Context: Panax notoginseng (Burk.) F.H. Chen (Araliaceae) preparations (PNP) are traditional Chinese medicines used as adjuvant therapeutics for diabetic kidney disease (DKD). Objective: To systematically review the efficacy of PNP as adjunct DKD therapy, including their effects on kidney function, serum lipid levels and fasting blood glucose levels. Methods: The databases PubMed, Embase, Medline, Cochrane Library, CINAHL, China Biology Medicine disc, Wanfang, VIP and China National Knowledge Infrastructure were systematically searched from the date of their inception until May 2019. Panax notoginseng, Panax notoginseng saponins, Lulutong, Xueshuantong and Xuesaitong were the key terms searched. Randomized controlled trials (RCTs) comparing the combined use of PNP and conventional medicines (CM) versus CM for DKD were included. Data were pooled using random or fixed effect models depending on heterogeneity. Results: In total, 24 RCTs involving 1918 participants were analysed. Adjunct PNP with CM was associated with reduction of albuminuria (MD-26.89 mg, 95% CI:-33.35 to-20.42), proteinuria (MD-0.32 g/24 h, 95% CI:-0.36 to-0.27), serum creatinine (MD-4.52 lmol/L, 95% CI:-8.71 to-0.32), total cholesterol (MD-1.56 mmol/L, 95% CI:-2.33 to-0.78), triglycerides (TG) (MD-0.56 mmol/L, 95% CI:-0.80 to-0.31) and low-density lipoprotein cholesterol (MD-0.94 mmol/L, 95% CI:-1.49 to-0.40) compared with CM. Conclusions: This is the first meta-analysis investigating adjuvant PNP therapy for DKD. PNP apparently exerted beneficial effects on kidney function and improved the metabolism of serum lipids by CM. Further, well-conducted, high-quality trials on DKD patients are needed to provide high-quality evidence.

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Background: Febrile neutropenia (FN) in cancer patients can be life threatening and require the timely antimicrobial agents treatment. Methods: To compare the effectiveness and safety of carbapenems versus β-lactams for FN. PubMed, Medline (Ovid SP), Cochrane CENTRAL, and Embase were searched up to March 2019. FN in patients due to undergoing chemotherapy and treated with carbapenems and β-lactams were included. Odds ratio (OR) and 95% confidence interval (CI) were estimated. Results: Fifty randomized controlled trials (RCTs) studies involving 10,995 participants were included. Carbapenems were more likely to experience treatment success without modification (OR = 1.34, 95% CI = 1.24–1.46) compared with β-lactams. Meropenem (OR = 1.36, 95% CI = 1.18–1.56; OR = 1.24, 95% CI = 1.01–1.53), imipenem/cilastatin (OR = 1.40, 95% CI = 1.19–1.65; OR = 1.31, 95% CI = 1.04–1.67) showed higher effectiveness from that by β-lactams monotherapy or in combination with aminoglycoside, respectively. Carbapenems–aminoglycoside combination therapy does not provide an advantage over carbapenems alone. Meropenem showed similar risk of adverse events (AEs) versus β-lactams. Imipenem/cilastatin was related to higher risk of AEs compared with β-lactams. There was no significant difference between carbapenems and β-lactams monotherapy or in combination. Conclusion: Meropenem and imipenem/cilastatin monotherapy appears to be available treatment for FN compared with β-lactams. Imipenem/cilastatin was related to higher risk of AEs. Balancing the evidence for drug efficacy and side effects, meropenem monotherapy appears to be available treatment for FN. Individual centers should select the best matching therapy regimens according to local epidemiology and susceptibility patterns.