Qianrui Li

Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective Acetyl-L-carnitine (ALC), a constructive molecule in fatty acid metabolism, is an agent potentially effective for treating peripheral neuropathic pain (PNP). Its effect, however, remains uncertain. We aimed to access the efficacy and safety of ALC for the treatment of patients with PNP. Methods We searched MEDLINE (1996–2014), EMBase (1974–2014), and CENTRAL (May 2014) up to June 27, 2014 for randomized controlled trials (RCTs) comparing ALC with placebo or other active medications in diabetic and non-diabetic PNP patients that reported the change of pain using visual analogue scale (VAS). Mean difference (MD) and 95% confidence interval (CI) were used for pooling continuous data. Results Four RCTs comparing ALC with placebo and reporting in three articles (n = 523) were included. Compared with placebo, ALC significantly reduced VAS scores of PNP patients (MD of VAS, 1.20; 95% CI, 0.68-1.72, P <0.00001). In the subgroup analysis, the effect of ALC on VAS was similar in different administration routes (intramuscular-oral sequential subgroup: MD, 1.19; 95% CI, 0.34-2.04, P = 0.006; oral only subgroup: pooled MD, 1.15; 95%CI, 0.33-1.96, P = 0.006), and ALC appeared more effective in diabetic PNP patients than non-diabetic PNP patients (diabetic subgroup: MD, 1.47; 95%CI, 1.06-1.87, P <0.00001; non-diabetic subgroup: MD, 0.71; 95% CI, -0.01-1.43, P = 0.05). No severe adverse events were reported related to ALC. The common adverse events were pain, headache, paraesthesia, hyperesthesia, retching, biliary colic, and gastrointestinal disorders. The rates of total adverse events were similar in ALC and control group. Conclusion The current evidence suggests that ALC has a moderate effect in reducing pain measured on VAS in PNP patients with acceptable safety. Larger trials with longer follow-up, however, are warranted to establish the effects.

Circulating Betatrophin in Patients with Type 2 Diabetes: A Meta-Analysis

Objective. To investigate the association between circulating betatrophin level and type 2 diabetes mellitus (T2DM) in human. Methods. A comprehensive literature search was performed in PubMed and Embase databases to identify eligible studies assessing the circulating levels of betatrophin in both T2DM patients and nondiabetic adults. Results. A total of nine eligible studies with twelve comparisons were included for the final meta-analysis. Circulating betatrophin levels in T2DM patients were higher than those in the nondiabetic controls (random-effect SMD 0.53; 95% CI 0.13 to 0.94; P = 0.010). In the subgroup of nonobese population but not the obese population, the overall betatrophin level in T2DM patients was much higher than that in the nondiabetic controls (nonobese: random-effect SMD, 0.82; 95% CI 0.42 to 1.21; P < 0.001; obese: random-effect SMD, −0.39; 95% CI, −0.95 to 0.18; P = 0.18). Metaregression indicated that body mass index of T2DM patients was associated with mean difference of betatrophin level between T2DM and nondiabetic adults (slope, −578.8; t = −2.7; P = 0.02). Conclusion. Based on the findings of our meta-analysis, circulating betatrophin level of T2DM patients is higher than that of nondiabetic adults in the nonobese population, but not in the obese population.

Cost‐effectiveness analysis of additional docetaxel for metastatic hormone‐sensitive prostate cancer treated with androgen‐deprivation therapy from a Chinese perspective

&NA; The E3805 (CHAARTED) study found that docetaxel combined with androgen‐deprivation therapy (ADT) significantly improved overall survival of patients with metastatic hormone‐sensitive prostate cancer. This study aims to determine whether docetaxel combined with ADT is a cost‐effective strategy for advanced prostate cancer in China. According to the E3805 study, two groups (docetaxel + ADT and ADT alone) and three health states [progression‐free survival (PFS), progressive disease (PD) and death] were analysed in a Markov model. All medical costs were calculated from the Chinese societal perspective. Quality‐adjusted life year (QALY) and incremental cost‐effectiveness ratios (ICERs) were applied as the primary outcome. Overall, the addition of docetaxel was estimated to increase the cost by

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

12 816.93, with a gain of 0.48 QALY. Additionally, for patients with high‐volume disease, the increased cost and effectiveness were

Immunological hypoglycemia associated with insulin antibodies induced by exogenous insulin in 11 Chinese patients with diabetes

14 627.75 and 0.69 QALYs in docetaxel + ADT group versus the ADT alone group, and the ICER was

Diagnosis and treatment for hyperuricaemia and gout: a protocol for a systematic review of clinical practice guidelines and consensus statements

21 199.63 per QALY. These ICERs are far more than the commonly accepted willingness‐to‐pay (WTP) threshold of

Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial.

20 301 per QALY in China. In spite of longer survival time, docetaxel combined with ADT is not a recommended cost‐effective treatment for metastatic hormone‐sensitive prostate cancer in the Chinese setting.

Exenatide in obese or overweight patients without diabetes: A systematic review and meta-analyses of randomized controlled trials

The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine (Hcy) with and without simultaneous supplementation of B-group vitamins or folic acid. A literature search was conducted in PubMed, EmBase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) reporting the concentration of serum Hcy in metformin-treated adults. Meta-analysis was applied to assess the association between metformin and the changes of Hcy concentration. Twelve publications were included in this study. In the overall analysis, metformin administration was not statistically associated with the change of Hcy when compared with the control treatment (mean difference (MD), 0.40 μmol/L; 95% confidence interval (CI), −0.07~0.87 μmol/L, p = 0.10). In the subgroup analysis, metformin was significantly associated with an increased concentration of Hcy in the absence of exogenous supplementation of folic acid or B-group vitamins (MD, 2.02 μmol/L; 95% CI, 1.37~2.67 μmol/L, p < 0.00001), but with a decreased concentration of serum Hcy in the presence of these exogenous supplementations (MD, −0.74 μmol/L; 95% CI, −1.19~−0.30 μmol/L, p = 0.001). Therefore, although the overall effect of metformin on the concentration of serum Hcy was neutral, our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given.

Alternative Statistical Analysis Shows Exercise Training-Induced Improvements in Peak VO2 are Clinically Significant

Aims. To investigate the characteristics of immunological hypoglycemia associated with insulin antibodies (IAbs) induced by exogenous insulin in Chinese patients with diabetes. Methods. The clinical data of patients with immunological hypoglycemia due to IAbs were retrospectively analyzed by screening patients with diabetes discharged from West China Hospital from 2007 to 2013. Results. A total of 11 patients (eight men and three women) were identified. Insulin-C-peptide separation was found in all patients via insulin and C-peptide release test. Previous insulin use was ceased after admission and was switched to oral hypoglycemic agents (OHAs) (8/11), lifestyle modification only (2/11), or regular human insulin (1/11). Hypoglycemia was ameliorated after a median of 20 days (interquartile range [IQR], 11–40), while IAbs turned negative after a median of 17 months (IQR, 4–19), and serum immunoreactive insulin (IRI) levels dropped substantially after a median of 22 months (IQR, 9–32) in these cases. Conclusions. In insulin-treated patients with unexpected and refractory hypoglycemia even after insulin therapy was gradually reduced or even withdrawn, IAbs induced by exogenous insulin should be considered, and insulin withdrawal might be promptly needed. The course of immunological hypoglycemia was benign and self-limited.

Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report.

Introduction Gout and hyperuricaemia are major health issues and relevant guidance documents have been released by a variety of national and international organisations. However, these documents contain inconsistent recommendations with unclear quality profiles. We aim to conduct a systematic appraisal of the clinical practice guidelines and consensus statements pertaining to the diagnosis and treatment for hyperuricaemia and gout, and to summarise recommendations. Methods We will search PubMed, EMBASE and guideline databases to identify published clinical practice guidelines and consensus statements. We will search Google and Google Scholar for additional potentially eligible documents. The quality of included guidelines and consensus statements will be assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and be presented as scores. We will also manually extract recommendations for clinical practice from all included documents. Ethics and dissemination The results of this systematic review will be disseminated through relevant conferences and peer-reviewed journals. Protocol registration number PROSPERO CRD42016046104.