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.
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.
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.
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.
ObjectiveTo evaluate the effectiveness of levetiracetam (LEV) added on to usual care, in treating children refractory partial seizure epilepsy.MethodsWe searched the Cochrane library, EMBASE and PubMed between January 1998-January 2017, We systematically searched CNKI database and Wanfang data, Chinese biology medline and the manual retrieval related magazines.RevMan 5.3 statistical software for Meta analysis.ResultsAccording to the enrollment criteria, fourtrials were included involving 498 participants according to the intent-to-treat, 268 for LEV, and 230 for placebo groups.We assessed the following outcomes: 50% or greater seizure reduction, seizure freedom, adverse effects, proportion of dropouts and quality of life. There was no evidence of statistical heterogeneity between trials.We assessed outcomes by using a meta-analysis to calculate odds ratio (OR) with 95% confidence intervals (95% CI). For the 50% or greater reduction in focal seizure frequency outcome, the OR was significantly in favour of LEV [OR=2.94, 95% CI(1.99, 4.34)].Participants were significantly more likely in LEV groups than placebo groups to get seizure free[OR=5.31, 95% CI(2.49, 11.32)]. There was no significance between LEV groups and placebo groupsin the rate of Treatment withdrawal[OR=0.76, 95% CI(1.32, 1.82)]. Somnolence[OR=2.57, 95% CI(1.36, 4.86)]and changes in behaviour [OR=2.54, 95% CI(1.56, 4.14)] were significantly associated with LEV. Other adverse effects were not significantly associated with LEV in children.ConclusionThe existing evidence suggests that LEV add in treatment of children refractory epilepsy have definite curative effect, LEV long-term treatment effect is stable, good security, retention rate is higher, can be used in clinical further promotion.
Nasopharyngeal carcinoma (NPC) is rather common in Southeast Asia and Southern China. The standard treatment for NPC is intensity-modulated radiotherapy (IMRT). A large number of the NPC survivors benefit from the IMRT, while some suffer from the late toxicities which can be life-threatening or significantly erode the patients’ quality of life and functional status, especially in the locally advanced NPC. Nowadays the late radiotherapy-related toxicities have been the most important concern for the radiotherapists and patients, who look forward to the better long-term tumor local control and overall survival. Therefore, we carried out a review about the late radiotherapy-related toxicities of the vital organs at risk after IMRT for NPC patients.
The primary principle of evidence-based medicine is that the best clinical decision-making is derived from clinical problems with combination of patient’s preferences with clinical experience and the best evidence. Evidence-based medicine by its nature, is a specific application on the evaluation of medical hypothesis. It also emphasize the importance of humanism in clinical practice. Our study explored the scientific and humanistic characteristics of evidence-based medicine from the prospective of philosophy, so as to facilitate the extensive application of evidence based practice paradigm in other fields.
The majority of problems are comprehensive and complex in the modern society, which leads to the increasing contradictions in the specialization and comprehensiveness of knowledge. Interdisciplinary cooperation is one approach to improve the effectiveness and transferability. The primary principle of evidence-based medicine is its scientific and transparent procedures. It combines the patient’s preferences with clinical experience and the best evidence. Meanwhile, evidence-based medicine is focused on how to transfer research outcomes into practice and the re-evaluation of the result of practice in order to striving for perfections. Combining this practical pattern of evidence-based medicine with other disciplines can have a significant improvement on scientific methods and thinking patterns, and become an effective way to improve the quality of scientific research and promote the transformation.
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.