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OBJECTIVE To systema tically evaluate the efficacy and safety of blinatumomab for acute lymphoblastic leukemia （ALL）in order to provide evidence-based reference for clinical use. METHODS Retrieved from PubMed ，Embase，Web of Science，the Cochrane Library ，CNKI，Wanfang database and CBM during the inception to February 3，2022，randomized controlled trials （RCTs）and cohort studies of blinatumomab （experimental group ） versus conventional chemotherapy （control group ）in the treatment of ALL were collected. After literature screening and data extraction ，the quality of RCTs was evaluated by the risk bias evaluation tool recommended by Cochrane handbook 5.1.0，and the quality of cohort studies was evaluated by the Newcastle-Ottawa scale （NOS）. Meta-analysis was performed by RevMan 5.4 software. GRADE grading system was used to evaluate the evidence quality of outcomes. The publication bias was analyzed by inverted funnel plot. RESULTS A total of 8 studies were included ，involving 3 RCTs and 5 cohort studies ，with a total of 2 841 patients. Results of Meta-analysis showed that the overall survival rate more than one year [RR ＝1.30，95％CI（1.14，1.48），P＜0.000 1]，relapse-free survival rate [RR ＝1.78，95％CI（1.50，2.12），P＜0.000 01]，complete remission rate [RR ＝1.42，95％CI（1.11，1.82），P＝0.006]，the incidence of tremor [RR ＝16.98，95％CI（2.17，133.12），P＝0.007]，and the incidence of cytokine release syndrome [RR ＝14.11， 95％CI（3.43，58.01），P＝0.000 2] in trial group were all significantly higher than control group ，but there was no statistical significance in the incidence of headache between two groups [RR ＝1.31，95％CI（0.66，2.59），P＝0.44]. The incidence of adverse events with grade more than or equal to 3，infection，stomatitis，thrombocytopenia，febrile neutropenia ，anorexia， constipation，diarrhea，abdominal pain ，hypokalemia in trial group were significantly lower than control group （P＜0.05）. The incidence of cough ，rash and hypogamma globulinemia and fever in the trial group were significantly higher than control group （P＜0.05）. There was no statistical significance in the total incidence of adverse events ，sepsis，anemia，leucopenia，neutropenia， lymphopenia，nausea，vomiting，hyperglycemia，hypotension，hypertension，elevated transaminase or epistaxis between two groups（P＞0.05）. Results of subgroup analysis by study type showed that the overall survival rate ，relapse-free survival rate and complete response rate （except for cohort studies ）of patients in trial group were significantly higher than control group in both RCTs and cohort studies （P＜0.05）. The results of GRADE evaluation showed that the overall quality of index evidence included in this study was low. There was little possibility of publication bias in this study based on the publication bias analysis. CONCLUSIONS Blinatumomab is effective in the treatment of ALL ，with low incidence of infection and adverse events of digestive system ，but high incidence of tremor ，cough，rash，fever，hypoproglobulinemia and cytokine release syndrome. The evidence quality of the indicators included in this study is generally low .
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Literatures on acupuncture-moxibustion treatment of chemotherapy-induced peripheral neuropathy (CIPN) in the recent decade were searched in the databases of Pubmed, MEDLINE, Biological Abstracts, EMBASE, Sinomed, CNKI, Wanfang, VIP, et al. The general situation was comprehensively analyzed and reviewed from experimental design, treatment method, efficacy evaluation, mechanism research and so on. The results showed that acupuncture has a certain therapeutic effect, but the research is still in the preliminary stage, the relative literatures are insufficient and in a low quality. There is still a controversy on the efficacy of acupuncture in the treatment of CIPN. High quality, large sample and multicenter randomized controlled trials and systematic reviews are needed to verify the efficacy of acupuncture. The mechanism of acupuncture treatment of CIPN is still unclear and needs further research and exploration.
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The current clinical efficacy evaluation system and evaluation methods of acupuncture have several limitations, and the application status is not optimistic. According to long-term observation, minimum clinically important difference (MCID) is consistent with the characteristics of clinical acupuncture, and has objective quanti- tative standard and wide applicability. Incorporating MCID into acupuncture clinical efficacy evaluation of tradition- al Chinese medicine can truly reflect the clinical effect of acupuncture and improve the disadvantages and shortcom- ings of acupuncture clinical evaluation, which could provide certain reference for building clinical efficacy evaluation system featured with TCM.
Subject(s)
Humans , Acupuncture Therapy , Reference Standards , Clinical Trials as Topic , Reference Standards , Moxibustion , Reference StandardsABSTRACT
Objective To study the influence of body mass index on ambulatory venous pressure of chronic venous insufficiency of lower extremity.Methods One hundred and two consecutive patients with chronic venous insufficiency of lower extremity were enrolled in this study.Ambulatory venous pressure and body mass index were assessed and compared.Normal body weight group had 28 cases,over weight group had 43 cases,obesity group had 31 cases.Resets The complication of pigmentation,eczema,skin sclerosis and ulcer were more in obesity group and over weight group than those in normal body weight group.The resting pressure (P0) in obesity group,over weight group and normal body weight group were (118.0 ± 11.5),(113.0 ± 9.7),(101.0 ± 10.6) mm Hg (1 mm Hg =0.133 kPa),the pressure after unclamp 4 s (4SP)were (75.00 ± 2.99),(71.00 ± 3.01),(65.00 ± 2.17) mm Hg,the percentage of decreased pressure(pd)were (35.0 ± 5.4)％,(39.0 ± 4.3)％,(43.0 ± 5.1)％,the time of P0 recovered 50％ (RT50) were(7 ± 1),(9 ± 2),(12 ± 3) s.The P0 and 4SP in obesity group,over weight group were significantly higher than those in normal body weight group (P ＜0.05).The Pd,RT50 in obesity group,over weight group were significantly lower than those in normal body weight group (P＜0.05).Conclusion With the increasing of body mass index,the chronic venous insufficiency of lower extremity is more severity.
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Objective To evaluate the preliminary mechanisms of endovenous laser treatment (EVLT) for lower extremity varicose vein.Methods Laser energy was endovenously administered to observe its biological effects on greater saphenous vein (GSV) segments with different conditions.Some great saphenous vein that was surgically removed after EVLT was examined by means of histopathology.Cruor status was tested after EVLT.Results Histopathologic examination found the vein wall treated by EVLT showed reddening,carbonization,or even perforation,denudation of the intima,loss of cellular contours,and fibrin deposition.Additionally,some areas showed marked vacuolization of cells or even spongiosis,swelling and waxy homogenization of collagen,focal coagulation necrosis within the intima.In saline-filled veins,EVLT-induced vessel wall injury was confined to the site of direct laser impact.In contrast,blood-filled veins exhibited thermal damage in more remote areas including the vein wall opposite to the laser impact.D-dimer was significantly changed after EVLT.Conclusions EVLT laser induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT.Intravascular blood plays a key role for homogeneously distributed thermal damage of the inner vein wall during EVLT.No significant difference could be detected between the two laser wavelengths.Continuous emission mode is better than pulse emission mode.
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Retrievable vena cava filters can be used to prevent pulmonary embolism. The advantage of the retrievable vena cava filters is that they can either be removed or be remained in the vena cava permanently if needed. This article describes the current status of retrievable vena cava filters including indications, outcomes, patient management, time of filter removal, and the management of thrombus in the filter.
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The paper analyzed the challenges for community-based rehabilitation of schizophrenic patients in China' s rural areas,from such six aspects as culture, prevention and control system for mental health, fairness of health resources allocation, shortage of specialists, confidence in treatment,and delay in rehabilitation. These studies aim at providing the government with decision making evidence for enacting rural mental health policies and taking effective intervention measures.