Objective To evaluate the effectiveness of exercise and rehabilitation program in improving shoulder function and quality of life for breast cancer patients after mastectomy. Method We searched the Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews, MEDLINE (1966 to 2008), EMbase (1989 to 2007), CINAHL (Cumulative Index to Nursing and Allied Health literature), CBMdisc (1978 to 2008), and CNKI (1994 to 2008) to collect randomized controlled trials (RCTs). The quality of RCTs was critically appraised and data were extracted by 3 reviewers independently. Meta-analyses were conducted for the eligible RCTs. Result Nineteen RCTs were included. Stepwise upper extremity exercise and body exercise were reported in the rehabilitation program. Nine studies indicated that the rehabilitation program significantly improved the shoulder function of breast cancer patients after mastectomy. Four studies demonstrated its effect on cardiopulmonary function and body endurance. Six RCTs proved the effect of rehabilitation program on health-related quality of life and fatigue alleviation. Conclusion Rehabilitation program consisting of stepwise upper extremity exercise and full-body exercise is effective in improving the shoulder function and enhancing the quality of life of breast cancer patients after mastectomy. It also has a positive effect in reducing fatigue for those undergoing chemotherapy or radiotherapy.
Objective To systematically evaluate the influence of PICC (peripherally inserted central catheter) ultrasound guidance on success rates and incidences of complications of elbow catheterization. Methods The Cochrane Library (Issue 3, 2012), Library of JBI evidence-based nursing center, MEDLINE, EMbase, CBM, VIP, CNKI and WanFang Data were searched for relevant studies to influence on success rates of puncture and catheterization and complications from upper arm placement of PICC ultrasound guidance as well as conventional PICC placement from inception to March, 2012. The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated. Meta-analysis was conducted using RevMan 5.1, or only descriptive analysis was conducted instead. Results Eleven randomized controlled trials, five clinical controlled trials and four cohort studies were included, involving 4 052 patients. The results of meta-analysis showed that, upper arm placement of PICC ultrasound guidance combined with modified Seldinger technique was associated with significantly higher one-time success rates of puncture and catheterization than conventional PICC placement below the elbow, with significant differences (OR=4.71, 95%CI 1.97 to 11.28, P=0.000 5; OR=8.63, 95%CI 1.92 to 38.82, P=0.005). Conventional elbow catheterization had a significantly higher incidence of phlebitis than catheterization on the elbow that under the guidance of PICC ultrasound and modified Seldinger technique (OR=0.13, 95%CI 0.08 to 0.21, Plt;0.000 01). Conclusion Elbow catheterization under the guidance of PICC ultrasound combined with modified Seldinger technique has an obvious advantage in improving the success rates of puncture and catheterization and reducing the incidence of complications, compared with conventional elbow catheterization.
ObjectivesTo systematically review the efficacy and safety of the first generation EGFR-TKIs versus pemetrexed as second-line treatment for advanced non-small cell lung cancer (NSCLC).MethodsDatabases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM were searched to collect randomized controlled trials (RCTs) about the first generation EGFR-TKIs versus pemetrexed as second-line treatment for advanced NSCLC from inception to June 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 20 RCTs involving 2 242 patients were finally included. The results of meta-analysis showed that: the rate of progression free survival (PFS) in the EGFR-TKI group was superior to the pemetrexed group (HR=0.78, 95%CI 0.58 to 0.99, P<0.000 1) with significant difference. However, there was no significant difference between two groups in complete remission rate (RR=1.81, 95%CI 0.65 to 5.07,P=0.26), partial remission rate (RR=0.93, 95%CI 0.78 to 1.11, P=0.44), stable disease rate (RR=0.92, 95%CI 0.82 to 1.03, P=0.16), progression disease rate (RR=1.09, 95%CI 0.99 to 1.20, P=0.09), overall response rate (RR=0.97, 95%CI 0.72 to 1.30, P=0.84), disease control rate (RR=0.93, 95%CI 0.87 to 1.01, P=0.07) and overall survival rate (HR=0.89, 95%CI 0.74 to 1.04, P<0.572). The incidences of skin rash (RR=12.43, 95%CI 3.98 to 38.84,P<0.01) and diarrhea (RR=3.94, 95%CI 2.32 to 6.70,P<0.01) were significantly higher in the EGFR-TKI group, but the incidences of leukopenia (RR=0.19, 95%CI 0.09 to 0.41,P<0.01 ), anemia (RR=0.40, 95%CI 0.17 to 0.92,P=0.03), thrombocytopenia (RR=0.37, 95%CI 0.14 to 0.97, P=0.04), nausea and vomiting (RR=0.50, 95%CI 0.28 to 0.87, P=0.01), constipation (RR=0.30, 95%CI 0.14 to 0.64, P=0.002) were significant lower in the EGFR-TKI group than that of the pemetrexed group.ConclusionGefitinib shows some superiority to pemetrexed in second-line treatment for NSCLC, and it can be used as the second-line drug for advanced NSCLC. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.