Sorafenib plus transarterial chemoembolization vs sorafenib alone for patients with advanced hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND Although the past decade has seen remarkable advances in treatment options for hepatocellular carcinoma(HCC),the dismal overall prognosis still envelops HCC patients.Several comparative trials have been conducted to study whether transarterial chemoembolization(TACE)could improve clinical outcomes in patients receiving sorafenib for advanced HCC;however,the findings have been inconsistent.AIM To study the potential synergies and safety of sorafenib plus TACE vs sorafenib alone for treating advanced HCC,by performing a systematic review and metaanalysis.METHODS This study was conducted following the PRISMA statement.A systematic literature search was conducted using the Cochrane Library,Embase,PubMed,and Web of Science databases.Data included in the present work were collected from patients diagnosed with advanced HCC receiving sorafenib plus TACE or sorafenib alone.Data synthesis and meta-analysis were conducted using Review Manager software.RESULTS The present study included 2780 patients from five comparative clinical trials(1 was randomized control trial and 4 were retrospective studies).It was found that patients receiving sorafenib plus TACE had better prognoses in terms of overall survival(OS),with a combined hazard ratio(HR)of 0.65[95%confidence interval(95%CI):0.46–0.93,P=0.02,n=2780].Consistently,progression free survival(PFS)and time to progression(TTP)differed significantly between the sorafenib plus TACE arm and sorafenib arm(PFS:HR=0.62,95%CI:0.40–0.96,P=0.03,n=443;TTP:HR=0.73,95%CI:0.64-0.83,P<0.00001,n=2451).Disease control rate(DCR)was also significantly increased by combination therapy(risk ratio=1.36,95%CI:1.02-1.81,P=0.04,n=641).Regarding safety,the incidence of any adverse event(AE)was increased due to the addition of TACE;however,no significant difference was found in grade≥3 AEs.CONCLUSION The combination of sorafenib with TACE has superior efficacy to sorafenib monotherapy,as evidenced by prolonged OS,PFS,and TTP,as well as increased DCR.Additional high-quality trials are essential to further validate the clinical benefit of this combination in the treatment of advanced HCC.

Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria:a randomized placebo-controlled trial

BACKGROUND:Microalbuminuria(MAU) is a key component of metabolic syndrome(MetS) and is an early sign of diabetic nephropathy as well.Although routine Western medicine treatments are given to MetS patients to control high blood pressure,hyperglycemia and dyslipidemia,some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE:To investigate the efficacy of Yiqi Huaju Qingli Herb Formula,a compound traditional Chinese herbal medicine,in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS:Sixty patients with MetS were randomized into the Chinese herbal formula group(CHF,Yiqi Huaju Qingli formula treatment in combination with Western medicine) and control group(placebo in combination with Western medicine).All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES:Urinary microalbumin(MA),urinary albumin-to-creatinine ratio (UACR),24-hour total urine protein(24-hTP),body mass index(BMI),waist circumference (WC),waist-to-hip ratio(WHR),fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2-hPPG),glycosylated hemoglobin(HbA1c),homeostasis model assessment for insulin resistance(HOMA-IR),blood lipid profile and blood pressure were observed. RESULTS:Compared with the control group,CHF treatment significantly decreased BMI (P<0.05),WC(P<0.01) and WHR(P<0.01).Both groups had significant decreases in FPG, 2-hPPG,HbA1c,HOMA-IR,MA,and UACR,with CHF treatment showing better effects on these parameters compared with the control treatment(P<0.05).Both treatments significantly reduced the levels of total cholesterol,low-density lipoprotein cholesterol and triacylglycerol(TAG),and a greater reduction in TAG was observed with CHF treatment(P<0.05).The level of high-density lipoprotein cholesterol did not change in the control group after treatment(P>0.05),whereas it significantly increased with CHF treatment(P<0.01).Compared with before the treatment,significant decreases in systolic blood pressure,diastolic blood pressure and mean arterial blood pressure were observed in both groups(P<0.01).However,there was no significant difference between the two groups(P>0.05). CONCLUSION:Combined treatment of Yiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU,which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER:This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.

Clinical efficacy of electromagnetic field therapy combined with traditional Chinese pain-reducing paste in myofascial pain syndrome

BACKGROUND Pulsed electromagnetic field(PEMF)therapy is widely used to treat myofascial pain syndrome(MPS).Damp-clearing and pain-reducing paste(DPP)comprises medical herbs and has been a traditional method of reducing myofascial pain in China for a long time,and it is usually administered with heating.However,the synergistic effect of PEMF therapy on heating-DPP in patients with MPS is unclear.AIM To investigate the synergistic effect of PEMF therapy plus heating-DPP in lumbar MPS.METHODS This double-blind,randomized,placebo-controlled trial was conducted on 120 patients with lumbar MPS who were randomly divided into an experimental group(EG,n=60)and a control group(CG,n=60).Patients in both groups were treated with heating-DPP combined with PEMF therapy;however,the electromagnetic function of the therapeutic apparatus used in the CG was disabled.Each treatment lasted for 20 min and was applied five times a week for two weeks.The short-form McGill Pain Questionnaire was applied at five time points:pretest,end of the first and second weeks of treatment,and end of the first and fourth week after completing treatment.Visual analog scale(VAS),present pain intensity index(PPI),and pain rating index(PRI;total,affective pain,and sensory pain scores)scores were then analyzed.RESULTS Compared with the CG,the VAS,PPI and PRI scores(total,affective pain and sensory pain scores)in the EG were significantly lower after treatment and during follow-up.CONCLUSION PEMF therapy combined with heating-DPP showed better efficacy than heating-DPP alone in reducing the overall intensity of pain and sensory and affective pain.

Usefulness of upright T wave in lead aVR for predicting short-term prognosis of patients with ischemic stroke

Background: Upright T wave in lead aVR (TaVR) has recently been reported to be associated with cardiovascular death and mortality in general population and in patients with prior cardiovascular disease (CVD). However, the evidence for the predictive ability of TaVR in patients with ischemic stroke (IS) is lacking. Methods: A total of 625 consecutive patients with IS (mean age:66 ± 12 years;379 male) were enrolled in this study between January 2013 and December 2014. Patients were divided into upright TaVR (≥0 mV;n = 201) and negative TaVR (<0 mV;n=424) groups. All patients were evaluated with respect to clinical features and in-hospital clinical results. Results: Overall, the prevalence of upright TaVR was 32.2%at baseline. Patients with an upright TaVR were older, had a higher percentage of CVD and hypertension, higher level of MB isoenzyme of creatine kinase (CKMB), faster heart rate, higher rate of QT prolongation>450 ms, higher rate of negative T in lead II, higher rate of negative T in lead V6, higher rate of ST depression, and longer QTc duration. During the mean follow-up period of 20.0 ± 5.8 months, 29 (4.6%) patients experienced all-cause death and 12 (1.9%) patients experienced cardiovascular death, the primary end point. Concomitantly, 94 (15%) patients experienced recurrence of IS, the secondary end point. After adjusting for clinical covariates, upright TaVR was independently associated with all-cause death [hazard ratio (HR): 2.88, 95%confidence intervals (CI): 1.07-7.73], cardiovascular death (HR: 3.04, 95% CI:1.07-8.64), and IS recurrence (HR:1.86, 95%CI:1.08-3.20). Conclusions: Upright TaVR in patients with IS is associated with increased mortality and recurrence of IS.