Results A total of 23 studies were included, and most of them found a relatively small change in the average outpatient and emergency medical expenses after the reform. However, the average inpatient expenses in some hospitals showed an increasing trend; the service volume of most hospitals increased slightly, and the income structure was optimized (e.g., surgery and other medical technology services revenue and its proportion increased). Conclusion The comprehensive reform of the medical consumption linkage in Beijing is the practice of deepening the reform of the medical service price mechanism. Based on the summary of the reform effect, it is recommended to further improve the price mechanism, improve service quality, and promote hierarchical diagnosis and treatment.
Objective To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth. Methods We searched the Cochrane Oral Health Group Trials Register （to 4 August, 2004）, the Cochrane Central Register of Controlled Trials （CENTRAL）, PubMed （1966 to 4 August, 2004）, EMBASE （1974 to 4 August, 2004）. There was no restriction to publication of language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. All randomised or controlled clinical trials （KCTs/CCTs） comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment （retention） were included. Assessment of relevance ,validity and data extraction were conducted in duplicate by three independent reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. The quality assessments of the trials were carried out. Results Only three trials were identified to fulfill the selection criteria. Two complete RCTs assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data and intended to publish in the near future. Although both complete trials met the inclusion criteria, different outcome measures were prevented us from pooling data. Conclusions No evidence has been found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliableevidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.
Objective To make an individualized treatment plan for a newly diagnosed Barrett esophagus patient by means of evidence-based medicine. Methods After the clinical problems were put forward, both the systematic reviews and randomized controlled trials (RCTs) were collected from The Cochrane Library (Issue 3, 2009) and PubMed (1995 to 2010) and SCIE (1995 to 2010). The treatment protocol was made by combining the evidence and the preference of patient. Results A total of 21 RCTs and 6 systematic reviews (meta-analyses) were identified. A rational treatment plan was made upon a serious evaluation and patient’s preferences: improving the lifestyle and adopting the APC therapy combined with acid-suppressive drugs (Omeprazole, 40 mg, bid) for six weeks. Three months later, the endoscope reexamination showed the patient was much better. After another twelve-month follow-up, the plan proved to be optimal. Conclusion In accordance with the evidence-based methods, the rational treatment plan made for a diagnosed Barrett esophagus male can effectively relieve symptoms and improve quality of life.
Objective To systematically review the efficacy of enteral nutrition with eicosapentaenoic acid ( EPA) , gamma-linolenicacid ( GLA) , and anti-oxidants for patients with sepsis. Methods We searched the PubMed, EMbase, Cochrane Library, Wanfang Database, CNKI and VIP for all randomized controlled trials about the efficacy of an enteral diet enriched with EPA, GLA, and anti-oxidants for patients with sepsis. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.0 software.Results Three RCTs involving 350 patients were included in our systematic review. The results showed a significant reduction in the length of ICU stay ( MD =6.21, 95% CI: 4.61-8.19; P lt;0.00001) and hospital stay ( P lt;0.0001) , a fewer development of neworgan dysfunctions in the patients fed with the study diet and no more adverse events were observed. However, no significant difference in 28-day mortality of all cause was revealed( RR=0.83, 95% CI: 0.60-1.16, P = 0.27) . There were controversial results about the duration of mechanical ventilation.Conclusion A diet enriched with EPA, GLA, and elevated antioxidants is safe and beneficial for the clinical outcome in patients with sepsis.