Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo systematically review the correlation between the birth number and the risk of breast cancer of Chinese female. MethodsWe electronically searched databases including the CNKI, WanFang Data and VIP databases from inception to September 1st 2015, to collect case-control studies about the correlation between the number of births and the risk of breast cancer among Chinese female. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Then meta-analysis was performed by using Stata software. ResultsA total of 14 case-control studies involving 3 428 patients and 3 906 controls were included. The results of meta-analysis showed that:the females who had term birth had significant lower incidence of breast cancer than those without childbirth history (OR=0.429, 95%CI 0.322 to 0.571). Subgroup analysis based on the number of term birth showed that:Compared with the female without childbirth history, those who had term birth of one time (OR=0.464, 95%CI 0.321 to 0.670), two times (OR=0.394, 95%CI 0.269 to 0.576) and≥3 times (OR=0.340, 95%CI 0.232 to 0.499) had significant lower incidence of breast cancer. ConclusionTerm birth is a protective factor for breast cancer of Chinese female, and more times of term birth will decrease the risk of breast cancer.
An increasing number of health system researchers use systematic review to synthesize research evidence to inform the development of health policies at global and national levels. However, there are methodological challenges facing the health system research in undertaking systematic reviews of health policy literatures. This paper explored the constraints and promise of systematic review as a tool for evidence-based health system research in developing countries. It introduced the systematic review method and its evolution in health research over the past decades. The paper then discussed the definition of health system research, as system science, and contrasted its features/characteristics to those of medical research. It discussed and analyzed if the systematic review could be an effective tool for evidence-based health system research, particularly in developing countries. The paper concludes that the systematic review may be a very useful tool that can be used for evidence-based health system research to address specific policy issues; however, research on some health system/policy issues may not be appropriate to use the systematic review at all.
Objective To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth. Methods We searched the Cochrane Oral Health Group Trials Register （to 4 August, 2004）, the Cochrane Central Register of Controlled Trials （CENTRAL）, PubMed （1966 to 4 August, 2004）, EMBASE （1974 to 4 August, 2004）. There was no restriction to publication of language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. All randomised or controlled clinical trials （KCTs/CCTs） comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment （retention） were included. Assessment of relevance ,validity and data extraction were conducted in duplicate by three independent reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. The quality assessments of the trials were carried out. Results Only three trials were identified to fulfill the selection criteria. Two complete RCTs assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data and intended to publish in the near future. Although both complete trials met the inclusion criteria, different outcome measures were prevented us from pooling data. Conclusions No evidence has been found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliableevidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.
ObjectiveTo systematically review the prevalence of cognitive impairment in patients with sarcopenia. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect studies related to the objectives from inception to December 10, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 14.0 software. ResultsA total of 27 studies were included. The overall prevalence rate of cognitive impairment in sarcopenia was 36.1% (95%CI 29.4% to 42.8%). Subgroup analysis showed that the prevalence in Europe was higher than that in other areas. The prevalence of nursing home residents was highest. ConclusionCurrent evidence shows that the prevalence of cognitive impairment in patients with sarcopenia is high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo systematically review the efficacy of palliative care in heart failure patients. MethodsPubMed, EMbase, CINAHL, The Cochrane Library, VIP, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of palliative care in heart failure patients from inception to September 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 RCTs involving 912 patients were included. The results of meta-analysis showed that palliative care could improve the quality of life of patients with heart failure (KCCQ & McGill QoL: SMD=0.85, 95%CI 0.13 to 1.58, P=0.02; MLHFQ: SMD=−1.32, 95%CI −2.10 to −0.54, P=0.000 9), reduce the level of depression (SMD=−0.58, 95%CI −0.87 to −0.28, P=0.000 1) and anxiety (SMD=−0.51, 95%CI −0.89 to −0.13, P=0.008), improve the adverse symptoms (SMD=−1.46, 95%CI −2.67 to −0.24, P=0.02), reduce the readmission rate (RR=0.64, 95%CI 0.42 to 0.98, P=0.04) and the per hospitalization time (MD=−0.94, 95%CI −1.28 to −0.60, P<0.000 01). However, it had no obvious effect on the mortality of patients (RR=1.00, 95%CI 0.63 to 1.57, P=0.99). ConclusionCurrent evidence shows that palliative care can improve the quality of life, emotional state and adverse symptoms of patients with heart failure, and reduce the length of hospital stay and readmission rate. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the efficacy and safety of the midvastus approach in total knee arthroplasty. Methods We searched The Cochrane Library, EMBASE, PubMed, and CBM to identify clinical controlled trials comparing the midvastus approach with the medial parapatellar approach in total knee arthroplasty. The quality of the included studies was critically assessed and the data analyses were performed by the Cochrane Collaboration’s RevMan 5.0. Results Eight studies were included, involving 4 randomized controlled trials (RCTs), 2 quasi-RCTs and 2 non-RCTs. Meta-analyses showed that rate of lateral retinacular release (RR=0.75, 95%CI 0.52 to 1.08, P=0.12), range of motion at 6 week postoperation (MD=2.65, 95%CI –1.20 to 6.50, P=0.18), operation time (MD=1.04, 95%CI –3.50 to 5.58), and adverse events postoperation (OR=1.04, 95%CI 0.43 to 2.52, P=0.94) were similar between the midvastus approach and the medial parapatellar approach in total knee arthroplasty. One study showed that there was no significant difference in blood loss interoperation between the two approaches, and two showed that the midvastus approach had less blood loss interoperation than the medial parapatellar approach. There was no statistical analysis about the blood loss interoperation in one study. For the time of straight leg raise, there was no significant difference in two studies. But in one study, it showed that patients needed longer time for straight leg raise. Conclusion Based on the current evidence, the midvastus approach for total knee arthroplasty is as safe and effective as the medial parapatellar approach, but blood loss interoperation and time of straight leg raise are not decided. Due to the poor quality of the included trials, more high-quality RCTs are needed.
ObjectiveTo systematically review the association between inhaled corticosteroids (ICS) and the risk of lung cancer in patients with chronic obstructive pulmonary disease (COPD). MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies on the risk of lung cancer in COPD patients using ICS from inception to August 15, 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 cohort studies involving 1 184 238 patients were included. The results of meta-analysis showed that ICS use decreased risk of lung cancer in COPD patients (HR=0.68, 95%CI 0.62 to 0.75, P<0.01). The dose of ICS was an influencing factor for the risk of lung cancer in COPD patients and a large dose of ICS could significantly reduce the risk. ConclusionCurrent evidence shows that the use of ICS can reduce the risk of lung cancer in patients with COPD, especially in high-dose patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.