BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are associated with significant cardiovascular benefit in type 2 diabetes(T2D).However,GLP-1RA or SGL...BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are associated with significant cardiovascular benefit in type 2 diabetes(T2D).However,GLP-1RA or SGLT-2I alone may not improve some cardiovascular outcomes in patients with prior cardiovascular co-morbidities.AIM To explore whether combining GLP-1RA and SGLT-2I can achieve additional benefit in preventing cardiovascular diseases in T2D.METHODS The systematic review was conducted according to PRISMA recommendations.The protocol was registered on PROSPERO(ID:42022385007).A total of 107049 participants from eligible cardiovascular outcomes trials of GLP-1RA and SGLT-2I were included in network meta-regressions to estimate cardiovascular benefit of the combination treatment.Effect modification of prior myocardial infarction(MI)and heart failure(HF)was also explored to provide clinical insight as to when the INTRODUCTION The macro-and micro-vascular benefits of glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are independent of their glucose-lowering effects[1].In patients with type 2 diabetes(T2D),the major cardiovascular outcome trials(CVOT)showed that dipeptidyl peptidase-4 inhibitors(DPP-4I)did not improve cardiovascular outcomes[2],whereas cardiovascular benefit of GLP-1RA or SGLT-2I was significant[3,4].Further subgroup analyses indicated that the background cardiovascular risk should be considered when examining the cardiovascular outcomes of these newer glucose-lowering medications.For instance,prevention of major adverse cardiovascular events(MACE)was only seen in those patients with baseline atherosclerotic cardiovascular disease[3,4].Moreover,a series of CVOT conducted in patients with heart failure(HF)have demonstrated that(compared with placebo)SGLT-2I significantly reduced risk of hospitalization for HF or cardiovascular death,irrespective of their history of T2D[5-8].However,similar cardiovascular benefits were not observed in those with myocardial infarction(MI)[9,10].Cardiovascular co-morbidities are not only approximately twice as common but are also associated with dispropor-tionately worse cardiovascular outcomes in patients with T2D,compared to the general population[11].Therefore,it is of clinical importance to investigate whether the combination treatment of GLP-1RA and SGLT-2I could achieve greater cardiovascular benefit,particularly when considering patients with cardiovascular co-morbidities who may not gain sufficient cardiovascular protection from the monotherapies.This systematic review with multiple network meta-regressions was mainly aimed to explore whether combining GLP-1RA and SGLT-2I can provide additional cardiovascular benefit in T2D.Cardiovascular outcomes of these newer antidiabetic medications were also estimated under effect modification of prior cardiovascular diseases.This was to provide clinical insight as to when the combination treatment might be prioritized.展开更多
Assessment of population parameters and genetic diversity is critical for the economic and threatened species,including Oreochromis mossambicus.The morphometric and population parameters data for O.mossambicus were ex...Assessment of population parameters and genetic diversity is critical for the economic and threatened species,including Oreochromis mossambicus.The morphometric and population parameters data for O.mossambicus were extracted based on the available literature from various countries.Phylogenetic and genetic diversity were analyzed based on cytochrome c oxidaseⅠ(COⅠ)sequences of the mitochondrial DNA(mtDNA)gene.The population parameters(asymptotic length(L_(∞)),growth constant(K),growth performance index(Ø),approximate maximum age(t_(max)),standard length(L),and weight(W))results revealed a variation among the populations studied.The result categorized the population into two groups:South African populations located close to Zimbabwe,Mozambique,Namibia,Australia,and China,as GroupⅠ,and the Indian population placed close to Thailand,the Philippines,Indonesia,America,and Mexico as GroupⅡ.The meta-regression results reveal that temperature strongly correlated with weight.In contrast,other population factors showed no significant differences.The haplotype analysis based on COI of mtDNA displayed 21 haplotypes,which revealed low nucleotide(π=0.025)diversity.Haplotype diversity(HD)was 0.65.The haplotype analysis showed that Tajima(D)was negative(-0.82)and Fu’s Fs was positive(2.2),and both tests were not significant(P>0.05),whereas the overall F-statistic(F_(st))value was 0.40(P<0.001).In conclusion,population parameters,and genetic analysis indices a high variation among the O.mossambicus from different locations.Additionally,the population parameters for O.mossambicus in America,Asia,and Australia were more influenced by ecological factors.At the same time,the population parameters in the African continent were influenced more by genetic factors.展开更多
The effectiveness of phosphodiesterase type 5 inhibitors （PDE5-1s） for erectile dysfunction （ED） varies considerably among trials, but available studies investigating the factors that affect the effectiveness are ...The effectiveness of phosphodiesterase type 5 inhibitors （PDE5-1s） for erectile dysfunction （ED） varies considerably among trials, but available studies investigating the factors that affect the effectiveness are few and findings are not consistent. A systematic search was performed in PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials comparing PDE5-1s with placebo for the treatment of ED. The methodological quality of included studies was assessed by the Cochrane Collaboration＇s tool for assessing risk of bias. The associations between prespecified study-level factors and effectiveness were tested by a random effects meta-regression model. This study included 93 trials with 26 139 patients. When all PDE5-1s were grouped together, Caucasian ethnicity was associated with 15.636% （95% confidence interval [CI]： 0.858% to 32.579%） increase in risk ratio （RR） for Global Assessment Questionnaire question-1 （GAQ-1）, and 1.473 （95% CI： 0.406 to 2.338） score increase in mean difference （MD） for posttreatment International Index of Erectile Function-Erectile Function domain score （IIEF-EF）, compared to Asian ethnicity. A one-score increase in baseline IIEF-EF was associated with -5.635% （95% CI： -9.120% to -2.017%） reduction in RR for GAQ-1, and -0.229 （95% CI： -0.425 to -0.042） score decrease in MD for posttreatment IIEF-EF. In conclusion, PDE5-1s are more effective in Caucasians than Asians, and in patients with more severe ED.展开更多
To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overa...To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overall survival(OS) and progression-free survival(PFS) was determined. Our literature search was essentially based on Pub Med but information sources were scanned. Trials were included if a fluoropyrimidine regimen was given to at least one arm and information on PFS and OS was available. Medians for OS and PFS were our end-points. Covariates included temporal trend, arm allocation and Kirsten rat sarcoma status. In analyzing 130 treatment arms identified through our literature search, meta-regression showed an improvement with time for both OS(P < 0.001) and PFS(P < 0.001). The increase in median OS was from 14.9 mo in 2000 to 18.8 mo in 2012. Likewise, the improvement in PFS was from 5.7 to 8.1 mo. Multivariate analysis confirmed these findings. A post-hoc multivariate analysis was focused on patient arms treated with bevacizumab(n = 17) or without bevacizumab(n = 113); the multivariate-adjusted improvement attributable to bevacizumab was 1.66 mo for OS(P = 0.071) and 1.59 mo for PFS(P = 0.002). Overall, our results indicatethat OS and PFS have improved from 2000 to 2012 but the extent of this improvement is small and seems to have quite a questionable clinical relevance.展开更多
Objective:To explore the relationship between Hashimoto's autoimmune hypothyroidism(HT)and male fertility,focusing on hormonal and seminal factors.Methods:A systematic literature search was conducted across databa...Objective:To explore the relationship between Hashimoto's autoimmune hypothyroidism(HT)and male fertility,focusing on hormonal and seminal factors.Methods:A systematic literature search was conducted across databases such as PubMed,Web of Science,EMBASE,Scopus,Cochrane,and Google Scholar,covering studies published from January 2000 to March 2024.Studies investigating the impact of HT on semen quality parameters and reproductive hormones were included.Pooled effect estimates were calculated using standard mean difference(SMD)and 95%confidence intervals(CI).Results:A total of 8 studies with 8965 participants were included.HT significantly affected semen quality and reproductive hormone levels.Specifically,there was a notable decrease in progressive morphology(SMD=-0.78;95%CI:-1.40 to-0.17;P=0.01)and sperm motility(SMD=-1.151;95%CI:-1.876 to-0.425;P=0.002).In addition,there were no significant changes in reproductive hormones,although there were elevated levels of luteinizing hormone(SMD=0.437;95%CI:0.000 to 0.874;P=0.050)and follicle-stimulating hormone(SMD=0.293;95%CI:-0.171 to 0.758;P=0.216),with a slight impact on testosterone levels(SMD=-1.143;95%CI:-2.487 to 0.200;P=0.095).Conclusions:This systematic review and meta-analysis provides robust evidence of the detrimental effects of HT on semen quality and reproductive hormones,underscoring the necessity for thorough evaluation and management of thyroid function in male infertility assessments.展开更多
Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority ...Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.展开更多
BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately char...BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.展开更多
Background Chinese dietary reference intakes for calcium are largely based on foreign studies. We undertook meta- regression to estimate calcium requirements for Chinese adults derived from calcium balance data in Chi...Background Chinese dietary reference intakes for calcium are largely based on foreign studies. We undertook meta- regression to estimate calcium requirements for Chinese adults derived from calcium balance data in Chinese adults. Methods We searched PubMed, Cochrane CENTRAL, and SinoMed from inception to March 5, 2014, by using a structured search strategy. The bibliographies of any relevant papers and journals were also screened for potentially eligible studies. We extracted a standardized data set from studies in Chinese adults that reported calcium balance data. The relationship between calcium intake and output was examined by an individual participant data （IPD） and aggregate data （AD） meta-regression. Results We identified 11 metabolic studies in Chinese adults within 18-60 years of age. One hundred and forty-one IPD （n=35） expressed as mg/d, 127 IPD （n=32） expressed as mg.kg body wt-l-d-1, and 44 AD （n=132） expressed as mg/d were collected. The models predicted a neutral calcium balance （defined as calcium output （Y） equal to calcium intake （C）） at intakes of 460 mg/d （Y=0.60C＋183.98） and 8.27 mg.kg body wt-l.d-1 （Y=0.60C＋3.33） for IPD, or 409 mg/d （Y=0.66C＋139.00） for AD. Calcium requirements at upper intakes were higher than that at lower intakes in all these models. Conclusion Calcium requirement for Chinese adults 18-60 years of age approximately ranges between 400 mg/d and 500 mg/d when consuming traditional plant-based Chinese diets.展开更多
Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting result...Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.展开更多
Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to correspondi...Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.展开更多
Purpose: The aim of this study was to examine whether the efficacy of transtheoretical model(TTM)-based interventions on physical activity(PA)varied according to the following criteria:(1) interventions targeted the a...Purpose: The aim of this study was to examine whether the efficacy of transtheoretical model(TTM)-based interventions on physical activity(PA)varied according to the following criteria:(1) interventions targeted the actual stages of change(SOCs) or did not;(2) participants were selected according to their SOC or were not; and(3) its theoretical constructs(decisional balance, temptation, self-efficacy, processes of change).Methods: Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified.Results: The between-group heterogeneity statistic(Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not(Qb = 1.48, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not(Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC(Cohen's d = 0.36; 95%confidence interval(CI): 0.22–0.49) or not(d = 0.23; 95%CI: 0.09–0.38) and whether they selected their participants according to their SOC(d = 0.33; 95%CI: 0.13–0.53) or not(d = 0.32; 95%CI: 0.19–0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention(Qb = 8.82, p = 0.003), the use of self-efficacy(Qb = 6.09, p = 0.01), and the processes of change(Qb = 3.51, p = 0.06).Conclusion: TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs.展开更多
BACKGROUND The perinatal period is a challenging time of substantial emotional,physiological,social,and relational changes.Depression,anxiety,and stress symptoms are common,and co-exist in the perinatal period.Digital...BACKGROUND The perinatal period is a challenging time of substantial emotional,physiological,social,and relational changes.Depression,anxiety,and stress symptoms are common,and co-exist in the perinatal period.Digital technology continues to grow at an unprecedented pace with wide application,including psychotherapeutic intervention.A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations,but relatively few meta-and meta-regression analyses have concentrated on perinatal women.AIM To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.METHODS Randomized controlled trials(RCTs)were obtained from eight databases,including Cumulative Index to Nursing and Allied Health Literature,Cochrane Library,Embase,Scopus,PsycINFO,PubMed,Web of Science,and ProQuest Dissertation and Theses from inception up until November 24,2020.Comprehensive Meta-analysis 3.0 software was used to conduct meta-and metaregression analyses.The Cochrane risk-of-bias tool and the Grading of the Recommendation,Assessment,Development,and Evaluation system were adopted to assess the individual and overall qualities of the evidence,respectively.RESULTS A total of 25 RCTs that included 3239 women were identified.Meta-analyses revealed that intervention significantly improved depression(Hedges’s g=0.49),anxiety(g=0.25),and stress(g=0.47)symptoms compared to the control.Subgroup analyses demonstrated that a website platform with≥eight therapistguided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women.Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms.Egger’s regression asymmetry tests suggested that no publication biases occurred,but the overall quality of the evidence was very low.CONCLUSION This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women.Further high-quality RCTs with large sample sizes are needed.展开更多
AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocep...AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocephalus after an-eurysm treatment. Data were divided by type of study （randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study）. They were also divided by type of aneurysm treatment （microvascular - clipping, or endo-vascular - coiling）. Additional predictive variables collected for each publication were average age, gender distribu-tion, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treat-ment, duration of follow-up and date of publication. Weemployed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.RESULTS： Because indications for the two treatments are different, there is little clinical equipoise for treat-ing most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Nei-ther this nor pooled values from other studies which compared the two treatments had the power to dem-onstrate signifcant differences between the two treat-ments. Nor was there an apparent difference when observational data were meta-analytically pooled. How-ever, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference ap-peared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocepha-lus was found to be significantly lower in coiled vsclipped cases （P = 0.014）.CONCLUSION： Pooled observational data were nec-essary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.展开更多
Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently ...Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently voice their frustrations when the media reports a treatment working on one day, but seemingly the next day reports a study refuting the previous one. Meta-analyses are being used more commonly by researchers to convey an understandable summary of scientific studies to the general public and healthcare providers. As time goes by, we have learned how to improve meta-analytic techniques to reflect more valid results and when it is appropriate to pool or not to pool results from different studies. Retrospective reviews often don’t acknowledge this learning curve and may fail to recommend the most current valid guidelines. This editorial presents an example of how the current use of meta-analysis has shifted in one feld （the therapeutic effects of probiotics） and recommendations on how to correctly interpret the results of such an analysis.展开更多
The exponential growth of scientific evidence(i.e., primary research) and the ongoing development of methods to summarize such evidence, such as meta-analyses and mixed treatment comparisons(i.e., secondary research),...The exponential growth of scientific evidence(i.e., primary research) and the ongoing development of methods to summarize such evidence, such as meta-analyses and mixed treatment comparisons(i.e., secondary research), make the worldwide dissemination of highquality meta-analyses and pertinent articles a key scientific priority. The World Journal of Meta-Analysis will apply an electronic open access publishing approach combined with a timely and thorough peer-review of submitted manuscripts, weighing more on quality than priority, in order to improve the dissemination of systematic reviews and meta-analyses, as well as novelties and advancements in methods related to them, focusing on clinical medicine, but spanning all biomedical, epidemiological, and psychological research fields.展开更多
Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in ...Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual populations within and outside Africa. Methods: We performed metaregression analysis of log odds of HIV infection between uncircumcised and circumcised men using a single covariate (MC prevalence) in the meta-regression model involving the metareg package in STATA 13 for 103 populations worldwide and for populations within Africa. The meta-regression of log odds and MC prevalence was fitted to a line, as were empirical Bayes estimates resulting from post-estimation. Results: Our critical evaluation of Van Howe’s arguments attempting to undermine the scientific evidence in support of the benefits of MC in protection of men against HIV during heterosexual intercourse, as well as other infections and conditions, together with his use of statistics to support his beliefs, revealed serious flaws, obfuscation and missing data. We therefore performed our own meta-regression analysis using a trivariate model. Doing so revealed that for MC prevalences of 50%, 75% and 100% for general populations within Africa, odds ratios for HIV risk in uncircumcised vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression analysis of data for all countries yielded similar findings. For a general population outside Africa with 100% MC prevalence, OR was 1.5. Van Howe failed to acknowledge that since MC prevalence in US whites (91%) and blacks (76%) exceeds 75% his results support MC having a protective effect in those population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both within and outside Africa. The debate engineered by MC opponents, and led by Van Howe, now appears to have run its course. The scientific evidence has prevailed.展开更多
<span style="font-family:Verdana;">A previous series of meta-analyses demonstrated that a protected blend of B vitamins (RPBV: </span><span style="font-family:Verdana;">folic acid...<span style="font-family:Verdana;">A previous series of meta-analyses demonstrated that a protected blend of B vitamins (RPBV: </span><span style="font-family:Verdana;">folic acid, B12, pyridoxine, pantothenic acid, and biotin;Jefo, St. Hyacinthe, QC, Canada) improved milk fat and protein yield, with variation in the extent of the response. These results represent additional analyses of the same dataset to determine if the degree of response to RPVB on milk, fat and protein yield might be related to </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">level of production, lactation number</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> or days in milk (DIM). Results from 50 on</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">farm switchback trials conducted in 7 countries between 2005 and 2015 were included in the analysis. All herds participated in monthly milk recording services, and all were Holstein herds. A total of 6483 cows, averaging 163 DIM on the first test date, participated in the studies. Data were analyzed using regression models that accounted for the effects of trial, period, days in milk (DIM) and lactation number on milk and component yield. Milk yield</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and fat yield increased with B vitamin inclusion, and the extent of change was determined to increase with lactation number (P < 0.05). Protein yield increased with the RPBV and was unaffected by lactation number (P < 0.05) Responses to the RPBV occurred throughout lactation but were found to decline with DIM for milk, fat and protein yield. The global equation revealed that milk yield with the rumen</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">protected B vitamin blend = 4.05 + [0.917</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">×</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">control milk] <span style="color:#636363;"><span style="font-size:13.3333px;">-</span></span> [0.0063</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">× DIM] + [0.246 × Lactation number] (R</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0.798) The use of regression models allows changes in milk, fat and protein yields with the rumen</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">protected B vitamin blend to be more accurately predicted.</span>展开更多
The prefrontal cortex(PFC)is a critical non-invasive brain stimulation(NIBS)target for treating depression.However,the alterations of brain activations post-intervention remain inconsistent and the clinical moderators...The prefrontal cortex(PFC)is a critical non-invasive brain stimulation(NIBS)target for treating depression.However,the alterations of brain activations post-intervention remain inconsistent and the clinical moderators that could improve symptomatic effectiveness are unclear.The study aim was to systematically review the effectiveness of NIBS on depressive symptoms targeting PFC in functional magnetic resonance imaging(fMRI)studies.In our study,we delivered a combined activation likelihood estimation(ALE)meta-analysis and meta-regression.Until November 2020,three databases(PubMed,Web of Science,EMBASE)were searched and 14 studies with a total sample size of 584 were included in the ALE meta-analysis;after NIBS,four clusters in left cerebrum revealed significant activation while two clusters in right cerebrum revealed significant deactivation(P<0.001,cluster size>150 mm3).Eleven studies were statistically reanalyzed for depressive symptoms pre–post active-NIBS and the pooled effect size was very large[(d=1.82,95%CI(1.23,2.40)];significant moderators causing substantial heterogeneity(Chi squared=75.25,P<0.01;I2=87%)were detected through subgroup analysis and univariate meta-regression.Multivariate meta-regression was then conducted accordingly and the model suggested good fitness(Q=42.32,P<0.01).In all,NIBS targeting PFC balanced three core depressive-related neurocognitive networks(the salience network,the default mode network,and the central executive network);the striatum played a central role and might serve as a candidate treatment biomarker;gender difference,treatment-resistant condition,comorbidity,treatment duration,and localization all contributed to moderating depressive symptoms during NIBS.More high-quality,multi-center randomized controlled trails delivering personalized NIBS are needed for clinical practice in the future.展开更多
基金Supported by China Scholarship Council,No.202006920018Key Talent Program for Medical Applications of Nuclear Technology,No.XKTJ-HRC2021007+2 种基金the Second Affiliated Hospital of Soochow University,No.SDFEYBS1815 and No.SDFEYBS2008National Natural Science Foundation of China,No.82170831The Jiangsu Innovation&Career Fund for PhD 2019.
文摘BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are associated with significant cardiovascular benefit in type 2 diabetes(T2D).However,GLP-1RA or SGLT-2I alone may not improve some cardiovascular outcomes in patients with prior cardiovascular co-morbidities.AIM To explore whether combining GLP-1RA and SGLT-2I can achieve additional benefit in preventing cardiovascular diseases in T2D.METHODS The systematic review was conducted according to PRISMA recommendations.The protocol was registered on PROSPERO(ID:42022385007).A total of 107049 participants from eligible cardiovascular outcomes trials of GLP-1RA and SGLT-2I were included in network meta-regressions to estimate cardiovascular benefit of the combination treatment.Effect modification of prior myocardial infarction(MI)and heart failure(HF)was also explored to provide clinical insight as to when the INTRODUCTION The macro-and micro-vascular benefits of glucagon-like peptide-1 receptor agonists(GLP-1RA)and sodium-glucose co-transporter-2 inhibitors(SGLT-2I)are independent of their glucose-lowering effects[1].In patients with type 2 diabetes(T2D),the major cardiovascular outcome trials(CVOT)showed that dipeptidyl peptidase-4 inhibitors(DPP-4I)did not improve cardiovascular outcomes[2],whereas cardiovascular benefit of GLP-1RA or SGLT-2I was significant[3,4].Further subgroup analyses indicated that the background cardiovascular risk should be considered when examining the cardiovascular outcomes of these newer glucose-lowering medications.For instance,prevention of major adverse cardiovascular events(MACE)was only seen in those patients with baseline atherosclerotic cardiovascular disease[3,4].Moreover,a series of CVOT conducted in patients with heart failure(HF)have demonstrated that(compared with placebo)SGLT-2I significantly reduced risk of hospitalization for HF or cardiovascular death,irrespective of their history of T2D[5-8].However,similar cardiovascular benefits were not observed in those with myocardial infarction(MI)[9,10].Cardiovascular co-morbidities are not only approximately twice as common but are also associated with dispropor-tionately worse cardiovascular outcomes in patients with T2D,compared to the general population[11].Therefore,it is of clinical importance to investigate whether the combination treatment of GLP-1RA and SGLT-2I could achieve greater cardiovascular benefit,particularly when considering patients with cardiovascular co-morbidities who may not gain sufficient cardiovascular protection from the monotherapies.This systematic review with multiple network meta-regressions was mainly aimed to explore whether combining GLP-1RA and SGLT-2I can provide additional cardiovascular benefit in T2D.Cardiovascular outcomes of these newer antidiabetic medications were also estimated under effect modification of prior cardiovascular diseases.This was to provide clinical insight as to when the combination treatment might be prioritized.
文摘Assessment of population parameters and genetic diversity is critical for the economic and threatened species,including Oreochromis mossambicus.The morphometric and population parameters data for O.mossambicus were extracted based on the available literature from various countries.Phylogenetic and genetic diversity were analyzed based on cytochrome c oxidaseⅠ(COⅠ)sequences of the mitochondrial DNA(mtDNA)gene.The population parameters(asymptotic length(L_(∞)),growth constant(K),growth performance index(Ø),approximate maximum age(t_(max)),standard length(L),and weight(W))results revealed a variation among the populations studied.The result categorized the population into two groups:South African populations located close to Zimbabwe,Mozambique,Namibia,Australia,and China,as GroupⅠ,and the Indian population placed close to Thailand,the Philippines,Indonesia,America,and Mexico as GroupⅡ.The meta-regression results reveal that temperature strongly correlated with weight.In contrast,other population factors showed no significant differences.The haplotype analysis based on COI of mtDNA displayed 21 haplotypes,which revealed low nucleotide(π=0.025)diversity.Haplotype diversity(HD)was 0.65.The haplotype analysis showed that Tajima(D)was negative(-0.82)and Fu’s Fs was positive(2.2),and both tests were not significant(P>0.05),whereas the overall F-statistic(F_(st))value was 0.40(P<0.001).In conclusion,population parameters,and genetic analysis indices a high variation among the O.mossambicus from different locations.Additionally,the population parameters for O.mossambicus in America,Asia,and Australia were more influenced by ecological factors.At the same time,the population parameters in the African continent were influenced more by genetic factors.
文摘The effectiveness of phosphodiesterase type 5 inhibitors （PDE5-1s） for erectile dysfunction （ED） varies considerably among trials, but available studies investigating the factors that affect the effectiveness are few and findings are not consistent. A systematic search was performed in PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials comparing PDE5-1s with placebo for the treatment of ED. The methodological quality of included studies was assessed by the Cochrane Collaboration＇s tool for assessing risk of bias. The associations between prespecified study-level factors and effectiveness were tested by a random effects meta-regression model. This study included 93 trials with 26 139 patients. When all PDE5-1s were grouped together, Caucasian ethnicity was associated with 15.636% （95% confidence interval [CI]： 0.858% to 32.579%） increase in risk ratio （RR） for Global Assessment Questionnaire question-1 （GAQ-1）, and 1.473 （95% CI： 0.406 to 2.338） score increase in mean difference （MD） for posttreatment International Index of Erectile Function-Erectile Function domain score （IIEF-EF）, compared to Asian ethnicity. A one-score increase in baseline IIEF-EF was associated with -5.635% （95% CI： -9.120% to -2.017%） reduction in RR for GAQ-1, and -0.229 （95% CI： -0.425 to -0.042） score decrease in MD for posttreatment IIEF-EF. In conclusion, PDE5-1s are more effective in Caucasians than Asians, and in patients with more severe ED.
文摘To evaluate the overall effectiveness of treatments for metastatic colorectal cancer, a meta-regression was undertaken in which randomized studies from 2000 to 2012 were evaluated and the temporal trend for both overall survival(OS) and progression-free survival(PFS) was determined. Our literature search was essentially based on Pub Med but information sources were scanned. Trials were included if a fluoropyrimidine regimen was given to at least one arm and information on PFS and OS was available. Medians for OS and PFS were our end-points. Covariates included temporal trend, arm allocation and Kirsten rat sarcoma status. In analyzing 130 treatment arms identified through our literature search, meta-regression showed an improvement with time for both OS(P < 0.001) and PFS(P < 0.001). The increase in median OS was from 14.9 mo in 2000 to 18.8 mo in 2012. Likewise, the improvement in PFS was from 5.7 to 8.1 mo. Multivariate analysis confirmed these findings. A post-hoc multivariate analysis was focused on patient arms treated with bevacizumab(n = 17) or without bevacizumab(n = 113); the multivariate-adjusted improvement attributable to bevacizumab was 1.66 mo for OS(P = 0.071) and 1.59 mo for PFS(P = 0.002). Overall, our results indicatethat OS and PFS have improved from 2000 to 2012 but the extent of this improvement is small and seems to have quite a questionable clinical relevance.
文摘Objective:To explore the relationship between Hashimoto's autoimmune hypothyroidism(HT)and male fertility,focusing on hormonal and seminal factors.Methods:A systematic literature search was conducted across databases such as PubMed,Web of Science,EMBASE,Scopus,Cochrane,and Google Scholar,covering studies published from January 2000 to March 2024.Studies investigating the impact of HT on semen quality parameters and reproductive hormones were included.Pooled effect estimates were calculated using standard mean difference(SMD)and 95%confidence intervals(CI).Results:A total of 8 studies with 8965 participants were included.HT significantly affected semen quality and reproductive hormone levels.Specifically,there was a notable decrease in progressive morphology(SMD=-0.78;95%CI:-1.40 to-0.17;P=0.01)and sperm motility(SMD=-1.151;95%CI:-1.876 to-0.425;P=0.002).In addition,there were no significant changes in reproductive hormones,although there were elevated levels of luteinizing hormone(SMD=0.437;95%CI:0.000 to 0.874;P=0.050)and follicle-stimulating hormone(SMD=0.293;95%CI:-0.171 to 0.758;P=0.216),with a slight impact on testosterone levels(SMD=-1.143;95%CI:-2.487 to 0.200;P=0.095).Conclusions:This systematic review and meta-analysis provides robust evidence of the detrimental effects of HT on semen quality and reproductive hormones,underscoring the necessity for thorough evaluation and management of thyroid function in male infertility assessments.
文摘Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.
文摘BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.
文摘Background Chinese dietary reference intakes for calcium are largely based on foreign studies. We undertook meta- regression to estimate calcium requirements for Chinese adults derived from calcium balance data in Chinese adults. Methods We searched PubMed, Cochrane CENTRAL, and SinoMed from inception to March 5, 2014, by using a structured search strategy. The bibliographies of any relevant papers and journals were also screened for potentially eligible studies. We extracted a standardized data set from studies in Chinese adults that reported calcium balance data. The relationship between calcium intake and output was examined by an individual participant data （IPD） and aggregate data （AD） meta-regression. Results We identified 11 metabolic studies in Chinese adults within 18-60 years of age. One hundred and forty-one IPD （n=35） expressed as mg/d, 127 IPD （n=32） expressed as mg.kg body wt-l-d-1, and 44 AD （n=132） expressed as mg/d were collected. The models predicted a neutral calcium balance （defined as calcium output （Y） equal to calcium intake （C）） at intakes of 460 mg/d （Y=0.60C＋183.98） and 8.27 mg.kg body wt-l.d-1 （Y=0.60C＋3.33） for IPD, or 409 mg/d （Y=0.66C＋139.00） for AD. Calcium requirements at upper intakes were higher than that at lower intakes in all these models. Conclusion Calcium requirement for Chinese adults 18-60 years of age approximately ranges between 400 mg/d and 500 mg/d when consuming traditional plant-based Chinese diets.
基金Supported by the National Natural Science Foundation of China (No.81973968)the China Academy of Chinese Medical Sciences (No.CI2021A03503, GH201901, and 2020YJSZX-1)。
文摘Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.
基金supported by GP Batteries Industrial Safety Trust Fund(Funding number:R-ZDDR).
文摘Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.
文摘Purpose: The aim of this study was to examine whether the efficacy of transtheoretical model(TTM)-based interventions on physical activity(PA)varied according to the following criteria:(1) interventions targeted the actual stages of change(SOCs) or did not;(2) participants were selected according to their SOC or were not; and(3) its theoretical constructs(decisional balance, temptation, self-efficacy, processes of change).Methods: Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified.Results: The between-group heterogeneity statistic(Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not(Qb = 1.48, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not(Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC(Cohen's d = 0.36; 95%confidence interval(CI): 0.22–0.49) or not(d = 0.23; 95%CI: 0.09–0.38) and whether they selected their participants according to their SOC(d = 0.33; 95%CI: 0.13–0.53) or not(d = 0.32; 95%CI: 0.19–0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention(Qb = 8.82, p = 0.003), the use of self-efficacy(Qb = 6.09, p = 0.01), and the processes of change(Qb = 3.51, p = 0.06).Conclusion: TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs.
基金Ministry of Education Academic Research Fund(AcRF)Tier 1,No.NUHSRO/2017/054/T1。
文摘BACKGROUND The perinatal period is a challenging time of substantial emotional,physiological,social,and relational changes.Depression,anxiety,and stress symptoms are common,and co-exist in the perinatal period.Digital technology continues to grow at an unprecedented pace with wide application,including psychotherapeutic intervention.A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations,but relatively few meta-and meta-regression analyses have concentrated on perinatal women.AIM To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.METHODS Randomized controlled trials(RCTs)were obtained from eight databases,including Cumulative Index to Nursing and Allied Health Literature,Cochrane Library,Embase,Scopus,PsycINFO,PubMed,Web of Science,and ProQuest Dissertation and Theses from inception up until November 24,2020.Comprehensive Meta-analysis 3.0 software was used to conduct meta-and metaregression analyses.The Cochrane risk-of-bias tool and the Grading of the Recommendation,Assessment,Development,and Evaluation system were adopted to assess the individual and overall qualities of the evidence,respectively.RESULTS A total of 25 RCTs that included 3239 women were identified.Meta-analyses revealed that intervention significantly improved depression(Hedges’s g=0.49),anxiety(g=0.25),and stress(g=0.47)symptoms compared to the control.Subgroup analyses demonstrated that a website platform with≥eight therapistguided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women.Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms.Egger’s regression asymmetry tests suggested that no publication biases occurred,but the overall quality of the evidence was very low.CONCLUSION This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women.Further high-quality RCTs with large sample sizes are needed.
文摘AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocephalus after an-eurysm treatment. Data were divided by type of study （randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study）. They were also divided by type of aneurysm treatment （microvascular - clipping, or endo-vascular - coiling）. Additional predictive variables collected for each publication were average age, gender distribu-tion, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treat-ment, duration of follow-up and date of publication. Weemployed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.RESULTS： Because indications for the two treatments are different, there is little clinical equipoise for treat-ing most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Nei-ther this nor pooled values from other studies which compared the two treatments had the power to dem-onstrate signifcant differences between the two treat-ments. Nor was there an apparent difference when observational data were meta-analytically pooled. How-ever, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference ap-peared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocepha-lus was found to be significantly lower in coiled vsclipped cases （P = 0.014）.CONCLUSION： Pooled observational data were nec-essary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.
文摘Scientific research is challenged to translate findingsfrom multiple, often conflicting, clinical trials into a simple answer of whether a treatment works or not. The public and healthcare providers alike frequently voice their frustrations when the media reports a treatment working on one day, but seemingly the next day reports a study refuting the previous one. Meta-analyses are being used more commonly by researchers to convey an understandable summary of scientific studies to the general public and healthcare providers. As time goes by, we have learned how to improve meta-analytic techniques to reflect more valid results and when it is appropriate to pool or not to pool results from different studies. Retrospective reviews often don’t acknowledge this learning curve and may fail to recommend the most current valid guidelines. This editorial presents an example of how the current use of meta-analysis has shifted in one feld （the therapeutic effects of probiotics） and recommendations on how to correctly interpret the results of such an analysis.
文摘The exponential growth of scientific evidence(i.e., primary research) and the ongoing development of methods to summarize such evidence, such as meta-analyses and mixed treatment comparisons(i.e., secondary research), make the worldwide dissemination of highquality meta-analyses and pertinent articles a key scientific priority. The World Journal of Meta-Analysis will apply an electronic open access publishing approach combined with a timely and thorough peer-review of submitted manuscripts, weighing more on quality than priority, in order to improve the dissemination of systematic reviews and meta-analyses, as well as novelties and advancements in methods related to them, focusing on clinical medicine, but spanning all biomedical, epidemiological, and psychological research fields.
文摘Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual populations within and outside Africa. Methods: We performed metaregression analysis of log odds of HIV infection between uncircumcised and circumcised men using a single covariate (MC prevalence) in the meta-regression model involving the metareg package in STATA 13 for 103 populations worldwide and for populations within Africa. The meta-regression of log odds and MC prevalence was fitted to a line, as were empirical Bayes estimates resulting from post-estimation. Results: Our critical evaluation of Van Howe’s arguments attempting to undermine the scientific evidence in support of the benefits of MC in protection of men against HIV during heterosexual intercourse, as well as other infections and conditions, together with his use of statistics to support his beliefs, revealed serious flaws, obfuscation and missing data. We therefore performed our own meta-regression analysis using a trivariate model. Doing so revealed that for MC prevalences of 50%, 75% and 100% for general populations within Africa, odds ratios for HIV risk in uncircumcised vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression analysis of data for all countries yielded similar findings. For a general population outside Africa with 100% MC prevalence, OR was 1.5. Van Howe failed to acknowledge that since MC prevalence in US whites (91%) and blacks (76%) exceeds 75% his results support MC having a protective effect in those population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both within and outside Africa. The debate engineered by MC opponents, and led by Van Howe, now appears to have run its course. The scientific evidence has prevailed.
文摘<span style="font-family:Verdana;">A previous series of meta-analyses demonstrated that a protected blend of B vitamins (RPBV: </span><span style="font-family:Verdana;">folic acid, B12, pyridoxine, pantothenic acid, and biotin;Jefo, St. Hyacinthe, QC, Canada) improved milk fat and protein yield, with variation in the extent of the response. These results represent additional analyses of the same dataset to determine if the degree of response to RPVB on milk, fat and protein yield might be related to </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">level of production, lactation number</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> or days in milk (DIM). Results from 50 on</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">farm switchback trials conducted in 7 countries between 2005 and 2015 were included in the analysis. All herds participated in monthly milk recording services, and all were Holstein herds. A total of 6483 cows, averaging 163 DIM on the first test date, participated in the studies. Data were analyzed using regression models that accounted for the effects of trial, period, days in milk (DIM) and lactation number on milk and component yield. Milk yield</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and fat yield increased with B vitamin inclusion, and the extent of change was determined to increase with lactation number (P < 0.05). Protein yield increased with the RPBV and was unaffected by lactation number (P < 0.05) Responses to the RPBV occurred throughout lactation but were found to decline with DIM for milk, fat and protein yield. The global equation revealed that milk yield with the rumen</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">protected B vitamin blend = 4.05 + [0.917</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">×</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">control milk] <span style="color:#636363;"><span style="font-size:13.3333px;">-</span></span> [0.0063</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">× DIM] + [0.246 × Lactation number] (R</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0.798) The use of regression models allows changes in milk, fat and protein yields with the rumen</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">protected B vitamin blend to be more accurately predicted.</span>
基金supported by National Science Fund for Distinguished Young Scholars(81725005 to Fei Wang)National Natural Science Foundation Regional Innovation and Development Joint Fund(U20A6005 to Fei Wang)+1 种基金Jiangsu Provincial Key Research and Development Program(BE2021617 to Fei Wang)National Natural Science Foundation of China(62176129 to Xizhe Zhang).
文摘The prefrontal cortex(PFC)is a critical non-invasive brain stimulation(NIBS)target for treating depression.However,the alterations of brain activations post-intervention remain inconsistent and the clinical moderators that could improve symptomatic effectiveness are unclear.The study aim was to systematically review the effectiveness of NIBS on depressive symptoms targeting PFC in functional magnetic resonance imaging(fMRI)studies.In our study,we delivered a combined activation likelihood estimation(ALE)meta-analysis and meta-regression.Until November 2020,three databases(PubMed,Web of Science,EMBASE)were searched and 14 studies with a total sample size of 584 were included in the ALE meta-analysis;after NIBS,four clusters in left cerebrum revealed significant activation while two clusters in right cerebrum revealed significant deactivation(P<0.001,cluster size>150 mm3).Eleven studies were statistically reanalyzed for depressive symptoms pre–post active-NIBS and the pooled effect size was very large[(d=1.82,95%CI(1.23,2.40)];significant moderators causing substantial heterogeneity(Chi squared=75.25,P<0.01;I2=87%)were detected through subgroup analysis and univariate meta-regression.Multivariate meta-regression was then conducted accordingly and the model suggested good fitness(Q=42.32,P<0.01).In all,NIBS targeting PFC balanced three core depressive-related neurocognitive networks(the salience network,the default mode network,and the central executive network);the striatum played a central role and might serve as a candidate treatment biomarker;gender difference,treatment-resistant condition,comorbidity,treatment duration,and localization all contributed to moderating depressive symptoms during NIBS.More high-quality,multi-center randomized controlled trails delivering personalized NIBS are needed for clinical practice in the future.
