ObjectiveTo systematiclly review the correlation between physical activity and the risk of ovarian cancer. MethodsSuch databases as CBM, CNKI, WanFang Data, VIP, The Cochrane Library (Issue 10, 2013), PubMed, EMbase were searched from database establishment to October 2013 to collect prospective cohort studies about physical activities and the risk of ovarian cancer. Relevant magazines and references of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 8 cohort studies involving 580 581 subjects, of which there were 2 444 cases of patients with ovarian cancer. The results of meta-analysis showed that, women who participated in moderate level physical activities tended to have a lower incidence of ovarian cancer, compared with those who participated in low level physical activities (age-adjusted:RR=0.87, 95%CI 0.75 to 1.01, P=0.06; multivariate-adjusted:RR=0.97, 95%CI 0.83 to 1.14, P=0.71) but with no significant difference; while women who participated in high level physical activities tended to have a higher incidence of ovarian cancer with a significant difference found in the multivariate-adjusted results (age-adjusted:RR=1.19, 95%CI 0.91 to 1.56, P=0.21; multivariate-adjusted:RR=1.35, 95%CI 1.08 to 1.67, P=0.008). Along with the increase of sedentariness, the incidence of ovarian cancer rose, but with no significant difference. ConclusionCurrent evidence shows that, compared with low level physical activities, high level ones increase the risk of ovarian caner; while the effects of moderate level ones and sedentariness on the risk of ovarian caner still remain uncertain. However, more high-quality studies are required to verify the conclusion of this study because of the limited quantity of the included studies as well as many confounding factors.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic radical hysterectomy (LRH) for cervical cancer. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), CBM, CNKI, VIP, WanFang Data (from inception to October, 2013) through computer, and manually searched related journals. Randomized controlled trials (RCTs) on LRH versus abdominal radical hysterectomy (ARH) in the treatment of cervical cancer were identified according to the inclusion and exclusion criteria, data were extracted, and methodological quality of the included studies was accessed by two reviewer independently. Meta-analysis was then performed using RevMan 5.2 software. ResultsSeven RCTs involving 462 patients were finally included. The results of meta-analysis showed that: there were significant differences between LRH and ARH in the operation time, intraoperative bleeding, recovery time of gastrointestinal function, postoperative pain, postoperative hospital stay, and surgical site infection (MD=20.25, 95%CI 0.26 to 40.24, P=0.05; MD=-56.18, 95%CI-74.84 to-37.52, P < 0.000 01; SMD=-1.54, 95%CI-2.92 to-0.16, P=0.03; MD=-1.37, 95%CI-1.85 to-0.89, P < 0.000 01; MD=-2.32, 95%CI-3.57 to-1.06, P=0.000 3; RR=0.42, 95%CI 0.18 to 0.97, P=0.04). But there was no significant difference in the number of lymph node biopsy (MD=1.34, 95%CI-4.26 to 6.94, P=0.64) and some operative complications (lymphocyte: RR=1.19, 95%CI 0.54 to 2.63, P=0.66; DVT: RR=1.23, 95%CI 0.48 to 3.20, P=0.67; urinary retention: RR=0.85, 95%CI 0.41 to 1.75, P=0.66; cystotomy: RR=1.91, 95%CI 0.49 to 7.51, P=0.35). ConclusionCurrent evidence shows that although applying LRH costs longer time, and with high-level technology, its safety and short-term efficacy are superior to ARH. Due to the limited quantity and quality of the included studies, its long-term efficacy still needs to be further confirmed by conducting more high-quality, multi-centre RCTs with large sample size.
ObjectiveTo systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors (BOTs) on postoperative recurrence. MethodsWe searched PubMed, The Cochrane Library (Issue 11, 2015), EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsNineteen cohort studies were included. The scores of NOS scale showed that 10 studies were < 7 points, while the other 9 studies were≥7 points. The results of meta-analysis showed that: the recurrence rate of tumor (OR=1.75, 95%CI 1.05 to 2.91, P=0.03) in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations (conservative surgery: OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery: OR=4.38, 95% CI 0.85 to 22.68, P=0.08). The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group (MD=-6.88, 95% CI-8.15 to-5.61, P < 0.000 01), and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group (OR=3.99, 95% CI 2.54 to 6.26, P < 0.000 01). ConclusionCurrent evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.
ObjectiveTo evaluate the efficacy and safety of moistened versus dry misoprostol for mid-trimester pregnancy termination. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015), Web of Science, WanFang Data, CBM and CNKI were searched to collect randomized controlled trials (RCTs) about misoprostol for mid-trimester pregnancy termination from inception to Nov. 2015. 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. ResultsFive RCTs involving 742 patients were included. The results of meta-analysis showed that, compared with dry tablet, moistened tablet could reduce induction-abortion interval (MD=-0.41, 95% CI-0.75 to-0.08, P=0.02), while there were no significant differences between two groups in completely abortion within 24 hours or 48 hours, nausea, vomiting, chill, fever, diarrhea, retained placenta, blood loss and total dose of misoprostol. ConclusionCurrent evidence shows that, compared with the dry misoprostol, the moistened misoprostol for treating mid-trimester pregnancy termination could reduce the induction-abortion interval without increasing adverse reactions. Due to the limited quality of quantity of included studies, more high-quality and large-scale RCTs are needed to prove the above conclusion.