Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of thi...Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk patients.Unfortunately,the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic considerations.Therefore,effective non-invasive pharmacologic prophylaxis remains appealing,particularly if it is inexpensive,easily administered,has a low risk side effect profile and is widely available.There have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis(PEP) prophylaxis,most of them yielding disappointing results.A recently published large,multicenter,randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.展开更多
Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,in...Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.展开更多
OBJECTIVE: To systematically assess the clinical ef- fectiveness of traditional Chinese medicine (TCM) in the treatment of functional dyspepsia (FD) of liv- er-stomach disharmony syndrome by meta-analysis. METHOD...OBJECTIVE: To systematically assess the clinical ef- fectiveness of traditional Chinese medicine (TCM) in the treatment of functional dyspepsia (FD) of liv- er-stomach disharmony syndrome by meta-analysis. METHODS: Random controlled trials (RCTs) were retrieved from databases, including Pubmed, China national knowledge infrastructure, Wanfang Data, VlP Information, and the Cochrane Library. Trials were selected according to inclusion criteria. The ef- fects of traditional Chinese medicine (TCM) versus prokinetic agents in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syn- drome were compared by meta-analysis. RevMan 5.0.24 was used for data analysis. The effective rate was assessed by odds ratios (ORs), and 95% confi- dence intervals (C'/s) were calculated. The cure rate was analyzed by the Peto OR. Simple statistica~ anal- ysis was chosen to assess the frequency of pre- scribed Chinese herbs in treating this syndrome.RESULTS: Thirteen trials were included, involving 1153 patients, and these were of poor methodolog- ical quality. Twelve studies mentioned the effective rate and cure rate. TCM therapy showed a better clinical effect rate compared with that with proki- netic agents [OR: 3.2, 95% CI (2.27, 4.51)]. The TCM group also had a better cure rate than that in the group of prokinetic agents [Peto OR: 2.26, 95% CI (1.61, 3.18)]. With regard to the frequency of Chi- nese herbs used in these 13 trials, Baishao (Radix Paeoniae), Chaihu (Radix Bupleuri), and Gancao (Ra- dix Glycyrrhizae) were mostly prescribed, followed by Xiangfu (Rhizoma Cyperi), Zhishi (Fructus Auran- tii Immaturus), Zhiqiao (Fructus Aurantii), Foshou (Citrus medica var.sarcodactylis), and Chenpi (Peri- carpium Citri Reticulatae). No serious adverse ef- fects were reported. CONCLUSION: TCM therapy shows a superior effec- tive rate and cure rate compared with those in pro- kinetic agents in the treatment of FD of liver-stom- ach disharmony syndrome. However, further strict- ly designed RCTs are required because of the poor quality of included trials.展开更多
OBJECTIVE: To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke. METHODS: PubMed, China Science And Technolo- gy Journal Database, Wanfang Database, Chinese periodicals in ...OBJECTIVE: To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke. METHODS: PubMed, China Science And Technolo- gy Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infra- structure, and the General Hospital of Tianjin Medi- cal University's Library were searched until July 2012. Randomized controlled trials (RCTs) and ob- servational studies that reported the use of DPC for treatment of stroke were selected. RESULTS: Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participat- ed in the studies. We found that there was a signifi-cant statistical difference between DPC treatment groups and the control groups in terms of the effec- tive rate [risk ratio (RR), 1.14; 95% confidence inter- vals (CI), 1.04, 1.25; P=0.01], FugI-Meyer Assessment Scale [weighted mean difference (WMD), 9.77; 95% CI (4.84, 14.70); P=0.00], Barthel Index [WMD=6.40; 95% CI (3.15, 9.65)], and mean flow velocity [WMD= 5.79; 95% CI (1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI ( - 1.09, 2.29)], vi- sual field defects [left visual field: WMD= - 203.10; 95% CI ( - 424.41, 18.21); right visual field: WMD= - 172.60; 95% CI ( - 409.29, 64.09)] or the functional independence measure [WMD= - 7.90; 95% CI ( - 16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two ar- ticles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quali- ty, and most of the sample sizes were small, our analysis was likely affected by bias. CONCLUSION: DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.展开更多
OBJECTIVE:To evaluate the efficacy and safety of Xuefuzhuyu decoction for hyperlipidemia.METHODS:Randomized clinical trials on hyperlipidemia treated by Xuefuzhuyu decoction,either alone or with Western Medicine,were ...OBJECTIVE:To evaluate the efficacy and safety of Xuefuzhuyu decoction for hyperlipidemia.METHODS:Randomized clinical trials on hyperlipidemia treated by Xuefuzhuyu decoction,either alone or with Western Medicine,were searched in electronic databases.Databases searched were:MEDLINE,Allied and Complementary Medicine Database,EMBASE,The Cochrane Library 2013(Issue4),China National Knowledge Infrastructure Database,Chinese Biomedical Literature Database,and Wanfang Database up to 2 May,2013.Study selection,data extraction,quality assessment,and data analysis were conducted according to the Cochranestandards.RESULTS:Six randomized clinical trials involving748 patients(373 patients in the treatment group,375 patients in the control group)were included in the analysis.The studies were of low methodological quality.Meta-analysis indicated that the effect of Xuefuzhuyu decoction on hyperlipidemia was better than that in the control group[n=748,OR=5.07,95%CI(3.40,7.58),P<0.01].Weighted mean differencesin total cholesterol,low-densitylipoprotein cholesterol,triglycerides,and high-density lipoprotein cholesterol were﹣0.79,﹣0.74,﹣0.44,0.16,respectively,and Meta-analysis revealed that the treatment group was better than the control group with 95%CI(﹣1.21,﹣0.36),(﹣0.94,﹣0.55),(﹣0.77,﹣0.11),(0.04,0.27),respectively(all P<0.05).Some adverse events in evaluated studies wererecorded.CONCLUSION:Xuefuzhuyu decoction may be effective for treating hyperlipidemia.The studies we analyzed were of low methodological quality,which indicates that the above findings should be considered cautiously.Therefore,more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Xuefuzhuyu decoction in hyperlipidemia.展开更多
Maximum likelihood recursions were used by Wu (1985) to estimate extreme quantiles of a quantal response curve. For certain choices of initial designs, Wu's method performs well. In many fields of application, ther...Maximum likelihood recursions were used by Wu (1985) to estimate extreme quantiles of a quantal response curve. For certain choices of initial designs, Wu's method performs well. In many fields of application, there often exist some different initial designs which are known as the up-and- down designs. Based on the existing data set from such a design, the authors propose three sequential empirical Bayesian designs by quickly and efficiently exploiting the information in the testing data and known knowledge. The improvement obtained by using the new procedures for the estimation of extreme quantiles is substantial.展开更多
文摘Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk patients.Unfortunately,the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic considerations.Therefore,effective non-invasive pharmacologic prophylaxis remains appealing,particularly if it is inexpensive,easily administered,has a low risk side effect profile and is widely available.There have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis(PEP) prophylaxis,most of them yielding disappointing results.A recently published large,multicenter,randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.
文摘Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.
基金Supported by Shenyang Municipal Program for Science and Technology 2011(F11-155-9-00)
文摘OBJECTIVE: To systematically assess the clinical ef- fectiveness of traditional Chinese medicine (TCM) in the treatment of functional dyspepsia (FD) of liv- er-stomach disharmony syndrome by meta-analysis. METHODS: Random controlled trials (RCTs) were retrieved from databases, including Pubmed, China national knowledge infrastructure, Wanfang Data, VlP Information, and the Cochrane Library. Trials were selected according to inclusion criteria. The ef- fects of traditional Chinese medicine (TCM) versus prokinetic agents in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syn- drome were compared by meta-analysis. RevMan 5.0.24 was used for data analysis. The effective rate was assessed by odds ratios (ORs), and 95% confi- dence intervals (C'/s) were calculated. The cure rate was analyzed by the Peto OR. Simple statistica~ anal- ysis was chosen to assess the frequency of pre- scribed Chinese herbs in treating this syndrome.RESULTS: Thirteen trials were included, involving 1153 patients, and these were of poor methodolog- ical quality. Twelve studies mentioned the effective rate and cure rate. TCM therapy showed a better clinical effect rate compared with that with proki- netic agents [OR: 3.2, 95% CI (2.27, 4.51)]. The TCM group also had a better cure rate than that in the group of prokinetic agents [Peto OR: 2.26, 95% CI (1.61, 3.18)]. With regard to the frequency of Chi- nese herbs used in these 13 trials, Baishao (Radix Paeoniae), Chaihu (Radix Bupleuri), and Gancao (Ra- dix Glycyrrhizae) were mostly prescribed, followed by Xiangfu (Rhizoma Cyperi), Zhishi (Fructus Auran- tii Immaturus), Zhiqiao (Fructus Aurantii), Foshou (Citrus medica var.sarcodactylis), and Chenpi (Peri- carpium Citri Reticulatae). No serious adverse ef- fects were reported. CONCLUSION: TCM therapy shows a superior effec- tive rate and cure rate compared with those in pro- kinetic agents in the treatment of FD of liver-stom- ach disharmony syndrome. However, further strict- ly designed RCTs are required because of the poor quality of included trials.
基金Supported by The National Science and Technology Infrastructure Program of China(2006BAI04A02-2)the National Basic Research Program of China(2012CB518505)the Natural Science Foundation of China(81173416)
文摘OBJECTIVE: To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke. METHODS: PubMed, China Science And Technolo- gy Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infra- structure, and the General Hospital of Tianjin Medi- cal University's Library were searched until July 2012. Randomized controlled trials (RCTs) and ob- servational studies that reported the use of DPC for treatment of stroke were selected. RESULTS: Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participat- ed in the studies. We found that there was a signifi-cant statistical difference between DPC treatment groups and the control groups in terms of the effec- tive rate [risk ratio (RR), 1.14; 95% confidence inter- vals (CI), 1.04, 1.25; P=0.01], FugI-Meyer Assessment Scale [weighted mean difference (WMD), 9.77; 95% CI (4.84, 14.70); P=0.00], Barthel Index [WMD=6.40; 95% CI (3.15, 9.65)], and mean flow velocity [WMD= 5.79; 95% CI (1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI ( - 1.09, 2.29)], vi- sual field defects [left visual field: WMD= - 203.10; 95% CI ( - 424.41, 18.21); right visual field: WMD= - 172.60; 95% CI ( - 409.29, 64.09)] or the functional independence measure [WMD= - 7.90; 95% CI ( - 16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two ar- ticles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quali- ty, and most of the sample sizes were small, our analysis was likely affected by bias. CONCLUSION: DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.
基金Supported by National Natural Science Foundation of China(the Inflammatory Mechanism of Renal Damage in Hyperlipidemia Rat After Myocardial Ischemia and the Intevention of Activating Blood and Dissolving Stasis.No.81072924)
文摘OBJECTIVE:To evaluate the efficacy and safety of Xuefuzhuyu decoction for hyperlipidemia.METHODS:Randomized clinical trials on hyperlipidemia treated by Xuefuzhuyu decoction,either alone or with Western Medicine,were searched in electronic databases.Databases searched were:MEDLINE,Allied and Complementary Medicine Database,EMBASE,The Cochrane Library 2013(Issue4),China National Knowledge Infrastructure Database,Chinese Biomedical Literature Database,and Wanfang Database up to 2 May,2013.Study selection,data extraction,quality assessment,and data analysis were conducted according to the Cochranestandards.RESULTS:Six randomized clinical trials involving748 patients(373 patients in the treatment group,375 patients in the control group)were included in the analysis.The studies were of low methodological quality.Meta-analysis indicated that the effect of Xuefuzhuyu decoction on hyperlipidemia was better than that in the control group[n=748,OR=5.07,95%CI(3.40,7.58),P<0.01].Weighted mean differencesin total cholesterol,low-densitylipoprotein cholesterol,triglycerides,and high-density lipoprotein cholesterol were﹣0.79,﹣0.74,﹣0.44,0.16,respectively,and Meta-analysis revealed that the treatment group was better than the control group with 95%CI(﹣1.21,﹣0.36),(﹣0.94,﹣0.55),(﹣0.77,﹣0.11),(0.04,0.27),respectively(all P<0.05).Some adverse events in evaluated studies wererecorded.CONCLUSION:Xuefuzhuyu decoction may be effective for treating hyperlipidemia.The studies we analyzed were of low methodological quality,which indicates that the above findings should be considered cautiously.Therefore,more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Xuefuzhuyu decoction in hyperlipidemia.
基金This research is supported by the National Natural Science Foundation of China under Grant No. 10971012.
文摘Maximum likelihood recursions were used by Wu (1985) to estimate extreme quantiles of a quantal response curve. For certain choices of initial designs, Wu's method performs well. In many fields of application, there often exist some different initial designs which are known as the up-and- down designs. Based on the existing data set from such a design, the authors propose three sequential empirical Bayesian designs by quickly and efficiently exploiting the information in the testing data and known knowledge. The improvement obtained by using the new procedures for the estimation of extreme quantiles is substantial.