Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
Objective To Evaluation of Accuracy and Quality of Diagnostic Test of CEA for the Diagnosis of NSCLC in Chinese Patients. Methods We searched Chinese Biological Medicine Database (CBM, 1978 to 2009) and China National Knowledge Infrastructure (CNKI, 1994 to 2009). Diagnostic tests of CEA for the diagnosis of NSCLC were included. Data were extracted, and the quality of included studies was evaluated according to the six criteria of diagnostic tests. The heterogeneity test and The Summary Receiver Operating Characteristic (SROC) curve and meta-analyses were performed by MetaDisc. Results A total of 84 relevant articles were retrieved and 11 were included in our review. Eleven studies involving 925 patients (861 NSCLC patients, all diagnosed by the gold standard) were included. Meta-analyses showed that the heterogeneity among studies was high (P=0.000 2, I2=69.1%), the pooled sensitivity was 0.542 and the pooled specificity was 0.869. Subgroup analyses indicated that 5 of the studies which used the ECLIA (P=0.376, I2=5.4%, AUC= 0.748 3) and 4 of the studies which lung adenocarcinoma (P=0.186, I2=37.6%, AUC=0.900 2) and 4 of the studies which lung squamous cell carcinoma (P=0.955，I2=0.00%, AUC=0.762 0) had no heterogeneity. serum CEA is low sensitive and high specific on the diagnosis of NSCLC. The sensitivity and diagnostic accuracy rate of CEA were higher in adenocarcionoma than squamous cell cance. Conclusion CEA could be regarded as one of the reference tests in patients with NSCLC, Serum CEA is more sensitive and specific than lung squamous cell carcinoma on lung adenocarcinoma. but more high quality trials are required.
Objective To compare and evaluate the effectiveness and safety of irinotecan (IRI) versus oxaplatin (OXA), in combination with 5-FU/LV for patients with advanced colorectal cancer. Methods The literature search, study selection and assessment, data collection and analysis were undertaken by two reviewers according to the Cochrane Handbook for Systematic Reviews of Interventions. Randomised controlled trials (RCTs) or quasi-RCTs comparing IRI versus OXA, in combination with 5-FU/LV in the treatment of advanced colorectal cancer were collected. Results Seven studies involving 2107 patients were included. The OXA/5-FU/LV regimen was superior or at least equal to the IRI/5-FU/LV regimen in prolonging overall survival and time to progression. The OXA/5-FU/LV regimen showed a higher response rate and was associated with lower toxicities. Conclusion Compared with IRI, OXA is more appropriate for the treatment of advanced colorectal cancer when combined with 5-FU/LV.
Objective To evaluate the effect and safety of infantile femoral vein blood sampling with vacuum versus disposable needle. Methods Such databases as VIP, CNKI, CBM, Google Academic and Wanfang data were searched to collect the randomized controlled trials (RCTs) about infantile femoral vein blood sampling with vacuum versus disposable needle published from January 2000 to July 2010. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the methodology quality was assessed, and meta-analysis was conducted by using RevMan 5.0 software. Results A total of 15 RCTs were included. Of 3 490 patients in all, 1 770 were in the treatment group and 1 726 were in the control group. The baseline conditions were reported in 14 studies, and the random methods were mentioned in 11 RCTs. All studies didn’t report the allocation concealment and blind method. Only 2 RCTs reported separately that, the degree of neonatal pain was lower in the treatment group (Plt;0.01), and the satisfaction of parents was higher in the treatment group (Plt;0.01). Four RCTs compared the sampling time between the two groups without meta-analysis mentioned due to the disunity of standard, only the descriptive outcomes showed a shorter time in the treatment group. The meta-analysis showed that, compared with the control group, the reject rate of sample quality was lower (RR=0.20, 95%CI 0.15 to 0.26), the success rate of one time sampling was higher (RR=1.20, 95%CI 1.16 to 1.24), the injury of local tissue was slighter (RR=0.62, 95%CI 0.45 to 0.86), and the iatrogenic contamination was lower (RR=0.62, 95%CI 0.45 to 0.86) in the treatment group. Conclusion This review shows that the vacuum sampling is superior to the disposable needle sampling for domestic infantile femoral vein blood collection. Due to the low quality of the included studies with high possibility of bias, this conclusion needs to be further verified by performing more high-quality studies.
ObjectiveTo explore the association between viral hepatitis and extrahepatic cholangiocarcinoma (ECC). MethodsDatabase of Medline, Embase, PubMed, CNKI, and Wanfang were searched for the articles which were related to the relationship between viral hepatitis and ECC. After the quality evaluation and the data extraction of the literatures, statistical software of RevMan 5.0 was used to perform Meta analysis. ResultsAccording to the inclusion criteria and exclusion criteria, 9 articles were enrolled, 8 articles of them were related to hepatitis B virus(HBV) and 6 articles of them were related to hepatitis C virus(HCV). Meta analysis results showed that the HBV infection may be the risk factor for ECC(OR=1.69, 95% CI:1.32-2.17, P<0.000 1). In the United States, HCV infection may be the risk factor for ECC(OR=5.53, 95% CI:2.21-13.82, P=0.000 3), but the relationship was not found in China(OR=0.82, 95% CI:0.44-1.52, P=0.520 0). ConclusionsThe present studies suggest that HBV infection may be a high risk factor for ECC. HCV in the United States can increase the incidence of ECC, but the situation can not be found in China.
Objective To estimate the effect of desensitizing toothpaste containing arginine on dentine hypersensitivity. Methods Such databases as CNKI, PubMed, Web of Science and Cochrane Trials Register (Issue 4, 2008) were retrieved, and Google was used as a supplementary tool to search the information up to March 2010. Randomized controlled trials (RCTs) of treating dentine hypersensitivity with arginine-containing toothpaste were included, and the relevant information was extracted and the quality evaluation was undertaken. Meta-analyses were performed with RevMan 5.0 software. Results Five RCTs with 397 patients were included. The results of meta-analyses showed that at 8 weeks, arginine-containing toothpaste was significantly different from potassium-containing toothpaste in terms of tactile sensitivity test (SMD=1.32, 95%CI 0.68 to 1.96) and air blast test (SMD= –0.77, 95%CI –1.22 to 0.32) with a better therapeutic effect. Conclusion Current literature evidence shows that the arginine-containing toothpaste is effective for the dentine hypersensitivity. However, this study is based on a small number of RCTs and samples, so further studies with high-quality and large-sample RCTs are needed.
Objective To investigate the efficacy of LDL-C lowering treatment on NSTE-ACS, and to analyze the target LDL-C level for clinical treatment. Methods PubMed, EMbase, the Cochrane Central Register of Controlled Trials, Web of Science databases were searched up to January 2016 for randomized controlled trials assessing the effects of LDL-C lowering therapy on major adverse cardiac events (MACE) in patients with NSTE-ACS. Two reviewers independently screened litertures, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using Stata12.0 and RevMan 5.3 software. Result A total of 12 RCT including 4 702 individuals with NATE-ACS were included. The results of meta-analysis showed that, compared with the control group, the statin group could significantly reduced the risk of MACE (RR=0.68, 95% CI 0.549 to 0.834,P=0.000). With 18.68 months of follow-up, patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lower risk of MACE than other LDL-C level group. When LDL-C lower 20% to 40% than baseline with 28.99 months follow-up, patients in target of LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lowest risk of MACE (RR=20.143, 95% CI 6.946 to 58.414,P=0.000). Conclusion LDL-C lower treatment can lower the risk of MACE in patients with NSTE-ACS. Patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group have relatively low risk of MACE, in which patients who lower 20% to 40% LDL-C than baseline will get more benefits from LDL-C lowering therapy.
Objective To systematically evaluate the effects of psychotherapy for cancer patients with depression. Methods We searched The Cochrane Library, PubMed, EMbase, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database up to October 2010 to identify randomized controlled trials (RCTs) comparing psychotherapy plus conventional treatment with conventional treatment alone. The data were analyzed by using RevMan 5.0 software. Results Eleven RCTs involving 1 670 participants were included. The results of meta-analyses showed: (1) A significant difference was found between psychotherapy plus conventional treatment and conventional treatment alone in decrease of depression score (SMD= – 0.40, 95%CI – 0.70 to – 0.11); (2) No difference was observed between the two groups in decrease of anxiety score (SMD= – 0.68, 95%CI – 1.37 to 0.01), but the result was changed when a sensitivity analysis was done (SMD= – 0.30, 95%CI – 0.52 to -0.08). Conclusion Compared with conventional treatment alone, psychotherapy combined with conventional treatment could improve depressive states in cancer patients, but the result still needs to be confirmed by high-quality and large-sample RCTs.
Objective To analyze the relationship between helicobacter pylori (HP) and gastric cancer. Methods We searched CNKI (Jan.1995-Dec.2005) and Wangfandatabase (Jan.1995-Dec.2005). Case-control studies on relationship of helicobacter pylori infection and gastric cancer were collected. Meta-analysis method was used to sum up the odds ratio (OR) and 95%CI of these studies.Results We identified 14 case-control studies with 11 studies of healthy adults versus gastric cancer patients and 4 studies of gastritis versus gastric cancer patients. The results of subgroup analyses based on patients resource showed: statistical difference was founded between healthy adults and gastric cancer patients with pooled OR 2.00 and 95%CI 1.25 to 3.20; no statistical difference was founded between gastritis patients and gastric cancer patients with pooled OR 1.54 and 95%CI 0.68 to 3.50. The results of subgroup analyses based on locations of gastric cancer showed: statistical difference was founded between the non-cardiac gastric cancer patients and the control with pooled OR 3.60 and 95%CI 1.25 to 10.36; no statistical difference was found between cardiac gastric cancer patients and control with pooled OR 0.88 and 95%CI 0.56 to 1.39.Conclusion HP infection can be associated with gastric cancer, and the different conclusions of the 14 reports may be attributed to the locations of gastric cancer and the selection of controls.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.