As we highlight,

the see more majority of studies were small, with typically 30 participants per arm. Meta-analysis aims to overcome issues of power through pooling, thus increasing sample size and power. We applied an OIS on the overall event rate of partial response and found that a pooled sample size of 1,108 provided sufficient evidence of an effect. This did not apply to specific formulations. We further assessed issues of methodological rigour MAPK inhibitor as two major concerns with Chinese-based clinical trials. Firstly, is that only positive trials are published in Chinese medical journals, and second, is that some trials reported as randomized are, in fact, not randomized. A recent evaluation by Wu et al. found that many studies labelled as RCTs with Chinese journals were, in fact, not randomized[71] In our own experience, we recognize this website many Chinese clinical trialists have not been exposed to appropriate clinical epidemiology training. We examined publication bias through both visual inspection of the funnel plot on the primary outcome (PR) and through statistical tests, but were unable to identify publication bias. However,

funnel plots cannot rule out publication bias and we remain cautious that many negative trials likely exist. From a clinical standpoint, the results of this study are very encouraging but should be implemented with caution. The average clinician will be reassured that TCM interventions, both herbal-based and animal/insect-based, were safely combined with chemotherapy. The average clinician, however, likely will not scrutinize the results of this study Resveratrol using evidence-based principles and may implement our findings into practice due to the overwhelming positive response in our meta-analysis. Given this tendency, the results from this study should be carefully disseminated to the medical community with the caveat that although promising, our findings need to be confirmed via a RCT conducted in a Western academic setting. Our study may prove useful for a number of reasons. Firstly, there is reason to further examine the evidence of several of the interventions included in our analysis. Other investigators have examined the role

of herbal medicines and TCM interventions for hepatocellular cancers, lung cancers and hepatitis and found compelling evidence in humans [72–75] However, perhaps a far more important finding from our analysis and approach is the role that searching for clinical trials in non-English languages may play in drug discovery. Important first line drugs, such as artemisin-based therapies for malaria, have been discovered through searching existing trials in non-English languages. [76] There have now been two studies prior to ours that examined the role of TCM interventions on survival and clinical outcomes in patients also receiving TACE. [72, 75] The first study, by Shu et al[72], published in 2005, included 26 RCTs of interventions including 2079 patients.