ABSTRACT
Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in treatment of IgA nephropathy. Methods The Cochrane library, PubMed, EMBASE, Wanfang Data Knowledge Service Platform, CNKI and VIP were searched from the time when the databases were established to March 31, 2018. Reports on randomized controlled trials (RCTs) on treating IgAN with MMF were collected. Data were extracted and assessed independently by three reviewers and the methodological quality of included RCTs was assessed by the Cochrane collaboration's tool for assessing risk of bias. The Meta analysis of homogeneous RCTs was managed by using Stata 12.0. Results Nine RCTs, of which two RCTs were assessed as A-level studies scoring from 4 to 7 points, six RCTs were assessed as B-level studies scoring from 2 to 3 points, and one RCT was assessed as C-level study with scores less than 2 points, were enrolled in the study. Important outcomes of this systematic review were described as follows: (1) Compared to placebo plus ACEI/ARB or ACEI/ARB monotherapy, MMF plus ACEI/ARB did not reduce the incidence of increased serum creatinine and ESRD, but increased the partial remission rate of urinary protein (OR=2.59, 95％CI 1.01-6.65, P=0.049. (2) No significant difference was detected in the efficacy of reducing urinary protein for MMF monotherapy or MMF plus glucocorticoid (GC) compared to GC monotherapy. (3) MMF showed no significant difference in the efficacy of reducing urinary protein compared to LEF or CTX, but lower incidence rate of serum creatinine increasing than that of CTX group (OR=0.21, 95％CI 0.04-1.07, P=0.043. (4) Different levels of adverse reactions occurred in each treatment group with MMF, but most symptoms were mild, and recovered gradually after reducing or withdrawing MMF. Conclusions MMF monotherapy shows a superiority in curing IgAN compared to ACEI/ARB, but no significant superiority compared to GC. MMF can replace a part of the effect of GC when used in combination with GC and can reduce the dosage of GC compared to GC monotherapy. Additionally, MMF displays no better short-term efficacy than LEF or CTX, but a better long-term efficacy and fewer side effects than CTX. And the side effects occurred in the treatment groups with MMF are mostly mild, and disappear gradually after reducing or stopping the use of the drug. MMF is a safe and effective drug for the treatment of IgAN.
ABSTRACT
Objective To systematically review the value of enhanced recovery after surgery(ERAS)in the perioperative period of hepatec-tomy. Methods A literature search was conducted in PubMed,Embase,Cochrane Library,Sinomed,Wanfang Data,VIP,and CNKI to iden-tify the articles on the application of ERAS in the perioperative period of hepatectomy published up to July 2017. Quality evaluation and data extraction were performed for the included articles. A Meta - analysis was performed using Revman 5.3 software. Results A total of 17 articles were included,with 14 randomized controlled trials and 3 controlled clinical trials. A total of 2220 patients were involved and divided into ERAS group(n=1002)and control group(n=1218). Compared with the control group,the ERAS group had significantly shortened length of postoperative hospital stay(weighted mean difference[WMD]= -2.58,95% confidence interval[CI]:-3.47 to-1.70,P<0.05),functional rehabilitation time(WMD= -3.39,95%CI:-4.32 to -2.45,P<0.05),and time to first flatus(standardized mean difference[SMD]= -1.56,95%CI:-2.15 to -0.97,P<0.05),as well as reduced complication rate(odds ratio[OR]=0.64,95%CI:0.52-0.78,P<0.05)and hospital costs(SMD= -0.85,95%CI:-1.23 to -0.47,P<0.05).There were no significant differences between the two groups in readmission rate(OR =1.28,95%CI:0.69 -2.69,P > 0.05),operation time(WMD = -11.36,95%CI:-23.25 to 0.53,P>0.05),and intraoperative blood loss(WMD= -22.62,95%CI:-38.89 to -6.34,P>0.05).Conclusion ERAS is safe and effective in the perioperative period of hepatectomy and holds promise for clinical application.
ABSTRACT
AIM: To estimate the pooled prevalence of myopia among primary school students in mainland China during 1980- 2013. Myopia had become a growing public health issue, with high prevalence rates in mainland China, particularly among children. However, we still had no population-based nationwide studies of the prevalence of myopia among primary school students in recent years. METHODS: Wanfang, Chinese National Knowledge Infrastructure and PubMed databases were searched independently until Dec. 31, 2013 to identify relevant articles. Data from the eligible articles were extracted by two reviewers. All of the data analyses were conducted using Meta-Analyst software (version 3. 13, USA). RESULTS: Thirty - seven eligible studies published between 1980 and 2013 were selected with a total of 245248 individuals. The pooled prevalence of myopia among the included individuals was 26. 5% (95% CI: 21. 8% -31. 7%). The prevalence of myopia increased with age (from 8. 4%at 6-8y to 57. 4% at 12-14y). CONCLUSION: The pooled prevalence of myopia among primary school students in mainland China was much higher than that of western countries or regions. The prevalence of myopia increased with age among primary school students. This study should be valuable for myopia prevention and treatment in mainland China.