Background: With the medical advancement some studies put forward that letrozole (LE), a specific aromatase inhibitor with the function of reducing oestrogen synthesis, has recently been applied as a potentially better alternative compared with clomiphene citrate (CC), owing to that it has a superior efficacy as compared with CC in patients of unexplained infertility undergoing intrauterine insemination (IUI). However, there is no one study can clear and definite whether LE can replace the CC as first line drug. Objective: Our objective is to compare the LE with CC in the induction of ovulation in patients with unexplained infertility IUI. Method: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the include studies should meet our demand of this meta-analysis: studies are comparison between LE and clomiphene for superovulation in patients with unexplained infertility undergoing IUI; the result includes one of outcomes at least or more; maybe in some literature they does not use LE but the meaning is as same as it, we also adopt them; the patients must be at least 1 side of the unobstructed fallopian tube confirmed by hysterosalpingography (HSG) or laparoscopy; uterus is normal that is confirmed by laparoscopy, hysteroscopy, ultrasound, etc; semen detection is normal or mildly abnormal that is based on WHO Standard (1999). In all interest outcomes below we take the full advantage of RevMan5 to assess, the main measure is risk ratio (RR) with 95%confidence. Result: Based on the current meta-analysis, we rigorously consider that LE has a likelihood to improve dominant follicles (MD= –0.56, I 2 = 100%, P = .04; MD= -0.39, I 2 = 73%, P = .0003, respectively) and reduces the miscarriage rate (RR= 0.61, I 2 = 0%, P = .03). There is no significant differences between the 2 groups in The total rate of pregnancy, pregnancy rate per cycle, multiple pregnancy and endometrial thickness. (RR= 1.06, I 2 = 11%, P = .38; RR= 1.09, I 2 = 7%, P = .32; RR= 0.79, I 2 = 0%, P = .46; respectively) Conclusion: Combined with the results of current systematic review and meta-analysis through subgroup analysis and sensitivity analysis, we can be cautious: in general, compared with CC, LE is an effective treatment in the IUI cycle, has a likelihood to improve dominant follicles and reduces the miscarriage rate.
Aim:Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery.Background:With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation even leading to more infection and so on. However, there is no one study can clear and definite whether omitting the drainage after surgery or not.Method:Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of RevMan5 to assess, the main measure is odds ratio (OR) with 95% confidence, the publication bias are assessed by Egger test and Begg test.Result:The rate of postoperative pancreatic fistula (POPF) in no drainage group is much lower than that in routine drainage group (OR = 0.47, I2 = 43%, P < .00001). The result of the 2 randomized controlled trials (RCTs) in this pool are almost accord with the former (OR = 0.57, I2 = 0%, P = .05). In subgroup the result suggest that the peritoneal drainage can increase the morbidity (OR = 0.71, I2 = 15%, P = .0002) after pancreaticoduodenectomy (PD), but reduce the mortality (OR = 1.92, I2 = 8%, P = .03) after PD. In distal pancreatectomy (DP) the rate of POPF and clinically relevant pancreatic fistula (CR-PF) is lower without drainage; there is no significant difference in the CR-PF, hospital stay, intra-abdominal abscess, radiologic invention, and the reoperation.Conclusion:In the current meta-analysis, we cannot make a clear conclusion whether to abandon the routine drainage or not, but from the subgroup we can see something is safer than nothing to routine peritoneal drainage. And the patients who underwent DP can attempt to omit the drainage. But it still needs more RCTs to assess the necessity of drainage.
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