Objective To assess the effectiveness and safety of irbesartan for hypertensive patients with hyperuricaemia. Methods The databases such as The Cochrane Library (Issue 2, 2010), MEDLINE (by the end of April 2010), SCI (by the end of April 2010), CBM (by the end of April 2010) and CNKI (by the end of April 2010) were searched to collected randomized controlled trails (RCTs) on irbesartan for hypertensive combined with hyperuricaemia. Studies were screened according to the inclusion and exclusion criteria; data were extracted; the methodological quality was evaluated; and meta-analyses were conducted by using RevMan 5.0.0 software. Results Nine studies involving 977 patients were included. The results of meta-analyses showed that compared with the control group, irbesartan was superior in decreasing serum uric acid (SUA) (MD=57.12, 95%CI 16.08 to 98.15, P=0.006); it was similar in controlling blood pressure (Systolic pressure: MD= –0.24, 95%CI –2.19 to 1.71, P=0.81; Diastolic pressure: MD=0.46, 95%CI –1.58 to 2.50, P=0.66), and lower in the incidence rate of adverse reaction (RR=0.07, 95%CI 0.02 to 0.24, P=0.000 1). Conclusion The study suggests that irbesartan is effective and safe to control blood pressure and decrease serum uric acid for hypertensive patients with hyperuricaemia. But because all nine included studies are graded C in quality, the conclusion still needs to be further verified by long-term, large scale and high quality studies.
Objective To assess the effectiveness and safety of mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis. Methods We searched CBM (November 1979 to February 2006), Chinese Cochrane Centre Database (2005), The Cochrane Library (Issue 4, 2005), MEDLINE (November 1966 to February 2006) and EMBASE (1975 to February 2006) for randomize controlled trials. Data were extracted and analyzed using The Cochrane Collaboration’s RevMan 4.2.7. Results Nine randomize controlled trials involving 512 patients met the inclusion criteria. The meta-analysis showed that the total clinical effective rate and complete remission rate were not significantly higher for MMF than for cyclophosphamide, azathioprine, or both. Renal survival rate and relapse rate of MMF were not significantly different from those for cyclophosphamide, azathioprine, or both. Patient survival rate and safety of MMF were significantly improved compared with cyclophosphamide, azathioprine, or both. Conclusion More large-scale multi-center randomized trials are needed to investigate the role of MMF in the treatment of proliferative lupus nephritis.
Objective To assess the correlation between bispectral index (BIS) and richmond agitation sedation scale (RASS) and sedation-agitation scale (SAS) through the spearman correlation coefficient by systematic review. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 7, 2016), CNKI, VIP, WanFang Data and CBM were searched from inception to July 2016 to collect literature on the correlation between BIS and RASS and SAS. The studies were screened according to the inclusion and exclusion criteria. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using Comprehensive Meta Analysis 3.0 software. Results A total of 12 studies involving 397 patients were included. BIS was positively correlated with RASS score and SAS, and the summary correlation coefficient was 0.742 with 95% CI 0.678 to 0.795 and 0.605 with 95% CI 0.517 to 0.681, respectively. Conclusion BIS has a good correlation with RASS and SAS, which will provide more options for assessing sedation of patients with mechanical ventilation in ICU.
Objective To evaluate the efficacy and safety of FTY720 (fligolimod) in different dosages in the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS), so as to provide references for clinical practice. Methods Such databases as MEDLINE, EMbase, The Cochrane Liabrary, CBM and CNKI were searched for collecting randomized controlled trials (RCTs) of FTY720 in the treatment of RRMS, which were published from January 1, 2001 to December 31, 2010. The studies were retrieved and the data were extracted according to the predefined inclusion and exclusion criteria, the quality of included studies was evaluated with improved Jadad scale, and the Meta-analyses were performed with RevMan5.1 software. Results Three high quality RCTs were included. The Meta-analyses showed that: a) compared with the control group, orally taking FTY720 could obviously decreased the annualized relapse rate (OR=-6.67, 95%CI -10.75 to -2.60, P=0.001), the confirmed disability progression rate (OR=0.64, 95%CI 0.47 to 0.87, P=0.004), and the incidence rate of intensified lesion on T2-weighted magnetic resonance imaging scans (OR=0.28, 95%CI 0.21 to 0.37, Plt;0.00001); b) There was no significant difference (P=0.55) between the small dosage (0.5mg/d) group and the big dosage (1.25mg/d) group of FTY720; and c) The incidence of adverse events was significantly different among the 3 dosage groups (5mg/d, 1.25mg/d and 0.5mg/d), and the minimum dosage group (0.5mg/d) was safer than the other groups. Conclusion FTY720 is safe to treat RRMS, and it can obviously decrease the annualized relapse rate, confirmed disability progression rate and incidence rate of intense lesion on T2-weighted magnetic resonance imaging scans. There is no dosage-effect relationship found in treating RRMS with FTY720 in different dosages, but the 0.5mg/d FTY720 as the minimum dosage is the safest.
Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention. Methods Such databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched to collect the randomized controlled trials (RCTs) and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration (≤6 months) and long-duration (gt;6 months) after percutaneous coronary intervention. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, the quality was evaluated, the data were extracted, and meta-analyses were performed by using RevMan 5.1 software. Results Eight trials were included, of which 3 were RCTs involving 7 475 patients, and 5 were observational studies involving 12 744 patients. Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group (OR=0.74, 95%CI 0.56 to 0.98, Plt;0.000 1), while meta-analyses on observation studies showed the similar result (OR=0.7, 95%CI 0.45 to 1.08, P=0.11). With the variables of published year and follow-up time, the heterogeneity of cohort studies was discussed through meta-regression (Z=3.61, P=0.000) which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution. For RCTs, the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group (OR=1.29, 95%CI 0.99 to 1.69, P=0.06). For observational studies, the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group (OR=0.40, 95%CI 0.15 to 1.07, P=0.07). Conclusion The long duration (gt;6months) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis, but cannot obviously increase the incidence rate of severe bleeding events. The current evidence shows no marked superiority in longer duration (gt;12months) of dual antiplatelet therapy.
Objective The risk factors of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with failure of respiratory failure were identified by meta-analysis, so as to provide a basis for early clinical prevention and treatment failure and early intervention. Methods PubMed, The Cochrane Library, EMbase, China National Knowledge Infrastructure, Wanfang, VIP and CBM Data were searched to collect studies about risk factors about failure of noninvasive positive pressure ventilation in AECOPD and respiratory failure published from January 2000 to January 2021. Two researchers independently conducted literature screening, literature data extraction and quality assessment. Meta-analysis was performed on the final literature obtained using RevMan 5.3 software. Results Totally 19 studies involving 3418 patients were recruited. The statistically significant risk factors included Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, pre-treatment PCO2, pre-treatment pH, Glasgow Coma Scale (GCS), respiratory rate (RR) before treatment, body mass index (BMI), age, C-reactive protein (CRP), renal insufficiency, sputum disturbance, aspiration of vomit. Conclusions High APACHE-Ⅱ score, high PCO2 before treatment, low pH value before treatment, low GCS score, high RR before treatment, low BMI, advanced age, low albumin, high CRP, renal insufficiency, sputum disturbance, and vomit aspiration were the risk factors for failure of respiratory failure in patients with COPD treated by NIPPV. Failure of non-invasive positive pressure ventilation in COPD patients with respiratory failure is affected by a variety of risk factors, and early identification and control of risk factors is particularly important to reduce the rate of treatment failure.
ObjectiveTo systematically review the clinical efficacy and safety of afatinib in the treatment of advanced non-small cell lung cancer (NSCLC).MethodsWe electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP to collect randomized controlled trials (RCTs) about the afatinib for advanced non-small cell lung cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsEight RCTs were included. The results of meta-analysis showed that afatinib could significantly prolonged progression-free survival (PFS) for lung adenocarcinoma patients (HR=0.43, 95%CI 0.32 to 0.57, P<0.000 01), but there was no significant difference between the two groups in terms of overall survival (OS) in patients with lung adenocarcinoma (HR=1.03, 95%CI 0.85 to 1.23, P=0.79). In addition, afatinib significantly increased the patient’s adverse reactions including diarrhea, skin rashes, nausea and vomiting.ConclusionAfatinib can improve PFS in patients with lung adenocarcinoma, but it does not prolong OS. Due to the limited quantity and quality of included studies, the above conclusions are still needed to be verified by more high quality studies.
Objective To assess the efficacy and safety of levoamlodipine besylate for essential hypertension. Methods We searched MEDLINE (1999 to October 2007), EMBASE (1999 to October 2007), The Cochrane Library (Issue 3, 2007), CNKI (1999 to 2007), Wanfang (1999 to 2007), VIP (1999 to 2007) and CBM (1999 to October 2007). The quality of included studies was critically evaluated. Data analyses were performed with The Cochrane Collaboration’ s RevMan 4.2 software. Results A total of 345 articles were retrieved, but only 17 were finally included. Meta-analyses showed that the effective rate in patients receiving levoamlodipine besylate was significantly higher than that in patients receiving indapamide (RD 0.14, 95%CI 0.06 to 0.22, P=0.0004), while no significant differences were noted between the levoamlodipine besylate group and other control groups. The incidence of adverse effects was significantly lower in the levoamlodipine besylate group compared to the indapamide group (RD –0.12, 95%CI –0.21 to –0.03, P=0.01), the amlodipine group (RD –0.06, 95%CI –0.11 to –0.01, P=0.02) and the nitrendipine group (RD –0.27, 95%CI –0.46 to – 0.08, P=0.006). No significant differences were observed between the levoamlodipine besylate group and other control groups. Conclusion Levoamlodipine besylate tends to have better efficacy and safety profiles compared with other antihypertensive drugs. However, most trials included in the review were of poor quality and, so, multi-center large-scale randomized controlled trials of higher quality are needed to confirm this.
ObjectiveTo investigate the relationship of the age-related maculopathy susceptibility 2 (ARMS2) A69S polymorphism and polypoidal choroidal vasculopathy (PCV), and to explore the distribution of risk allele in PCV and exudative age-related macular degeneration (wAMD). MethodsThis is a systemic review and meta-analysis. A literature research was performed in Pubmed, Embase, Web of Knowledge, Chinese national Knowledge Infrastructure and Wanfang Medicine Database by the key words of "ARMS2, LOC387715, A69S, rs10490924, age related macular degeneration, polypoidal choroidal vasculopathy, single nucleotide polymorphism". Case-control studies were included, while review, case report, or systemic reviews were excluded. The latest one of multiple articles was included only which published by the same group. The results of individual studies were pooled using the software Review Manager 5.1.4, and the correlation between allele frequencies, genotype and phenotype were analyzed. ResultsA total of 14 articles, consisting 2007 PCV patients, 1308 wAMD patients and 3286 controls were recruited. The pooled odds ratio (OR) in random-effects models for genotype TT versus wild homozygous genotype GG is 5.20 (95% CI: 3.90-6.95). Heterozygous genotype GT mildly increased the risk in affecting PCV, and the OR of GT versus GG is 1.85 (95% CI: 1.42-2.40. The frequency of T allele in wAMD was higher than in PCV, pool OR=1.60 (95% CI: 1.31-1.96). ConclusionsThe ARMS2 A69S variant is associated with PCV. Genotypes of TT and GT had an effect in increasing the risk of PCV, and the effect is even greater in genotype of TT. T allele had an effect in increasing the risk of PCV and wAMD, and the risk for wAMD is slightly greater than for PCV.
Objective To systematically evaluate the clinical effectiveness of right ventricular outflow tract (RVOT) pacing for heart disease. Methods We searched the electronic bibliographic databases, including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI, and WANFANG database to assemble the randomized controlled trials (RCTs) of RVS Pacing compared with right ventricular apical (RVA) pacing for heart disease. The deadline of the retrieval time was January 2010. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis. Results A total of 16 RCTs involving 926 patients were included. The results of meta-analyses showed that right ventricular outflow tract (RVOT) pacing significantly increased the left ventricular ejection fraction of 3 months and 18 months (WMD= 3.53, 95%CI 1.02 to 6.04; WMD= 8.94, 95%CI 7.35 to 10.52).Compared with RVA pacing, RVOT pacing could significantly reduce the QRS wave duration (WMD= –22.42, 95%CI –31.05 to – 13.80) immediately after the operation. Conclusion RVOT pacing can give patients a good physiological state which is more consistent with biventricular electric conduction and lead to the hemodynamic improvement in the short term, but the long-term result is not confident.