Targeted therapy with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has become a standardized treatment option for epidermal growth factor receptor (EGFR) mutation-positive advanced non-small cell lung cancer (NSCLC), but clinical findings of unavoidable primary or secondary resistance ultimately lead to disease progression. For this reason, finding markers for early prediction of effective populations and exploring optimized therapeutic regimens to prolong or reverse secondary resistance have become the focus of research at home and abroad.
To systematically evaluate the efficacy and safety of EGFR-TKI combined with chemotherapy for the first-line treatment of EGFR-mutated advanced non-small cell lung cancer based on data from domestic and international literature.
Three professionally recognized databases, PubMed, Embase, and Cochrane Library, were searched for randomized controlled trials eligible for the efficacy and safety of EGFR-TKI combination chemotherapy versus single-agent EGFR-TKI for the first-line treatment of patients with EGFR-mutated advanced non-small-cell lung cancer published from the time of construction to November 2023.Data on progression-free survival (PFS), overall survival (OS), objective remission rate (ORR), disease control rate (DCR), and grade≥3 adverse events were collected and analyzed by two investigators who independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Subgroup analyses were performed based on baseline clinical characteristics, and data were statistically analyzed using RevMan 5.4.1.
Ten eligible studies with a total of 2 029 patients were included, including 1 049 patients in the experimental group of EGFR-TKI combined with standard chemotherapy; and 980 patients in the control group of EGFR-TKI alone. Meta-analysis showed that compared with EGFR-TKI monotherapy, EGFR-TKI combination chemotherapy prolonged PFS (HR=0.54, 95%CI=0.49-0.60, P<0.000 01) and OS (HR=0.69, 95%CI=0.59-0.79, P<0.000 01). Compared with EGFR-TKI monotherapy, EGFR-TKI combination chemotherapy improved ORR (OR=1.95, 95%CI=1.57-2.42, P<0.000 01) and DCR (OR=1.76, 95%CI=1.13-2.74, P=0.01) in patients with advanced NSCLC with EGFR mutations. In patients with concomitant brain metastases, EGFR-TKI combination chemotherapy prolonged PFS (HR=0.42, 95%CI=0.34-0.52, P<0.000 01) and OS (HR=0.69, 95%CI=0.51-0.94, P=0.02) in patients with EGFR-mutated advanced NSCLC compared with single-agent EGFR-TKI treatment.In patients without brain metastases at baseline, EGFR-TKI combination chemotherapy prolonged PFS compared with single-agent EGFR-TKI treatment in patients with advanced NSCLC with EGFR mutations (HR=0.62, 95%CI=0.53-0.72, P<0.000 01). The incidence of grade ≥3 adverse reactions was higher with EGFR-TKI combination chemotherapy than with single-agent EGFR-TKI treatment in patients with advanced NSCLC with EGFR mutations (OR=4.25, 95%CI=2.74-6.61, P<0.000 01). The incidence of grade ≥3 adverse reactions was higher in the combination therapy group than in the monotherapy group.
EGFR-TKI combination chemotherapy significantly prolongs first-line PFS and OS in EGFR-mutated advanced non-small cell lung cancer, especially in patients with baseline brain metastases. The incidence of adverse events was increased in the combination therapy group, particularly the incidence of grade ≥3 hematologic toxicity, but was overall safe and manageable.
Malnutrition has become one of the adverse complications in patients with cirrhosis, and early nutritional screening and early identification of patients with cirrhosis can effectively improve clinical outcomes, however, the types of nutritional screening tools for patients with cirrhosis are varied and not yet standardized, and further research is needed.
To evaluate the applicability of 4 nutritional screening tools for patients with cirrhosis.
CNKI, VIP, Wanfang Data, PubMed, Embase, Cochrane Library and Web of Science were searched for diagnostic studies related to nutritional screening tool screens for malnutrition in cirrhotic patients. The search time was limited to December 2023. Two researchers individually read and filtered the literatures, extracted data, and assessed the bias risk of the incorporated researches. RevMan 5.4.1, Meta-DiSc, and StataMP 17.0 were used to perform network meta-analysis. The sensitivity, specificity, positive predictive value and negative predictive value of different nutritional screening tools were ranked by the surface under the cumulative ranking curve (SUCRA) .
5 Chinese and 5 English literatures were incorporated, totaling 10, including 1 299 patients; and four nutritional screening tools were included: the Nutritional Risk Screening 2002 (NRS2002), the Royal Free Hospital-Nutritional Prioritization Tool (RFH-NPT), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Assessment (SGA). The findings of meta-analysis revealed that the combined sensitivity of the four nutritional screening tools was 0.65 (95%CI=0.56-0.73), 0.93 (95%CI=0.89-0.96), 0.77 (95%CI=0.72-0.82), respectively. The combination specificity was 0.87 (95%CI=0.83-0.91), 0.72 (95%CI=0.64-0.79), 0.81 (95%CI=0.68-0.90), and MUST only be studied separately, without the combination sensitivity and combination specificity. The results of network meta-analysis showed the sensitivity and negative predictive value of SGA were lower than that of RFH-NPT (OR=0.03, 95%CI=0-0.55; OR=0.08, 95%CI=0.01-0.81, P<0.05) ; and the sensitivity and negative predictive value of RFH-NPT were higher than that of NRS2002 (OR=44.33, 95%CI=3.94-498.52; OR=17.68, 95%CI=2.13-147.05, P<0.05). The results of the combined subject work characterization curve (SROC) showed that the area under the SROC curve (AUC) for screening for malnutrition in cirrhotic patients was 0.86 for NRS2002, 0.90 for RFH-NPT, and 0.85 for SGA. The SUCRA values of the tools ranked in terms of combined sensitivity from highest to lowest were RFH-NPT (SUCRA=99.5%) >MUST (SUCRA=43.0%) >SGA (SUCRA=39.0%) >NRS2002 (SUCRA=18.5%) ; the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: MUST (SUCRA=91.4%) >NRS2002 (SUCRA=49.1%) >SGA (SUCRA=39.8%) >RFH-NPT (SUCRA=19.7%) ; the SUCRA values of these tools ranked in terms of positive predictive value from highest to lowest were MUST (SUCRA=95.2%) >RFH-NPT (SUCRA=37.4%) >NRS2002 (SUCRA=36.1%) >SGA (SUCRA=31.3%) ; the SUCRA values of these tools ranked in terms of negative predictive value from highest to lowest were RFH-NPT (SUCRA=99.1%) >MUST (SUCRA=44.9%) >SGA (SUCRA=39.4%) >NRS2002 (SUCRA=16.7%) .
The current evidence shows that RFH-NPT and MUST are suitable, but this conclusion still needs to be further confirmed by large samples and multiple high-quality studies.
Population aging has heightened, raising concerns about elderly health. Oral frailty, a novel frailty phenotype in the elderly, directly impacts the quality of life. A thorough grasp of oral frailty's prevalence in the elderly is crucial for formulating effective preventive and interventional strategies.
To systematically evaluate the prevalence of oral frailty in the elderly.
The CNKI, Wanfang Data, VIP, CBM, PubMed, Web of Science, Embase, CINAHL and Cochrane Library databases were searched for literature related to the study purpose with a time limit of the construction of the database to 19 April 2024. Literature was independently screened, information extracted and quality assessed by 2 researchers, and meta-analysis was performed using Stata 14.0 software.
A total of 19 cross-sectional studies were included, with a total sample size of 11 776 cases and a risk of bias quality score of 6-9, all of which were of moderate or high quality. Meta-analysis showed that the prevalence of oral frailty in elderly people was 29.5% (95%CI=24.1%-35.2%), and the prevalence of pre-oral frailty was 47.9% (95%CI=40.5%-55.4%). Subgroup analyses showed that the progressive increase in the prevalence of oral frailty in the elderly with advancing age. Higher prevalence rates of oral frailty were observed in individuals screened using the Oral Frailty Index-8 (P<0.05) .
The prevalence of oral frailty is high in the elderly, and attention should be focused on the oral health status of the elderly in China, with the selection of appropriate screening and assessment tools and early interventions.
Studies have confirmed that executive function in overweight and obese children is closely related to obesity and may have a bidirectional association. Aerobic exercise, as an effective intervention, can effectively promote their brain development and cognitive function, especially executive function, but the quantitative relationship of the improvement effect still needs to be further explored.
To systematically evaluate the intervention effect of aerobic exercise on executive function-related indexes in overweight and obese children.
Randomized controlled trials of aerobic exercise interventions for executive function in overweight and obese children were searched in CNKI, Wanfang Data, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases, and the timeframe for searching was from the establishment of each database to July 2023. The quality of the included literature was assessed according to the Cochrane Risk of Bias Assessment Tool, and Meta-analysis of outcome indicators was performed using RevMan 5.3 and Stata 15.0 software.
Nine randomized controlled trials, including 940 overweight and obese children, were finally included. The results of Meta-analysis showed that a single session of aerobic exercise intervention was effective in improving the executive function of overweight and obese children (WMD=-6.98, 95%CI=-11.89 to -2.07, P=0.005). Subgroup analyses showed no significant differences in the improvement of any of the executive function subcomponents in overweight and obese children with a single intervention duration of less than 30 minutes of aerobic exercise (WMD=-0.84, 95%CI=-9.37 to 7.68, P=0.85) ; aerobic exercise with a single intervention duration longer than 30 minutes improved inhibitory function in overweight and obese children (WMD=-10.50, 95%CI=-19.15 to -1.85, P=0.02). When a long-term exercise intervention was carried out (the intervention period was 8 weeks), in contrast to the control group, the aerobic exercise improved interference control in overweight and obese children (WMD=-0.16, 95%CI=-0.18 to -0.14, P<0.000 01), on planning (WMD=4.20, 95%CI=-8.34 to 16.73, P=0.51), attention (WMD=0.41, 95%CI=-12.08 to 12.91, P=0.95), synchronization (WMD=3.93, 95%CI=-8.22 to 16.08, P=0.53), and continuity (WMD=2.48, 95%CI=-9.18 to 14.14, P=0.68) were not significantly improved.
Aerobic exercise for a single long period of time had a selective positive effect on executive function subcomponents in overweight and obese children, and aerobic exercise for a long period of time with a fixed frequency and duration improved interference control in overweight and obese children, but did not produce an improvement in planning, attention, synchronization, or continuity.
