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Meta-analysis

Meta-analysis is the collection, arrangement and analysis of numerous empirical studies on a certain topic by scholars and experts in the hope of finding a clear relationship model between the problem or the variables concerned, which can make up for the deficiency of traditional review articles.
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A Meta-analysis of the efficacy and safety of Kanglaite injection combined with chemotherapy in the treatment of pancreatic cancer
Lu Zhang, Jia-Jian Lv, Zhe Yang, Shu-Zhen Wu, Jun-Chen Feng, Xin-Juan Wang, Ya-Nan Liu, Xiao-Chun Han
7Drug Combination Therapy    2019, 1 (4): 210-223.   https://doi.org/10.12032/DCT201903005
Abstract PDF (761KB)  

Objective: To investigate the efficacy and safety of Kanglaite injection (KLT) combined with chemotherapy in the treatment of pancreatic cancer. Methods: PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Data, and  Chinese Biomedical Database (CBM) were searched to get the studies about KLT plus chemotherapy for pancreatic cancer  (from established to May 2019). Data extraction and bias risk assessment were carried out by two authors independently according to the retrieval method. RevMan (version 5.3) were employed for data analysis. Results: A total of 151 literatures were retrieved and 11 literatures were finally included. A total of 614 patients were included, including 308 in the treatment group and 306 in the control group. The results of meta-analysis showed that compared with chemotherapy alone, KLT combined with chemotherapy could improve the effective rate [PORR = 0.0009, OR=1.96, 95% CI (1.32, 2.92)] and disease control rate [PDCR <0.00001, OR=2.53, 95% CI (1.76, 3.62)], improve KPS score [P<0.00001, OR=3.59, 95% CI (2.00, 6.44)] and body mass indexes [P=0.0003, OR=3.45, 95% CI (1.78, 6.69)], prolong progression free survival (PFS) and overall survival (OS), reduce the rate of myelosuppression [P=0.03, OR=0.54, 95% CI (0.30, 0.95)], but could not reduce the occurrence of neurotoxicity [P=0.49, OR=0.80, 95% CI (0.42, 1.51)] and digestive tract reaction [P=0.51, OR=0.83, 95% CI (0.48, 1.44)]. Conclusion: KLT combined with chemotherapy can improve the curative effect of pancreatic cancer, improve the quality of life of patients, prolong the survival of patients, and reduce the incidence of bone marrow suppression. However, due to the limitation of the quality and quantity of included literatures, this conclusion needs to be verified by high-quality study.

Systematic evaluation and meta-anlysis of the efficacy of Xiaochaihu Decoction in the treatment of chronic superficial gastritis
Shi-Jun Li, Teng Huang, Xiao-Li Ma
7Drug Combination Therapy    2019, 1 (4): 224-236.   https://doi.org/10.12032/DCT201905001
Abstract PDF (613KB)  

Objective: To compare the effectiveness of Xiaochaihu Decoction (XCHD) or the modified XCHD combined with western medicine in the treatment of superficial gastritis. Methods: We collected the studies about XCHD or the modified XCHD combined with western medicine for superficial gastritis in China Biology Medicine (CBM) Database (2010-2018), China National Knowledge Infrastructure (CNKI) Database (2010-2018), VIP Database (2010-2018), Wanfang Database (2010-2018) and the Back Issues Database of Hebei University. The randomized controlled trials (RCTs) were included in this study. The literatures were independently extracted by two researchers and the Cochrane Review Handbook (version 5.1.0) was applied to assess the quality of included trials. Statistical analysis was performed with RevMan (version 5.3). Results: A total of 8 RCTs, including 732 cases, were included finally. Meta-analysis results showed that compared with the western medicine treatment group, XCHD or the modified XCHD combined with western medicine could improve the total effective rate [OR=4.67, 95%CI (2.90,7.55), P<0.00001], physiological function [MD=10, 95%CI (8.78,11.23), P<0.00001], role physical [MD=13.85, 95%CI (11.19,16.51), P<0.00001], physical pain [MD=11.64, 95%CI (9.05,14.23), P<0.00001], general health [MD=11.20, 95%CI (9.52,12.88), P<0.00001], vitality [MD=13.46, 95%CI (12.30,14.62), P<0.00001], social function [MD=19.20, 95%CI (17.32,21.09), P<0.00001], affection  function [MD=30.3, 95%CI (28.99,31.62), P<0.00001], mental health [MD=9.80, 95%CI (8.44,11.16), P<0.00001]. Conclusion: XCHD or the modified XCHD combined with western medicine in the treatment of superficial gastritis has good performance in clinical efficacy and the improvement of quality of life. However, with several methodology problems existing in the included RCTs, the effectiveness of XCHD or the modified XCHD is still need more high-quality randomized, double-blind, placebo-controlled trials to further confirmed.

A meta-analysis of Banxia Xiexin decoction versus omeprazole in the treatment of gastroesophageal reflux disease
Xiao-Ting Ma, Jing-Na Zhou, Bin Hao
5TMR Clinical Research    2019, 2 (4): 148-156.   https://doi.org/10.12032/TMRClinRes20190907013
Abstract PDF (666KB)  

Objective: To investigate the clinical efficacy and safety of Banxia Xiexin decoction and omeprazole in the treatment of gastroesophageal reflux disease (GERD). Methods: EMbase, Cochrane, PubMed, CNKI, Wan Fang and VIP database were searched from inception to November 2018 according to the search strategy. Eligible randomized controlled clinical trials related to the efficacy of omeprazole compared with Banxia Xiexin decoction in the treatment of GERD were included according to the inclusion and exclusion criteria. Total effective rate, pathological improvement rate, total symptom score, acid reflux symptoms, heartburn symptoms, improvement of post-sternal pain symptoms, and incidence of adverse reactions were evaluated. Data analysis was performed with RevMan5.3 software provided by Cochrane Collaboration. Results: A total of 15 studies were enrolled, including 1,532 patients. Meta-analysis results showed that the total effective rate of Banxia Xiexinfang was higher than that of omeprazole in the treatment of GERD (odds ratio (OR) = 3.99, 95% confidence intervals (CI) (2.58, 6.15), P < 0.00001). Pathological improvement under endoscopy was not obvious (OR = 1.98, 95% CI (0.94, 4.19), P = 0.07) between the two groups. The total symptom score improved significantly , indicating that Banxia Xiexin decoction has an objective advantage over omeprazole in the treatment of GERD (standardised mean difference(SMD) = −2.56, 95% CI (−3.86, −1.26), P = 0.0001), The incidence of adverse reactions in patients treated with Banxia Xiexin decoction is lower than omeprazole group (OR = 0.09, 95% CI (0.02, 0.39), P = 0.001). In addition, total effective rate of Banxia Xiexin decoction combined with omeprazole was higher than omeprazole alone (OR = 6.31, 95% CI (2.86, 13.92), P < 0.00001). Conclusion: Banxia Xiexin decoction is superior to omeprazole in total effective rate, total symptom score and adverse reaction rate in the treatment of GERD. The clinical efficacy of Banxia Xiexin decoction combined with omeprazole is better than that of omeprazole alone. However, due to the low quality of the included literatures, large-scale and high-quality RCTs are still needed for further confirmation.

Lower level of copper and zinc in serum confer risk to vitiligo: a systematic review and meta-analysis
Tao-Yang, Yi-Bo Cao, Wan-Ling Liang, Jian-Xia Wen, Shi-Zhang Wei, Hao-Tian Li, Tian-Bao Xiao
5TMR Clinical Research    2019, 2 (4): 136-147.   https://doi.org/10.12032/TMRClinRes20191001015
Abstract PDF (811KB)  

Etiology and pathogenesis of vitiligo has not been interpreted perfectly. Epidemiologic evidence about falling level of copper and zinc in blood serum increasing the risk of vitiligo remains contradictory. We investigated the association between blood serum copper and zinc with vitiligo via performing a meta-analysis. Results indicates there was a significant lower level of copper and zinc in patients with vitiligo compared with healthy population ((Z = 3.55, P = 0.000; SMDCu = −0.84, 95% CI, −1.30 to −0.38) and (Z = 5.40, P = 0.000; SMDZn = −1.01, 95% CI, −1.38 to −0.64), respectively). Meanwhile, no statistical evidence for publication bias in the end outcome. Conclusion from our finding offers a meaningful insight into lower level of copper and zinc in serum confer risk to vitiligo.

Effects of core stability exercise on rehabilitation in stroke patients with hemiplegia: a meta-analysis
Liu Ting-Ting, Lei Meng-Jie, Liu Ya-Qian, Meng Li-Na, Jin Chang-De
TMR Non-Drug Therapy    2018, 1 (2): 41-52.   https://doi.org/10.12032/TMRND201801007
Abstract HTML PDF (11744KB)  

Highlights

Core stability training on the basis of conventional rehabilitation therapy can improve the trunk control ability, balance ability, walking function and activity of daily living in patients with stroke hemiplegia.

Editor’s Summary

Core stability exercise, as one of the non-drug therapies, combined with conventional rehabilitation therapy has better effects on rehabilitation in stroke patients with hemiplegia.

Abstract

Objective: To evaluate the effects of core stability exercise (CST) on rehabilitation in stroke patients with hemiplegia. Methods: Randomly controlled trials about the effects of CST on rehabilitation in stroke patients with hemiplegia were searched in the database, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, CBM and VIP. Search terms include “core stability training / core stability exercise / core stabilization training / core stabilization exercise / core strength training / core strength exercise” and “stroke / brain ischemia / cerebral infarction / cerebral hemorrhage / intracranial thrombosis / brain hemorrhage / cerebrovascular disorder / cerebrovascular accident, cerebrovascular disease / hemiplegia / hemiparesis / stroke rehabilitation”. Study screening, data extraction and quality assessment were conducted by two researchers independently. Data was analyzed using RevMan 5.3 software. Results: Totally 11 studies and 704 patients were included with 352 patients in experiment group and 352 in control group.Results of meta-analysis showed that combination of CST and conventional rehabilitation had better effects on trunk control [MD = 10.44, 95% CI (8.83-12.04), P < 0.001], banlace [MD = 5.6, 95% CI (4.81-6.39), P < 0.001], activities of daily living [MD = 12.06, 95% CI (7.65-16.46), P < 0.001], ambulation functional [MD = 0.72, 95% CI (0.32-1.12), P < 0.001] and walking speed [MD = 3.39, 95% CI (2.03-4.76), P < 0.001] than conventional rehabilitation, but there is no clear difference on walking stride [MD = 2.52, 95% CI (-0.25-5.29), P = 0.07] between two groups. Conclusion: CST together with conventional rehabilitation can better improve trunk control, banlace, activities of daily living, ambulation functional and walking speed in stroke patients compared with conventional rehabilitation, but can not make the walking stride better significantly. However, since the conclusion of this meta-analysis was drawn based on middle quality RCTs, future high quality researchs should be conducted to confirm its positive intervention effects.

Effects of midwife-led psychological intervention on delivery outcomes: a meta-analysis
Jia Yuan, Yang Si-Yuan, Guo Li-Ming, Wu Qian, Meng Fan-Jie
TMR Non-Drug Therapy    2018, 1 (3): 109-118.   https://doi.org/10.12032/TMRND201801015
Abstract HTML PDF (1466KB)  

Highlights

Midwife-led psychological interventions can improve the natural delivery rate of pregnant women, shorten the duration of the first stage of delivery, and decrease postpartum hemorrhage.

Editor’s Summary

This meta-analysis illustrates the importance of midwife-led psychological interventions for the natural delivery, providing reliable evidence for its clinical use.

Abstract

Objective: To systematically review the influence of psychological intervention of midwives on the delivery mode and outcomes. Methods: Databases including Cochrane Library, PubMed, Medline, EMBASE, CINAHL, CNKI, Wangfang, and VIP were searched for randomized controlled trials studying the effects of midwife-led psychological nursing on puerpera. Two evaluators independently searched and screened the papers, extracted relevant data, and quality assessment of the included studies, followed by a meta-analysis of the papers using RevMan 5.3 software. Results: 12 studies with 1,395 patients were included. The results of the meta-analysis showed that compared to conventional nursing, midwife-led psychological intervention can improve the number of people who choose natural delivery [Z = 7.53, 95% CI (2.07, 3.45), P < 0. 001], shorten the duration of the first stage of delivery [Z = 45.10, 95% CI (-4.43, -4.06), P < 0. 001), reduce postpartum hemorrhage after delivery for two hours [Z = 21.68, 95% CI (-63.92, -53.32), P < 0. 001]; these differences were statistically significant. Conclusion: Psychological interventions led by midwives can improve the natural delivery rate of pregnant women, shorten the duration of the first stage of delivery, and decrease postpartum hemorrhage after delivery for two hours; thus, it can be popularized for clinical use.

Efficacy of Liuzijue respiratory exercise in patients with chronic obstructive pulmonary disease: a meta-analysis
Liu Ting-Ting, Lei Meng-Jie, Wang Hui-Ping, Huang Yan-Qiu, Jin Chang-De
9TMR Non-Drug Therapy    2018, 1 (3): 75-86.   https://doi.org/10.12032/TMRND201801012
Abstract HTML PDF (1495KB)  

Highlights

Liuzijue respiratory exercise can better improve lung function, functional capacity, and life quality of COPD patients compared with conventional care. Compared with the whole body respiratory exercise, Liuzijue only improves the functional capacity of COPD.

Editor’s Summary

As early as Qin and Han dynasties, the treatment of pulmonary diseases with guided breathing has already been recorded in the ancient book of Lüshichunqiu (B.C. 239, Warring States).

Abstract

Objective: To evaluate the effects of Liuzijue respiratory exercise in patients with chronic obstructive pulmonary disease (COPD). Method: Randomly controlled trials of Liuzijue respiratory exercise in the treatment of COPD were searched in the database, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, CBM, and VIP. Study screening, data extraction, and quality assessment were conducted by two researchers independently. Data were analyzed using RevMan 5.3 software. Results: 11 studies with 915 COPD patients were included. Results of meta-analysis showed that compared with conventional care, Liuzijue respiratory exercise had shown better effects on FEV1 (Forced expiratory volume in 1 second) [MD = 0.18, 95% CI (0.06, 0.30), P = 0.004], FEV1% pred [MD = 10.21, 95% CI (7.25, 13.18), P < 0.001], FEV1 / FVC% (Forced vital capacity) [MD = 8.32, 95% CI (3.23, 13.40), P < 0.001], 6-minute walk distance [MD = 10.97, 95% CI (5.81, 16.12), P < 0.001] and life quality [MD = -10.07, 95% CI (-12.84, -7.30), P < 0.001]. However, no difference was observed in the effective rate between these two groups. Compared with whole body respiratory exercise, except for the better effects on 6-minute walk distance [MD = 37.82, 95% CI (6.51, 69.13), P = 0.02], no difference in FEV1, FEV1% pred, FEV1 / FVC% and life quality were observed between these two groups. Conclusion: Liuzijue respiratory exercise can better improve lung function, functional capacity, and life quality of COPD patients compared with conventional care. Compared with the whole body respiratory exercise, Liuzijue could improve the functional capacity of COPD patients significantly and showed similar effcets on lung function and life quality.

Effects of moxibustion on cancer-related fatigue: a meta-analysis
Yuan Jia, Si-Yuan Yang, Li-Min Guo, Xue Bai, Ya-Nan Wang, Fan-Jie Meng
9TMR Non-Drug Therapy    2019, 2 (2): 62-70.   https://doi.org/10.12032/TMRND201902013
Abstract HTML PDF (910KB)  

Highlights

Moxibustion can improve cancer-related fatigue (CRF) and enhance immune function. With the advantages of simplicity, convenient, efficacy, inexpensiveness, and lack of side effects, moxibustion appeared to be efficacious auxiliary therapeutic method for CRF.

Editor’s Summary

The conclusion has some limitations as there exist few but rigorous randomized controlled trials and no trials in English, they were all from China. Much more high-quality studies with adequate design and power are in need urgently to confirm the therapeutic value of moxibustion for cancer-related fatigue profoundly.

Abstract

Objective: To systematically evaluate the efficacy of moxibustion in the treatment of cancer-related fatigue (CRF). Methods: Randomized controlled trials (RCTs) using moxibustion to treat cancer-related fatigue in Cochrane Library, PubMed, China Knowledge Network, Wanfang and VIP databases were searched. Two reviewers independently searched, reviewed the literature, extracted data, and evaluated the methodological quality. RevMan5.3 software was used for meta-analysis. Results: A total of 942 patients were included in 11 RCTs. The meta-analysis results showed that moxibustion can reduce fatigue score [MD = -2.04, 95% CI (-4.06, -0.33), P < 0.001], improve the score of quality of life QLQ-C30 [(MD = 8.44, 95% CI (1.85, 15.03), P < 0.001], also boost the number of differentiation antigen of T cells , such as CD3 [MD = 7.82, 95% CI (3.14, 12.49), P = 0.01], CD8 [MD = -3.15, 95% CI (-11.36, 5.06), P < 0.001], and the number of NK cells [MD = 5.88, 95% CI (3.56, 8.20), P = 0.01].Conclusion: Moxibustion can improve the degree of CRF, improve the quality of life and enhance immune function.

Comparison of the effects of moxibustion and lipid-lowering drugs for primary hyperlipidemia: a meta-analysis
Si-Yu Liu, Yan-Ru Xia, Yan-Zuo Liu, Sheng-Nan Song, Wei Xu, Bao-Jie Han
9TMR Non-Drug Therapy    2019, 2 (3): 85-94.   https://doi.org/10.12032/TMRND201902015
Abstract HTML PDF (822KB)  

Highlights

The goal of the meta-analysis in this paper is to compare the effects of moxibustion and lipid-lowering drugs on the patients with hyperlipidemia. The results showed that the moxibustion had a more significantly effect compared with statins and fibrates on Total cholesterol (TC) and Low-density lipoprotein cholesterol (LDL-C), but the results didn't show statistically significant difference on Triglycerides and High-density lipoprotein cholesterol (HDL-C). In the comparison of adverse reactions, moxibustion had advantages. In terms of the comparison between moxibustion and proprietary Chinese medicine, it was impossible to show therapeutic differences between moxibustion and proprietary Chinese medicine in various indicators.

Editor’s Summary

By systematically comparing the effects of moxibustion and lipid-lowering drugs on hyperlipemia, the authors found that moxibustion had a better effect to reduce the TC and LDL-C compared with statins and fibrates, but no advantages in lowing triglyceride level and HDL-C. While, there was no robust evidence that moxibustion was superior to Chinese patent medicine in improving the blood lipid indexes of patients with hyperlipidemia.

Abstract

Objective: Systematically compared the effects of moxibustion and lipid-lowering drugs on hyperlipemia. Methods: Randomized controlled trials (RCTs) published before December 2018 were all aggregated, focusing on evaluation of moxibustion and lipid-lowering drugs for hyperlipemia from PubMed, EMbase, the Cochrane Library, Web of Science, CNKI, CBM, WANFANG database and VIP databases. The quality of the included studies was assessed basing on Cochrane handbook 5.1.0, and the available data were analyzed with RevMan software (version 5.3). Results: Totally 8 RCTs were included with 561 patients. Compared with statins, moxibustion had a better effect to reduce the total cholesterol (TC) (MD = -0.19, 95% CI: -0.24, 0.13, P < 0. 001). Moxibustion also had a better effect to reduce low density lipoprotein cholesterol (LDL-C) in compared with statins and fibrates (MD = 0.20, 95% CI: 0.15, -0.25, P < 0. 001), but there were no significant differences between statins, fibrates and moxibustion in lowering triglyceride (TG) (MD = -0.02, 95% CI: -0.09, 0.05, P = 0.61) and High-density lipoprotein cholesterol (HDL-C) (MD = 0.03, 95% CI: 0.06, 0.13, P = 0.51). While, compared with the Chinese patent medicine, there was no significant difference in the efficacy of lowering TC (MD = 0.05, 95% CI: 0.17, 0.27, P = 0.67), TG (MD = -0.08, 95% CI: 0.41, 0.24, P = 0.61), LDL-C (MD = -0.14, 95% CI: 0.38, 0.11, P = 0.28) and HDL-C (MD = 0.11, 95% CI: 0.01, 0.22, P = 0.06). Conclusion: Compared with statins and fibrates, moxibustion had advantages in lowering TC and LDL-C, but there was no robust evidence that moxibustion was superior to Chinese patent medicine in improving the blood lipid indexes of patients with hyperlipidemia.

Efficacy of blood-letting puncture and cupping in the treatment of periarthritis of shoulder: a systematic review
Li-Hui Zhang, Li-Xin Wang, Qian Cui, Guo-Wei Zhang
2TMR Integrative Medicine    2018, 2 (4): 175-191.   https://doi.org/10.12032/TMRIM201802033
Abstract HTML PDF (1123KB)  

Highlights:

The application of blood-letting puncture and cupping in the treatment of scapulohumeral periarthritis can provide strong evidence for future clinical treatment.

Abstract

Objective: To systematically evaluate the clinical efficacy and safety of blood-letting puncture and cupping in the treatment of periarthritis of shoulder. Methods: We electronically searched databases including CNKI, VIP, PubMed, WanFang Data, EMbase Cochrane Library and to collect randomized controlled trials (RCTs) and quasi-randomized controlled trials about blood-letting puncture and cupping for periarthritis of shoulder and evaluated the quality of the documents collected by the Cochrane collaboration, provided by Review Manager 5 software for statistical analysis. Then the quality of the included trials was assessed using the Jadad scale and GRADE system was used to score the quality and grade recommendation. Results: Thirty RCTs involving 2556 patients were included. The results of meta-analysis showed that: Total effective rate OR = 6.21 [OR = 6.21, 95%CI (4.69, 8.21), P < 0.001]. The results of GRADE system evaluation showed that the level of evidence was B, and the recommendation level was weak recommendation. Conclusion: Blood-letting puncture and cupping shows better effects than other treatments and preferably security in the treatment of periarthritis of shoulder. We do not find any serious adverse reaction reports. Due to limited quality of the included studies, more high quality studies are needed to verify the above conclusion.

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