Objective To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD). Methods Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software. Results A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
Objective To evaluate the effectiveness and safety of kushenin for chronic hepatitis B. Methods We searched The Cochrane Hepato-Bil iary Group Controlled Trials Register (March, 2006), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2006), MEDLINE (1966 to present), EMBASE (1966 to present), OVID (1965 to present), the Chinese Biomedical Database (CBM) (1978 to 2006) and CNKI. Qual ity assessment and data extraction were conducted by two reviewers independently, and disagreement, if any, was resolved by discussion. Meta-analyses were performed for homogeneous studies. Results A total of 56 studies involving 5156 patients met the inclusion criteria. These included 3 randomized controlled trials (RCTs), 7 quasi-RCTs, and 46 other studies that did not report randomization methods. None of the trials enforced allocation concealment and only one trial performed blinding.We conducted subgroup analyses based on the outcome measures and interventions. Compared with interferon,the HBeAg seroconversion rate at 12 months after treatment was lower in patients treated with kushenin (RR=0.72, 95%CI 0.58 to 0.90); compared with lamivudine, a lower HBV DNA seroconversion rate after 12 and 24 weeks of treatment was associated with kushenin (RR=0.48, 95%CI 0.33 to 0.70; RR=0.40, 95%CI 0.26 to 0.63). No significant differences were noted between the kushenin group and the control group for all the other outcome measures. Conclusion Kushenin might be effective in normal izing ALT levels, clearing HBV DNA, achieving virus seroconversion and improving hepatic fibrosis, without any serious adverse effects. However, because the overall effects cannot be pooled for analysis, more evidence is needed to support this finding.