BACKGROUNDThe difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied. We performed a meta-analysis to compare the risk of cardiovascular adverse effects in patients with type 2 diabetes treated with rosiglitazone compared to pioglitazone.

METHODSThe Cochrane Library, PubMed, and Embase were searched to identify retrospective cohort studies assessing cardiovascular outcomes with rosiglitazone and pioglitazone. Meta-analysis of retrospective cohort studies was conducted using RevMan 5.0 software to calculate risk ratios.

RESULTSOf the 74 references identified, eight studies involving 945 286 patients fit the inclusion criteria for the analysis. The results of meta-analyses showed that, compared with pioglitazone, rosiglitazone therapy significantly increased the risk of myocardial infarction (risk ratios (RR) 1.17, 95% confidence interval (CI) 1.04 - 1.32; P = 0.01), the risk of heart failure (RR 1.18, 95%CI 1.02 - 1.36; P = 0.03), and total mortality (RR 1.13, 95%CI 1.08 - 1.20; P < 0.000 01).

CONCLUSIONCompared with pioglitazone, rosiglitazone was associated with an increased risk of myocardial infarction, heart failure, and all-cause mortality in diabetic patients.

Cardiovascular Diseases ; epidemiology ; Diabetes Mellitus ; drug therapy ; epidemiology ; mortality ; Humans ; Hypoglycemic Agents ; therapeutic use ; Retrospective Studies ; Thiazolidinediones ; therapeutic use

Objective To evaluate the comparative effectiveness and safety of bisphosphonates.Methods PubMed and Cochrane Database of Systematic Review were electronically searched for Meta -analysis and network Meta-analysis about the effectiveness and safety of bisphospho-nates.The randomized controlled trials ( RCTs ) comparing different bi-sphosphonates were manually searched.We then complete the descriptive analysis about the direct and indirect comparison between bisphospho-nates.Results Seventeen Meta-analyses were included, including 1 Meta-analysis comparing different bisphosphonates, 10 Meta-analyses comparing bisphosphonates and placebo, and 6 network Meta-analyses. The results of direct comparison showed that there was no significant difference between different bisphosphonates in effectiveness and safety. The results of indirect comparison showed that zoledronic acid, alendr-onate or zoledronic acid, alendronate, risedronate ranked first in preven-ting vertebral fracture, hip fracture, wrist, non -hip -non -vertebral fracture among different bisphosphonates, respectively.Zoledronic acid, zoledronic acid, etidronate ranked highest in causing any gastrointestinal adverse events, nausea, and discontinuation due to adverse drug reactions among different bisphosphonates, respective-ly.Conclusion Bisphosphonates are effective and safe medications for treating osteoporosis.Although zoledronic acid ranked highest in preventing fracture, it was also more likely to cause gastrointestinal adverse events.However, the quality of a body of evidence comparing different bisphosphonates is low.More well -designed clinical studies are needed to support above conclusion.

Objective To systematic evaluate whether combining drugs influence renal function could increases the risk of nephrotoxicity caused by vancomycin. Methods Electronic databases such as PubMed , EMBase, the Cochrane library and Chinese database (CNKI, WanFang, CBM) were searched from establishment dates of databases to January 2014.The clinical observational studies which include vancomycin com-bines other drugs which could influence renal function was identified . The studies were screened according to the inclusion and exclusion crite-ria, the data were extracted, the quality of the included studies was as-sessed , and Meta-analysis was performed using RevMan 5.3 software. Results A total of six cohort studies were included , containing 1312 pa-tients, 791 patients of them using vancomycin alone , the other 521 patients combining other renal influence drugs .Compare with singly using vancomy-cin, combining renal influence drugs could increase nephrotoxicity signifi-cantly(P<0.01), but the heterogeneity is huge(P<0.05).After the sensi-tivity analysis , nephrotoxicity increasing still significantly ( P <0.01 ) . Conclusion Combining drugs which influence renal function could increase nephrotoxicity caused by vancomycin , so we should avoid combining drugs in clinical practice , or focus on monitoring when combining .

Objective To systematic evaluate the necessity of vancomy-cin therapeutic drug monitoring in cancer patients .Methods Electronic databases such as PubMed , EMBase, Cochrane library and Chinese data-base (CNKI, WanFang, CBM) were searched from establishment dates of databases to January 2014.The clinical observational studies which in-clude cancer patients using vancomycin intravenously was identified .The studies were screened according to the inclusion and exclusion criteria , the data were extracted , the quality of the included studies was assessed , and Meta -analysis was performed using Rev Man 5.3 software. Results Six cohort studies were identified .Compared with no -cancer patients, infectious treatment failure increases significantly (P<0.05), the target concentration rate of vancomycin decrease significantly (P<0.05).Conclusion As the decrease of target concentration rate and increase of treatment failure , cancer patients need therapeutic drug monitoring ( TDM) to adjust the dose of vancomycin .

Objective To systematically assess the relationship between individualized vancomycin regimens and clinical outcomes .Methods Electronic databases such as PubMed , EMbase, CNKI were searched. The clinical studies which focus on individualized vancomycin regimens was identified.Meta-analysis was conducted by Revmen 5.3 software. Results A total of 6 studies were included ,involving 797 patients.The results of Meta -analysis revealed that compared with conventional group, there was a significant differences in attainment of target concen-tration and microbiological eradicated rates of patient -tailored group (P<0.05), but no significant differences in mortality , clinical cure rates and nephrotoxicity ( P>0.05 ) .There was a significant differences in attainment of target concentration between therapeutic drug monitoring ( TDM) and non -TDM groups ( P<0.05 ) .Conclusion A patient -tailored initial dosing regimens may increases the attainment of target con-centration and microbiological eradicated rates .Adjust dosing regimen with TDM may increases the attainment of target concentration .

Objective To systematic evaluate the necessity of vancomy-cin therapeutic drug monitoring in intensive care unit ( ICU ) patients compare with general ward patients . Methods Electronic databases such as PubMed , Embase , the Cochrane library and Chinese database (CNKI, WanFang, CBM) were searched from establishment dates of databases to January 2014.The clinical observational studies which in-clude ICU patients using vancomycin intravenously was identified .The studies were screened according to the inclusion and exclusion criteria , the data were extracted , the quality of the included studies was assessed , and Meta-analysis was performed using Rev Man 5.3 software. Results Three cohort studies were identified . One study shows no difference in the rate of treatment failure of ICU compare with general ward patients ( P>0.05 ) .Two studies shows nephrotoxicity increased significantly of ICU patients compare with general ward patients (P<0.05).Conclusion As the increase of nephrotoxicity and large individual difference , ICU patients need vancomycin TDM more .Due to the low methodological quality of the included studies , more high -quality clinical studies need to be conducted to verify this conclusion .

Objective To evaluate the quality of clinical practice guide-lines (CPGs) for type 1 diabetes mellitus(T1DM), so as to provide rec-ommendations for regulating the development of diabetes evidence-based clinical guidelines and updating the existing diabetes clinical guidelines. Methods CNKI, WANFANG, PubMed, EMBase, China guideline clearinghouse(CGC), national guideline clearinghouse (NGC), guide-lines international network ( G-I-N) were searched for CPGs published between January 1st 2009 and July 31st 2014 for type 1 diabetes.Two in-dependent assessors assessed the quality of each CPG using the appraisal of guidelines for research and evaluation Ⅱ ( AGREE Ⅱ) instrument. Results Sixteen guidelines were evaluated in which 15 are in English and the other is in Chinese.The mean scores for each domain were:scope and purpose 72%, stakeholder involvement 53%, rigor of development 51%, clarity of presentation 72%, applicability 53%, editorial independence 49%.Five guidelines ( NICE, BOHTA, CDA, SIGN, NKF ) scored above 50% in each domain.Conclusion The overall quality of CPGs for glycemic control in T1DM is quite well.Greater efforts are needed to improve Chinese T1DM guideline quality, especially in the domain of rigor, stakeholder, applicability and editorial independence.

Objective To evaluate the association between vancomycin trough concentrations and incidence of nephrotoxicity . Methods Pubmed, EMbase, Cochrane Library, China National Knowledge Infra-structure ( CNKI ) , WanFang Data and Chinese Bio Medical Literature Database ( CBM) were systematically searched from inception to February 2014.Specificity, sensitivity and predictive odds ratios with 95% confi-dence intervals were calculated.Results Seventeen observational stu-dies and 2802 patients were included in the Meta-analysis.While cut-offs of trough concentrations were 10 , 15 or 20 mg? L-1 , pooled sensi-tivity were 0.83, 0.69 or 0.43, pooled specificity were 0.35, 0.61 or 0.83 , pooled predictive odds ratios were 2.65 , 3.60 or 3.85. Conclusion There is definitive association between vancomycin trough concentrations ( ascending from 10 to 20 mg? L-1 ) and incidence of nephrotoxicity.Trough concentration is an appropriate parameter of thera-peutic drug monitoring of vancomycin.

Objective To assess the optimal voriconazole dosing regimens for obese patients.Methods PubMed, EmBase, the Cochrane Library, Clinicaltriasl.gov and three Chinese databases ( CNKI, CBM, and Wan-Fang ) were searched through March 2015.Clinical trials or observational studies comparing the clinical and pharmacokinetic outcomes of different dosing regimens in obese patients or healthy subjects were included.Results Three cohort studies involving 237 subjects were included in the review.There were no statistical difference among actual body weight ( ABW) , ideal body weight ( IBW) , adjusted body weight ( AdjBW) and normal body weight ( NBW) groups on rates of hepatotoxicity and neuro-toxicity.No studies reported clinical response of treatment.Attainment of target concentration in AdjBW group was significantly higher than ABW and NBW group , respectively.Random plasma concentration in ABW group was significantly higher than NBW group when using intravenous administration (Median 6.4 vs 2.8μg· mL-1 ).Trough concentration in ABW group was significantly higher than NBW ( MD=2.70μg· mL-1 ) , IBW ( MD=2.25μg· mL-1 ) and AdjBW ( MD =2.90 μg · mL-1 ) groups , respectively.Conclusion Voriconazole AdjBW and IBW dosing regimens are recommended for obese patients.Drug monitoring may be necessary for obese patients to ensure the safety of voriconazole.

Objective To evaluate the efficacy and safety of salvianolate injection for angina by overview of systematic reviews( SRs).Methods The Cochrane library, PubMed, EMbase, CBM, CNKI and Wanfang da-ta were searched from the inception to July 2015.According to the inclu-sion and exclusion criteria, articles for systematic reviews and Meta -analysis were selected.Extracted the trials of systematic reviews and then RevMan 5.3 was used to undertake Meta analysis.Results A total of 7 articles were included, and the scores of AMSTAR tool in 67 percent of articles were above 7.A total of 18 outcomes were included, the results of grading showed that 15 outcomes ( 83 percent ) were graded as low quality.A total of 33 trials involving 3126 patients were overviewed.The results showed that:compared with the control group, salvianolate signifi-cantly increased the clinical efficacy ( P <0.001 ) and improved of electrocardiograph ( P<0.001 ) in treating unstable angina;and lowered the adverse drug reaction ( P <0.001 ).Conclusion Salvianolate is effective and safe for angina pectoris.Because of the poor methodological quality on the whole studies, high quality randomized controlled trials are required to provide reliable evidence.