This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(...Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.展开更多
Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effectiv...Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.展开更多
Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based ins...Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.展开更多
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
OBJECTIVE:To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral h...OBJECTIVE:To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage through a network Meta-analysis.METHODS:A computer-based search was conducted in 8 databases,including China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Pub Med,Cochrane Library,Web of Science,Scopus,and Embase,from their inception until February 19,2023.Randomized controlled trials(RCTs)investigating the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage were included.Two researchers independently screened the literature,extracted data from the included studies,and performed quality assessment using the Cochrane Collaboration's standards.The software Stata 17.0 was used to create a network evidence graph for each combination of Traditional Chinese Medicine external treatment methods and rehabilitation training,and to generate a publication bias funnel plot.Network Meta-analysis was conducted using Rev Man 5.3 to assess the risk of bias in the included studies,with mean difference(MD)used for continuous variables and odds ratio(OR)used for dichotomous variables.If there was good consistency among the included studies(P>0.05),a consistency model was applied for data analysis.If there was poor consistency among the included studies(P<0.05),an inconsistency model was used.RESULTS:A total of 27 studies involving 2113 patients with limb dysfunction caused by cerebral hemorrhage were included.The results of the network Meta-analysis indicated that the combined use of 7 Traditional Chinese Medicine external treatment methods and rehabilitation training was more effective in improving limb function in patients with cerebral hemorrhage compared to rehabilitation training alone.In terms of improving simplified Fugl-Meyer Assessment(FMA)scores,the effectiveness ranking was as follows:acupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>massage+rehabilitation training>electroacupuncture+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training>Chinese herbal fumigation+rehabilitation training.In terms of improving Barthel Index(BI)scores,the effectiveness ranking was as follows:electroacupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>acupuncture+rehabilitation training>massage+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine fumigation+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training.CONCLUSION:Based on existing literature evidence,our findings suggest the following:(a)The combination of the seven commonly used external treatment methods with rehabilitation training is superior to using rehabilitation training alone for the treatment of hemiplegia resulting from cerebral hemorrhage.(b)In terms of improving FMA scores,the combination of acupuncture and rehabilitation training shows the most significant effectiveness.(c)In terms of improving BI scores,the combination of electro-acupuncture and rehabilitation training demonstrates the most significant effectiveness.Therefore,we still need more multicenter,large-sample,high-quality randomized controlled trials to further validate the findings of this study.展开更多
Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in t...Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.展开更多
Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally ...Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.展开更多
Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interve...Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interventions.Although more patients are turning to supplements to manage osteoarthritis,their actual effectiveness remains uncertain.Objective:This study aims to provide a comprehensive evaluation of the available evidence concerning the efficacy of various dietary supplements in osteoarthritis treatment.Search strategy:We searched PubMed,Embase,Cochrane Library and Web of Science for studies on the use of various dietary supplements in the treatment of osteoarthritis from the creation of each database until Jan 20,2025.Inclusion criteria:(1)Research object:osteoarthritis.(2)Intervention measures:patients in the treatment group received dietary supplements,while the control group received placebos.(3)Research type:randomized controlled trials(RCTs).Data extraction and analysis:Two researchers independently examined the literature and retrieved data based on predefined criteria.The information gathered included the first author,year of publication,sample size,participant demographics,length of the follow-up period,intervention and control measures,and inclusion indications.RCTs comparing dietary supplements to placebo with the pain and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)among patients with osteoarthritis were included.The optimal dietary supplement was identified based on the total ranking by summing the surface under the cumulative ranking curve(SUCRA)of these two scores.Furthermore,the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to confirm the quality of the evidence.Results:Overall,23 studies covering 21 dietary supplements and involving 2455 participants met the inclusion criteria.In the WOMAC pain score,the SUCRA of passion fruit peel extract was 91%(mean difference[MD]:–9.2;95%confidence interval[CI]:[–16.0,–2.3]),followed by methylsulfonylmethane(89%),undenatured type II collagen(87%),collagen(84%),and Lanconone(82%).The SUCRA(99%)of passion fruit peel extract(MD:–41.0;95%CI:[–66.0,–16.0])ranked first in terms of the WOMAC function score,followed by Lanconone(95%),collagen(86%),ParActin(84%),and Lactobacillus casei strain Shirota(83%).The top three total rankings are passion fruit peel extract(95.0%),Lanconone(88.5%),and collagen(85.0%).However,the GRADE revealed low evidence quality.Conclusion:Passion fruit peel extract was the best supplement for improving WOMAC pain and function scores in patients with osteoarthritis,followed by Lanconone and collagen.However,further large-scale,well designed RCTs are required to substantiate these promising findings.展开更多
Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic re...Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic review evaluated the efficacy of several therapeutic approaches based on immune checkpoint inhibitors(ICIs).Methods:A comprehensive evaluation of the literature was conducted,looking at randomized controlled trials(RCTs)that were published in Embase,PubMed,and the Cochrane Central Register of Controlled Trials since database establishment.The risk of bias of the enrolled studies was analyzed using The Review Manager(RevMan)5.4.Using network meta-analyses(NMA),the relative treatment effects on overall survival(OS)and progression-free survival(PFS)from qualifying randomized controlled trials were synthesized and evaluated.Results:Regarding OS,compared with nivolumab plus chemotherapy,chemotherapy(Hazard ratio(HR)2.1,95%Confidence interval=(CI):1.2,3.4)showed a treatment disadvantage.Meanwhile,nivolumab plus chemotherapy may represent the most efficient(57.89%)and has a lower cost among all the treatments enrolled in this study for advanced HNSCC.Regarding PFS,compared with nivolumab plus ipilimumab,nivolumab plus chemotherapy(HR 0.4,95%CI:0.2,0.8)showed=treatment superiority.Additionally,nivolumab plus chemotherapy(77.18%)has the longest PFS among all interventions.Conclusion:Taking into account OS and PFS,the combination of nivolumab plus chemotherapy may appear to be the most effective option and is associated with a comparatively lower cost among all treatments included in this network meta-analysis,thereby recommending its use as a first-line therapy for HNSCC.Registration:INPLASY(2024070073).展开更多
Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide ...Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.展开更多
OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife...OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife)in the treatment of nonspecific low back pain(NLBP),providing evidence-based medical support for clinical treatment.METHODS:Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,PubMed,Web of Science,Chinese Biomedical Literature Database,Embase,and the Cochrane Library.Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool,and the data were analyzed using STATA 15.1.RESULTS:This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale(VAS),improvement in dysfunction using the oswestry disability index(ODI),and the effective rate.Blood-letting[surface under the cumulative ranking curve(SUCRA)=81.4]exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator,followed by cupping(SUCRA=70.4)and moxibustion(SUCRA=58.5).Scrapping therapy(SUCRA=77.7)had the most significant effect on improving NLBP-related functional impairment,followed by moxibustion(SUCRA=59.8),and then bloodletting(SUCRA=58.2).The effective rates of warm acupuncture(SUCRA=78.0),scrapping therapy(SUCRA=77.2)and blood-letting(SUCRA=58.6)were better than those of acupuncture(SUCRA=12.0),especially for cold and wet NLBP.These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment.CONCLUSION:Blood-letting was the most effective treatment for relieving pain,and scrapping therapy was the most effective treatment for improving dysfunction.Warm acupuncture was the preferred treatment for cold and wet NLBP.However,further high-quality clinical studies are needed for validation.展开更多
Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a...Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammator...BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.展开更多
Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial ...Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation(rTMS)on motor function in stroke patients.There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke.The MEDLINE,Embase,Cochrane Library,ISI Science Citation Index,Physiotherapy Evidence Database,China National Knowledge Infrastructure Library,and ClinicalTrials.gov databases were searched.Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke,published from inception to November 28,2019,were included.Standard pairwise meta-analysis was conducted using R version 3.6.1 with the“meta”package.Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions.Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation.Network meta-analysis results of five randomized controlled trials demonstrated that highfrequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation.These findings suggest that rTMS can improve motor function in patients with stroke,and that low-frequency rTMS mainly affects motor function,whereas high-frequency rTMS increases the amplitudes of motor evoked potentials.More highquality randomized controlled trials are needed to validate this conclusion.The work was registered in PROSPERO(registration No.CRD42020147055)on April 28,2020.展开更多
Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness ...Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment(MCI)or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.Methods:We searched PubMed,Web of Science,Embase,Cochrane Central Register of Controlled Trials,SPORTDiscus,and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia.Primary outcomes included global cognition,executive cognition,and memory cognition.Secondary outcomes included activities of daily living,neuropsychiatric symptoms,and quality of life.Pairwise analyses and network meta-analyses were performed using a random effects model.Results:A total of 73 articles from 71 trials with 5606 participants were included.All types of exercise were effective in increasing or maintaining global cognition,and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition(standard mean difference(SMD)=1.05,95%confidence interval(95%CI):0.56-1.54),executive function(SMD=0.85,95%CI:0.21-1.49),and memory function(SMD=0.32,95%CI:0.01-0.63)in patients with cognitive dysfunction.Subgroup analyses for patients with MCI revealed different effects,and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition(SMD=0.99,95%CI:0.44-1.54)and executive function(SMD=0.72,95%CI:0.06-1.38).However,only resistance exercise showed significant effects on memory function for patients with MCI(SMD=0.35,95%CI:0.01-0.69).Exercise interventions also showed various effects on the secondary outcomes.Conclusion:Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive declin e in patients withcognitive dysfunction,especially in patients with dementia.Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.展开更多
OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/trea...OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/treated by GI were searched in China National Knowledge Infrastructure Database, Wanfang, China Science and Technology Journal Database, Web of Science, Cochrane library, Embase, PubMed and Chinese Biomedical Literature Database, with the publication data no later than April, 2016. The Co- chrane risk of bias method was used to evaluate the methodological quality of the RCTs. The data were analyzed by Review Manager 5.3, Stata 13.0, and WinBUGS 14 software.RESULTS： Totally 37 RCTs involving 4330 patients were included. By direct comparison, the results of GI group were significantly superior to the routine WM group in the total effective rates [OR = 3.61, 95% CI （2.93, 4.44）, P 〈 0.0001], the neural function defect score （NFDS） [MD = - 4.39, 95% CI （- 5.47, - 3.32）, P 〈 0.0001]. Network Meta-analysis （NMA） results showed that, between S GIs in efficacy, the difference comparing ginaton injections （GbE） to ginkgo-dipyidamolum injections （GD） [OR = 1.74, 95% CI （0.73, 3.65）], shuxuening injections （SXN） [OR = 1.06, 95% CI （0.609, 1.697）] or ginkgolides in- jections （GK） [OR = 4.711, 95% CI （1.178, 13.21）] reach statistical significance; the difference compar- ing GD to GK reach statistical significance [OR = 2.791, 95% CI （0.866, 6.908）]; the difference com- paring SXN to GK reach statistical significance [OR = 4.537, 95% CI （1.203, 12.41）]. Besides, there was no difference between 4 GIs in NFDS. Proba- bility ranking result showed a great possibility for GK [Surface under the Cumulative Ranking curve （SUCRA） = 80.3%] in improving the total effective rates, which were followed by GD （SUCRA = 73.34%）, SXN （SUCRA = 46.59%）, GbE （SUCRA = 45.46%）, floium ginkgo extract and tertram ethy- pyrazine sodium chloride injections （FT） （SU- CRA = 35.64%）. However, GK （SUCRA = 80.3%） or GbE （SUCRA = 69.4%） was better than other GIs in reducing NFDS.GK ＋ WM is the best treatment measures to reduce NFDS in cerebral infarction, which were followed by SXN ＋ WM （SUCRA = 51.6%）, GD ＋ WM （SUCRA = 48.1%）. CONCLUSION： GIs was more effectiveness on CI than the routine Western Medicine. But based on the limitations of the study, more high-quality ran- domized controlled trials will be necessary.展开更多
Objective To systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency（POI）. Methods Computer retrieval was carried out in such databases a...Objective To systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency（POI）. Methods Computer retrieval was carried out in such databases as Pub Med, Embase, Cochrane Library, web of science, Chinese biomedicine database（CBM）, China National Knowledge Infrastructure（CNKI）, Wan Fang and VIP in order to collect the randomized controlled trials（RCT） concerning acupoint stimulation therapy for treatment of POI. Software R 3.40 and stata 14.0 were used for Meta-analysis and network Meta-analysis, and Rev Man 5.3 was used for plotting the risk bias diagrams. Results Fortythree RCTs were included in total, involving 3046 POI patients and 18 acupoint stimulation therapies and comprehensive therapies. Metaanalysis showed：（1） The curative effects of acupoint stimulation therapy（RR=1.25, 95%CI [1.07,1.45]）, acupoint stimulation therapy＋Chinese herbal medicine（RR=1.25, 95%CI [1.18,1.32]） and acupoint stimulation therapy＋ hormone replacement therapy（HRT）（RR=1.20, 95%CI [1.12,1.29]） were all superior to that of HRT, indicating that the differences were statistically significant（Z=2.90, P=0.04; Z=7.56, P〈0.000 01; Z=4.06, P〈0.000 01）.（2） Compared with HRT, the occurrence rate of adverse effect of acupoint stimulation therapy was lower, and the safety was superior to that of HRT（RR=0.18, 95%CI [0.08,0.41]）, indicating that the differences were statistically significant（Z=4.08, P〈0.000 1）. Forty-two direct comparisons and 110 indirect comparisons were generated according to network Meta-analysis, among which, 38 comparisons were statistically significant. Network Metaanalysis results with HRT as control showed： the therapeutic measures ranking top 3 according to the curative effect sequence were catgut embedment in acupoint, moxibustion and warming-needle moxibustion, successively, and all the 3 measures were monotherapies without reflecting the advantages of comprehensive therapy. HRT ranked 17 th among the 18 included therapeutic measures. Conclusion On the basis of current evidences, acupoint stimulation therapy has a better clinical efficacy and safety for treatment of POI when compared with HRT. The acupoint stimulation therapies ranking the top 3 have more significant curative effects, but the long-term efficacy and the effect on the ovarian function still need to be further explored. In addition, the conclusion of this study still needs to be verified through a large number of RCTs with reasonable designs and appropriate methods.展开更多
OBJECTIVE: To address the optimal Chinese herbal injections(CHIs) against liver cancer, the present network Meta-analysis is designed to investigate the comparative efficacy and safety of different CHIs.METHODS: Sever...OBJECTIVE: To address the optimal Chinese herbal injections(CHIs) against liver cancer, the present network Meta-analysis is designed to investigate the comparative efficacy and safety of different CHIs.METHODS: Several electronic databases were searched up to June 1 st, 2017. The quality assessment was conducted and network Meta-analysis was performed to compare the efficacy and safety of different CHIs plus transcatheter hepatic arterial chemoembolization(TACE). Primary outcomes were 1-year and 2-year survival rate, the secondary outcomes includes the clinical effective rate, performance status and the adverse reactions(ADRs). Data analysis was applied Stata 13.0 and Win BUGS 1.4 software.RESULTS: A total of 105 randomized controlled trials(RCTs) were identified for inclusion in this analysis, with data for 7683 patients and 13 CHIs. The results suggested that Javanica oil emulsion,Huachansu injection plus TACE were more favorable for 1-year and 2-year survival rate than other CHIs. Kanglaite, Astragalus polysaccharide injection plus TACE showed superiority in the clinical effective rate and performance status over other CHIs.And Shenmai injection plus TACE was superior to reducing ADRs than other CHIs for patients with liver cancer.CONCLUSION: Our findings indicated that receiving CHIs combined with TACE may have therapeutic benefits for patients with liver cancer in improving survival rate, clinical effective rate, the performance status and alleviating the ADRs.展开更多
Objective:To perform a network meta-analysis on four commonly used acupuncture therapies(electroacupuncture,fire acupuncture,warm acupuncture,and filiform needling) and rehabilitation therapy in the treatment of post-...Objective:To perform a network meta-analysis on four commonly used acupuncture therapies(electroacupuncture,fire acupuncture,warm acupuncture,and filiform needling) and rehabilitation therapy in the treatment of post-stroke spastic hemiplegia so as to compare the differences in clinical therapeutic effect between acupuncture therapy and rehabilitation therapy as well as among different therapeutic methods of acupuncture.Methods:A computer-based retrieval was conducted in Chinese and English databases,i.e.CNKI,WanFang,VIP,SinoMed,PubMed,Embase,Web of Science and Cochrane library.The search period limit was from the database establishment to April 17,2020.Data analysis was performed through Revman 5.3,Gemtc 0.14.3 and Stata 14.2.Results:A total of 27 trials were finally eligible,including 1880 patients,943 patients of which were in observation group and 937 patients in control group.In terms of the improvement of effective rate,electroacupuncture,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,warm acupuncture was the highest in probability to be the optimal measure.Regarding the improvement in Fugl-Meyer Assessment(FMA) motor function score,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,fire needling method was the highest in probability to be the optimal measure.In view of the improvement of BI score,fire needling method was better than electroacupuncture and filiform needling method,while,warm acupuncture was better than electroacupuncture,thus,fire needling method may be the optimal measure.For the modified Ashworth muscular tension assessment,there was no significant differences in pairwise comparison among different interventions and warm acupuncture was probably the optimal measure.Conclusion:The overall therapeutic effect of 4 acupuncture therapies is better than rehabilitation therapy on post-stroke spastic hemiplegia,respectively,among which,the therapeutic effect of warm acupuncture and fire needling method is the best.However,because of a limitation of the varieties of acupuncturemoxibustion therapy and the number of included trials,it needs to conduct more rigorous and scientific randomized controlled trials so that this conclusion can be further confirmed.展开更多
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
基金supported by the National Natural Science Foundation of China(82305273)the Central High-Level Clinical Research Fund for Traditional Chinese Medicine Hospitals(DZMG-QNGG0010).
文摘Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.
基金supported by the program of Guangdong Provincial Clinical Research Center for Rehabilitation Medicine(2023B110003)the Research Foundation of Traditional Chinese Medicine Bureau of Guangdong Province(20231,067)the Guangdong Hopson-Pearl River Education Development Foundation(No.H20190116202012724).
文摘Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.
基金the Obstetrics and Gynecology Hospital of Fudan University for supporting this project。
文摘Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.
基金Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
基金Supported by the Key Research and Development Plan Project of Shaanxi Province:Standardized Diagnosis and Treatment Protocol for Cerebral Hemorrhage with Integrated Traditional Chinese and Western Medicine and Research on its Therapeutic Mechanisms(No.2019ZDLSF04-06-01)the National Key Research and Development Plan Project:Development and Implementation of a Clinical Research Information Sharing System for Traditional Chinese Medicine(No.2017YFC1703500,No.2017YFC1703502)the Discipline Innovation Team Building Project of Shaanxi University of Chinese Medicine:Innovative Research Team for the Construction of Integrated Traditional Chinese and Western Medicine Cerebrovascular Disease Diagnosis and Treatment System and Its Clinical Application(No.2019-YL15)。
文摘OBJECTIVE:To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage through a network Meta-analysis.METHODS:A computer-based search was conducted in 8 databases,including China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Pub Med,Cochrane Library,Web of Science,Scopus,and Embase,from their inception until February 19,2023.Randomized controlled trials(RCTs)investigating the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage were included.Two researchers independently screened the literature,extracted data from the included studies,and performed quality assessment using the Cochrane Collaboration's standards.The software Stata 17.0 was used to create a network evidence graph for each combination of Traditional Chinese Medicine external treatment methods and rehabilitation training,and to generate a publication bias funnel plot.Network Meta-analysis was conducted using Rev Man 5.3 to assess the risk of bias in the included studies,with mean difference(MD)used for continuous variables and odds ratio(OR)used for dichotomous variables.If there was good consistency among the included studies(P>0.05),a consistency model was applied for data analysis.If there was poor consistency among the included studies(P<0.05),an inconsistency model was used.RESULTS:A total of 27 studies involving 2113 patients with limb dysfunction caused by cerebral hemorrhage were included.The results of the network Meta-analysis indicated that the combined use of 7 Traditional Chinese Medicine external treatment methods and rehabilitation training was more effective in improving limb function in patients with cerebral hemorrhage compared to rehabilitation training alone.In terms of improving simplified Fugl-Meyer Assessment(FMA)scores,the effectiveness ranking was as follows:acupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>massage+rehabilitation training>electroacupuncture+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training>Chinese herbal fumigation+rehabilitation training.In terms of improving Barthel Index(BI)scores,the effectiveness ranking was as follows:electroacupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>acupuncture+rehabilitation training>massage+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine fumigation+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training.CONCLUSION:Based on existing literature evidence,our findings suggest the following:(a)The combination of the seven commonly used external treatment methods with rehabilitation training is superior to using rehabilitation training alone for the treatment of hemiplegia resulting from cerebral hemorrhage.(b)In terms of improving FMA scores,the combination of acupuncture and rehabilitation training shows the most significant effectiveness.(c)In terms of improving BI scores,the combination of electro-acupuncture and rehabilitation training demonstrates the most significant effectiveness.Therefore,we still need more multicenter,large-sample,high-quality randomized controlled trials to further validate the findings of this study.
基金Supported by National Key Research and Development Program of China:2022YFC3500701。
文摘Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.
基金The Natural Science Foundation of Fujian,China(Grant No.2021J01397)Fujian Provincial Health Technology Project(Grant No.2022GGA010)Fujian Provincial Joint Funding Project of Scientific and Technological Innovation(Grant No.2023Y9347).
文摘Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.
基金supported by the Association Foundation Program of the Yunnan Provincial Science and Technology Department and Kunming Medical University(No.202401AY070001-176 and 202401AY070001-180)the Xing Dian Talent Support Plan(to ZC),the Yunnan Province “the 14th Five-Year Plan”Provincial Key Clinical Specialty Construction Project(Traumatology Surgery)the Yunnan University Medical Research Foundation(No.YDYXJJ2024-0029,YDYXJJ2024-0040 and YDYXJJ2024-0017)。
文摘Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interventions.Although more patients are turning to supplements to manage osteoarthritis,their actual effectiveness remains uncertain.Objective:This study aims to provide a comprehensive evaluation of the available evidence concerning the efficacy of various dietary supplements in osteoarthritis treatment.Search strategy:We searched PubMed,Embase,Cochrane Library and Web of Science for studies on the use of various dietary supplements in the treatment of osteoarthritis from the creation of each database until Jan 20,2025.Inclusion criteria:(1)Research object:osteoarthritis.(2)Intervention measures:patients in the treatment group received dietary supplements,while the control group received placebos.(3)Research type:randomized controlled trials(RCTs).Data extraction and analysis:Two researchers independently examined the literature and retrieved data based on predefined criteria.The information gathered included the first author,year of publication,sample size,participant demographics,length of the follow-up period,intervention and control measures,and inclusion indications.RCTs comparing dietary supplements to placebo with the pain and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)among patients with osteoarthritis were included.The optimal dietary supplement was identified based on the total ranking by summing the surface under the cumulative ranking curve(SUCRA)of these two scores.Furthermore,the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to confirm the quality of the evidence.Results:Overall,23 studies covering 21 dietary supplements and involving 2455 participants met the inclusion criteria.In the WOMAC pain score,the SUCRA of passion fruit peel extract was 91%(mean difference[MD]:–9.2;95%confidence interval[CI]:[–16.0,–2.3]),followed by methylsulfonylmethane(89%),undenatured type II collagen(87%),collagen(84%),and Lanconone(82%).The SUCRA(99%)of passion fruit peel extract(MD:–41.0;95%CI:[–66.0,–16.0])ranked first in terms of the WOMAC function score,followed by Lanconone(95%),collagen(86%),ParActin(84%),and Lactobacillus casei strain Shirota(83%).The top three total rankings are passion fruit peel extract(95.0%),Lanconone(88.5%),and collagen(85.0%).However,the GRADE revealed low evidence quality.Conclusion:Passion fruit peel extract was the best supplement for improving WOMAC pain and function scores in patients with osteoarthritis,followed by Lanconone and collagen.However,further large-scale,well designed RCTs are required to substantiate these promising findings.
文摘Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic review evaluated the efficacy of several therapeutic approaches based on immune checkpoint inhibitors(ICIs).Methods:A comprehensive evaluation of the literature was conducted,looking at randomized controlled trials(RCTs)that were published in Embase,PubMed,and the Cochrane Central Register of Controlled Trials since database establishment.The risk of bias of the enrolled studies was analyzed using The Review Manager(RevMan)5.4.Using network meta-analyses(NMA),the relative treatment effects on overall survival(OS)and progression-free survival(PFS)from qualifying randomized controlled trials were synthesized and evaluated.Results:Regarding OS,compared with nivolumab plus chemotherapy,chemotherapy(Hazard ratio(HR)2.1,95%Confidence interval=(CI):1.2,3.4)showed a treatment disadvantage.Meanwhile,nivolumab plus chemotherapy may represent the most efficient(57.89%)and has a lower cost among all the treatments enrolled in this study for advanced HNSCC.Regarding PFS,compared with nivolumab plus ipilimumab,nivolumab plus chemotherapy(HR 0.4,95%CI:0.2,0.8)showed=treatment superiority.Additionally,nivolumab plus chemotherapy(77.18%)has the longest PFS among all interventions.Conclusion:Taking into account OS and PFS,the combination of nivolumab plus chemotherapy may appear to be the most effective option and is associated with a comparatively lower cost among all treatments included in this network meta-analysis,thereby recommending its use as a first-line therapy for HNSCC.Registration:INPLASY(2024070073).
基金The 2022 Ministry of Education General Project for Humanities and Social Sciences Research(Grant No.22YJAZH147)the General Subject of Guangzhou Philosophy and Social Science Development“14th Five-Year Plan”in 2023(Grant No.2023GZYB68)+2 种基金China University Industry-Academia-Research Innovation Fund-Huatong Guokang Medical Research Special Project(Grant No.2023HT017)2024 Guangdong Province General Project for the Planning of Philosophy and Social Sciences(Grant No.GD24CGL29)the Innovation Team Project of Colleges and Universities in Guangdong Province(Grant No.2022WCXTD011).
文摘Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.
基金Supported by the National Natural Science Foundation of China:Novel Dynamic Regulation Method of Acupoint Stimulation Based on Injectable Magnetic Gel for Myocardial Ischemia-Reperfusion Injury (No. 82074560)Effect Evaluation of Different Combinations of Acupuncture Techniques (No. 8207152951)Sanqin Talent Special Support Program:Leading Talent Project for Technological Innovation (No. 2024)
文摘OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife)in the treatment of nonspecific low back pain(NLBP),providing evidence-based medical support for clinical treatment.METHODS:Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,PubMed,Web of Science,Chinese Biomedical Literature Database,Embase,and the Cochrane Library.Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool,and the data were analyzed using STATA 15.1.RESULTS:This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale(VAS),improvement in dysfunction using the oswestry disability index(ODI),and the effective rate.Blood-letting[surface under the cumulative ranking curve(SUCRA)=81.4]exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator,followed by cupping(SUCRA=70.4)and moxibustion(SUCRA=58.5).Scrapping therapy(SUCRA=77.7)had the most significant effect on improving NLBP-related functional impairment,followed by moxibustion(SUCRA=59.8),and then bloodletting(SUCRA=58.2).The effective rates of warm acupuncture(SUCRA=78.0),scrapping therapy(SUCRA=77.2)and blood-letting(SUCRA=58.6)were better than those of acupuncture(SUCRA=12.0),especially for cold and wet NLBP.These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment.CONCLUSION:Blood-letting was the most effective treatment for relieving pain,and scrapping therapy was the most effective treatment for improving dysfunction.Warm acupuncture was the preferred treatment for cold and wet NLBP.However,further high-quality clinical studies are needed for validation.
文摘Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.
文摘BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.
基金supported by the 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project,West China Hospital,Sichuan University,China,No.2020HXFH051(to QG).
文摘Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation(rTMS)on motor function in stroke patients.There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke.The MEDLINE,Embase,Cochrane Library,ISI Science Citation Index,Physiotherapy Evidence Database,China National Knowledge Infrastructure Library,and ClinicalTrials.gov databases were searched.Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke,published from inception to November 28,2019,were included.Standard pairwise meta-analysis was conducted using R version 3.6.1 with the“meta”package.Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions.Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation.Network meta-analysis results of five randomized controlled trials demonstrated that highfrequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation.These findings suggest that rTMS can improve motor function in patients with stroke,and that low-frequency rTMS mainly affects motor function,whereas high-frequency rTMS increases the amplitudes of motor evoked potentials.More highquality randomized controlled trials are needed to validate this conclusion.The work was registered in PROSPERO(registration No.CRD42020147055)on April 28,2020.
基金financial support from the National Natural Science Foundation of Chinafunded by the National Natural Science Foundation of China(81871854)。
文摘Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment(MCI)or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.Methods:We searched PubMed,Web of Science,Embase,Cochrane Central Register of Controlled Trials,SPORTDiscus,and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia.Primary outcomes included global cognition,executive cognition,and memory cognition.Secondary outcomes included activities of daily living,neuropsychiatric symptoms,and quality of life.Pairwise analyses and network meta-analyses were performed using a random effects model.Results:A total of 73 articles from 71 trials with 5606 participants were included.All types of exercise were effective in increasing or maintaining global cognition,and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition(standard mean difference(SMD)=1.05,95%confidence interval(95%CI):0.56-1.54),executive function(SMD=0.85,95%CI:0.21-1.49),and memory function(SMD=0.32,95%CI:0.01-0.63)in patients with cognitive dysfunction.Subgroup analyses for patients with MCI revealed different effects,and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition(SMD=0.99,95%CI:0.44-1.54)and executive function(SMD=0.72,95%CI:0.06-1.38).However,only resistance exercise showed significant effects on memory function for patients with MCI(SMD=0.35,95%CI:0.01-0.69).Exercise interventions also showed various effects on the secondary outcomes.Conclusion:Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive declin e in patients withcognitive dysfunction,especially in patients with dementia.Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.
基金Supported by National Natural Science Foundation of China:Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection(No.81473547)Multidimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris(No.81673829)
文摘OBJECTIVE： To assess the clinical effectiveness and safety of injections of ginkgo （GI） combined with Western Medicine （WM） for cerebral infarction （C/）. METHODS; Randomized controlled trials （RCTs） of C/treated by GI were searched in China National Knowledge Infrastructure Database, Wanfang, China Science and Technology Journal Database, Web of Science, Cochrane library, Embase, PubMed and Chinese Biomedical Literature Database, with the publication data no later than April, 2016. The Co- chrane risk of bias method was used to evaluate the methodological quality of the RCTs. The data were analyzed by Review Manager 5.3, Stata 13.0, and WinBUGS 14 software.RESULTS： Totally 37 RCTs involving 4330 patients were included. By direct comparison, the results of GI group were significantly superior to the routine WM group in the total effective rates [OR = 3.61, 95% CI （2.93, 4.44）, P 〈 0.0001], the neural function defect score （NFDS） [MD = - 4.39, 95% CI （- 5.47, - 3.32）, P 〈 0.0001]. Network Meta-analysis （NMA） results showed that, between S GIs in efficacy, the difference comparing ginaton injections （GbE） to ginkgo-dipyidamolum injections （GD） [OR = 1.74, 95% CI （0.73, 3.65）], shuxuening injections （SXN） [OR = 1.06, 95% CI （0.609, 1.697）] or ginkgolides in- jections （GK） [OR = 4.711, 95% CI （1.178, 13.21）] reach statistical significance; the difference compar- ing GD to GK reach statistical significance [OR = 2.791, 95% CI （0.866, 6.908）]; the difference com- paring SXN to GK reach statistical significance [OR = 4.537, 95% CI （1.203, 12.41）]. Besides, there was no difference between 4 GIs in NFDS. Proba- bility ranking result showed a great possibility for GK [Surface under the Cumulative Ranking curve （SUCRA） = 80.3%] in improving the total effective rates, which were followed by GD （SUCRA = 73.34%）, SXN （SUCRA = 46.59%）, GbE （SUCRA = 45.46%）, floium ginkgo extract and tertram ethy- pyrazine sodium chloride injections （FT） （SU- CRA = 35.64%）. However, GK （SUCRA = 80.3%） or GbE （SUCRA = 69.4%） was better than other GIs in reducing NFDS.GK ＋ WM is the best treatment measures to reduce NFDS in cerebral infarction, which were followed by SXN ＋ WM （SUCRA = 51.6%）, GD ＋ WM （SUCRA = 48.1%）. CONCLUSION： GIs was more effectiveness on CI than the routine Western Medicine. But based on the limitations of the study, more high-quality ran- domized controlled trials will be necessary.
基金Supported by China Academy of Chinese Medical Sciences:ZZ0908019
文摘Objective To systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency（POI）. Methods Computer retrieval was carried out in such databases as Pub Med, Embase, Cochrane Library, web of science, Chinese biomedicine database（CBM）, China National Knowledge Infrastructure（CNKI）, Wan Fang and VIP in order to collect the randomized controlled trials（RCT） concerning acupoint stimulation therapy for treatment of POI. Software R 3.40 and stata 14.0 were used for Meta-analysis and network Meta-analysis, and Rev Man 5.3 was used for plotting the risk bias diagrams. Results Fortythree RCTs were included in total, involving 3046 POI patients and 18 acupoint stimulation therapies and comprehensive therapies. Metaanalysis showed：（1） The curative effects of acupoint stimulation therapy（RR=1.25, 95%CI [1.07,1.45]）, acupoint stimulation therapy＋Chinese herbal medicine（RR=1.25, 95%CI [1.18,1.32]） and acupoint stimulation therapy＋ hormone replacement therapy（HRT）（RR=1.20, 95%CI [1.12,1.29]） were all superior to that of HRT, indicating that the differences were statistically significant（Z=2.90, P=0.04; Z=7.56, P〈0.000 01; Z=4.06, P〈0.000 01）.（2） Compared with HRT, the occurrence rate of adverse effect of acupoint stimulation therapy was lower, and the safety was superior to that of HRT（RR=0.18, 95%CI [0.08,0.41]）, indicating that the differences were statistically significant（Z=4.08, P〈0.000 1）. Forty-two direct comparisons and 110 indirect comparisons were generated according to network Meta-analysis, among which, 38 comparisons were statistically significant. Network Metaanalysis results with HRT as control showed： the therapeutic measures ranking top 3 according to the curative effect sequence were catgut embedment in acupoint, moxibustion and warming-needle moxibustion, successively, and all the 3 measures were monotherapies without reflecting the advantages of comprehensive therapy. HRT ranked 17 th among the 18 included therapeutic measures. Conclusion On the basis of current evidences, acupoint stimulation therapy has a better clinical efficacy and safety for treatment of POI when compared with HRT. The acupoint stimulation therapies ranking the top 3 have more significant curative effects, but the long-term efficacy and the effect on the ovarian function still need to be further explored. In addition, the conclusion of this study still needs to be verified through a large number of RCTs with reasonable designs and appropriate methods.
基金Supported by the National Natural Science Foundation of China(Study on the Key Influential Factors of Anaphylaxis Induced by Chinese Herbal Injection Based on Three-dimensional Database and Multi-dimensional Data Mining,No.81473547Establishment of Multi-dimensional Clinical Evaluation Model of Danshen Injection for Treating Unstable Angina Pectoris Based on Bayesian Network Meta Analysis,No.81673829)。
文摘OBJECTIVE: To address the optimal Chinese herbal injections(CHIs) against liver cancer, the present network Meta-analysis is designed to investigate the comparative efficacy and safety of different CHIs.METHODS: Several electronic databases were searched up to June 1 st, 2017. The quality assessment was conducted and network Meta-analysis was performed to compare the efficacy and safety of different CHIs plus transcatheter hepatic arterial chemoembolization(TACE). Primary outcomes were 1-year and 2-year survival rate, the secondary outcomes includes the clinical effective rate, performance status and the adverse reactions(ADRs). Data analysis was applied Stata 13.0 and Win BUGS 1.4 software.RESULTS: A total of 105 randomized controlled trials(RCTs) were identified for inclusion in this analysis, with data for 7683 patients and 13 CHIs. The results suggested that Javanica oil emulsion,Huachansu injection plus TACE were more favorable for 1-year and 2-year survival rate than other CHIs. Kanglaite, Astragalus polysaccharide injection plus TACE showed superiority in the clinical effective rate and performance status over other CHIs.And Shenmai injection plus TACE was superior to reducing ADRs than other CHIs for patients with liver cancer.CONCLUSION: Our findings indicated that receiving CHIs combined with TACE may have therapeutic benefits for patients with liver cancer in improving survival rate, clinical effective rate, the performance status and alleviating the ADRs.
基金Supported by National Administration of Traditional Chinese Medicine,Construction Project of Inheritance Studio of National Famous Traditional Chinese Medicine Experts:[2016]No.42.
文摘Objective:To perform a network meta-analysis on four commonly used acupuncture therapies(electroacupuncture,fire acupuncture,warm acupuncture,and filiform needling) and rehabilitation therapy in the treatment of post-stroke spastic hemiplegia so as to compare the differences in clinical therapeutic effect between acupuncture therapy and rehabilitation therapy as well as among different therapeutic methods of acupuncture.Methods:A computer-based retrieval was conducted in Chinese and English databases,i.e.CNKI,WanFang,VIP,SinoMed,PubMed,Embase,Web of Science and Cochrane library.The search period limit was from the database establishment to April 17,2020.Data analysis was performed through Revman 5.3,Gemtc 0.14.3 and Stata 14.2.Results:A total of 27 trials were finally eligible,including 1880 patients,943 patients of which were in observation group and 937 patients in control group.In terms of the improvement of effective rate,electroacupuncture,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,warm acupuncture was the highest in probability to be the optimal measure.Regarding the improvement in Fugl-Meyer Assessment(FMA) motor function score,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,fire needling method was the highest in probability to be the optimal measure.In view of the improvement of BI score,fire needling method was better than electroacupuncture and filiform needling method,while,warm acupuncture was better than electroacupuncture,thus,fire needling method may be the optimal measure.For the modified Ashworth muscular tension assessment,there was no significant differences in pairwise comparison among different interventions and warm acupuncture was probably the optimal measure.Conclusion:The overall therapeutic effect of 4 acupuncture therapies is better than rehabilitation therapy on post-stroke spastic hemiplegia,respectively,among which,the therapeutic effect of warm acupuncture and fire needling method is the best.However,because of a limitation of the varieties of acupuncturemoxibustion therapy and the number of included trials,it needs to conduct more rigorous and scientific randomized controlled trials so that this conclusion can be further confirmed.
