Jinhui Tian

Intravesical Bacillus Calmette‐Guérin versus epirubicin for Ta and T1 bladder cancer

BACKGROUNDnBladder cancer accounts for approximately 4.4% of adult malignancies, and approximately 80% of bladder cancer presents initially as transitional cell carcinoma that is confined to the urothelium (stage Ta) or lamina propria (stage T1). Intravesical administration of Bacillus Calmette-Guérin (BCG) and epirubicin (EPI) has been proven to reduce tumour recurrence and prevent or delay progression to muscle invasion and metastases. However, comparison of the effectiveness and safety of intravesical BCG and EPI in bladder cancer has yet to be explored.nnnOBJECTIVESnTo compare the effectiveness and safety of BCG with EPI in the treatment of Ta and T1 bladder cancer.nnnSEARCH STRATEGYnA comprehensive search of MEDLINE (1966 to Aprilxa02010), EMBASE (1980 to Aprilxa02010), Health Services Technology, Administration, and Research (HealthSTAR), the Cochrane Central Register of Controlled Trials (CENTRAL), CancerLit, and Database of Abstracts of Reviews of Effectiveness (DARE), was performed, and handsearching of relevant journals was undertaken.nnnSELECTION CRITERIAnAll randomised or quasi-randomised trials (in which allocation was obtained by alternation - e.g., alternate medical records, date of birth, or other predictable methods) in patients with Ta or T1 bladder cancer that compared intravesical BCG with EPI were included. No language restrictions were applied.nnnDATA COLLECTION AND ANALYSISnTrial eligibility, methodological quality and data extraction were assessed independently by two reviewers. We compared dichotomous outcomes (frequency of tumour recurrence, progressive disease by stage, mortality, distant metastases, local and systemic adverse effects, treatment delayed or stopped due to adverse effects) using risk ratios (RR) with 95% confidence intervals (CI).nnnMAIN RESULTSnFive trials of 1111 participants were included in this review. For BCG, 549 patients were treated, and 562 with EPI. Of the evaluated patients, 35.5% (195/549) in the BCG group and 51.4% (289/562) in the EPI group had tumour recurrence (P < 0.05). For disease progression (BCG, 44/549; EPI, 58/562) and distant metastases (BCG, 23/487; EPI, 31/495), there were no significant differences (P = 0.19 and P = 0.29, respectively). Only two trials, including 769 patients, had sufficient data for us to analyze disease-specific (BCG, 22/383; EPI, 26/386) and overall mortality (BCG, 125/383; EPI, 147/386). Neither comparison was significant (P = 0.93 and P = 0.12, respectively). In four studies reporting toxicity, BCG was associated with significantly more drug-induced cystitis [BCG, 54.1% (232/429); EPI, 31.7% (140/441)] and haematuria [BCG, 30.8% (132/429); EPI, 16.1% (71/440)]. Similarly, in three studies reporting systemic toxicity, BCG had significantly higher toxicity than the EPI (34.8% (134/385) versus 1.3% (5/393), respectively). In a meta-analysis comparing treatment delayed or stopped (BCG, 40/431; EPI, 33/441), there was no significant difference between BCG and EPI treatments (P = 0.82).nnnAUTHORS CONCLUSIONSnThe data from the present meta-analysis indicate that intravesical BCG treatment is more efficacious than EPI in reducing tumour recurrence for Ta and T1 bladder cancer. However, BCG appears to be associated with a higher incidence of adverse effects, such as drug-induced cystitis, haematuria and systemic toxicity, than EPI. The overall quality of the evidence is rather low. Well-designed, high quality randomised controlled trials with good allocation concealment are required.

Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials

BACKGROUNDnWe carried out a meta-analysis to determine the effectiveness of breast conservation therapy (BCT) or mastectomy (MT) for stage I or stage II breast cancer.nnnMETHODSnA fully recursive literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, EMBASE and Chinese Biomedical Literature Database in any language. Randomized controlled trials (RCTs) were considered for inclusion. Analyses were carried out using RevMan software.nnnRESULTSnIn all, 18 RCTs including a total of 9388 patients were included. The meta-analysis showed that the overall survival in 3, 5, 10, 15 and 20 years and the locoregional recurrence rate in 3, 5, 15 and 20 years were not statistically significantly different between group BCT and group MT, but 10-year locoregional recurrence rate increased in group BCT. The sensitivity analysis indicated that both overall survival and locoregional recurrence rate were not statistically significant difference between group BCT and group MT. In the subgroup analysis, there was no significant difference in OS and locoregional recurrence rate between group BCT and group MT, but 20-year locoregional recurrence rate was statistically significantly higher in group BCT than group MT for women with tumors 2 cm or smaller.nnnCONCLUSIONnBCT was better choice than MT for women with stage I or stage II breast cancer.

Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta-analysis

The objective of the present meta‐analysis was to estimate the magnitude of survival and recurrence free benefits from different lymphadenectomy in patients with resectable gastric cancer.

Systematic review and meta‐analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer

The extent of lymphadenectomy in the treatment of gastric cancer has been debated for more than two decades. This meta‐analysis sought to evaluate the effectiveness and safety of extended lymphadenectomy in patients with gastric cancer.

Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis

Background and objectiveIt is unclear whether the preoperative administration of oral carbohydrates (CHO) is safe and effective, and therefore we herein evaluated the efficacy and adverse events associated with CHO for elective surgery.MethodsComprehensive searches were conducted to identify randomized controlled trials (RCTs), which evaluated preoperative CHO for elective surgery. Two reviewers independently selected the trials, extracted data, and assessed the methodological qualities and evidence levels. The data were analyzed by the RevMan 5.0 software program.ResultCHO increased the insulin and glucose levels on the first day after surgery higher than those in overnight fasting group (fifteen RCTs) and i.v. glucose infusion group (three RCTs). The pooled results of thirteen RCTs showed greater declines in the insulin level at the induction of anesthesia and a smaller increase in the glucose level at the end of surgery, and fewer decreases in the postoperative insulin sensitivity index in the CHO group were observed as compared to the placebo group. No aspiration was observed in any of the included studies.ConclusionCHO appears to be safe, and may attenuate postoperative insulin resistance as compared to placebo. However, the quality of most of the published trials has been poor, and the evidence levels for most outcomes were low, so rigorous and larger RCTs are needed in the future.

Effects of yoga on psychologic function and quality of life in women with breast cancer: a meta-analysis of randomized controlled trials.

OBJECTIVEnThe aim of this meta-analysis was to evaluate the effects of yoga on psychologic function and quality of life (QoL) in women with breast cancer.nnnDESIGNnA systematic search of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database, and the Chinese Digital Journals Full-text Database was carried out. Randomized control trials (RCTs) examining the effects of yoga, versus a control group receiving no intervention, on psychologic functioning and QoL in women with breast cancer were included. Methodological quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1, and data were analyzed using the Cochrane Collaborations Review Manager 5.1.nnnRESULTSnSix (6) studies involving 382 patients were included. The meta-analysis showed that yoga can improve QoL for women with breast cancer. A statistically significant effect favoring yoga for the outcome of QoL was found (standard mean difference=0.27, 95% confidence interval [0.02, 0.52], p=0.03). Although the effects of yoga on psychologic function outcomes--such as anxiety, depression, distress and sleep--were in the expected direction, these effects were not statistically significant (p>0.05). Fatigue showed no significant difference (p>0.05).nnnCONCLUSIONSnThe present data provided little indication of how effective yoga might be when they were applied by women with breast cancer except for mildly effective in QOL improvement. The findings were based on a small body of evidence in which methodological quality was not high. Further well-designed RCTs with large sample size are needed to clarify the utility of yoga practice for this population.

The effects of laparoscopic vs. open gastric bypass for morbid obesity: a systematic review and meta-analysis of randomized controlled trials.

The aim of this meta‐analysis was to assess the effects of laparoscopic vs. open gastric bypass for morbid obesity. A systematic review of the literature was undertaken to assess randomized controlled trials on laparoscopic and open gastric bypass for morbid obesity. Six randomized controlled trials involving a total of 422 patients were included. There were 214 patients in the laparoscopic group and 208 patients in the open group separately. Compared with open surgery, laparoscopic surgery for morbid obesity could significantly shorten hospital stays (WMDu2003=u2003−1.11u2003d, 95% confidence interval [CI][−1.65, −0.56]). However, laparoscopic surgery for morbid obesity showed higher re‐operation (RRu2003=u20034.82, 95% CI [1.29, 17.98]) and longer surgical time (WMDu2003=u200328.00u2003min, 95% CI [7.84, 48.16]). There were no statistical differences in complication (RRu2003=u20030.84, 95% CI [0.64, 1.10]) and weight loss (WMDu2003=u20031.00u2003kgu2003m−2, 95% CI [−0.79, 2.79]). The effects of laparoscopic and open gastric bypass for morbid obesity were basically the same except that laparoscopic had a shorter hospital stay and open surgery had a rate of fewer re‐operations and shorter surgical time. Further high‐quality, long follow‐up period randomized controlled trials should be carried out to provide more reliable evidence.

Safety and efficacy of a new parenteral lipid emulsion (Smof) for surgical patients: a systematic review and meta-analysis of randomized controlled trials

To assess the comparative safety and efficacy of a new parenteral lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid20%) for postoperative patients, a meta-analysis of randomized controlled trials (RCTs) was conducted. Six RCTs with a total of 306 patients were included in the analysis. The overall quality of evidence for each outcome was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) software. Compared with a soybean-based (Lipoven20%) and a soybean- and olive oil-based (ClinOleic20%) lipid emulsion, SMOFlipid20% was associated with lower levels of hepatic enzymes, suggesting less toxicity. Changes in low-density lipoprotein triglyceride and C-reactive protein levels were also lower with SMOFlipid20% compared with Lipoven20%. Differences between SMOFlipid20% and a lipid emulsion containing medium- and long-chain triglycerides (MCT/LCT20%) were not statistically significant. For all trials, there were no significant differences in adverse events and length of hospital stay. The quality of evidence from the RCTs evaluating SMOF20% versus Lipoven20% was moderate, while most of the evidence from RCTs of SMOF20% versus ClinOleic20% and MCT/LCT20% lipid emulsions was low.

Quality and transparency of overviews of systematic reviews

Objective: To evaluate the reporting and methodological quality of overviews of systematic reviews.

Overview of Methodological Quality of Systematic Reviews about Gastric Cancer Risk and Protective Factors

BACKGROUND AND OBJECTIVEnA comprehensive overall review of gastric cancer (GC) risk and protective factors is a high priority, so we conducted the present study.nnnMETHODSnSystematic searches in common medical electronic databases along with reference tracking were conducted to include all kinds of systematic reviews (SRs) about GC risk and protective factors. Two authors independently selected studies, extracted data, and evaluated the methodological qualities and the quality of evidence using R-AMSTAR and GRADE approaches.nnnRESULTSnBeta- carotene below 20 mg/day, fruit, vegetables, non-fermented soy-foods, whole-grain, and dairy product were GC protective factors, while beta-carotene 20 mg/day or above, pickled vegetables, fermented soy-foods, processed meat 30 g/d or above, or salty foods, exposure to alcohol or smoking, occupational exposure to Pb, overweight and obesity, helicobacter pylori infection were GC risk factors. So we suggested screening and treating H. pylori infection, limiting the amount of food containing risk factors (processed meat consumption, beta-carotene, pickled vegetables, fermented soy-foods, salty foods, alcohol), stopping smoking, avoiding excessive weight gain, avoidance of Pb, and increasing the quantity of food containing protective components (fresh fruit and vegetables, non-fermented soy-foods, whole-grain, dairy products).nnnCONCLUSIONSnThe conclusions and recommendations of our study were limited by including SRs with poor methodological bases and low quality of evidence, so that more research applying checklists about assessing the methodological qualities and reporting are needed for the future.