Objective To evaluate the effectiveness and safety of doxepin in the treatment of primary insomnia. Methods We searched The Cochrane Library (Issue 4, 2009), PubMed (1966 to December 2009), EMbase (1974 to December 2009), ISI (1961 to December 2009), CNKI (1979 to December 2009), VIP (1989 to December 2008), CBM (1978 to December 2009), and WANFANG Data (1998 to December 2009). We also searched the correlated grey literature and conference literature for complement. Data were extracted, methodologically evaluated, and cross-checked by two reviewers independently. RevMan 5.0 was used for statistical analysis. Results One randomized controlled trial and three cross trials involving 171 patients were included. The results of meta-analyses showed that total sleep time (TST), wake time during sleep (WTDS), wake time after sleep (WTAS), and sleep efficiency (SE) were improved by low and medium dosage of doxepin (1-25 mg) with statistically significant difference compared with placebo. On the contrary, most indicators of sleep quality had no statistically significant difference between high dose doxepin (50 mg) and placebo. While the sleeping structural indicators of rapid eye movement sleep (REM), rapid-eyemovement latency (REM-L), and sleep stage II (St.II) were changed by high and medium dosage of doxepin (25-50 mg) with statistically significant difference. Conclusions Low and medium dosage of doxepin (1-25 mg) is effective in improvement of the sleep quality in patients with primary insomnia, but it is necessary to concern the side effects and the effects on sleep structure when treating primary insomnia with medium dosage of doxepin (25 mg). High dosage of doxepin (50 mg) is not recommended to treat primary insomnia. However, this conclusion still needs clinical trials to be further validated.
Objective To evaluate the adverse events following immunization (AEFI) of meningococcal vaccines, so as to provide references for the appraisal and treatment of AEFI. Methods The Chinese Bio-medicine Database (1978 to April, 2010), China Journal Full-text Database (1994 to April, 2010), VIP Database (1989 to April, 2010) and WangFang database (1988 to April, 2010) were fully searched, and the references listed in original studies were searched manually as well. Then two reviewers independently screened studies and abstracted relevant data.Results A total of 52 articles involving 61 cases were included. Among the AEFI cases, 72.13% were hypersensitive response, including henoch-schonlein purpura (accompanied with or without nephritis), anaphylactic shock, allergic eruption, angioedema, local allergic reaction and so on. Conclusion The results of this study show that meningococcal vaccines may result in AEFI. However, most AEFI are temporary and can be cured after treatment in time. In general, meningococcal vaccine is safe, but monitoring and treatment for AEFI are necessary.