Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
Objective To explore the influencing factors of inhalation medication compliance in Chinese asthma patients, and to provide evidence for improving the compliance of patients with inhalation therapy. Methods PubMed, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for literature on factors influencing inhalation medication compliance in Chinese asthma patients from the establishment of databases to December 2021. Meta-analysis was performed using RevMan 5.2 software. Results A total of 16 studies were included, with a sample size of 2 600 cases, 1 084 cases of good compliance with inhalation administration, 1 516 cases of poor compliance with inhalation administration, and good compliance with inhalation administration accounted for 41.69%. The literature quality evaluation scores were all ≥4 points, all of which were of medium quality and above. Meta-analysis showed that the factors affecting inhalation compliance of asthma patients included age [odds ratio (OR)=0.54, 95% confidence interval (CI) (0.32, 0.91), P=0.02], educational level [OR=0.57, 95%CI (0.36, 0.90), P=0.02], doctor-patient relationship [OR=0.42, 95%CI (0.19, 0.93), P=0.03], disease severity [OR=0.25, 95%CI (0.11, 0.58), P=0.001], degree of mastery of asthma knowledge [OR=2.51, 95%CI (1.11, 5.65), P=0.03], degree of mastery of inhalation technique [OR=8.66, 95%CI (3.20, 23.40), P<0.0001], adverse drug reaction [OR=0.23, 95%CI (0.13, 0.41), P<0.00001]. Conclusion The compliance of inhaled dosing in Chinese asthma patients needs to be improved urgently. Age, education level, doctor-patient relationship, disease severity, mastery of asthma knowledge, mastery of inhalation technology, and adverse drug reactions are the important influencing factors of inhaled medication compliance.
Objective To systematically evaluate the efficacy and safety of iris-registration in wavefront-guided LASIK (IR+WG LASIK) versus conventional LASIK for correction of myopia accompanied with astigmatism. Methods Such databases as PubMed, EMbase, The Cochrane library (Issue 2, 2012), CBM, CNKI, VIP, and WangFang Data were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about IR+WG LASIK versus conventional LASIK for correction of myopia accompanied with astigmatism. The retrieval time was from inception to February 2012, and the language was in both Chinese and English. Two reviewers independently screened the literature, extracted the data and assessed the quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies involving 3 903 eyes were included. The results of meta-analysis showed that, compared with the conventional LASIK group, the IR+WG LASIK group had a higher ratio in patients with postoperative uncorrected visual acuity no less than 1.0 (RR=1.03, 95%CI 1.01 to 1.05, P=0.002), as well as in patients with best-corrected visual acuity gained over 1 line (RR=1.75, 95%CI 1.49 to 2.16, Plt;0.000 01); it was smaller in the postoperative high order aberration RMS (WMD=−0.16, 95%CI −0.21 to −0.11, Plt;0.000 01), coma-like RMS (WMD=−0.05, 95%CI −0.11 to 0.00, P=0.07), spherical-like RMS (WMD=−0.15, 95%CI −0.23 to −0.07, P=0.000 2), and residual astigmatism (WMD=0.14, 95%CI 0.10 to 0.18, Plt;0.000 01); moreover, it was lower in the incidence of postoperative glare (RR=0.27, 95%CI 0.15 to 0.50, Plt;0.000 1), and it was higher in the subjective satisfaction of patients (RR=1.08, 95%CI 1.04 to 1.13, P=0.000 3). Conclusion Compared with conventional LASIK, IR+WG LASIK can more effectively reduce astigmatism, postoperative high order aberration RMS and spherical-like RMS. It can also get visual function including uncorrected visual acuity and best-corrected visual acuity, consequently increase patient’s satisfaction. But further studies are still required for its long-term effect.
Objectives To assess the effectiveness and safety of any form of therapy compared with glucocorticoid for the treatment of oral lichen planus. Method The Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMbase (1966-2007), CBM (1978-2005), CNKI (1989-2007), and VIP (1989-2007) were searched for randomized controlled trials or quasi-randomized controlled trials. Quality assessment and data extraction were performed by two reviewers independently. Meta-analysis was performed for the results of homogeneous studies by RevMan 4.2.9 software.Results Finally, 14 studies involving 9 therapy methods were included. Four studies were concerned with cyclosporine.We performed a meta-analysis of 3 studies. The results showed there was no statistically significant difference in the curative effect of cyclosporine and the steroid with RR 2.94 and 95%CI 1.03 to 9.97. The results showed that the curative effect of total glucosides of paenia plus topical application of triamcinolone acetonide (RR0.21, 95%CI 0.10 to 0.44),tacrolimu (RR 0.18 and 95%CI 0.05 to 0.72), and pimecrolimus (WMD –0.50 and 95%CI –0.85 to –0.15) were better than glucocorticoid. There was a statistically significant difference between fluocinolone acetonide and retinoic acid in terms of curative effect with RR 3.20 and 95%CI 1.03 to 9.97. The curative effect of mesalazine (RR 0.42 and 95%CI 0.05 to 3.54), Mycostatin paste plus desamethasone paste (RR 1.23 and 95%CI 0.93 to 1.61), triamcinolone acetonide plus vitamin B12 ( RR 0.50 and 95%CI 0.05 to 4.94), chitin (RR 1.30 and 95%CI 0.86 to 1.96) was similar with that of glucocorticoid.Conclusion Statistical analysis showed the curative effect of total glucosides of paenia combined with triamcinoloneacetonide is better than glucocorticoid. Due to the mistakes of theincluded studies designs,,further high-quality,largescale randomized controlled trials are required to confirm the effectiveness and safety of this therapy method.
The social needs, disciplinary development and humanistic reflection has promoted the emergence and development of evidence-based medicine. Moreover, evidence-based medicine-problems oriented research, evidence based decision, transferring results to practice and outcome evaluation-continues to meet society demands, promote the development of discipline and show humanist concern. The application of evidence-based medicine has gradually extended from the field of clinical medicine to the public health, society, management, economy, policy research and education in the process of solving various problems. The high quality evidence has also been important to decision-making in these fields. Our study explored the emergence and development of evidence-based medicine from the perspective of social needs, disciplinary development and humanistic reflection for the first time.
Objective To analyze the causal relationship between cerebrospinal fluid (CSF) metabolites and tic disorder (TD) based on two-sample Mendelian randomization (MR). Methods CSF metabolites data from humans were downloaded from genome-wide association study databases, and CSF metabolites were selected as exposure factors. single nucleotide polymorphisms (SNPs) strongly associated with the exposure factors and independent of each other were selected as instrumental variables. The TD dataset from the Finngen database was downloaded, including 365 cases of TD and 411 816 controls. Analysis was conducted using inverse variance weighting, MR-Egger, weighted median, weighted mode, and simple mode. Sensitivity analysis was conducted using leave-one-out, and multiple-effects testing was conducted using MR-Egger and MR-PRESSO. Heterogeneity was detected using Cochran’s Q. Results A total of 9 CSF metabolites were found to have a causal relationship with the occurrence and development of TD (P<0.05), with a total of 394 SNPs included in the analysis. Inverse variance weighting results showed that N-acetylneuraminic acid [odds ratio (OR)=2.715, 95% confidence interval (CI) (1.102, 6.961), P=0.030], γ-glutamylglutamine [OR=1.402, 95%CI (1.053, 1.868), P=0.021], lysine [OR=2.816, 95%CI (1.084, 7.319), P=0.034] could increase the risk of TD. Cysteinylglycine disulfide [OR=0.437, 95%CI (0.216, 0.885), P=0.021], propionylcarnitine [OR=0.762, 95%CI (0.616, 0.941), P=0.012], pantothenate [OR=0.706, 95%CI (0.523, 0.952), P=0.023], gulareic acid [OR=0.758, 95%CI (0.579, 0.992), P=0.044], and cysteine-glycine [OR=0.799, 95%CI (0.684, 0.934), P=0.005] could reduce the risk of TD. The results of leave-one-out sensitivity analysis were stable, and no horizontal pleiotropy or heterogeneity was observed. Conclusions N-acetylneuraminic acid, γ-glutamylglutamine, and lysine can increase the risk of TD, but cysteinylglycine disulfide, propionylcarnitine, pantothenate, gulagic acid and cysteine-glycine can reduce the risk of TD. However, the mechanism of their effects on TD still needs to be further explored.
Objective To systematically evaluate the effectiveness and safety of disodium cantharidinate and vitamin B6 injection plus chemotherapy compared with chemotherapy alone, in the treatment of non-small cell lung cancer (NSCLC). Methods The Cochrane Library (Issue 1, 2011), MEDLINE (1966 to November 2011), EMbase (1984 to November 2011), CBM (1978 to November 2011), CNKI (1995 to November 2011) and VIP (1989 to November 2011) were searched electronically, and the randomized controlled trials (RCTs) about disodium cantharidinate and vitamin B6 injection plus chemotherapy for NSCLC were included. The quality of the included studies was assessed and crosschecked by two reviewers independently, and meta-analyses were performed for homogeneous studies by using Cochrane Collaboration’s RevMan 5.1 software. Results Eight RCTs involving 539 patients met inclusion criteria were included in meta-analyses. The quality of all studies was in Grade B. The results of meta-analyses showed that disodium cantharidinate and vitamin B6 injection plus chemotherapy, compared with chemotherapy alone, could increase effective rate (RR=1.32, 95%CI 1.07 to 1.62) and clinical benefit rate (RR=1.24, 95%CI 1.12 to 1.37), improve quality of life (RR=2.23, 95%CI 1.55 to 3.19) and clinical symptoms (RR=1.55, 95%CI 1.24 to 1.95), increase body weight (RR=2.72, 95%CI 1.74 to 4.25), and decrease bone marrow suppression (leucocyte reduction rate) (RR=0.36, 95%CI 0.21 to 0.61). Conclusion The evidence available indicates that the treatment regimen of disodium cantharidinate and vitamin B6 injection plus chemotherapy is superior to chemotherapy alone in increasing effects and decreasing toxicity for the patients with NSCLC. More high-quality and multi-center RCTs with larger sample and longer follow-up are proposed.
Science is a system of knowledge that reflects the essential connections and laws of the objective world. Classification of disciplines is a subsystem of science, which involves the development of human cognition which evolved from the scientific category to the department of higher education, and then formation of a complex management system. Nowadays with the rapid development of science and technology which triggering numerous complex social problems, an increasing trend of scientific integration calls for multidisciplinary and interdisciplinary research and education. In the 1990s, evidence-based medicine was emerged in the self-doubting of medical science, and extended to other fields of medicine, health policy and social sciences, forming an interdisciplinary evidence-based science system. Evidence-based science is an embodiment of scientific integration, and also the carrier and mechanism of cross-disciplinary convergence. It attempts to break through barriers of disciplines and management, and promotes interdisciplinary research, during which it has encountered many difficulties due to limitations of traditional disciplines. Evidence-based science does not provide an intrusion or transformation of thinking paradigm into other disciplines, but rather an equal dialogue to promote broader discipline collaboration and a new round of self-improvement, so as to constantly explore novel methods and theories to solve emerging problems, achieve continuous improvement, and pursue excellence.