Objectives To assess the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus. Method We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha-glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Date of most recent search: December 2003 (Current Contents) and April 2003 (other databases). Randomised controlled trials of at least 12 weeks duration comparing alpha-glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. Results We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin –0.77% (95% confidence interval –0.90 to –0.64), fasting blood glucose –1.1 mmol/L (95% confidence interval –1.4 to –0.9), post-load blood glucose –2.32 mmol/L (95% confidence interval –2.73 to –1.92). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by –24.8 pmol/L (95% confidence interval –43.3 to –6.3) and –133.2 pmol/L (95% confidence interval –184.5 to –81.8) respectively and acarbose caused more adverse effects. Conclusions It remains unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha-glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated haemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects.
ObjectiveTo systematically review the efficacy and safety of flibanserin for hypoactive sexual desire disorder in premenopausal women. MethodsWe searched PubMed, EMbase, MEDLINE, The Cochrane Library (Issue 7, 2014), CBM, CNKI, VIP and WanFang Data from their inception to August 2014, to collect randomized controlled trials (RCTs) on the effectiveness and safety of flibanserin for hypoactive sexual desire disorder in premenopausal women. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. And then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 4 RCTs involving 3 881 patients were included. The results of meta-analysis showed that:compared with the placebo group, the flibanserin group was superior in increasing the number of satisfying sexual events (SSE) (MD=0.72, 95%CI 0.51 to 0.92, P<0.000 01), improving the eDiary desire score (MD=2.21, 95%CI 1.45 to 2.97, P<0.000 01), FSFI domain score (MD=0.29, 95%CI 0.24 to 0.35, P<0.01) and FSFI total score (MD=1.82, 95%CI 1.47 to 2.17, P<0.000 01), and decreasing the FSDS-R item 13 score (MD=-0.24, 95%CI -0.31 to -0.17, P<0.000 01) and FSDS-R total score (MD=-2.70, 95%CI -3.43 to -1.96, P<0.000 01). However, the incidence of adverse events in the flibanserin group was higher than that of the placebo group (OR=1.31, 95%CI 1.11 to 1.54, P=0.001). ConclusionThe current evidence suggests that, in premenopausal women with HSDD, flibanserin treatment is effective but may increase the incidence of adverse events.
ObjectiveTo evaluate the quality of guidelines for the management of delirium in adult patients in the last ten years, so as to provide references for updating, selection, implementation guidelines and delirium management optimization.MethodsWe searched guidelines from databases including PubMed, EMbase, WanFang Data and CNKI, and websites of guidelines from January 1st 2010 to September 1st 2019. Guidelines were comprehensively screened, evaluated based on AGREE Ⅱ and data was independently extracted by two researchers.ResultsGuidelines of NICE, RNAO and SIGN had higher scores, while CSCCM’s and IPS’s gained lower. Among domains of AGREE Ⅱ, Domain I (scope and purpose) and IV (clarity of presentation) scored the highest, with a minimum of Domain Ⅱ (stakeholder involvement) and V (applicability). Delirium management focused on screening, prediction, prevention and treatment both pharmacologically and non-pharmacologically, and information support.ConclusionsFuture development of delirium guidelines should follow the methodology of guideline development, update or adjustment, and dedicate to every domain, especially domain of application. Medical staffs can establish our own domestic guidelines based on high quality guidelines, to promote knowledge translation and delirium management.
Objective To assess the effectiveness of intraarticular injection of hyaluronate (HA) on temporomandibular disorders (TMD). Methods Searching various databases available, handsearching 15 Chinese dental journals to find articles, abstracts and unpublished literature with randomized or quasi-randomized design on the effects of intraarticular injection of HA on TMD.Data extraction, appraisal, and the methods for Meta-analysis were conducted based on the Cochrane guidelines. Results 12 RCTs and 2 CCT on TMD and 1 RCT on rheumatoid arthritis involving temporomandibular joints (TMJ) were located, 10 of them fulfilled inclusion criteria in which 561 patients were reported.Except 71 cases with only qualitative data, 490 cases could be calculated in Meta-analysis: 277 on HA, 113 on placebo or non-treatment (PL) and 100 on corticosteroids (CO). In comparison with PL, HA injection showed no statistically significant effect on short and long term improvement of symptoms, and short term improvement of VAS as well. But it presented significant better effects than PL in short and long term improvement of clinical signs, especially mouth opening. When sensitivity analysis was conducted for improvement of short term signs, the conclusion was not stable. Comparison of the effect between HA and CO showed the same efficacy levels. Adverse reactions of HA were mild and transient. Conclusions HA may improve short and long term clinical signs of TMD and have only mild and transient adverse reactions. However, more RCTs are needed to confirm its therapeutic effect.
ObjectiveTo analyze the status of systematic reviews/meta-analyses on tuberculosis. MethodsThe Web of Science was searched for systematic reviews/meta-analyses on tuberculosis up to February 4th, 2015. According to the inclusion and exclusion criteria, two reviewers screened literature and extracted data. Then SPSS 11.0 software was used to analysis data including publication year, country, institution, journal and citation situation. ResultsA total of 461 systematic reviews/meta-analyses were included. The publication numbers was increasing from 1 in 1997 to 82 in 2014. Among them, China ranked the top country (113 studies), followed by the USA and Canada. The area with the most number of countries where studies were published was Europe, followed by Asia and Africa. In terms of institution, McGill University in Canada ranked the top, followed by University of London in England and Sichuan University in China. As for the number of papers in journals, the International Journal of Tuberculosis and Lung Disease ranked the top, followed by PLOS One and European Respiratory Journal. In the terms of citation, the citation ranged from 0 to 591, and the median citation frequency was 8. ConclusionThe systematic reviews/meta-analyses on tuberculosis is gradually increasing; the developed countries are still important output areas; and China is playing more and more important role in this research field.
Objective To assess the effect of Dengzhanhua Injection for angina pectoris. Methods We performed an electronic search for MEDLINE (1966 to 2004), EMBASE (1974 to 2004), The Cochrane Library (Issue 4, 2004), CBM and CNKI (1980 to 2004). We included randomized controlled trials that met the inclusion and exclusion criteria and evaluated the quality of those trials and performed the meta-analysis by RevMan 4.2.7. Results Eight trials were included involving 634 patients. However, they were of poor quality. The results of meta-analysis indicated that there were statistical difference on symptoms and electrocardiogram (ECG) improvements between Dengzhanhua and control group (Breviscarpine≥30 mg) with RR 1.26, 95%CI 1.11 to 1.44 and RR 1.30, 95%CI 1.14 to 1.49, respectively. However, Dengzhanhua Injection (Breviscarpinelt;30 mg) vs. basic therapy showed no statistical difference in either symptom improvement (RR 1.03, 95%CI was 0.90 to 1.18) or ECG improvement (RR 1.01, 95%CI 0.86 to 1.20). In addition, Dengzhanhua decreased the myocardial infarction attacks in one year following up (OR 0.06, 95%CI 0.01 to 0.29). Conclusions Little evidence shows that Dengzhanhua is superior to simple basic therapy in the symptoms and ECG improvements as an auxiliary drug. However, this systematic review can not draw a conclusion about the effectiveness of Dengzhanhua Injection compared to simple basic therapy in the treatment of angina pectoris due to the poor quantity of included trials.
Objective To evaluate the effectiveness and safety of Chinese medicine treatment of cholelithiasis. Methods We searched electronic databases including MEDLINE (1966 to Feb. 2009), EMbase (1974 to Feb. 2009), The Cochrane Library (Issue 4, 2008), Chinese Biomedical Literature Database (CBM, 1978 to Feb. 2009), CJFD (CNKI, 1994 to Feb. 2009), the Chinese Scientific and Technical Journals database (VIP, 1989 to Feb. 2009), and a database of Chinese biomedical journals (CMCC, 1994 to Feb. 2009). At the same time, we searched references of the included studies. Metaanalysis was performed using RevMan 5 if there was no significant heterogeneity. We described the date which could not be combined. Results A total of 18 randomized controlled trials involving 2 276 patients were included. According to measurement indicators and interventions, subgroup analysis was performed. Efficacy was reported in 10 studies, which showed that part of proprietary Chinese medicines had a higher efficiency for cholelithiasis. Gallbladder emptying index and the trend of bile into the stone were compared in 5 studies, suggesting that the bile of proprietary Chinese medicines reduced the stone index, which eased the bile tendency to rock. Three studies reported the rate of cholecystokinin. Metaanalysis results suggested that the difference was significant. Two studies reported adverse drug reactions (ADRs), such as epigastric discomfort and diarrhea. Most ADRs were slight, and could be self relieved. Conclusion Results suggest that Chinese medicines produce effects on clinical symptoms of cholelithiasis, gallbladder function and reduce the trend of bile into stones. However, the therapeutic effects for long-term are rarely reported. The conclusion needs further verification due to low methodological quality and apparent heterogeneity.
Objective To assess the effectiveness and the safety of clinical use of growth hormone (GH) in burn patients. Method Search were applied to the following electronic databases: Chinese Bio-medicine Database (CBM), MEDLINE, EMBASE and Cochrane Library. Language was restricted in Chinese and English. Data were extracted and evaluated by the two reviewers independently of each other. Applied RevMan 4.1 for statistical analyse. Results Nine trials involving 732 patients were included. The combined results showed that GH can shorten wound healing time [weighted mean difference (WMD) = -11.25, 95%CI (-14.84 to -7.66), Plt;0.000 01], donor site healing times [WMD= -1.87, 95%CI (-2.28 to -1.47), P＜0.000 01), and length of hospital stay [WMD= -8.10, 95%CI (-10.40 to -5.79), P＜0.000 01]. There was no statistical significance on resting energy expenditure [WMD= -0.04, 95%CI ( -0.08 to 0.00), P=0.06], mortality [odds ratio (OR) =1.15, 95%CI (0.15 to 8.53), P=0.9], sepsis [OR=1.08, 95%CI (0.50 to 2.34), P=0.8] and ventilatory support required [OR=1.51, 95%CI (0.72 to 3.16), P=0.3]. Nevertheless, the plasma levels of glucose [standardized mean difference (SMD) =0.98, 95%CI (0.54 to1.42), P＜0.000 01] and insulin [SMD=0.86, 95%CI (0.43 to1.30), P=0.000 1] were increased in GH groups. Conclusions GH for burn patients is effective and safe if blood glucose can be controlled well.
Objective To systematically evaluate the correlation between coffee and risk of endometrial cancer. Methods Such databases as CBM, CNKI, WanFang data, PubMed, EMbase and The Cochrane Library (Issue 5, 2012) were searched to collect the prospective cohort studies about correlation between coffee and endometrial cancer. The retrieval time was by the end of May 2012, and the references of the included literature were also retrieved. Two evaluators independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the statistical analysis was conducted by using Stata 12.0 software. Results A total of 10 cohort studies involving 4 484 patients with endometrial cancer were included. The results of meta-analysis showed that, compared with the women who didn’t drink coffee or drank in the lowest dose, the women who drank coffee in the highest dose had a decreased risk of endometrial cancer (RR=0.69, 95%CI 0.62 to 0.78), same as the women who drank coffee frequently (RR=0.83, 95%CI 0.77 to 0.89). The results of dose-response analysis revealed that, when there was an increase of 2 more cups of coffee per day, there was the risk of endometrial cancer decreased by 12%. Conclusion Drinking coffee frequently (more than 2 cups per day) can decrease the risk of endometrial cancer which can be significantly decreased when drinking in a big dose (more than 5 cups per day).
Objective To systematically review the association between Chinese eye exercises and myopia onset in children and adolescents to provide a theoretical basis for clinical prevention of myopia. Methods The PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched from inception to March 2022 to collect observational studies about the association between Chinese eye exercises and myopia onset in children and adolescents. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 28 studies were included, including 217 112 subjects. The results of meta-analysis showed that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously and doing eye exercises correctly and normatively were the protective factors of myopia onset in children and adolescents. Conclusion Current evidence shows that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously, doing eye exercises correctly and normatively can prevent myopia onset in children and adolescents. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.