Interventions for preventing influenza: An overview of Cochrane systematic reviews and a Bayesian network meta-analysis / 中西医结合学报

BACKGROUND@#Influenza places a heavy public health burden in numerous countries every year. In addition to vaccines, there are some interventions that are effective in preventing influenza.@*OBJECTIVE@#This overview of systematic reviews (SRs) aimed to evaluate the efficacy and safety of interventions for influenza prevention.@*SEARCH STRATEGY@#We searched the Cochrane Database of Systematic Reviews, 2020, Issue 1 for relevant Cochrane SRs using the keywords "common cold," "influenza," and "flu."@*INCLUSION CRITERIA@#Cochrane SRs that investigated the prevention of influenza were included. Participants included the general population without influenza or influenza-like symptoms, who were treated with preventative interventions and compared to individuals receiving no treatment or placebo.@*DATA EXTRACTION AND ANALYSIS@#Two reviewers independently screened citations against pre-defined inclusion criteria and extracted data. The methodological quality of these SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-II (AMSTAR-II) guidelines. The primary outcome of our analysis was the incidence of influenza, and the secondary outcomes were the incidence of influenza-like illness and hospitalization. In addition to the narrative summary of SR findings, we also pooled data from homogeneous trials among these SRs and produced evidence mapping. We conducted a network meta-analysis to compare the effect across interventions and used the Cochrane approach to grading of recommendations, assessment, development, and evaluation (GRADE) to assess the quality of evidence.@*RESULTS@#Eleven Cochrane SRs were included, covering five medications, eleven vaccinations and four complementary therapies. Among these SRs, 73% scored "high" quality on AMSTAR-II rating. We found that eight interventions, including amantadine, garlic, and six different vaccines, were beneficial for reducing the incidence of influenza compared to placebo, while oseltamivir, zanamivir, Ganmao capsule, Echinacea, and another three types of vaccine were probably beneficial. Ganmao capsule ranked highest for influenza prevention in the network meta-analysis, followed by amantadine, garlic, and vaccines of all types. Monovalent inactivated parenteral vaccine was found to be beneficial in reducing the incidence of influenza-like illness. None of the interventions reduced the hospitalization rate.@*CONCLUSION@#High-quality evidence showed that garlic or vaccine had advantages in preventing influenza, and that vitamin C is not effective. The effect of other interventions needs to be further verified with high-quality evidence.

Acupuncture for Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis

PURPOSE: To assess the effectiveness and safety of acupuncture for erectile dysfunction (ED). MATERIALS AND METHODS: We searched six major English and Chinese databases included randomized controlled trials (RCTs) testing acupuncture alone or in combination for ED. Dichotomous data were presented as risk ratio (RR) and continuous data were presented as mean difference (MD) both with 95% confidence interval (CI). The Revman (v.5.3) was used for data analyses. Quality of evidence across studies was assessed by the online GRADEpro tool. RESULTS: We identified 22 RCTs, fourteen of them involving psychogenic ED. Most of the included RCTs had high or unclear risk of bias. There was no difference between electro-acupuncture and sham acupuncture with electrical stimulation on the rate of satisfaction and self-assessment (RR, 1.50; 95% CI, 0.71–3.16; 1 trial). Acupuncture combined with tadalafil appeared to have better effect on increasing cure rate (RR, 1.31; 95% CI, 1.00–1.71; 2 trials), and International Index of Erectile Function-5 scores (MD, 5.38; 95% CI, 4.46–6.29; 2 trials). When acupuncture plus herbal medicine compared with herbal medicine alone, the combination therapy showed significant better improvement in erectile function (RR, 1.68; 95% CI, 1.31–2.15; 7 trials). Only two trials reported facial red and dizziness cases, and needle sticking and pruritus cases in acupuncture group. CONCLUSIONS: Low quality evidence shows beneficial effect of acupuncture as adjunctive treatment for people mainly with psychogenic ED. Safety of acupuncture was insufficiently reported. The findings should be confirmed in large, rigorously designed and well-reported trials.

Comparison between Xingnaojing Injection () and Naloxone in Treatment of Acute Alcohol Intoxication: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials / 中国结合医学杂志

OBJECTIVES@#To investigate the effectiveness and safety of Xingnaojing Injection (XNJ, ) compared with naloxone for the treatment of acute alcohol intoxication (AAI), and provide the latest evidence through evidence-based approach.@*METHODS@#Seven electro-databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure Databases, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database (VIP) and Wanfang Database were searched from the inception to January 2018. Randomized controlled trials (RCTs) comparing XNJ with naloxone for patients with AAI and reporting at least one of the below outcomes were included: patients' conscious recovery time, stay length in emergency department, disappearance time of the ataxia symptom, the severity of the symptoms, the blood alcohol content as well as the adverse events. Methodological quality of included trials was assessed using the risk of bias tool which recommended by the Cochrane Collaboration. Meta-analysis was conducted by Review Manager 5.3 software.@*RESULTS@#Totally 141 trials with 13,901 patients were included in this review, all of them were assessed as unclear or high risk of bias. Results showed that on the basis of routine therapy, standard dose XNJ (10-20 mL) may have similar results with naloxone on the recovery time of consciousness (MD 12 min, 95% CI 7.2-17.4 min) and disappearance time of symptoms (MD 6 min, 95% CI-13.8-25.8 min) for patients with AAI. Larger dose of XNJ Injection (21-40 mL) may speed up the time (almost 1 h earlier). Combination of XNJ and naloxone seemed superior to the naloxone alone for all the relevant outcomes. The average difference of time in consciousness recovery was 2 h and the number of AAI patients whose consciousness recovery within 1 h was above 50% the combination group than in the control group (RR 1.42, 95% CI 1.29 to 1.56). No severe adverse events or adverse reactions of XNJ were reported in the included trials.@*CONCLUSIONS@#Low quality of evidence showed XNJ may have equal effect as naloxone and may achieve better effect as add-on intervention with naloxone for patients with AAI. We failed to evaluate the safety of XNJ Injection due to the insufficient evidence in this review. Registration number. in PROSPERO (No. CRD42018087804).

The effect of SvO2-guided early goal directed fluid therapy on hemodynamic and oxygen dynamics in septic shock pig model / 天津医药

Objective To evaluate the effect of SvO2-guided early goal directed fluid therapy on hemodynamic and oxygen dynamics in septic shock pig model. Methods Twelve Bama miniature pigs (male, 21-24 kg) were equally randomized into 2 groups, group C and group G. Septic shock was induced by intravenous infusion endotoxin. Group C received hemodynamic support aiming central venous pressure at 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg. Group G maintained SvO2 greater than 0.65 in addition to the above indicators. The interventions lasted 6 h and at T0-T8 (0, 60, 120, 180, 240, 300, 360, 420 and 480 min) recorded temperature, hemodynamic and oxygen dynamics indexes for each group, and recorded 6 hours for accumulated liquid volume, vascular active drug, and changes of urine. Results There were no significant differences in mean arterial blood pressure (MAP), heart rate (HR) and systemic vascular resistance index (SVRI) at each time point between group G and group C ( P>0.05). Values of CI and CVP were increased at T4-T8 in group G (P<0.05). Values of MPAP and PVRI were decreased at T8 in group G (P<0.05). Values of SvO2 were increased at T3-T8, O2ER were decreased at T3-T8 (P<0.05), DO2 were increased at T4-T8 (P<0.05), Lac were decreased at T5-T8, andΔp(CO2) was decreased at T8 in group G (P<0.05). There were no significant differences in values of VO2 at T1-T8 between two groups (P>0.05). The amount of intravenous infusion and urine volume were more and the amount of norepinephrine was less in animals of group G (P<0.05). The dosage of dobutamine was more in animals of group G, and which was not used in animals of group C. Conclusion SvO2 guided fluid therapy is more effective than conventional treatment to stabilize hemodynamics and oxygen kinetics, which is characterized by the increased cardiac output, increased oxygen supply, normal oxygen uptake rate and good tissue perfusion.

Analysis of NK Cells and Receptors in Peripheral Blood of Patients with HBV Related Acute-on-chronic Liver Failure in Different Phases / 中山大学学报(医学科学版)

[Objective]To investigate the character of expression of NK cells and its receptors in peripheral blood of pa-tients with HBV-related acute-on-chronic liver failure(HBV-ACLF)in different phase.[Methods]There are thirteen pa-tients with HBV-ACLF in advanced phase group and thirty-three patients in plateau phase group,with thirteen healthy per-son in control group.The frequency of NK cells and expression of NK cell activating receptors(NKAR)including NKG2D, NKp30 and NKp46,NK cell inhibitory receptors(NKIR))cludingsd ate the character of including NKG2A,KIR2DL1, KIR2DL3 and KIR3DL1,NK cell killing function related factors including Perforin,GranzymeB and FasL in peripheral blood of all patients were detected by flow cytometry.[Results]The percentage of NK cells in advanced group was lower than plateau group and healthy control group(H=7.771,P=0.021).The expression of KIR3DL1 in healthy control group was high-er than advanced group and plateau group(Z=6.639,P=0.036)while the expression of FasL was significantly lower than ad-vanced group and plateau group(Z=22.5,P<0.001).[Conclusion]Patients in advanced group had lower frequency of NK cells,lower expression of inhibitory receptor KIR3DL1 and higher expression of FasL than patients in plateau group and healthy control group,which is associated with immune status of patients in different phase of liver failure.

Treating vascular mild cognitive impairment by acupuncture: a systematic review of randomized controlled trials / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To systematically evaluate the effect and safety of acupuncture in the treatment of vascular mild cognitive impairment (VMCI).</p><p><b>METHODS</b>Recruited were China National Knowledge Infrastructure Database (CNKI) (1979-2012), Chinese Science and Technology Periodical Database (VIP) (1989-2012), Chinese Biomedical Database (CBM), Wanfang degree and conference papers database (1985-2012), PubMed Database (1966-2012), and The Cochrane Library (Issue 1, 2012). The search date ended in February 2012. Randomized controlled trials (RCTs) by taking acupuncture as the main treatment for VMCI (nonvascular dementia) were collected. Results were measured using at least one internationally recognized evaluation cognitive scale. Two analysts selected the data independently. The assessment of methodological quality was based on the Cochrane Handbook and the data were analyzed by using RevMan 5.1.0 Software. The mean difference (MD) or risk ratio (RR) were taken and graphed with 95% confidence interval (CI).</p><p><b>RESULTS</b>Recruited 12 RCTs included a total of 691 cases meeting the inclusion criteria (all of the methodological quality was of B level). Acupuncture combined other therapies was involved in 9 RCTs, with effect compared with that of other therapies. Results of meta-analysis showed, compared with the cognitive function training alone, electroacupuncture (MD 1.59, 95% CI 0.69-2.48, P = 0.0005, 3 studies) or body acupuncture (MD 3.26, 95% CI 1.69-4.83, P < 0.01, 1 study) combined with the cognitive function training could significantly increase the mini-mental state examination (MMSE) score of patients. In comparison to Western medicine, acupuncture could elevate ADAS-Cog score (MD 2.16, 95% CI 1.36-2.95, P < 0.01, 3 studies). In all the studies, adverse event had not been reported.</p><p><b>CONCLUSIONS</b>Acupuncture in combination with other therapies could significantly improve cognitive functions. Acupuncture itself appeared to have better therapeutic effects than Western medicine alone.</p>

Establishment and application of standard serum proteomic pattern for diagnosis of early liver cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish standard serum proteomic pattern for early liver cancer and explore its value in early liver cancer diagnosis.</p><p><b>METHODS</b>The serum samples were obtained from 12 healthy subjects and 12 patients with early liver cancer. After removal of serum albumin and IgG, 300 µg serum sample was mixed with the hydrating solution for two-dimensional gel electrophoresis. Each experiment was repeated for 3 times. With silver staining and image analysis, the differentially expressed proteins were identified to establish the standard proteomic pattern for early liver cancer. The proteomics pattern was then tested in the diagnosis of 13 cases of chronic liver disease and 10 healthy individuals in a double-blind manner.</p><p><b>RESULTS</b>Thirty-eight differentially expressed protein spots were identified. Eleven protein spots with differential expressions by over 5 folds were analyzed to establish the standard proteomics pattern for early liver cancer, which showed a sensitivity of 92% and specificity of 90% in early diagnosis of liver cancer.</p><p><b>CONCLUSION</b>The standard serum 2-DE proteomic pattern for early liver cancer shows distinct differences from that of healthy subjects. The differentially expressed proteins and their specific combination pattern may have the potential for diagnosis and prognostic evaluation of early liver cancer.</p>

Detection of Helicobacter species related genes coding for 16S rRNA in the liver tissue of patients with chronic liver disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the infection of Helicobacter pylori (Hp) in the liver tissue of patients with chronic liver disease and the association between Hp and chronic liver disease.</p><p><b>METHODS</b>Liver tissue samples were obtained by liver biopsy and surgical resection from 30 healthy subjects, 30 patients with chronic hepatitis, 30 with cirrhosis and 30 with liver cancer. All the samples were confirmed by pathological examination. The gene fragment coding for 16SrRNA were amplified by PCR with sequence analysis.</p><p><b>RESULTS</b>The PCR product of the 16SrRNA gene was 109 bp in length. Hp 16SrRNA was detected in 18 out of 30 liver biopsy samples from patients with primary cancer (60.0%), in 14 samples from patients with liver cirrhosis (47.0%), and in none of the samples from normal subjects or patients with chronic hepatitis. Sequencing analysis of Hp 16SrRNA gene in the liver tissue showed a 98.8% homology with the gene fragment encoding Hp 16SrRNA.</p><p><b>CONCLUSION</b>Hp is identified in the liver tissue of patients with chronic liver disease, suggesting the possible correlation between Hp infection and hepatocellular carcinoma.</p>

Status of H. pylori infection in the hepatic tissue of patients with hepatocarcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To survey the status of Helicobacter pylori (Hp) infection in the liver of patients with liver cancer and explore the correlation between Hp infection and liver cancer.</p><p><b>METHODS</b>Liver specimens were obtained 30 patients with chronic liver disease (CLD), 30 with liver cancer, and 30 healthy control subjects. The specimens were cultured in Colombian agar medium in microaerophilic condition for isolation of Hp. The presence of Hp was also identified by biochemical test, urease test, immunohistochemistry, and PCR and sequence analysis.</p><p><b>RESULTS</b>Hp was found in none of the liver specimens by culture tests. One out of the 30 patients with liver cancer (3%) was positive for Hp by urease tests. Immunohistochemical staining identified Hp positivity in 9 liver cancer tissue (30.0%), but in none of control or CLD cases (P<0.05). PCR detected Hp 16S rRNA in 18 out of the 30 patients with liver cirrhosis (60.0%) and in none of the control or chronic hepatitis cases. Sequencing analysis of Hp 16S rRNA in liver tissue showed a 98.8% homology with the Hp16S rRNA gene.</p><p><b>CONCLUSION</b>A greater incidence of Hp infection in the liver is identified in patients with liver cancer than in healthy subjects and CLD patients, suggesting a potential correlation between Hp infection to liver cancer.</p>

Number needed to treat (NNT), an index for clinical therapeutic efficacy assessment--its significance and application / 中国中西医结合杂志

Number needed to treat (NNT) is a simple and effective index for clinical therapeutic effect assessment worldwide accepted in recent years. By calculation of absolute risk reduction (ARR) of classified variables, it made the effect estimate reflect objectively the therapeutic effect of an intervention. However, clinical application of this index was introduced rarely in Chinese literature. With the examples from some published clinical reports, the calculation of NNT and its 95% confidence interval were demonstrated in this paper, and its application was illustrated by some relevant terms explanation and Meta-analysis methods introduction.