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Conventional Billroth II (BII) anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) is associated with bile reflux gastritis, and Roux-en-Y anastomosis is associated with Roux-Y stasis syndrome (RSS). The uncut Roux-en-Y (URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BII with Braun (BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.To evaluate the value of URY in patients with GC.PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals (VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal (https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). We cited high-quality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials (RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager (Version 5.4).Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval (CI): 0.03-0.19,This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

Acupuncture has been widely used to relieve migraine-related symptoms. However, the findings of previous systematic reviews (SRs) and meta-analyses (MAs) are still not completely consistent. Their quality is also unknown, so a comprehensive study is needed.To evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine, and summarize evidence about the efficacy and safety of acupuncture for migraine.PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Databases, Wanfang Data, and VIP databases were searched from inception to September 2020, with a comprehensive search strategy.The pairwise MAs of randomized controlled trials (RCTs) concerning migraine treated by acupuncture or acupuncture-based therapies, with a control group that received sham acupuncture, medication, no treatment, or acupuncture at different acupoints were included.Two independent investigators screened studies, extracted relevant data, and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), then all results were cross-checked. Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores.A total of 20 MAs were included in this study. The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention. There was a high correlation between reporting and methodological quality scores (rAcupuncture is an effective and safe intervention for preventing and treating migraine, and could be considered as a good option for patients with migraine. However, the reporting and methodological quality of MAs included in this overview is suboptimal. In the future, AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.

ObjectiveThe purpose of this systematic review and meta-analysis is to evaluate the efficacy and safety of carbon ion radiotherapy (CI-RT) in improving meningioma by comparing photon and protons radiotherapy.MethodsA comprehensive search for relevant studies published until March 17, 2021, was conducted in PubMed, the Cochrane Library, Chinese Biomedical Literature Database and EMBASE. Statistical analyses were performed with R 4.0.3.ResultsWe identified 396 studies, of which 18 studies involving 985 participants were included. Except for one low quality study, the quality of the included studies was found to be either moderate or high quality. The analyses conducted according random effects model indicated that the 1-year overall survival rate (OS) of benign and non-benign meningiomas after the CI-RT treatment was 99% (95%CL=.91-1.00, I2 = 0%). The overall average 5-year OS for meningiomas was 72% (95%CL=0.52-0.86, I2 = 35%), not as effective as proton radiotherapy (PR-RT) 85% (95%CL=.72-.93, I2 = 73, Q=4.17, df=2, p=.12). Additionally, 5-year OS of atypical meningiomas (81%) was found to be significantly higher than anaplastic meningiomas (52%). The 10-year OS after CI-RT of patients with mixed grade meningioma was 91% (95%CL=.75-.97, I2 = 73%). The 15-year OS after CI-RT 87% (95%CL=.11-1.00) or PR-RT 87% (95%CL=.23-.99, I2 = 79%) were the same (Q=0, df=1, p=.99). After undergoing CI-RT for 3 and 5 years, the LC for benign meningioma was 100% and 88%, respectively, while the 2-year LC of non-benign meningiomas (atypical/anaplastic) was 33%. Headache, sensory impairment, cognitive impairment, and hearing impairment were found to be the most common adverse reactions, with individual incidences of 19.4%, 23.7%, 9.1%, and 9.1%, respectively.ConclusionCI-RT is a rapidly developing technique that has been proven to be an effective treatment against meningioma. The efficacy and safety of CI-RT for meningiomas were similar to those of PR-RT, better than photon radiotherapy (PH-RT). However, there is a need for more prospective trials in the future that can help provide more supportive evidence.

Objective: To clarify the expression of HMGB1 and its relationship with clinical features of gastric cancer.Methods: Multiple databases were systematically searched for relevant studies from 1997 to 2021. We screened case - control studies stating that the association between HMGB1 protein expression and clinical characteristics in gastric cancer.Results: In total, eight independent studies with 872 patients were included. Meta – analysis indicated higher odds of HMGB1 being present in gastric tumor tissues compared to para - tumor controls ［OR ＝ 4.15, 95％ CI (3.09, 5.58), P ＜ 0.01］. High HMGB1 expression was also associated with poor differentiation rate ［OR ＝ 0.73, 95％ CI (0.54, 0.99), P ＝ 0.04］, TNM stages Ⅲ - Ⅳ ［OR ＝0. 28, 95％ CI (0.18, 0.44), P ＜ 0.01］, lymphatic metastasis ［OR ＝ 2. 08, 95％ CI (1.52, 2.84), P ＜0.01］ and diffuse type of Lauren classification [OR ＝ 0.57, 95％ CI (0.38, 0.84), P ＜0. 01］. However, there was no significant correlation between HMGB1 expression between gender and age.Conclusion: Our results illustrated that HMGB1 protein was strongly associated with adverse clinicopathological features of gastric cancer. HMGB1 may be a promising target in the development of gastric cancer.

Objective: To study the efficacy and safety of apatinib combined with S – 1 in the treatment of advanced gastric cancer, in order to provide more evidence based medical evidence for the clinic.Methods: Randomized controlled trials of apatinib combined with S – 1 (experimental group) versus S - 1 (controlg roup) in the treatment of advanced gastric cancer were collected by computer literature search in Chinese and English databases, for the deadlines of March 21, 2021. Two investigators independently screened the literature, extracted the data, and evaluated the quality of the literature using the Cochrane risk bias assessment tool. And the Meta – analysis was performed using Review Manager 5. 3 software almost.Results: A total of 20 articles were included, totaling 1,150 patients. Meta – analysis showed that the objective response rate [OR = 2.02, 95% CI (1.56, 2.63), P < 0.00001], disease control rate [OR = 3.10, 95% CI (2.30, 4.17), P < 0.00001], median overall survival [MD = 3.99, 95% CI (3.56, 4.43), P < 0.00001] of patients with apatinib combined with S – 1 group were higher than the S – 1 group, then the median progression – free survival had not significant differences [MD = 1.24, 95% CI (-1.19, 3.67), P = 0.32]. In the adverse reactions, only the incidence of hypertension [OR = 6.19, 95% CI (1.89, 20.23), P = 0.003] and the incidence of proteinuria [OR = 4.02, 95% CI (1.11, 14.62), P = 0.03] in the apatinib combined with S – 1 group were higher than the S – 1 group, and there was no significant difference in the other adverse reactions. In addition, the levels of IFN – γ and TNF – α in the apatinib combined with S – 1 group were higher than those in the S – 1 group, and the levels of IL - 10, IL – 4, TSGF, CA199 and CEA were lower than those of the S – 1 group.Conclusion: Current evidence suggests that apatinib combined with S - 1 can achieve higher objective response rate, disease control rate, median overall survival, less adverse reactions, and improve immune function, effectively reduce the level of tumor markers.

Objective: To explore the correlation between CTLA-4 + 49A > G polymorphism and risks of upper gastrointestinal cancer.Methods: Searched Pubmed, Embase, Cochran Library, Chinese Biomedical Literature Database, Chinese CNKI, VIP and Wanfang database, retrieve the deadline to Feb 2021. Document acquired independently by the two collectors according to inclusion and exclusion criteria. System analysis was performed by Revman 5.3 software.Results: A total of seven case-control studies were included in the study, including 3045 patients and 3545 controls. The results of the systematic analysis showed that all studies on upper gastrointestinal tumors were combined: random effects model, dominant genetic model GG + GA vs AA: the difference was not statistically significant [OR=1.15; 95%CI: 0.74-1.81]; recessive genetic model GG vs GA + AA [OR=0.99; 95%CI: 0.74-1.31], codominant model GG vs AA [OR=1.14; 95%CI: 0.67-1.95], GA vs AA [OR=1.20; 95%CI: 0.80-1.79], allele model G vs A [OR=1.06; 95%CI: 0.82-1.38]. The above results show CTLA-4 + 49A > G locus. There was no correlation between gene polymorphism and susceptibility to upper gastrointestinal tumors including gastric cancer and esophageal cancer. After the five studies on gastric cancer were combined, each genetic model showed that the CTLA-4 + 49.Conclusion: This study showed that there was no correlation between single nucleotide polymorphisms in CTLA-4 + 49A > G locus and upper gastrointestinal tumors including gastric cancer and esophageal cancer.

The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.

Supplemental Digital Content is Available in the Text., Background: Voriconazole (VRZ) is a second-generation triazole antifungal agent with broad-spectrum activity. It is available in both intravenous and oral formulations, and is primarily indicated for treating invasive aspergillosis. The most commonly used dose for adults is 4 mg/kg or 200 mg twice daily. VRZ presents nonlinear pharmacokinetics in adults, whereas drug–drug interactions and cytochrome P450 2C19 (CYP2C19) polymorphism are of great concern for VRZ. Because the liquid chromatography method has been widely used for measuring VRZ blood concentration, and target VRZ blood concentration has been recommended in some guidelines regarding efficacy and safety, therapeutic drug monitoring is considered as a useful tool for VRZ-individualized medication. Also, the CYP2C19 genotype test is available for guiding relevant drugs use in some health care facilities. Our objective was to develop an evidence-based practice guideline for VRZ-individualized medication. Methods: We followed the latest guideline definition from the Institute of Medicine and referred to the World Health Organization handbook for guideline development. The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2015CN001). The guideline is, in principle, targeted at all Chinese health care providers. The quality of evidence and strength of the recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Results: Twenty-six recommendations were formulated regarding therapeutic drug monitoring, special groups of patients, drug safety, off-indication use, and drug–drug interactions. Of them, 12 were strong recommendations. Most quality of evidence was low, very low, or expert opinions. Conclusions: We developed an evidence-based practice guideline for VRZ-individualized medication, which provided comprehensive and practical recommendations for health care providers. The development of the guideline exposed several research gaps to improve VRZ use.

Background: Current studies suggest that vitamin D deficiency during pregnancy can produce a certain effect for preterm birth, but there is no research showing whether vitamin D deficiency has a consistent effect in different pregnancies; thus, we conducted a systematic review and meta-analysis of 24 observational studies, grouping them according to the gestational age at the time of serum sampling, to investigate whether vitamin D deficiency in different periods of gestation has different effects on preterm birth and to provide an evidence-based basis for pregnant women to measure and supplement vitamin D. Methods: The databases PubMed-Medline, EMBASE, the Cochrane Library, Web of Science, EBSCO, CBM, and CNKI were searched until July 2019. Two researchers independently assessed the eligibility and quality of studies, and STATA 12.0 software was used for meta-analysis. Result: Seven cohort studies, 13 case-control studies, and four cross-sectional studies were included from 2500 articles by inclusion and exclusion criteria. After adjusting for age, race, and other confounding factors, meta-analysis results showed that vitamin D deficiency in the first trimester, the second trimester and the third trimester did not increase the risk of preterm birth (odds ratio (OR) = 1.01, 95% confidence interval (CI) (0.88, 1.16), P = 0.867; OR = 1.12, 95%CI (0.92, 1.37), P = 0.249; OR = 1.05, 95%CI (0.87, 1.27), P = 0.602). However, there was moderate heterogeneity in the study of vitamin D deficiency in the second trimester, and subgroup analysis suggested that vitamin D deficiency in the second trimester may increase the risk of preterm birth (OR = 1.33, 95%CI (1.15, 1.54), P = 0.000). A sensitivity analysis of the second trimester showed that excluding any one study did not significantly change the results. Conclusions: Vitamin D deficiency in early and late pregnancy may not be associated with preterm birth, while vitamin D deficiency in middle pregnancy is likely to have an important effect on preterm birth. Vitamin D levels should be measured in the second trimester of pregnancy, and vitamin D supplements should be provided if necessary.

Additional file 1. S1. Search strategy and flow chart of the literature review. S2. Available published examples of reporting moxibustion SRs.

The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients' records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus (

Background. To comprehensively assess the efficacy and safety of whole-brain radiotherapy (WBRT) combined with gefitinib/erlotinib for treatment of brain metastases (BM) from non-small-cell lung cancer (NSCLC).Methods. Databases including PubMed, EMBASE.com, Web of Science, and Cochrane Library were searched from inception to April 12, 2015. Studies on randomized controlled trials (RCTs) and case-control trials comparing WBRT combined with gefitinib/erlotinib versus WBRT alone for BM from NSCLC were included. Literature selection, data extraction, and quality assessment were performed independently by two trained reviewers. RevMan 5.3 software was used to analyze data.Results. A total of 7 trials involving 622 patients were included. Compared with WBRT alone or WBRT plus chemotherapy, WBRT plus gefitinib/erlotinib could significantly improve response rate (OR = 2.16, 95% CI: 1.35–3.47;P=0.001), remission rate of central nervous system (OR = 6.06, 95% CI: 2.57–14.29;P<0.0001), disease control rate (OR = 3.34, 95% CI: 1.84–6.07;P<0.0001), overall survival (HR = 0.72, 95% CI: 0.58–0.89;P=0.002), and 1-year survival rate (OR = 2.43, 95% CI: 1.51–3.91;P=0.0002). In adverse events (III-IV), statistically significant differences were not found, except for rash (OR = 7.96, 95% CI: 2.02–31.34;P=0.003) and myelosuppression (OR = 0.19, 95% CI: 0.07–0.51;P=0.0010).Conclusions. WBRT plus gefitinib/erlotinib was superior to WBRT alone and well tolerated in patients with BM from NSCLC.

Appendix 1 Search strategies. Appendix 2 Definition of interventions. Appendix 3 Results of risk of bias. Appendix 4 Results of direct, indirect, network meta-analyses, and inconsistency. Appendix 5 subgroup analyses. Appendix 6 Absolute effect estimates of different exercise modalities using no exercise as baseline risk (PDF 400 kb)

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.

Breast cancer is the most common type of cancer in females worldwide. Patients with breast cancer and bone metastases may experience increased osteoclast activity, resulting in local bone destruction and skeletal complications, including pain, hypercalcemia and skeletal-related events. Intravenous bisphosphonates (BPs) are the standard treatment administered to patients with breast cancer and bone metastases to prevent skeletal-related events. However, in certain patients, BPs may cause renal toxicity, acute-phase reactions and osteonecrosis of the jaw. More effective, safer and more tolerable therapies, which prevent bone destruction and skeletal complications, are required in order to improve patient quality of life. Denosumab is a fully human monoclonal antibody that binds to and neutralizes receptor activator of nuclear factor-κB ligand, which is a key mediator in the pathogenesis of a broad range of skeletal diseases, thereby inhibiting osteoclast function and bone resorption. Therefore, we conducted a meta-analysis to compare both the safety and efficacy of denosumab and BPs in the treatment of breast cancer and bone metastases. Five databases, two clinical trial registry platforms and reference lists of relevant papers were analyzed. The meta-analysis concluded that denosumab was more effective at preventing pain and skeletal-related events than BPs, in patients with breast cancer and bone metastases. Patients receiving denosumab demonstrated a higher level of clinical improvement in terms of health-related quality of life than patients receiving BPs. Compared with BPs, denosumab reduced the incidence of certain indicators of adverse events, including pyrexia, bone pain, edema and renal failure.

Background Guideline development should be based on the quality of evidence, balance of benefits and harms, economic evaluation and patients' views and preferences. Therefore, these factors were considered in the development of a new guideline for therapeutic drug monitoring (TDM) of vancomycin. Objectives To develop an evidence-based guideline for vancomycin TDM and to promote standardized vancomycin TDM in clinical practice in China. Methods We referred to the WHO Handbook for Guideline Development and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence and grade the strength of recommendations, according to economic evaluation and patients' views and preferences. We used the GRADE Grid method to formulate the recommendations. Results The guideline presents recommendations about who should receive vancomycin TDM, how to monitor vancomycin efficacy and renal safety, therapeutic trough concentrations, time to start initial vancomycin TDM, loading dose and how to administer and adjust the vancomycin dose. Conclusions We developed an evidence-based guideline for vancomycin TDM, which provides recommendations for clinicians and pharmacists to conduct vancomycin TDM in China.

Problem-based learning is recognized as promoting integration of knowledge and fostering a deeper approach to life-long learning, but is associated with significant resource implications. This paper utilizes preliminary data from both the facilitator and postgraduate viewpoint to determine whether the use of this novel methodology is feasible with large groups of postgraduates in evidence based medicine. To investigate the effectiveness of problem-based learning (PBL) in comparison with lecture-based learning (LBL) in postgraduate coursework on evidence based medicine by the double-blind randomized control trial. Participating postgraduates were assigned to the LBL group and PBL group. The examination scores, questionnaire, and seminars were used to evaluate the teaching effectiveness. SPSS 11.5 software was used for statistical analysis. 103 postgraduates were included in the study, the baseline characteristics were balanced between the two groups. The examination mark was higher in the PBL group than in the LBL group, there were significant differences between the two groups in the attitude of the LBL. The postgraduate of PBL group revealed a high overall satisfaction with the course. The problem-based program appeared to be more effective than the lecture-based program in EBM teaching.

Aim To determine whether the cisplatin plus etoposide (EP) combination was more efficacious and less toxic than other platinum-based regimens for patients with extensive-stage small-cell lung cancer. Methods We performed an extensive literature search (from their inception to July 2010). Two reviewers independently assessed search results and methodological quality of included studies. Pooled hazard ratios (HRs) and relative risks (RRs) were calculated according to a random-effects model. Results Twelve randomised, controlled trials involving seven different platinum-based chemotherapy regimens were included into this meta-analysis. The meta-analysis showed that compared with EP regimen, irinotecan plus cisplatin (IP) might decrease the risk of death (HR = 0.87, 95% confidence interval (CI) 0.780.97, P = 0.01) (five trials), unlike the sensitivity analysis (HR = 0.91, 95% CI 0.811.02, P = 0.12), progression-free survival (HR = 0.95, 95% CI 0.861.05, P = 0.28) and overall response rate (RR 1.08, 95% CI 0.931.24) that were not superior for IP. IP regimen produced more non-haematological toxicities and less haematological toxicities. One trial found that etoposide + cisplatin + epirubicin + cyclophosphamide and cisplatin + etoposide + ifosfamide regimen might prolong the overall survival respectively. Etoposide + cisplatin + epirubicin + cyclophosphamide regimen also might improve progression-free survival but with high rate of haematological toxicities. None of the other trials included in the study demonstrated a significant improvement in survival. Conclusions There is no strong evidence that any clinical advantage for extensive small-cell lung carcinoma patients requiring chemotherapy when comparing EP with other platin-based regimens, with exception of IP that might prolong overall survival. The decision to prescribe which chemotherapy should take into consideration both cost and treatment preference.

Objective To evaluate the effect of ephedrine on intubation conditions (ICs) one minute after anesthesia induction using propofol and rocuronium. Methods: PubMed, EMbase, The Cochrane Library, ISI Web of Knowledge, Chinese Biomedical Literature Database, Google Scholar, and other databases were searched from inception to September 2012 to collect relevant randomized clinical trials (RCTs). We evaluated the risk of bias of the included studies by the Cochrane Collaboration's risk of bias tool and analyzed the data using RevMan 5.1. As the outcomes, excellent ICs, clinically acceptable ICs and side effects were evaluated with risk ratios (RRs). Results: Five RCTs involving 396 patients were identified. The results of the meta-analysis demonstrated that ephedrine increased the rate of excellent ICs (RR = 2.40, 95% CI 1.89 to 3.05), but had no effects on the rate of clinically acceptable ICs (RR = 1.15, 95% CI 0.93 to 1.42) and the incidence of side effects (RR = 2.00, 95% CI 0.19 to 21.36). Besides, the results of subgroup analysis showed that both low dose and high dose of ephedrine increased the rate of excellent ICs, but only low dose increased the rate of clinically acceptable ICs. The results of sensitive analysis showed that both favored ephedrine (excellent ICs: RR = 2.54, 95% CI 1.69 to 3.83; clinically acceptable ICs: RR = 1.21, 95% CI 1.07 to 1.38). Conclusion: Ephedrine, without extra side effects, created superior ICs one minute after anesthesia induction using propofol and rocuronium, and low dose (i.e., 70–100 μg/kg) is recommended as the possible optimal dose.

To assess the clinical effect and safety of Chinese traditional medicine injection combined with radiotherapy for esophageal cancer. The relative randomized controlled trials (RCTs) of Chinese medical injections (CMI) combined with radiotherapy as well as simple radiotherapy for esophageal cancer were searched from PubMed, Cochrane Library, EMBASE, Chinese Biomedical Literature Database(CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database as at September 2014. Two researchers completed the data extraction and quality evaluation independently. The data were analyzed by GeMTC 0.14.3 and Stata 12. 0 software. Finally, 43 RCTs involving 3 289 patients were finally included. The star network was constructed by different comparison groups. The results of network meta-analysis showed that the seven CMIs combined with radiotherapy was superior to simple radiotherapy in the treatment of esophageal cancer in efficacy, quality of life, and reduction in the incidence of nausea and leucopenia, but with no significant difference among the seven CMIs. Probability ranking result showed a great possibility for Shenqi Fuzheng and astragalus polysaccharide injections in improving the overall response rate and quality of life, which were followed by cinobufagin and kangai injections. However, only one study was included for Shenqi Fuzheng and astragalus polysaccharide injections. Therefore, cinobufagin or kangai injections were preferred in improving the overall response rate and quality of life. Aidi or compound sophora injections were better than other CMIs in reducing? the incidences of nausea (III-IV) and leukopenia. More RCTs of Shenqi Fuzheng and astragalus polysaccharide injections combined with radiotherapy for patients with esophageal cancer were expected in the future to confirm our results. Moreover, study findings will be reported, particularly for the adverse events in radiotherapy for esophageal cancer.

The rotation matrix estimation problem is a keypoint for mobile robot localization, navigation, and control. Based on the quaternion theory and the epipolar geometry, an extended Kalman filter (EKF) algorithm is proposed to estimate the rotation matrix by using a single-axis gyroscope and the image points correspondence from a monocular camera. The experimental results show that the precision of mobile robot's yaw angle estimated by the proposed EKF algorithm is much better than the results given by the image-only and gyroscope-only method, which demonstrates that our method is a preferable way to estimate the rotation for the autonomous mobile robot applications.

BACKGROUND: The aim of the study was to assess the efficacy and safety of D2 compared with D4 surgery in patients treated with curative intent. METHODS: An electronic search of the Cochrane Central Register of Controlled Trials, PubMed, Embase, ISI databases and Chinese Biomedical Literature Database was conducted till September 2010 to identify randomized controlled trials on related studies. Statistic analyses were carried out using RevMan software. RESULTS: Three randomized controlled trials with 1067 patients were included. The meta-analysis showed that D4 dissection tended to be associated with slightly higher 5-year survival rate, but there were no statistically significant differences between two groups [OR = 0.93, 95% CI (0.69–1.25)]. However, there appeared to be no statistically differences between D2 and D4 group in terms of recurrences of cancer, re-operation, hospital mortality, overall morbidity, anastomotic leakage, pancreatic fistula, operation time, though pulmonary increased in the D2 group comparing to that in the D4 group. CONCLUSIONS: Prophylactic D4 dissection is not recommended for patients with curable gastric cancer.

Tonsillectomy remains to be an ordinary operative process in otorhinolaryngology. Although there are a plenty of surgical means adopting in otorhinolaryngology, the advantage of one method over another has not been systematically demonstrated. The aim of designing this systematic review is to evaluate the efficiency of electrocautery tonsillectomy (ECT) compared with the microdebrider intracapsular tonsillotomy (MIT).We retrieved randomized controlled trials (RCTs) from PubMed, EMBASE, Cochrane Library, CBM. Two reviewers extracted the information of included trials independently. The quality of included trials was assessed according to the criteria provided by Cochrane Handbook 5.0.1.Four researches were meeting the inclusive criteria which contained 501 participants, 253 in microdebrider tonsillotomy group and 248 in electrocautery tonsillectomy group. Systematic review illustrated that MT group had the recovery to normal activity and diet faster than ECT group [χ(2)=1.02, P0.00001, 95% CI (-1.74, -1.30)] and [χ(2)=0.01, P0.0001, 95% CI (-2.56, -0.92)]. There was a statistically significant in blood loss between microdebrider tonsillotomy and electrocautery tonsillectomy, the mean difference of 5.0 ml [P=0.01, 95% CI (3.4, 26.6)]. There was no statistical significance in surgical time.Compared with the electrocautery tonsillectomy, microdebrider tonsillotomy could significantly speed up the time to return to normal activity and normal diet. Two groups were similar in terms of surgical time of tonsillectomy. This conclusion is needed to be further supported by large-scale, high-quality, placebo-controlled, double-blind trials between microdebrider tonsillotomy and other techniques in the surgery time and blood loss of operation.

Background and objective Survivin has gradually become an important target in diagnosis, prognosis prediction and treatment of tumor. There are many studies on urine-based survivin mRNA test using reverse transcription-polymerase chain reaction (RT-PCR) as a noninvasive examination for bladder cancer. However, its clinical value remains controversial. This study was to evaluate the diagnostic value of urine survivin mRNA detection with RT-PCR for bladder cancer by a systematic review of related studies. Methods With the search terms such as bladder neoplasm, survivin, RT-PCR, sensitivity, specificity and diagnosis, we systematically searched through PubMed, EMBASE, SCI, Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Full-text Database (CSJD), China Journal Full-text Database (CJFD), Chinese Medical Association (CMA) digital periodicals and Google Scholar totally from January 1997 to April 2009 for diagnostic trials with RT-PCR detection of urine survivin mRNA for bladder cancer. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) items were used to evaluate the quality of the included studies. Meta-disc software was used to calculate outcome indicators. Results Twenty-six studies, totally 2 416 patients, were eligible. Meta-analysis showed that compared with pathologic examination, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and summary receiver operating characteristic curve (SROC) of urine-based survivin mRNA test using RT-PCR for bladder cancer were 88%, 94%, 14.56, 0.13 and 0.9736, respectively. Nested RT-PCR got the highest sensitivity, specificity and SROC and the values were 91%, 95% and 0.9805, respectively. The sensitivity and specificity of general RT-PCR were the second highest, which were 87% and 94%, respectively. The sensitivity of quantitative RT-PCR was 80% and the specificity was 93%. Conclusions Comparing with pathologic examination, the sensitivity and specificity of urine-based survivin mRNA test using RT-PCR are relatively high. It can be used as an important adjunct method for cystoscope in early screening and postoperative monitoring of bladder cancer.

OBJECTIVE To evaluate the efficacy and adverse effects of gemcitabine versus pegylated liposomal doxorubicin in patients with progressive or recurrent ovarian cancer. METHODS We conducted a systematic literature search to identify all randomized controlled trials comparing gemcitabine and pegylated liposomal doxorubicin for progressive or recurrent ovarian cancer. Trial data were reviewed and extracted independently by 2 reviewers. We evaluated the quality of the included studies using the Handbook 5.0 recommend standards and then analyzed data by Cochrane Collaboration’s RevMan 5.0. RESULTS Two trials which included a total of 348 patients were analyzed. The results of meta-analysis showed that gemcitabine improved disease control rates signifi cantly be t er than pegylated liposomal doxorubicin. A greater number of patients receiving gemcitabine experienced neutropenia compared with patients receiving pegylated liposomal doxorubicin; however, hand-foot syndrome and mucositis were more severe in patients receiving pegylated liposomal doxorubicin. CONCLUSION Gemcitabine provided a limited advantage compared with pegylated liposomal doxorubicin. There exists an urgent need for more high-quality, multicenter, adequate randomized, controlled clinical trials for comparing gemcitabine with pegylated liposomal doxorubicin in patients with progressive/recurrent ovarian cancer.

Objective A meta-analysis of randomized controlled trials (RCT) was carried out to determine the efficacy and safety of capecitabine plus oxaliplatin (CAPOX) or fluorouracil plus oxaliplatin (FUOX) as first-line treatment for metastatic colorectal cancer (MCRC). Method A literature search was conducted of the Cochrane Controlled Trials Register Databases, Medline, Embase, ISI databases and Chinese Biomedical Literature Database without exclusion of material published in any language. RCTs conducted between 1998 and 2008 of CAPOX compared with FUOX regimens were considered for inclusion. Statistical analyses were carried out using RevMan software. Results Ten RCTs were included, involving 3208 patients. The meta-analysis showed that there were no statistically significant differences in tumour response rate (RR, 0.93; 95% CI, 0.87–1.01; P = 0.09), progression-free survival (PFS) (RR, 0.98; 95% CI, 0.94–1.01; P = 0.19), and overall survival (OS) (RR, 1.02; 95% CI, 0.97–1.07; P = 0.47) between CAPOX and FUOX regimen. However, symptoms of thrombocytopenia and hand-foot syndrome (HFS) were increased in the CAPOX regimen (RR, 1.89; 95% CI, 1.33–2.69; P = 0.0004 and RR, 3.40; 95% CI, 2.25–5.15; P

Background Several studies in the literature have investigated the possible role of the extent of lymphadenectomy in gastric cancer treatment failure. The current study attempted to determine the effectiveness and safety of lymphadenectomy with gastrectomy for the treatment of gastric cancer. Methods Randomized controlled trials (RCTs) were identified by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database, as well as by selecting references from relevant articles. Results Overall, 14 RCTs (3,432 patients) were included in the meta-analysis. Of the D1 and D2 surgery groups, the operative mortality and postoperative morbidity were higher in the D2 group than in the D1 group, but the 3- and 5-year survival rates were not statistically different. Also the operative time was shorter in D1 compared to D2. In the D2 versus the D3 surgical group, the operative mortality, percentage of postoperative complications, operative time, and hospital stay were not significantly different. Conclusions The results suggest that D2 and D3 surgery may not offer specific advantages for gastric cancer and instead may lead to disadvantages for patient outcomes.

Background: We 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. Methods: A 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. Results: In 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. Conclusion: BCT was better choice than MT for women with stage I or stage II breast cancer.