Table1_Systematic review and meta-analysis of Coptis chinensis Franch.-containing traditional Chinese medicine as an adjunct therapy to metformin in the treatment of type 2 diabetes mellitus.DOC

Background: In China, Coptis chinensis Franch. (Chinese name: Huanglian) prescriptions (HLPs) are prominent hypoglycemic agents used in glycemic control. However, the curative effect of HLPs as adjunctive therapies for type 2 diabetes mellitus (T2DM) has not been evaluated. Based on a systematic review and a meta-analysis, this study was conducted to assess the effects of HLPs combined with metformin as a reinforcing agent for T2DM.Materials and methods: A total of 33 randomized controlled trials (RCTs) reporting on 2,846 cases concerning the use of HLPs in the treatment of T2DM were identified from the China National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang, PubMed, Cochrane Library, and EMBASE databases. Primary outcomes included fasting blood glucose (FBG), 2-h postprandial blood glucose (2hPG), glycosylated hemoglobin, type A1c (HbA1c), fasting serum insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Secondary outcomes included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and gastrointestinal dysfunction (GD). Continuous data were expressed as mean differences (MDs) with 95% confidence intervals (CIs). The methodological quality of the included RCTs was assessed by Cochrane evidence-based medicine systematic evaluation. Statistical analysis was performed using the Review Manager and Stata software. The required information size and treatment benefits were evaluated by trial sequential analysis (TSA). The quality of evidence was rated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach.Results: The results revealed that HLPs are beneficial to improve the following: FBG (MD = −1.16%, 95% CI: −1.24 to −1.07), 2hPG (MD = −1.64%, 95% CI: −1.84 to −1.43), HbA1c (MD = −0.78%, 95% CI:−0.96 to −0.60), FINS (MD = −1.94%, 95% CI: −2.68 to −1.20), HOMA-IR (MD = −0.77%, 95% CI: −1.28 to −0.27), TC (MD = −0.70%, 95% CI: −1.00 to −0.39), TG (MD = −0.57%, 95% CI: −0.74 to −0.40), LDL-c (MD = −0.70%, 95% CI: −0.97 to −0.43), and HDL-c (MD = −0.21%, 95% CI: −0.32 to −0.10) for patients with T2DM. The funnel plot, Egger’s test, and trim-and-fill method indicated a moderate publication bias in the results. The TSA showed that the required sample size of HLPs in improving FBG, 2hPG, HbA1c, FINS, HOMA-IR, TC, TG, LDL-c, and HDL-c could sufficiently draw reliable conclusions. GRADE assessment revealed that the quality of the evidence for the effectiveness of HLPs in improving FBG was moderate, but the quality of evidence for 2hPG, HbA1c, FINS, HOMA-IR, TC, TG, LDL-c, and HDL-c was low, and for GD was very low.Conclusion: The systematic review and meta-analysis suggested that HLPs were beneficial for achieving glycemic control. However, HLPs recommended for T2DM patients have yet to be confirmed because of the poor methodological quality of some trials. Therefore, more RCTs with multicenter and double-blind designs are needed to assess the efficacy of HLPs for patients with T2DM.</p

Forest plots for enrolled studies showing that there were no associations between PARP expression and (A) ER expression (positive vs. negative), (B) PR expression (positive vs. negative), (C) HER2 expression (positive vs. negative), and (D) Ki67 level (high vs. low).

Forest plots for enrolled studies showing that there were no associations between PARP expression and (A) ER expression (positive vs. negative), (B) PR expression (positive vs. negative), (C) HER2 expression (positive vs. negative), and (D) Ki67 level (high vs. low).</p

Prognostic and clinicopathological value of poly (adenosine diphosphate-ribose) polymerase expression in breast cancer: A meta-analysis

<div><p>Background</p><p>Previous studies have shown that the poly (adenosine diphosphate-ribose) polymerase (PARP) level is a promising indicator of breast cancer. However, its prognostic value remains controversial. The present meta-analysis evaluated the prognostic value of PARP expression in breast cancer.</p><p>Materials and methods</p><p>Eligible studies were retrieved from the PubMed, Web of Science, Embase, and Cochrane Library databases through July 20, 2016. Studies investigating PARP expression as well as reporting survival data in breast cancer were included. Two independent reviewers carried out all literature searches. The pooled relative risk (RR) and hazard ratio (HR) with 95% confidence interval (95% CI) were applied to assess the association between PARP expression and the clinicopathological features and survival outcome in breast cancer.</p><p>Results</p><p>A total of 3506 patients from eight eligible studies were included. We found that higher PARP expression indicated a worse clinical outcome in early stage breast cancer, with a HR of 3.08 (95% CI, 1.14–8.29, P = 0.03) for disease-free survival and a HR of 1.82 (95% CI, 1.20–2.76; P = 0.005) for overall survival. Moreover, increased PARP expression was significantly associated with higher nuclear grade (RR, 1.51; 95% CI, 1.12–2.04; P = 0.008) in breast cancer. A similar correlation was detected in triple-negative breast cancer (TNBC; RR, 1.81; 95% CI, 1.04–3.17; P = 0.04).</p><p>Conclusions</p><p>Our findings indicated that elevated PARP expression correlated with worse prognosis in early stage breast cancer. Furthermore, high PARP expression was associated with higher nuclear grade and TNBC.</p></div

Image1_Systematic review and meta-analysis of Coptis chinensis Franch.-containing traditional Chinese medicine as an adjunct therapy to metformin in the treatment of type 2 diabetes mellitus.TIF

Background: In China, Coptis chinensis Franch. (Chinese name: Huanglian) prescriptions (HLPs) are prominent hypoglycemic agents used in glycemic control. However, the curative effect of HLPs as adjunctive therapies for type 2 diabetes mellitus (T2DM) has not been evaluated. Based on a systematic review and a meta-analysis, this study was conducted to assess the effects of HLPs combined with metformin as a reinforcing agent for T2DM.Materials and methods: A total of 33 randomized controlled trials (RCTs) reporting on 2,846 cases concerning the use of HLPs in the treatment of T2DM were identified from the China National Knowledge Infrastructure (CNKI), Weipu (VIP), Wanfang, PubMed, Cochrane Library, and EMBASE databases. Primary outcomes included fasting blood glucose (FBG), 2-h postprandial blood glucose (2hPG), glycosylated hemoglobin, type A1c (HbA1c), fasting serum insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Secondary outcomes included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and gastrointestinal dysfunction (GD). Continuous data were expressed as mean differences (MDs) with 95% confidence intervals (CIs). The methodological quality of the included RCTs was assessed by Cochrane evidence-based medicine systematic evaluation. Statistical analysis was performed using the Review Manager and Stata software. The required information size and treatment benefits were evaluated by trial sequential analysis (TSA). The quality of evidence was rated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach.Results: The results revealed that HLPs are beneficial to improve the following: FBG (MD = −1.16%, 95% CI: −1.24 to −1.07), 2hPG (MD = −1.64%, 95% CI: −1.84 to −1.43), HbA1c (MD = −0.78%, 95% CI:−0.96 to −0.60), FINS (MD = −1.94%, 95% CI: −2.68 to −1.20), HOMA-IR (MD = −0.77%, 95% CI: −1.28 to −0.27), TC (MD = −0.70%, 95% CI: −1.00 to −0.39), TG (MD = −0.57%, 95% CI: −0.74 to −0.40), LDL-c (MD = −0.70%, 95% CI: −0.97 to −0.43), and HDL-c (MD = −0.21%, 95% CI: −0.32 to −0.10) for patients with T2DM. The funnel plot, Egger’s test, and trim-and-fill method indicated a moderate publication bias in the results. The TSA showed that the required sample size of HLPs in improving FBG, 2hPG, HbA1c, FINS, HOMA-IR, TC, TG, LDL-c, and HDL-c could sufficiently draw reliable conclusions. GRADE assessment revealed that the quality of the evidence for the effectiveness of HLPs in improving FBG was moderate, but the quality of evidence for 2hPG, HbA1c, FINS, HOMA-IR, TC, TG, LDL-c, and HDL-c was low, and for GD was very low.Conclusion: The systematic review and meta-analysis suggested that HLPs were beneficial for achieving glycemic control. However, HLPs recommended for T2DM patients have yet to be confirmed because of the poor methodological quality of some trials. Therefore, more RCTs with multicenter and double-blind designs are needed to assess the efficacy of HLPs for patients with T2DM.</p

Forest plots for enrolled studies showing positive associations between the PARP expression level and (A) nuclear grade (3 vs. 1 and 2) and (B) triple-negative breast cancer (TNBC) (positive vs. negative).

<p>Forest plots for enrolled studies showing positive associations between the PARP expression level and (A) nuclear grade (3 vs. 1 and 2) and (B) triple-negative breast cancer (TNBC) (positive vs. negative).</p

Forest plots for enrolled studies showing that there were no associations between PARP expression and (A) age (≥50 vs. <50 years), (B) tumor size (large vs. small), (C) lymph node metastasis (positive vs. negative), and (D) BRCA1 status (positive vs. negative).

<p>Forest plots for enrolled studies showing that there were no associations between PARP expression and (A) age (≥50 vs. <50 years), (B) tumor size (large vs. small), (C) lymph node metastasis (positive vs. negative), and (D) BRCA1 status (positive vs. negative).</p

Baseline characteristics of the included publications.

<p>Baseline characteristics of the included publications.</p

Flow diagram for identification of retrieved publications.

<p><i>From</i>: Moher D, Liberati A, Tetzlaff j, Altman DG, The PRISMA Group (2009). <i>Preferred</i> Reporting items for Systematic Reviews and <i>Meta</i>-<i>Analyses</i>: The PRISMA Statement. PLOS Med 6(7):e1000097. doi: <a href="http://dx.doi.org/10.1371/journal.pmed1000097" target="_blank">10.1371/journal.pmed1000097</a> For more information, visit <a href="http://www.prisma-statement.org" target="_blank">www.prisma-statement.org</a>.</p

Forest plot for enrolled publications showing that there was no correlation between PARP level and pCR in breast cancer.

<p>Forest plot for enrolled publications showing that there was no correlation between PARP level and pCR in breast cancer.</p

Forest plot for publications assessing the hazard ratio (HR) for PARP expression and breast cancer overall survival (OS).

<p>Forest plot for publications assessing the hazard ratio (HR) for PARP expression and breast cancer overall survival (OS).</p