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Zhang P.,Nanyang Central Hospital | Tian J.,Nanyang Central Hospital | Jing L.,Xi'an Jiaotong University | Wang Q.,Xijing University | And 3 more authors.
International Journal of Surgery | Year: 2016

Background and objective Available evidence showed inconsistent results between laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for children with gastro-oesophageal reflux disease (GERD), so this study aimed to evaluate the efficacy and safety between LNF and ONF. Methods Systematic, comprehensive literature searches were conducted to include randomized controlled trials (RCTs) that compared LNF and ONF for GERD. Two reviewers independently selected studies, abstracted data and assessed the methodological quality and evidence level. Data was analyzed by Review Manager Version 5.0. Risk ratio (RR) was used for dichotomous outcomes, and mean difference (MD) was used for continuous scales. Heterogeneity was estimated with the I2 statistic, fixed-effect model was used if I2 <50%, and otherwise random-effects model was used. Results Three RCTs (171 children) were included. There was not a statistical difference in mortality (RR 1.12, 95%CI 0.50 2.48), or postoperative complications (RR 0.87, 95%CI 0.61 1.25), readmission (RR 1.53, 95%CI 0.67 3.51), or hospital stay (MD 0.85, 95%CI -0.06 1.75) between LNF and ONF. But LNF was associated with more incidence of recurrence (RR 3.32, 95%CI 1.40 7.84), longer surgery duration (MD 76.33, 95%CI 69.37 83.28), but fewer retching (RR 0.11, 95%CI 0.02 0.58) than ONF. Conclusions LNF might be as effective and safe as ONF in the short and long term, but both were associated with high risk of recurrence and mortality, especially for those children with neurological impairment, before the age of 18 months and female gender. This required a comprehensive evaluation of children before surgery. © 2016 IJS Publishing Group Ltd


Zhao F.,Lanzhou University | Zhao F.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Zhao F.,Northwest University, China | Tian J.,Lanzhou University | And 4 more authors.
Journal of Neuro-Oncology | Year: 2014

The aim of this study was to assess the effectiveness of adding viral vector-mediated gene therapy with herpes simplex virus thymidine kinase (HSV-tk) to standard treatment, in comparison with standard treatment alone to treat patients with high-grade gliomas (HGGs). A literature search of the databases PubMed, Embase, the Cochrane Library, Web of Science, and Chinese biomedicine was performed to identify eligible studies. Three randomized controlled trials (involving a total of 532 patients) were included in this systematic review. A meta-analysis of included studies demonstrated a significant increase in median survival time (MST) in patients who were treated with HSV-tk gene therapy (mean deviation 0.59, 95 % CI: 0.41-0.76, p < 0.0001). The results of pooled analysis for different patient groups show that overall survival (OS) for all HGG patients was improved by adding gene therapy [hazard ratio (HR) = 0.91, 95 % CI: 0.74-1.13, p = 0.42], while a different result was seen for glioblastoma multiforme (GBM) patients (HR = 1.06, 95 % CI: 0.80-1.41, p = 0.70). Furthermore, the combined results for tumor progression implied that standard therapy was superior to gene therapy [odds ratio (OR) = 1.31, p = 0.09]; yet differences in HR and OR between experimental groups and control groups had no statistical significance (p > 0.05). Based on the best available evidence, it appears that adding gene therapy with HSV-tk has some effect in treating HGG patients, especially with respect to MST. However, neither the pooled analysis of OS, nor the combined analysis of tumor progress indicates any significant advantage to adding gene therapy compared with standard treatment alone. More prospective studies are needed to draw solid conclusions about whether gene therapy has significant prognostic advantage. © 2014 Springer Science+Business Media New York.


Zhang F.-W.,Gansu Provincial Hospital | Zhang F.-W.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Zhou Z.-Y.,Lanzhou University | Wang H.-L.,Gansu Provincial Hospital | And 5 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2014

Background and Aim: Laparoscopic and open rectum surgery for rectal cancer remains controversial. This systematic review compared the short-term and long-term efficiency and complications associated with laparoscopic and open resection for rectal cancer. Materials and Methods: We searched PubMed, Embase, Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potential randomized controlled trials from their inception to March 31, 2014 without language restriction. Additional articles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessed the full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodological quality of included trials. The meta-analysis was performed using RevMan 5.2. Results: A total of 16 randomized controlled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) were reviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier return of bowel movement and reduced length of hospital stay as compared to open surgery, although with increased operative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowel obstruction. Importantly, there were no significant differences in other postoperative complications, oncological clearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures. Conclusions: On the basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperative recovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcome is comparable after laparoscopic and open resection for rectal cancer.


Shi C.,Lanzhou University | Shi C.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Tian J.,Lanzhou University | Tian J.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | And 7 more authors.
BMJ Open | Year: 2014

Objectives: Considering equity into guidelines presents methodological challenges. This study aims to qualitatively synthesise the methods for incorporating equity in clinical practice guidelines (CPGs). Setting: Content analysis of methodological publications. Eligibility criteria for selecting studies: Methodological publications were included if they provided checklists/frameworks on when, how and to what extent equity should be incorporated in CPGs. Data sources: We electronically searched MEDLINE, retrieved references, and browsed guideline development organisation websites from inception to January 2013. After study selection by two authors, general characteristics and checklists items/framework components from included studies were extracted. Based on the questions or items from checklists/ frameworks (unit of analysis), content analysis was conducted to identify themes and questions/items were grouped into these themes. Primary outcomes: The primary outcomes were methodological themes and processes on how to address equity issues in guideline development. Results: 8 studies with 10 publications were included from 3405 citations. In total, a list of 87 questions/ items was generated from 17 checklists/frameworks. After content analysis, questions were grouped into eight themes ('scoping questions', ' searching relevant evidence', 'appraising evidence and recommendations', 'formulating recommendations', 'monitoring implementation', 'providing a flow chart to include equity in CPGs', and 'others: reporting of guidelines and comments from stakeholders' for CPG developers and 'assessing the quality of CPGs' for CPG users). Four included studies covered more than five of these themes. We also summarised the process of guideline development based on the themes mentioned above. Conclusions: For disadvantaged population-specific CPGs, eight important methodological issues identified in this review should be considered when including equity in CPGs under the guidance of a scientific guideline development manual. © 2014, BMJ Publishing Group. All rights reserved.


Chen Y.,Lanzhou University | Chen Y.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Jiang L.,Lanzhou University | Gao B.,Lanzhou University | And 6 more authors.
Breast Cancer Research and Treatment | Year: 2016

The objective of the present meta-analysis was to estimate the magnitude of survival and disease-free benefits from mastectomy compared with breast conservation therapy (BCT) in patients with early breast cancer. We searched PubMed, Embase, the Cochrane Library, Web of Science, and Chinese biomedical literature database from their inception to May 2015. All the data were independently extracted from the publications by two reviewers. Results regarding the overall survival (OS) and disease-free survival (DFS) in the meta-analysis were expressed as hazard ratios (HRs) with 95 % confidence intervals (CIs). Nine randomized control trials were eligible for final meta-analysis. Meta-analysis showed that mastectomy provided significant benefit in OS compared with BCT (HR 1.09, 95 % CI 1.01–1.19; P = 0.03). Sensitivity analysis gives similar OS estimates (HR 1.12, 95 % CI 1.01–1.25). In the subgroup analysis of patients according to tumor size, the pooled HRs for OS indicated that there is a borderline statistical difference between two arms in the subgroup with tumor size ranging between ≥2 cm and <5 cm (HR 1.09, 95 % CI 1.00–1.19), but subgroup analysis of tumor size <2 cm showed no statistically significant difference in OS (HR 1.08, 95 % CI 0.88–1.33) when comparing the BCT arm with the mastectomy arm. There was no significant difference in DFS between BCT and mastectomy groups (HR 1.08, 95 % CI 0.99–1.18; P = 0.08). Sensitivity analysis also gives similar DFS estimates (HR 1.11, 95 % CI 0.96–1.27). Subgroup analysis indicated that the pooled HRs for DFS did not favor mastectomy arm or BCT arm either in the subgroup with tumor size <2 cm (HR 1.09, 95 % CI 0.78–1.52) or in the subgroup with tumor size ranging between ≥2 cm and <5 cm (HR 1.08, 95 % CI 0.99–1.18) according to tumor size. Five-year OS decreased from 70 to 68 % with BCT. The present meta-analysis indicated that mastectomy might provide slight OS benefit compared with BCT in early breast cancer patients with larger tumor size, but the absolute survival gain is small. © 2016, Springer Science+Business Media New York.


Liu D.,Lanzhou University | Liu D.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Jin J.,Lanzhou University | Jin J.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | And 4 more authors.
PLoS ONE | Year: 2015

Background: Comprehensive monitoring of the quality of systematic reviews (SRs) and meta-analyses (MAs) of endoscopic ultrasound (EUS) requires complete and accurate reporting and methodology. Objective: To assess the reporting and methodological quality of SRs/MAs on EUS diagnosis and to explore the potential factors influencing articles' quality. Methods: The quality of the reporting and methodology was evaluated in relation to the adherence of papers to the PRISMA checklist and the AMSTAR quality scale. The total scores for every criterion and for every article on the two standards were calculated. Data were evaluated and analyzed using SPSS17.0 and RevMan 5.1 in terms of publication time, category of reviews, category of journals, and funding resource. Results: A total of 72 SRs/MAs was included, but no Cochrane Systematic Reviews (CSRs) were obtained. The number of SRs/MAs ranged from 1 in 1998 to 15 in 2013; 88.1% used the QUA- DAS tool; the average overall scores by PRISMA statement and AMSTAR tool were 19.9 and 5.4, respectively. Scores on some items showed substantial improvement after publication of PRISMA and AMSTAR. However, no reviews followed the criterion of protocol and registration, and only 11.1% of articles fulfilled the criterion of literature search. SRs/MAs from the Science Citation Index (SCI) were of better quality than non-SCI studies. Funding resource made no difference to quality. Regression analysis showed that time of publication and inclusion in the SCI were significantly correlated with total scores on the two standards. Conclusion: The reporting and methodological quality of SRs/MAs on EUS diagnosis has improved measurably since PRISMA and AMSTAR checklists released. It is hoped that CSR in this field will be produced. Literature searching and protocol criteria, as well as QUADAS-2 tool need to be addressed more in the future. Time of publication and SCI relate more to the overall quality of SRs/MAs than does funding resource. © 2015 Liu et al.


Jiang L.,Lanzhou University | Jiang L.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | Yang K.-H.,Lanzhou University | Yang K.-H.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province | And 4 more authors.
Journal of Clinical Gastroenterology | Year: 2015

Background: The objective of the present meta-analysis was to estimate the magnitude of survival benefits of neoadjuvant chemotherapy (NAT) in resectable cancer of the gastric and gastroesophageal junction. Materials and Methods: We searched PubMed, Embase, the Cochrane Library, ISI Web of Knowledge, Chinese biomedical literature database, Chinese Scientific Journals full-text database of retrieved articles from their inception to 2013. Two reviewers independently retrieved study and data extraction of included studies. Results regarding the overall survival and progression-free survival in the meta-analysis were expressed as hazard ratios (HRs) with 95% confidence intervals (CI). Results: Twelve randomized control trials (n=1755) were eligible for final meta-analysis. NAT was associated with a statistically significant benefit in terms of overall survival (HR=0.72; 95% CI, 0.56-0.93, P=0.01), progression-free survival (HR=0.73; 95% CI, 0.62-0.87, P=0.0003), 5-year survival rate [relative risk (RR)=1.36; 95% CI, 1.10-1.67, P=0.0004], and curative resection rate (RR=1.11; 95% CI, 1.03-1.20, P=0.009). Five-year survival rate increased from 30% to 42% with NAT. No significant difference with regards to overall postoperative complications rate (RR=1.08; 95% CI, 0.92-1.27, P=0.28) was found between 2 groups. Conclusion: There is convincing evidence for a survival benefit of NAT over surgery alone in patient with cancer of the gastric and gastroesophageal junction. © 2014 Wolters Kluwer Health, Inc.


Wang J.-C.,Lanzhou University | Tian J.-H.,Lanzhou University | Ge L.,Lanzhou University | Gan Y.-H.,Lanzhou University | And 2 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2014

Background: Few studies have directly compared clinical efficacy and safety among Chinese herb injections (CHIs) for gastric cancer (GC). The present study aimed to compare CHIs combined with FOLFOX regimens for GC to show which provides the best CHIs results. Materials and Methods: 9 electronic databases and 6 gray literature databases were comprehensive searched in April 20, 2013. According to inclusion and exclusion criteria, two reviewers independently selected and assessed the included trials. The risk of bias tool described in the Cochrane Handbook version 5.1.0 and CONSORT statement were used to assess the quality of the trials. All calculations and graphs were performed and produced using ADDIS 1.16.5 software. Results: A total of 541 records were searched and 38 RCTs met the inclusion criteria (2,761 participants), involving 10 CHIs. The results of network meta-analysis showed that compared with FOLFOX alone, combinations with Kanglaite, Astragalus polysaccharides, Cinobufacini, or Yadanziyouru injections could furthest strengthen ORR, improve the quality of life, reduce nausea and vomiting, and reduce the incidence of leukopenia (III-IV). Conclusions: Kanglaite injection, Astragalus polysaccharides injection, Yadanziyouru injection were superior to other CHIs in clinical efficacy and safety for GC. The conclusions now need to be confirmed by large sample size direct head-to-head studies.


PubMed | Lanzhou University and Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province
Type: | Journal: BMC medical research methodology | Year: 2015

With increasing attention put on the methodology of reporting guidelines, Moher et al. conducted a review of reporting guidelines up to December 2009. Information gaps appeared on many aspects. Therefore, in 2010, the Guidance for Developers of Health Research Reporting Guidelines was developed. With more than four years passed and a considerable investment was put into reporting guideline development, a large number of new, updated, and expanded reporting guidelines have become available since January 2010. We aimed to systematically review the reporting guidelines published since January 2010, and investigate the application of the Guidance.We systematically searched databases including the Cochrane Methodology Register, MEDLINE, and EMBASE, and retrieved EQUATOR and the website (if available) to find reporting guidelines as well as their accompanying documents. We screened the titles and abstracts resulting from searches and extracted data. We focused on the methodology and reporting of the included guidelines, and described information with a series of tables and narrative summaries. Data were summarized descriptively using frequencies, proportions, and medians as appropriate.Twenty-eight and 32 reporting guidelines were retrieved from databases and EQUATOR network, respectively. Reporting guidelines were designed for a broad spectrum of types of research. A considerable number of reporting guidelines were published and updated in recent years. Methods of initial items were given in 45 (75%) guidelines. Thirty-eight (63%) guidelines reported they have reached consensus, and 35 (58%) described their consensus methods. Only 9 (15%) guidelines followed the Guidance.Only few guidelines were developed complying with the Guidance. More attention should be paid to the quality of reporting guidelines.


PubMed | Peoples Hospital of Gansu Province, Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province and Gansu Provincial Cancer Hospital
Type: Journal Article | Journal: Environmental science and pollution research international | Year: 2016

Although the relationship between asthma and exposure to fine particulate matter (PM2.5) has been frequently measured, reported conclusions have not been consistent. As emergency department (ED) visits are an effective way to estimate health outcomes for people with asthma and short-term exposure to PM2.5, this review systematically searched five databases without language or geographical restrictions from inception to January 13, 2015 to study the impact of PM2.5 on asthma ED visits. A random-effects model was used to calculate the pooled risk ratio (RR) and 95% confidence intervals (CI). With respect to short-term effects, asthma ED visits increased at higher PM2.5 concentrations (RR 1.5% per 10 g/m(3); 95% CI 1.2-1.7%), and children were more susceptible (3.6% per 10 g/m(3); 95% CI 1.8, 5.3%) than adults (1.7, 95% CI 0.7%, 2.8%) to increased PM2.5; the ED visits increased during the warm season by 3.7% (95% CI 0.5, 6.9%) per 10 g/m(3) increase in PM2.5, which was higher than the corresponding increase during the cold season (2.6, 95% CI 0.7-4.6%). This demonstrates that ambient PM2.5 has an adverse impact on asthma ED visits after short-term exposure and that children are a high-risk population when PM2.5 concentrations are high, particularly in warm seasons, during which measures should be taken to prevent PM2.5.

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