Systemic review through published clinical trials of artavakshaya

Menstrual irregularity is one of the most frequent gynaecologic disorders among women in reproductive age. In modern science, the treatment is based on mostly hormone therapy. Due to the need of an era for alternative medicine in field of gynecology, present study was tried to overview oral medicine used to treat Artavakshayaaccording Ayurveda classics. This systematic review was designed in order to gather information regarding oral medications for Artavakshayain Ayurveda.This study had several steps assearching only randomised clinical trials in Ayurveda medicine literature, extracting them and finding evidences. To search Ayurveda medicine digital library was used, which includes several ancient traditional medical references. There quire data was gathered using data base such as Google scholar, PubMed, Dhara, Medknow, OMICS, Scopus, J-gate for knowledge. This paper explores different research articles related reviews and overall analysis about oral therapy which can be applied in the treatment of Artavakshaya.

Systematic review and Meta-analysis of 26 randomized controlled clinical trials of Compound Danshen Dripping Pill for non-proliferating diabetic retinopathy / 中草药·英文版

Objective: Diabetic retinopathy (DR) is the retinal consequence of chronic progressive diabetic microvascular leakage and occlusion. Non-proliferating diabetic retinopathy (NPDR) is the early stage of DR. It eventually occurs to some degree in all patients with diabetes mellitus. In recent years, many clinical trials have shown that Compound Danshen Dripping Pill (CDDP) may be associated with the improvement of NPDR symptoms. The aim of this study was to quantitatively summarize the association between CDDP and the therapeutic effects of NPDR. Methods: It was conducted that a systematic literature search of PubMed, Web of Science, CNKI, VIP and Wanfang Data updated in June 2020 with the following search terms: “diabetic retinopathy” or “retinopathy” or “DR” or “NPDR”, in combination with “Compound Danshen Dripping Pill” or “Salvia miltiorrhiza” or “Danshen”. Risk ratio (RR) and weighted mean difference (WMD) with their 95% confidence interval (CI) was calculated between treatment and control groups. The sensitivity analyses were undertaken by removing each individual study when high heterogeneity appeared. Subgroup analysis, Meta-regression, and publication bias analysis were also conducted. The strength of evidence was evaluated with the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method. Results: Twenty-six RCTs involving 2047 subjects were included to conduct a Meta-analysis after screening the studies, extracting the data, and assessing the study quality. The Stata15.0 software was utilized for processing. Meta-analysis indicated that curative effects of treatment group with CDDP was significantly better than control [RR = 0.54, 95% CI (0.40, 0.73); moderate-quality evidence]. In addition, the results showed that CDDP was significantly associated with improving retinal hemorrhages [WMD = −0.62, 95% CI (−0.78, −0.46); low-quality evidence], the vision [WMD = 0.14, and 95% CI (0.09, 0.19), low-quality evidence], fundus fluorescence angiography [RR = 0.37 and 95% CI (0.23, 0.60); low-quality evidence], reduction of retinal microaneurysm [WMD = −3.74 and 95% CI (−4.38, −3.11); moderate-quality evidence], hemangioma volume [WMD = −3.15, 95%CI (−3.45, −2.85); moderate-quality evidence], macular thickness [WMD = −5.52, 95%CI = (−64.27, −48.78); low-quality evidence], mean defect [WMD = −1.65 and 95% CI (−1.95, −1.34); very low-quality evidence], fasting blooding glucose [WMD = −0.95, 95% CI (−1.19, −0.70); low-quality evidence), hemoglobin A1c [WMD = −0.62, 95% CI (−0.93, −0.30); low-quality evidence], high sensitive C reaction protein [WMD = −5.66, 95% CI (−8.01, −3.31); low-quality evidence]. Sensitivity, subgroup, and Meta-regression analyses were also assessed. Conclusion: The study demonstrated that CDDP has beneficial clinical effects for treating NPDR and improve the vision. Moreover, it indicated that oral CDDP in NPDR patients led to significant regulation of serum level of fasting blooding glucose, hemoglobin A1c and high sensitive C reaction protein, which was associated with the pathogenesis of NPDR. However, high-quality and large randomized clinical trials will be needed to prove the consequence in future.

Serie de Redacción Científica: Revisiones Sistemáticas / Scientific Writing Series: Systematic Review

RESUMEN Introducción: La revisión sistemática es la evaluación comprehensiva, reproducible, crítica y explícita de la mejor evidencia disponible en respuesta a una pregunta de investigación específica. Para conseguir ello las revisiones sistemáticas deben cubrir como mínimo los siguientes siete pasos: i) una pregunta de investigación específica y estructurada usando la técnica PICO; ii) criterios de elegibilidad de las evidencias; iii) una estrategia de búsqueda clara y reproducible; iv) selección de las evidencias y extracción de datos; v) análisis de sesgos; vi) síntesis de resultados; y, vii) publicación. Si los datos son suficientes y homogéneos es factible incluir en las síntesis de resultados el metanálisis de los mismos. De esta manera las revisiones sistemáticas y metanálisis pueden generar conocimiento nuevo y fundamental para la toma de decisiones en el área clínica y en otras áreas

ABSTRACT Introduction: The systematic review is the comprehensive, reproducible, critical, and detailed evaluation of the best available evidence in response to a specific research question. To achieve this, systematic reviews should cover at least the following seven steps: i) a detailed and structured research question using the PICO technique; ii) evidence eligibility criteria; iii) a precise and reproducible search strategy; iv) selection of evidence and data extraction; v) analysis of biases; vi) synthesis of results; and vii) publication. If the data are sufficient and homogeneous, it is feasible to include their meta-analysis to synthesize results. In this way, systematic reviews and meta-analyzes can generate new and fundamental knowledge for decision-making in the clinical and other areas.

Systemic review of Jintiange Capsules in treatment of postmenopausal osteoporosis / 中国中药杂志

To systemically evaluate the efficacy and safety of Jintiange Capsules in the treatment of postmenopausal osteoporosis(PMOP).Seven literature databases were retrieved systematically,and two reviewers independently searched and screened studies,extracted data,and included all the randomized controlled trials on Jintiange Capsules in the treatment of PMOP.Interventions included comparison of Jintiange Capsules with placebo and routine treatment,and the studies on Jintiange Capsules combined with routine treatment versus conventional treatment were also included.The evaluation indicators of the study included at least one of the followings:fracture,quality of life,daily living ability,clinical symptoms,death,adverse events/adverse reactions,bone density,and bone metabolism indexes.The original study quality evaluation was conducted by following the Cochrane Handbook standard and statistical analysis was performed by using Rev Man 5.2.A total of 7 randomized controlled trials were included and the study quality was low.Meta-analysis showed that as compared with conventional treatment alone,Jintiange Capsules combined with conventional treatment showed more obvious effects in pain relief(MD=-0.98,95% CI[-1.55,-0.41],P=0.000 8),increasing blood calcium levels(MD=0.05,95% CI[0.02,0.09],P=0.003) and lowering serum alkaline phosphatase levels(MD=-12.92,95% CI[-24.09,-1.75],P=0.02).In addition,the Chinese patent medicine alone or in combination with conventional treatment was relatively safe.In conclusion,Jintiange Capsules has a certain effect in treating PMOP,but the quality of evidence is low.It is necessary to conduct well designed randomized controlled trials and select recognized evaluation indicators,especially the end outcomes in order to further improve the clinical evidence.

Systemic review: the accuracy of lactic dehydrogenase in the diagnosis of pneumocystis pneumonia / 中华危重病急救医学

Objective To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP). Methods The data of this systemic review was retrieved from the PubMed, China Biology Medicine disc, Wanfang, Weipu and China National Knowledge Infrastructure (CNKI) databases from establishment till to October 31st, 2017. Case-control studies about the diagnosis of PCP were enrolled. Enrolled studies were required that patients in case group ware PCP and patients in control group were lung diseases other than PCP. The QUADAS tool was used to evaluate the quality of studies. The RevMan 5.3 software was used to draw a forest plot. The StataMP 14 software was used to make subgroup analyses by drawing receiver operator characteristic (SROC) curves for the whole group, the acquired immune deficiency syndrome (AIDS) group, and the not all-AIDS group, and calculating their diagnostic odds ratio (DOR) and 95% confidential interval (95%CI). Results Thirteen studies, all in English, were included. There were 825 patients in the case group, in which 650 patients were AIDS. There were 1 341 patients in control group, in which 888 patients were AIDS and most of them were Pulmonary Kaposi Sarcoma, bacterial pneumonia, pulmonary tuberculosis etc. Although there were different positive values of LDH in different studies, from 200 U/L to 598 U/L, sensitivities were good, especially in AIDS patients all values were above 80% (80%-100%). The specificities had big fluctuations, from 6% to 85%, which made them poor. The DOR (95%CI) of LDH in PCP diagnosis of all patients, AIDS patients and not-all AIDS patients were 6.73 (3.19-14.21), 9.17 (3.79-22.18) and 5.07 (1.30-19.80) respectively. Conclusions The sensitivity of LDH in the diagnosis of PCP is high, especially in AIDS group. In practice if LDH is negative, there should be more evidences to support the treatment of PCP.

Meta-analysis for efficacy and safety of rosuvastatin and simvastatin in the treatment of hyperlipidemia / 天津医药

Objective To investigate the effectiveness and safety of rosuvastatin and simvastatin in the treatment of hyperlipidemia. Methods The database including CNKI, VIP, Wanfang data base and CBM were retrieved to search the clinical randomized controlled trials (RCT) of rosuvastatin and simvastatin in the treatment of hyperlipidemia, and the data were analyzed with Review Manager 5.2. Results Eighteen RCTs were included with a total sample size of 1819 cases with hyperlipidemia, in which there were 917 patients in rosuvastatin group and 902 in simvastatin group. The Meta-analysis results showed that there were significantly lower serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and significantly higher level of high-density lipoprotein cholesterol (HDL-C) in rosuvastatin group compared with those of simvastatin group [(MD=-0.15, 95%CI:-0.22--0.09, P<0.01), (MD=-0.18, 95%CI:-0.25--0.11, P<0.01), (MD=-0.23, 95%CI:-0.28--0.19, P<0.01) and (MD=-0.11, 95%CI:-0.06--0.15, P<0.01)]. There was no significant difference in the incidence of gastrointestinal adverse reaction between the two groups. Conclusion The current clinical evidences show that rosuvastatin has a better effect on the treatment of hyperlipidemia, and has no adverse reactions.

Efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer:a Meta-analysis / 肿瘤研究与临床

Objective To evaluate the efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer (AGC). Methods The related randomized controlled trials were searched in the following databases such as Cochrane Library, PubMed, Web of Science from database establishment to April 2017. Data extraction and quality assessment by means of NOS were completed by two researchers.The survival rate,recurrence rate,mortality and morbidity were analyzed by RevMan 5.3 software. Results Seventeen literatures which were strictly filtrated from the original 2 383 literatures were included for Meta-analysis and the NOS score was 6-8. A total of 2 302 AGC cases were included to divide for 1 175 undergoing surgery with intraperitoneal chemotherapy and 1 127 undergoing surgery alone. Meta-analysis results showed that compared with surgery alone, surgery with intraperitoneal chemotherapy could improve the 1-year(OR=1.93,95 % CI 1.41-2.66,P<0.000 1),2-year(OR=1.82,95 % CI 1.41-2.35,P<0.000 01) and 3-year (OR= 1.93, 95 % CI 1.54 - 2.42, P< 0.000 01) survival rate of ACG cases, while the overall mortality was reduced (OR=0.47, 95 % CI 0.34-0.64, P<0.000 01). In terms of recurrence rate, the overall(OR=0.46,95 % CI 0.32-0.68,P<0.000 1)and peritoneal(OR=0.47,95 % CI 0.29-0.76,P=0.002) recurrence rates of surgery with intraperitoneal chemotherapy were both lower than those of surgery alone. There were not significantly differences between surgery with intraperitoneal chemotherapy and surgery alone in lymph nodes and liver metastasis rate. However, surgery with intraperitoneal chemotherapy had more high occurrence rates than surgery alone (OR= 1.47, 95 % CI 1.16 - 1.85, P= 0.001), especially the bone suppression (OR= 3.07, 95 % CI 1.70 - 5.54, P= 0.002) and bleeding (OR= 3.00, 95 % CI 1.09- 8.27, P= 0.03), and there were no differences in other complications. Subgroup results indicated that the overall mortalities were obviously decreased in surgery with intraperitoneal chemotherapy + MMC (OR= 0.35, 95 % CI 0.20-0.62,P=0.000 3)or CDDP+5-Fu(OR=0.32,95 % CI 0.17-0.61,P=0.000 5)compared with surgery alone. Conclusions Surgery with intraperitoneal chemotherapy can improve survival rate of AGC cases over a period of time and reduce mortality and peritoneal recurrence, but it is likely to cause the morbidities.The safety needs to be improved in the future.

Ubenimex Combined with Chemotherapy in the Treatment of Malignant Tumor: A Systematic Review / 中国药房

OBJECTIVE:To evaluate therapeutic efficacy and safety of ubenimex combined with chemotherapy in the treatment of malignant tumor,and to provide evidence-based reference in clinic.METHODS:Retrieved from Central,PubMed,CJFD,VIP and Wanfang database,randomized controlled trials (RCTs) about ubenimex combined with chemotherapy (trial group) vs.single chemotherapy (control group) in the treatment of malignant tumor were collected.The quality of studies were evaluated by bias risk evaluation criteria of Cochrane system evaluator manual 5.1.0 after screening literatures and extracting data.Meta-analysis was performed by using Rev Man 5.3 statistical software.RESULTS:A total of 12 RCTs were included,involving 762 patients.The resuits of Meta-analysis showed that:shorter-term response rate [RR=1.24,95 ％ CI (1.08,1.43),P=0.002] and the improvement rate of life quality Karnofsky score [RR=1.69,95％ CI(1.46,1.95),P＜0.001] in trial group were significantly higher than control group;the incidence of gastrointestinal toxicity [RR=0.74,95％CI(0.57,0.94),P=0.02] and leucocyte suppression rate[Ⅰ °-Ⅳ°(＜3 months):RR=0.54,95％CI(0.37,0.79),P=0.002;Ⅲ°-Ⅳ°:RR=0.44,95％CI(0.29,0.68),P＜0.001] were significantly lower than control group,with statistical significance.CONCLUSIONS:Ubenimex combined with chemotherapy can improve malignant tumor,shorter-term efficacy and life quality,and reduce gastrointestinal and marrow toxicity.

Danshen injection as adjuvant treatment for unstable angina pectoris: A systematic review and meta-analysis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To systematically evaluate the clinical effectiveness and safety of Danshen Injection (, DS) as one adjuvant treatment for conventional therapy with Western medicine (WM) for unstable angina pectoris (UAP).</p><p><b>METHODS</b>Using literature databases, a thorough and systematic retrieval of randomized controlled trials (RCTs) comparing DS plus WM with WM was conducted from inception to April 2015. The extracted data from included studies was analyzed by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests conducted by Stata 12.0 were used to evaluate the potential presence of publication bias.</p><p><b>RESULTS</b>A total of 17 RCTs, which involving 1,433 participants, were identified and reviewed. The meta-analysis indicated that the combined use of DS and WM was significantly superior to WM alone for UAP in terms of the total effectiveness rate of angina pectoris [risk ratio (RR) =1.23, 95% confidence interval (CI): 1.17, 1.29, P<0.01] and the total effectiveness rate of electrocardiogram (ECG) [RR=1.18, 95%CI: 1.06, 1.30, P=0.001]. Additionally, DS could also further reduce the content of fibrinogen, adjust blood lipid level, correct T wave inversion, and so on. Fifteen adverse drug reactions were reported in two studies, Four of which appeared in the experimental group.</p><p><b>CONCLUSION</b>Based on the systematic review, the combined use of DS and WM was more effective than WM alone, it can be further widely used in clinic, however, there was no exact conclusion for its safety.</p>

Adoptive immunotherapy with interleukin-2 & induced killer cells in non-small cell lung cancer: A systematic review & meta-analysis.

Background & objectives: The effectiveness of interleukin-2 (IL-2) and induced killer cells for non-small cell lung cancer (NSCLC) is controversial. This study evaluates the efficacy and safety of interleukin-2 and induced killer cells on NSCLC, so as to provide references for further clinical practice and research. Methods: Relevant randomized controlled trials (RCTs) were searched in Cochrane library (Issue 2, 2013), Web of Science (1980-March 2013), PubMed (1966-March 2013), China Knowledge Resource Integrated database (CNKI) (1994-March 2013), China Biology Medicine database (CBM) (1978-March 2013), VIP (1989-March 2013), and Wan Fang databases (1997-March 2013). There were no language restrictions. After independent quality assessment and data extraction by two authors, meta-analysis was conducted by RevMan 5.1 software. Results: Ten RCTs were included. Odds ratio (OR), 95% confidence intervals (CI), P value expressed as test group (interleukin-2 or induced killer cells combined chemotherapy) versus control group (chemotherapy alone), was 2.02 (1.24, 3.29; P=0.004) for disease control rate. Hazard ratios (HR) (95% CI; P value), expressed as test group (interleukin-2 or induced killer cells) versus control group, were 0.60 (0.46, 0.79; P=0.0003) for overall survival of postoperative treatment, and 0.77 (0.60, 0.99; P =0.04) for overall survival of combination with chemotherapy. Mean differences (MD) (95% CI; P value), expressed as test group (interleukin-2 or induced killer cells) versus control group (after treatment), were 11.32 (6.32, 16.33; P=0.00001) for NK cells, 11.79 (2.71, 20.86; P=0.01) for CD3+ cells, 14.63 (2.62, 26.64; P=0.02) for CD4+ cells, and -4.49 (-7.80, 1.18; P=0.008) for CD8+ cells. Interpretation & conclusions: The meta-analysis showed that IL-2 or induced killer cells combination therapy was efficacious in treating NSCLC and improved overall survival. Further analysis of trials having adequate information and data need to be done to confirm these findings.

Systematic review on safety of Xinyuan capsules / 中国中药杂志

To systematically review the adverse drug reactions/adverse events(ADRs/AEs) of Xinyuan capsules in clinical application. A systematic literature search was performed in the databases of the Cochrane Library, Medline, EMBASE, the Web of Science, Clinical trials, CNKI, VIP, WanFang Data and CBM. The literature was screened and data was extracted according to the inclusion and exclusion criteria. Because of the substantial heterogeneity among different studies, we assessed them only with descriptive analysis by study type, disease diagnosis, and ADRs/AEs conditions. All included studies were assessed by using the internationally recognized report quality evaluation standard or methodological quality assessment tools. A total of 42 studies involving 3 671 patients were included finally. Two thouand four hundred and thirty-mine patients of them took Xinyuan capsules, and 1 242 patients did not take Xinyuan capsules. No serious ADRs occurred in all patients. One patient died as AE during the research. Sixteen patients of the 2 439 patients taking Xinyuan capsules (alone or in combination) had ADRs, including 7 patients with polytherapy of Xinyuan capsules and 9 patients with monotherapy. The most common ADRs were in gastrointestinal tract, mainly including thirst, nausea, vomiting and abdominal pain, etc. The ADRs included 10 gastrointestinal tract ADRs, 3 renal ADRs and 1 ADR respective in skin system, respiratory system and cardiovascular system. Xinyuan capsules was generally safe in clinical application. The reports on the study of Xinyuan capsules were dispersed in various clinical studies, the study on drug safety still should be strengthened in the future. Further mechanism studies or clinical observation studies of the drug safety shall be conducted to better guide clinical application in the future.

The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis

Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.

Relación de la menarquia precoz con disminución de la reserva ovárica en la vida adulta: Revisión sistemática y meta-análisis / Relationship of early menarche with decreased ovarian reserve in adult life: systematic review and meta-analysis

ANTECEDENTES: La identificación de factores que pudieran afectar la reserva ovárica permitiría predecir el resultado a la hiperestimulación ovárica en las técnicas de reproducción asistida, y en forma independiente a la edad, el éxito de estos procedimientos. Se ha propuesto que la presencia de menarquia precoz, definido como su aparición antes de los 12 años, sería uno de los factores predictivos de baja reserva ovárica. OBJETIVO: Determinar si existe asociación entre menarquia precoz y disminución de la reserva ovárica futura. MÉTODO: Se realizó una revisión sistemática de la literatura en las bases de datos MEDLINE y EMBASE entre los años 2000 y 2013 con los conceptos "premature menarchae" y "ovarian reserve". Sólo 3 artículos cumplieron los criterios de selección, con un total de 2.470 pacientes. RESULTADO: El meta-análisis mostró una asociación significativa entre menarquia temprana y disminución de la reserva ovárica en la vida adulta (OR 1,89; IC95% 1,52-2,35; p=0,001). CONCLUSIÓN: De confirmarse la relación entre disminución de reserva ovárica en pacientes que presentaron menarquia precoz, será fundamental que ésta información sea debidamente registrada y evaluada dentro de la consejería preconcepcional.

BACKGROUND: The identification of predictors of controlled ovarian hyperstimulation could predict the outcome of assisted reproductive technologies procedures, and independently of age, predict the success of said procedures. It has been suggested that premature menarchae, i.e. below 12 years of age, predicts diminished ovarian reserve. OBJECTIVE: To determine if there is an association between premature menarche and diminished ovarian reserve. METHODS: We performed a systematic review in MEDLINE and EMBASE, for articles published between 2000 and 2013, with key words "premature menarchae" and "ovarian reserve". Three articles fulfilled the inclusion criteria, including a total of 2,470 patients. RESULTS: The meta-analysis of the results demonstrated an association between premature menarchae and diminished ovarian reserve (OR 1.89; 95%CI 1.52-2.35; p=0.001). CONCLUSION: If our findings are confirmed, it would be fundamental to include this information in any routine gynecological visit.

Heparin for treatment of sepsis: a systemic review / 中华危重病急救医学

Objective To systemically review the efficacy and safety of heparin for treatment of sepsis.Methods Database search of IM/MEDLINE,Cochrane Library,SCIE,CBM,CNKI,VIP Data,WanFang Data (from January 2000 to June 2012) was conducted.The quality of included randomized controlled trials (RCTs) about heparin for treatment of sepsis was assessed,and relevant data were extracted according to the inclusion and exclusion criteria.Then meta analysis was performed using RevMan 5.1.Results 17 trials with 1 167 participants were included.The results of meta-analysis showed:compared with the control group,heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio (OR) =0.59,95％ confidence interval (95％CI) 0.45-0.77,P=0.0001] ; heparin did not deteriorate coagulation disorders,but corrected sepsis-induced platelet (PLT) count reduction [mean difference (MD) =13.94,95％ CI 10.15 to 17.72,P＜0.000 01],while it had no significant effect on the activated partial thromboplastin time (APTT) and prothrombin time (PT,APTT:MD=-3.18,95％CI-6.88 to 0.53,P=0.09; PT:MD=-0.68,95％ CI-1.48 to 0.12,P=0.09).There was no significant difference between the two groups in the incidence of bleeding either.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of heparin group was significantly lower than that of the control group (MD=-2.58,95％CI-3.29 to-1.87,P＜0.000 01),and the incidence of multiple organ dysfunction syndrome (MODS) was significantly lower than that of the control group (OR=0.32,95％CI 0.17 to 0.61,P=0.000 6).In addition,heparin could shorten intensive care unit (ICU) stay (MD=-4.43,95％CI-6.79 to-2.07,P=0.000 2),whereas it showed no significant effect on the total length of hospital stay.Conclusions Heparin can ameliorate sepsis,and has high degree of safety and lower hospital expense.Due to limitation of the quality of included studies,larger sample and well-designed RCTs are needed to further support this conclusion.

A systemic review of global emergency department (1974-2012) crowding research / 中华急诊医学杂志

Objective Emergency department overcrowding (EDO) is an increasingly international occurrence which affects the quality and access of health care across the globe.We assessed perceptions of EDO by a detailed and comprehensive surveying of current international research literatures.Methods Through PubMed and BMC electronic literatures search engines from 1974 to 2012,1587 papers of original articles,reviews and comments with key wordsemergency departmentANDcrowding OR overcrowding are selected.Results 52.6％ (835/1587) all selected literatures is original research articles.21.2％ (n =337) of these papers involved the disciplinary construction of emergency medicine,and editorial comment (included viewpoints) holds almost one fifth (302,19.0％).Most common types of study methods in all original researches is single-center cohort study (722/835,86.5％),and none of them was multi-center,randomized control clinical trial.The number of papers on EDO is 8 during 1974 and 1988,and gradually elevated to 325 during 1989 and 2002.Yet the number has climbed up to 1254 dramatically (account for 79％) during 2003 and 2012.Together,USA,Canada and Austria,these three countries generated more than three-quarters of all published literatures (81.0％).So far,the authors in 48 countries and areas gave forth initial contributions in the field of EDO.Conclusions The studies and papers about EDO are steadily increasing in recent years.But the investigation shows the research quality still remain need to improve.This systemic review on EDO studies showed that the standardized measurement of EDO has become the bottleneck of EDO study.It is very important and urgent for ED staff to establish an objective and effective EDO evaluation system.

Meta-analysis on the randomized controlled trials of Fufang-Danshen injection in the treatment of unstable angina pectoris / 国际中医中药杂志

Objective To systematically evaluate the clinical efficacy and safety of Fufang-Danshen Injection (FD) in the treatment of unstable angina pectoris(UAP). Methods Randomized controlled trials (RCTs) and quasi-RCTs regarding FD in the treatment of UAP were collected through comprehensive searches of China National Knowledge Infrastructure(CNKI), Chinese Scientific Journals Database(VIP), Wan fang Database, Chinese Biomedical Literature Database(CBM), PubMed, Embase and Cochrane Library from January 1979 to December 2013. Two reviewers independently assessed the quality of the included studies by the Cochrane risk of bias, and extracted the information from the included studies. Meta-analysis was conducted with the software Review Manager 5.2. Results A total of 13 studies with 1156 participants were included. In the meta-analysis, ①the total effective rate of UAP:in term of FD+conventional therapy with western medicine(WM)vsWM, the difference between two groups was statistically significant [RR=1.32, 95%CI(1.21, 1.43), P<0.01]; FD+low molecular weight heparin+WM vs WM, difference between two groups was also statistically significant [RR=1.29, 95% CI(1.17, 1.42), P<0.01], which indicated that the efficacy of experimental group was higher than the control group. Other interventions, such as FD+WM vs low molecular weight heparin+WM and FD vs WM, there was no significant difference between two groups. ②the total effective rate of ECG:in term of FD+WM vs WM, the difference between two groups was statistically significant [RR=1.34, 95%CI (1.14, 1.57), P<0.01]; in term of FD vs WM, difference between two groups was statistically significant [RR=1.49, 95%CI(1.13, 1.96), P<0.01], which indicated that experimental group can effectively improve the total effective rate of ECG. ③ frequency of angina attacks:in term of FD+WM vs WM, the difference between two groups was statistically significant [MD=1.07, 95%CI(0.48, 1.66), P<0.01]. No differences between groups existed in other analysis. ④ adverse drug reactions(ADRs):4 articles cleared that there was no ADRs in the studies, 4 studies reported ADRs, which represented headache, nausea, flushing and so on. There were 9 cases in the experimental group, and 9 in control group. Conclusion Based on the meta-analysis, FD was effective and relatively safe for the treatment of UAP in clinical. However, since the articles enrolled in the study were not in high quality, more qualified studies should be conducted for the further assessment of efficacy and safety of FD for UAP.

Hand hxgiene compliance rates of health care workers in general hospitals from 20 1 0 to 20 1 2-A sxstem review / 中国感染控制杂志

Objective To assess the prevalence of hand hygiene compliance rates of health care workers (HCWs) at general hospitals in China in 2010-2012. Methods Literatures about hand hygiene compliance of HCWs from 2010 to 2012 were retrieved from China Biology Medicine disc (CBM),China National Knowledge Infrastructure (CNKI),Wan Fang database,VIP ,and PubMed database ,Comprehensive Meta Analysis V2 software and Stata 1 2 .0 software were adopted to conduct statistical analysis . Results Ninety literatures were selected with heterogeneity (Q= 48 118.32,P0.05);the compliance rate after patient contact was higher than before patient contact (54.33% [95% CI :44.76% -63.59% ]vs 20.21% [95% CI:14.12% -28.06% ])(Q= 32.59, P<0.01 );hand compliance rate from field observation was higher than from covert observation (70.91% [95% CI :70.71% - 71.10% ]vs 41.20% [95% CI:37.55% -44.94% ])(Q= 247.66,P<0.01).Conclusion The overall hand hygiene compliance rate of HCWs in 2010-2012 was low,in order to reduce the risk of healthcare-associated infec-tion,hand hygiene compliance of HCWs need to be increased .

Repetitive transcranial magnetic stimulation for post-stroke dysphagia:a systematic review of the literature / 中国脑血管病杂志

Objective To systematically review the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS)for post-stroke dysphagia. Methods The clinical trials about rTMS for post-stroke dysphagia were searched on Pubmed,EMbase,MEDLINE,Cochrane library,China National Knowledge Infrastructure (CNKI),Chinese BioMedical Literature Database on disc (CBMdisc),and Wanfang database with computers. Two independent reviewers selected the literatures by the inclusion and exclusion criteria,data extraction and cross-checking,and then conducted the analysis. Results A total of seven trails (228 patients,136 of them in a rTMS group and 92 in a control group)were included. Four randomized controlled trials (RCTs)were used for Meta-analysis (54 patients in the rTMS group,42 in the control group). The other three non-RCTs were only reviewed systematically. (1)Meta-analysis showed that the improvement of swallowing function score after rTMS was better than that of the control group (SMD=1. 73,95%CI 0. 45 to 3. 01;P=0. 008). (2)After high-frequency rTMS (>1 Hz),there was significant difference in the improvement of swallowing function score between the two groups (SMD=1. 60,95%CI 0. 10 to 3. 11;P=0. 04). Compared to the control group,there were also significant differences in the improvement of some swallowing function scores in low-frequency rTMS (1 Hz),suggesting the potential advantages of low-frequency therapy. (3)After rTMS,there was no significant difference in the improvement of Barthel index in patients with stroke compared with the control group (MD= -21. 60,95%CI-36. 21 to-7. 00;P=0. 004). (4)In terms of adverse reactions,seven trials did not report any adverse events, such as headache,tinnitus or epilepsy,etc. Conclusion Using rTMS may significantly promote the recovery of swallowing function for patients with post-stroke dysphagia,and it is both safe and effective.

Efficacy of the Phosphorylated tau 181 in Differential Diagnosis of the Alzheimer's Disease: A Systematic Review and Meta-Analysis

BACKGROUND: The purpose of this study was to evaluate the value of phosphorylated tau with epitopes threonine 181(p-tau181) in cerebrospinal fluid (CSF) for the differential diagnosis of Alzheimer's disease typed dementia from other type of dementia. METHODS: A systematic literature search was performed to identify studies on p-tau181. Two evaluators independently evaluated the quality of the ten studies using the Scottish Intercollegiate Guidelines Network (SIGN) tool. The literature review covered from October 27, 1946 to October 22, 2013, and eight domestic databases including KoreaMed and international databases including Ovid-MEDLINE, EMBASE, and Cochrane Library were used. Tau concentrations were compared to healthy controls and to subjects with Alzheimer's disease (AD) using random effect meta-analysis. Outcome measures were Cohen's delta, sensitivity and specificity. RESULTS: Finally, 8 studies (8 diagnostic evaluation studies) were identified to evaluate CSF p-tau181. The effectiveness of this test was evaluated based on diagnostic accuracy. The diagnostic accuracy for identifying AD by ELISA was high which revealed pooled sensitivity as 0.843 (95% CI 0.818-0.867), pooled specificity as 0.799(95% CI 0.768-0.828) and summary receiver operating characteristic area under the curve 0.9082+/-0.0236. CONCLUSIONS: CSF p-tau181 concentrations in other type of dementia are intermediate between controls and AD patients. Overlap between both controls and AD patients results in insufficient diagnostic accuracy, and the development of more specific biomarkers for these disorders is needed.

Revisiones sistemáticas y metaanálisis en la práctica clínica: una aproximación al tema / Systematic reviews and meta-analysis in clinical practice: an approach to the topic

Introducción: la corriente denominada hoy «medicina basada en la evidencia¼ aporta una especie de marco conceptual o paradigma novedoso para la solución de los problemas clínicos. Esta forma de practicar la medicina pretende acercar más los resultados provenientes de la investigación clínica a la práctica médica. Se necesitan para esto entonces soluciones ante el exceso actual de información proveniente de la investigación médica. Objetivo: realizar una aproximación al tema de las revisiones sistemáticas y metánalisis como método eficaz para resumir la mejor evidencia científica disponible. Desarrollo: ambos términos no son necesariamente equivalentes si bien están estrechamente relacionados. El metaanálisis es una síntesis cuantitativa de información que debe basarse en una revisión sistemática de la literatura para eliminar posibles sesgos de selección. Una revisión sistemática puede o no ir acompañada de un metaanálisis. Conclusiones: las revisiones sistemáticas acompañadas de metaanálisis proporcionan estimaciones más precisas sobre los efectos de la atención sanitaria, que aquellas derivadas de los estudios individuales y constituyen por tanto un instrumento metodológico para la evaluación del efecto de un factor de riesgo o la eficacia de una medida terapéutica. Esto nos permite ampliar el conocimiento científico a partir de elementos verdaderamente confiables, para así a brindar a nuestros pacientes el mejor y más seguro servicio.

Introduction: there is a current named "evidence-based medicine" and it brings a kind of novel conceptual framework or paradigm for solving clinical problems. This way of practicing medicine aims to bring more results from the clinical research to the medical practice. It is required then solutions to face the present excess of information from the clinical research. Objective: to carry out an approach to systemic reviews and meta-analysis as an efficient method to summarize the best available scientific evidence. Development: both terms are not necessarily equivalent though they are closely related. Meta-analysis is a quantitative synthesis of information that should be based on a literature systemic review to eliminate possible selection biases. A systemic review may or may not be accompanied of a meta-analysis. Conclusions: the systemic reviews with meta-analysis provide more precise estimates of the effects of health care than those derived from the individual studies and, therefore, they constitute a methodological tool for evaluating the effect of a risk factor or the effectiveness of a therapeutic measure. This allows us to broaden the scientific knowledge departing from truly reliable elements, in order to give our patients the best and safest service.