OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/trea...OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/treated by GI were searched in China National Knowledge Infrastructure Database, Wanfang, China Science and Technology Journal Database, Web of Science, Cochrane library, Embase, PubMed and Chinese Biomedical Literature Database, with the publication data no later than April, 2016. The Co- chrane risk of bias method was used to evaluate the methodological quality of the RCTs. The data were analyzed by Review Manager 5.3, Stata 13.0, and WinBUGS 14 software.RESULTS： Totally 37 RCTs involving 4330 patients were included. By direct comparison, the results of GI group were significantly superior to the routine WM group in the total effective rates [OR = 3.61, 95% CI （2.93, 4.44）, P 〈 0.0001], the neural function defect score （NFDS） [MD = - 4.39, 95% CI （- 5.47, - 3.32）, P 〈 0.0001]. Network Meta-analysis （NMA） results showed that, between S GIs in efficacy, the difference comparing ginaton injections （GbE） to ginkgo-dipyidamolum injections （GD） [OR = 1.74, 95% CI （0.73, 3.65）], shuxuening injections （SXN） [OR = 1.06, 95% CI （0.609, 1.697）] or ginkgolides in- jections （GK） [OR = 4.711, 95% CI （1.178, 13.21）] reach statistical significance; the difference compar- ing GD to GK reach statistical significance [OR = 2.791, 95% CI （0.866, 6.908）]; the difference com- paring SXN to GK reach statistical significance [OR = 4.537, 95% CI （1.203, 12.41）]. Besides, there was no difference between 4 GIs in NFDS. Proba- bility ranking result showed a great possibility for GK [Surface under the Cumulative Ranking curve （SUCRA） = 80.3%] in improving the total effective rates, which were followed by GD （SUCRA = 73.34%）, SXN （SUCRA = 46.59%）, GbE （SUCRA = 45.46%）, floium ginkgo extract and tertram ethy- pyrazine sodium chloride injections （FT） （SU- CRA = 35.64%）. However, GK （SUCRA = 80.3%） or GbE （SUCRA = 69.4%） was better than other GIs in reducing NFDS.GK ＋ WM is the best treatment measures to reduce NFDS in cerebral infarction, which were followed by SXN ＋ WM （SUCRA = 51.6%）, GD ＋ WM （SUCRA = 48.1%）. CONCLUSION： GIs was more effectiveness on CI than the routine Western Medicine. But based on the limitations of the study, more high-quality ran- domized controlled trials will be necessary.展开更多
Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease(PAD). Coro-nary artery disease(CAD) is highly prevalent, and often times coexist, in patients with PAD. The management ...Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease(PAD). Coro-nary artery disease(CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive re-vascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complica-tions in the peri-operative period, is not effective and may be associated with significant bleeding and throm-botic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiactroponin after vascular surgery is predictive of long-term mortality risk. Medical therapies such as aspirin and statins are recommended for patients with post-operative myocardial ischemia. Ongoing trials are as-sessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.展开更多
基金Supported by National Natural Science Foundation of China:Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection(No.81473547)Multidimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris(No.81673829)
文摘OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/treated by GI were searched in China National Knowledge Infrastructure Database, Wanfang, China Science and Technology Journal Database, Web of Science, Cochrane library, Embase, PubMed and Chinese Biomedical Literature Database, with the publication data no later than April, 2016. The Co- chrane risk of bias method was used to evaluate the methodological quality of the RCTs. The data were analyzed by Review Manager 5.3, Stata 13.0, and WinBUGS 14 software.RESULTS： Totally 37 RCTs involving 4330 patients were included. By direct comparison, the results of GI group were significantly superior to the routine WM group in the total effective rates [OR = 3.61, 95% CI （2.93, 4.44）, P 〈 0.0001], the neural function defect score （NFDS） [MD = - 4.39, 95% CI （- 5.47, - 3.32）, P 〈 0.0001]. Network Meta-analysis （NMA） results showed that, between S GIs in efficacy, the difference comparing ginaton injections （GbE） to ginkgo-dipyidamolum injections （GD） [OR = 1.74, 95% CI （0.73, 3.65）], shuxuening injections （SXN） [OR = 1.06, 95% CI （0.609, 1.697）] or ginkgolides in- jections （GK） [OR = 4.711, 95% CI （1.178, 13.21）] reach statistical significance; the difference compar- ing GD to GK reach statistical significance [OR = 2.791, 95% CI （0.866, 6.908）]; the difference com- paring SXN to GK reach statistical significance [OR = 4.537, 95% CI （1.203, 12.41）]. Besides, there was no difference between 4 GIs in NFDS. Proba- bility ranking result showed a great possibility for GK [Surface under the Cumulative Ranking curve （SUCRA） = 80.3%] in improving the total effective rates, which were followed by GD （SUCRA = 73.34%）, SXN （SUCRA = 46.59%）, GbE （SUCRA = 45.46%）, floium ginkgo extract and tertram ethy- pyrazine sodium chloride injections （FT） （SU- CRA = 35.64%）. However, GK （SUCRA = 80.3%） or GbE （SUCRA = 69.4%） was better than other GIs in reducing NFDS.GK ＋ WM is the best treatment measures to reduce NFDS in cerebral infarction, which were followed by SXN ＋ WM （SUCRA = 51.6%）, GD ＋ WM （SUCRA = 48.1%）. CONCLUSION： GIs was more effectiveness on CI than the routine Western Medicine. But based on the limitations of the study, more high-quality ran- domized controlled trials will be necessary.
基金Supported by A career development award from the VA Office of Research and Development,No.1IK2CX000699-01
文摘Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease(PAD). Coro-nary artery disease(CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive re-vascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complica-tions in the peri-operative period, is not effective and may be associated with significant bleeding and throm-botic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiactroponin after vascular surgery is predictive of long-term mortality risk. Medical therapies such as aspirin and statins are recommended for patients with post-operative myocardial ischemia. Ongoing trials are as-sessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.
