Background Temporomandibular disorders(TMD)are the leading cause of chronic orofacial pain,which significantly affects patients’quality of life.However,the efficacy of acupuncture in the management of TMD remains unc...Background Temporomandibular disorders(TMD)are the leading cause of chronic orofacial pain,which significantly affects patients’quality of life.However,the efficacy of acupuncture in the management of TMD remains unclear.Objective This systematic review aimed to conduct a PRISMA-compliant review to critically assess the therapeutic efficacy of acupuncture as an intervention for patients with TMD.Methods We searched nine electronic databases for randomized controlled trials on acupuncture for TMD published up to February 4,2025.Eligible studies included adults diagnosed with TMD and compared acupuncture(manual,electroacupuncture,warm,auricular,thread-embedding,or laser)with conservative treatment(positive control)or sham acupuncture(negative control).Outcomes included pain intensity,mouth opening,pressure pain threshold,and adverse events.Risk of bias was assessed using ROB 2,and certainty of evidence was evaluated using GRADE.All outcome data were analyzed using RevMan 5.4 software.Low heterogeneity was defined as I^(2)≤50% and P≥0.1,in which case a fixed-effects model was applied.High heterogeneity(I^(2)>50% or P<0.1)prompted further analysis to identify its source.After excluding the influence of evident heterogeneity,a random-effects model was used for the meta-analysis.Results Of the 2664 screened records,14 randomized controlled trials involving 476 participants met the inclusion criteria.Acupuncture significantly reduced pain intensity compared with that of negative controls(MD=-1.75,95%confidence interval[CI]-2.47 to-1.03;P<0.00001;I^(2)=60%)but showed no difference compared with that of positive controls(MD=-0.06,95%CI-0.62 to 0.50;P=0.83;I^(2)=0%).No significant differences were observed in pain-free jaw opening,whereas acupuncture improved maximum mouth opening relative to negative controls(MD=1.80,95%CI 1.62 to 1.97;P<0.00001;I^(2)=0%).For pressure pain threshold,two small studies suggested greater increases with acupuncture.Safety data were limited,with only one trial reporting mild adverse events in the acupuncture group.Conclusion Based on limited evidence,acupuncture appears superior to negative controls in relieving pain associated with TMD but shows no significant advantage over positive controls.The certainty of the evidence for all outcomes,as assessed by GRADE,was low or very low.Therefore,these findings should be interpreted with caution.Future high-quality randomized controlled trials are warranted to further evaluate the role of acupuncture in the management of patients with TMD.展开更多
BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatiti...BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatitis B virus decompensated cirrhosis(HBV-DC)remains to be investigated.AIM To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.METHODS This retrospective study included patients with HBV-DC admitted to two tertiary centers in China.In-hospital overall survival,90-d transplant-free survival,5-year post-discharge survival,and cumulative incidence of ACLF were evaluated.Risk factors for death were analyzed considering liver transplantation as a competing event.RESULTS A total of 1281 hospitalized HBV-DC patients were included;284 had ACLF at admission.The overall prevalence of BI was 28.1%.The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without,in both the patients admitted with and without ACLF.The presence of BI significantly increased the risk of developing ACLF[subdistribution hazard ratio(sHR)=2.52,95%CI:1.75-3.61,P<0.001]in the patients without ACLF.In the patients discharged alive,those who had an episode of BI had a significantly lower 5-year transplant-free survival.BI was an independent risk factor for death in the patients admitted without ACLF(sHR=3.28,95%CI:1.93-5.57),while in ACLF admissions,the presence of pneumonia,but not other type of BI,independently increased the risk of death(sHR=1.87,95%CI:1.24-2.82).CONCLUSION BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival.HBV-DC patients should be monitored carefully for the development of BI,especially pneumonia,to avoid an adverse outcome.展开更多
Ti-Al-V-Zr quaternary titanium alloys were designed followingα-{[Al-Ti12](AlTi2)}17-n+β-{[Al-Ti12Zr2](V3)}n,where n=1-7(the number ofβunits),on the basis of the dual-cluster formula of popular Ti-6Al-4V alloy.Such ...Ti-Al-V-Zr quaternary titanium alloys were designed followingα-{[Al-Ti12](AlTi2)}17-n+β-{[Al-Ti12Zr2](V3)}n,where n=1-7(the number ofβunits),on the basis of the dual-cluster formula of popular Ti-6Al-4V alloy.Such an alloying strategy aims at strengthening the alloy via Zr and V co-alloying in theβ-Ti unit,based on the originalβformula[Al-Ti14](V2Ti)of Ti-6Al-4V alloy.The microstructures of the as-cast alloys by copper-mold suction-casting change from pureα(n=1)toα+α’martensite(n=7).When n is 6,Ti-5.6Al-6.8V-8.1Zr alloy reaches the highest ultimate tensile strength of 1,293 MPa and yield strength of 1,097 MPa,at the expense of a low elongation of 2%,mainly due to the presence of a large amount of acicularα’martensite.Its specific strength far exceeds that of Ti-6Al-4V alloy by 35%.展开更多
文摘Background Temporomandibular disorders(TMD)are the leading cause of chronic orofacial pain,which significantly affects patients’quality of life.However,the efficacy of acupuncture in the management of TMD remains unclear.Objective This systematic review aimed to conduct a PRISMA-compliant review to critically assess the therapeutic efficacy of acupuncture as an intervention for patients with TMD.Methods We searched nine electronic databases for randomized controlled trials on acupuncture for TMD published up to February 4,2025.Eligible studies included adults diagnosed with TMD and compared acupuncture(manual,electroacupuncture,warm,auricular,thread-embedding,or laser)with conservative treatment(positive control)or sham acupuncture(negative control).Outcomes included pain intensity,mouth opening,pressure pain threshold,and adverse events.Risk of bias was assessed using ROB 2,and certainty of evidence was evaluated using GRADE.All outcome data were analyzed using RevMan 5.4 software.Low heterogeneity was defined as I^(2)≤50% and P≥0.1,in which case a fixed-effects model was applied.High heterogeneity(I^(2)>50% or P<0.1)prompted further analysis to identify its source.After excluding the influence of evident heterogeneity,a random-effects model was used for the meta-analysis.Results Of the 2664 screened records,14 randomized controlled trials involving 476 participants met the inclusion criteria.Acupuncture significantly reduced pain intensity compared with that of negative controls(MD=-1.75,95%confidence interval[CI]-2.47 to-1.03;P<0.00001;I^(2)=60%)but showed no difference compared with that of positive controls(MD=-0.06,95%CI-0.62 to 0.50;P=0.83;I^(2)=0%).No significant differences were observed in pain-free jaw opening,whereas acupuncture improved maximum mouth opening relative to negative controls(MD=1.80,95%CI 1.62 to 1.97;P<0.00001;I^(2)=0%).For pressure pain threshold,two small studies suggested greater increases with acupuncture.Safety data were limited,with only one trial reporting mild adverse events in the acupuncture group.Conclusion Based on limited evidence,acupuncture appears superior to negative controls in relieving pain associated with TMD but shows no significant advantage over positive controls.The certainty of the evidence for all outcomes,as assessed by GRADE,was low or very low.Therefore,these findings should be interpreted with caution.Future high-quality randomized controlled trials are warranted to further evaluate the role of acupuncture in the management of patients with TMD.
基金Supported by the National Natural Science Foundation of China,No.81570535 and No.81770587Key Projects in the National Science and Technology Pillar Program during the Thirteenth Five-year Plan Period,No.2017ZX10203201-008,No.2018ZX09206005-003,and 2017ZX10202202-005-004+4 种基金the Shanghai Three-Year Plan of the Clinical Skills and Innovations,No.16CR1002Athe Shanghai Municipal Key Clinical Specialty,No.shslczdzk01103the Shanghai Three-Year Plan of the Key Subjects Construction in Public Health-Infectious Diseases and Pathogenic Microorganism,No.15GWZK0102the Suzhou Expert Team of Clinical Medicine,No.SZYJTD201717the Joint Research Initiative-Shanghai Jiao Tong University School of Medicine,No.YW20190002
文摘BACKGROUND Reports on bacterial infection(BI)in decompensated cirrhosis(DC)is mainly from alcoholic cirrhosis.The role of BI as a trigger or complication of acute-onchronic liver failure(ACLF)in patients with hepatitis B virus decompensated cirrhosis(HBV-DC)remains to be investigated.AIM To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.METHODS This retrospective study included patients with HBV-DC admitted to two tertiary centers in China.In-hospital overall survival,90-d transplant-free survival,5-year post-discharge survival,and cumulative incidence of ACLF were evaluated.Risk factors for death were analyzed considering liver transplantation as a competing event.RESULTS A total of 1281 hospitalized HBV-DC patients were included;284 had ACLF at admission.The overall prevalence of BI was 28.1%.The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without,in both the patients admitted with and without ACLF.The presence of BI significantly increased the risk of developing ACLF[subdistribution hazard ratio(sHR)=2.52,95%CI:1.75-3.61,P<0.001]in the patients without ACLF.In the patients discharged alive,those who had an episode of BI had a significantly lower 5-year transplant-free survival.BI was an independent risk factor for death in the patients admitted without ACLF(sHR=3.28,95%CI:1.93-5.57),while in ACLF admissions,the presence of pneumonia,but not other type of BI,independently increased the risk of death(sHR=1.87,95%CI:1.24-2.82).CONCLUSION BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival.HBV-DC patients should be monitored carefully for the development of BI,especially pneumonia,to avoid an adverse outcome.
基金financially supported by the Key Discipline and Major Project of Dalian Science and Technology Innovation Foundation(Grant No.2020JJ25CY004)the National Basic Research Program of China(Grant No.2020JCJQZD165)。
文摘Ti-Al-V-Zr quaternary titanium alloys were designed followingα-{[Al-Ti12](AlTi2)}17-n+β-{[Al-Ti12Zr2](V3)}n,where n=1-7(the number ofβunits),on the basis of the dual-cluster formula of popular Ti-6Al-4V alloy.Such an alloying strategy aims at strengthening the alloy via Zr and V co-alloying in theβ-Ti unit,based on the originalβformula[Al-Ti14](V2Ti)of Ti-6Al-4V alloy.The microstructures of the as-cast alloys by copper-mold suction-casting change from pureα(n=1)toα+α’martensite(n=7).When n is 6,Ti-5.6Al-6.8V-8.1Zr alloy reaches the highest ultimate tensile strength of 1,293 MPa and yield strength of 1,097 MPa,at the expense of a low elongation of 2%,mainly due to the presence of a large amount of acicularα’martensite.Its specific strength far exceeds that of Ti-6Al-4V alloy by 35%.
