[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure...[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.展开更多
We highly commend Dr Souza et al.1for their systematic review research.The authors conducted a detailed investigation into the effects of ischemic preconditioning(IPC)on athletic performance,comparing it with placebo ...We highly commend Dr Souza et al.1for their systematic review research.The authors conducted a detailed investigation into the effects of ischemic preconditioning(IPC)on athletic performance,comparing it with placebo and no-intervention conditions.The study found that while IPC demonstrated superior effects over the no-intervention group in certain metrics(e.g.,time to exhaustion),its performance did not significantly surpass that of the placebo group.This suggests that the potential benefits of IPC may partially stem from participants’psychological expectations,or placebo effects.The study also highlighted the significant impact of placebo interventions on athletic performance,emphasizing the importance of distinguishing between placebo and no-intervention conditions in experimental designs.展开更多
Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a com...Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a comprehensive qualitative synthesis of six studies meeting their inclusion criteria,we believe that additional quantitative analysis would strengthen the evidence base for foot reflexology in managing nausea and vomiting.We conducted a complementary meta-analysis to provide quantitative evidence supporting the qualitative findings presented in the systematic review.展开更多
We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic ...We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.展开更多
BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related...BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related cardiotoxicity remain understudied.We investigated the association between SGLT2i and cardiac outcomes in cancer patients.METHODS PubMed,Embase,and the Cochrane Library were searched from their inception until September 30,2024 for studies evaluating the effects of SGLT2i in patients with cancer.The primary outcomes included incident heart failure(HF),HF exacerbation,HF hospitalization,atrial fibrillation/atrial flutter(AF/AFL),myocardial infarction,and all-cause mortality.The secondary outcomes included acute kidney injury and sepsis.Odds ratio(OR)with 95%CI was pooled.RESULTS Thirteen studies with 85,596 patients were included.Compared to non-SGLT2i use,SGLT2i treatment was associated with lower risks of incident HF(OR=0.51,95%CI:0.32-0.79,P=0.003),HF exacerbation(OR=0.74,95%CI:0.63-0.87,P<0.001),AF/AFL(OR=0.67,95%CI:0.55-0.82,P<0.001),myocardial infarction(OR=0.61,95%CI:0.41-0.90,P=0.01),and all-cause mortality(OR=0.44,95%CI:0.28-0.69,P<0.001),but not for HF hospitalization(OR=0.58,95%CI:0.22-1.55,P=0.28).As for safety outcomes,SGLT2i use was associated with lower risks of acute kidney injury(OR=0.68,95%CI:0.57-0.81,P<0.001)and sepsis(OR=0.32,95%CI:0.23-0.44,P<0.001).CONCLUSIONS SGLT2i were associated with lower risks of incident HF,HF exacerbation,AF/AFL,myocardial infarction,allcause mortality,acute kidney injury,and sepsis in cancer patients.展开更多
BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances s...BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.展开更多
Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,e...Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,equipment,and expertise needed to conduct laboratory cardiopulmonary exercise testing(CPET)to determine the maximal rate of oxygen uptake(VO2max)as an objective measure of CRF.Alternatively,indirect estimates of CRF have been applied by measuring maximal duration on treadmill or cycle ergometer tests,2,3 extrapolating maximal CRF from workload or heart rate during submaximal fitness tests,4,5 and using non-exercise algorithms to estimate CRF from an individual’s age,sex,body mass,and physical activity habits.6 It is assumed that objectively measured VO2max is superior to extrapolated and estimated values due to errors associated with the estimated values;7,8 however,until Singh et al.9 newly released article in the Journal of Sport and Health Science,the comparability of these methods in identifying risks for all-cause and cardiovascular disease(CVD)mortality was unknown.展开更多
Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,Ps...Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,PsycINFO,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang database,China Science and Technology Journal Database(VIP)and SinoMed were searched for studies that reported data on the correlated factors associated with PTG in patients with CRC from inception to September 3,2024.The methodological quality of the included studies was assessed via the Agency for Healthcare Research and Quality(AHRQ)methodology checklist and the Newcastle-Ottawa Scale(NOS).Pearson correlation coefficient(r)was utilized to indicate effect size.Meta-analysis was conducted in R Studio.Results:Thirty-one eligible studies encompassing 6,400 participants were included in this review.Correlated factors were identified to be significantly associated with PTG in patients with CRC including demographic factors:residential area(r=0.13),marital status(r=0.10),employment status(r=0.18),education level(r=0.19),income level(r=0.16);disease-related factors:time since surgery(r=0.17),stoma-related complications(r=0.14),health-promoting behavior(r=0.46),and sexual function(r=0.17);psychosocial factors:confrontation coping(r=0.68),avoidance coping(r=-0.65),deliberate rumination(r=0.56),social support(r=0.47),family function(r=0.50),resilience(r=0.53),selfefficacy(r=0.91),self-compassion(r=-0.32),psychosocial adjustment(r=0.39),gratitude(r=0.45),stigma(r=-0.65),self-perceived burden(r=-0.31),fear of cancer recurrence(r=-0.45);and quality of life(r=0.32).Conclusions:This meta-analysis identified 23 factors associated with PTG in CRC patients.Medical workers can combine those relevant factors from the perspective of positive psychology,further explore the occurrence and development mechanism of PTG,and establish targeted interventions to promote PTG.展开更多
This study aimed to systematically evaluate the clinical efficacy of combining wax therapy with conventional drug therapy for rheumatoid arthritis(RA)and to provide evidence supporting its clinical application.A compr...This study aimed to systematically evaluate the clinical efficacy of combining wax therapy with conventional drug therapy for rheumatoid arthritis(RA)and to provide evidence supporting its clinical application.A comprehensive search was conducted across PubMed,Cochrane Library,China Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases from their inception to May 2024.Randomized controlled trials(RCTs)investigating the combination of wax therapy and conventional drug therapy for RA were included in the analysis.Statistical analysis was performed using Review Manager 5.3 software.Nine studies,encompassing a total of 843 patients,were included.The results demonstrated that the combination therapy significantly improved clinical efficacy compared to conventional drug therapy alone[RR=1.22,95%CI(1.11,1.34)].Moreover,the combination therapy led to notable improvements in DAS 28 scores[MD=-0.90,95%CI(-1.23,-0.57),P<0.00001],VAS scores[MD=-0.90,95%CI(-1.13,-0.66),P<0.00001],reduction in joint tenderness[MD=-1.27,95%CI(-1.81,-0.72),P<0.00001],decreased duration of morning stiffness[MD=-25.47,95%CI(-34.33,-16.61),P<0.00001],and lowered C-reactive protein levels[MD=-6.29,95%CI(-12.02,-0.57),P<0.05].In conclusion,wax therapy combined with conventional anti-rheumatic drugs significantly enhanced the clinical outcomes for RA patients by alleviating symptoms,reducing joint pain and morning stiffness,and decreasing inflammatory markers more effectively than conventional drug therapy alone.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
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
Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-...Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain(CIBP).Methods We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems.It included four Chinese databases[Chinese Biomedical Literature Database(SinoMed),China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(VIP)],six English databases(Scopus,Embase,Web of Science,PubMed,Cochrane Library,and OpenGrey),and two registration systems(Chinese Clinical Trial Registry and ClinicalTrials.gov).The timeframe for the literature search extended from the inception of each database to December 31,2023.Meta-analysis was performed using RevMan(v5.4.1),and the outcome indicators(pain relief rate,analgesic duration,quality of life,pain intensity,breakthrough pain frequency,and adverse reactions)were graded using GRADE profiler(v3.6).Results According to the established inclusion and exclusion criteria,a total of 43 studies was deemed eligible,involving 3142 participants with CIBP.The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone,the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate[risk ratio(RR)=1.32,95%confidence interval(CI):1.24 to 1.41,P<0.00001],analgesic duration[mean difference(MD)=1.33,95%CI:0.97 to 1.69,P<0.00001],and quality of life(MD=5.66,95%CI:4.88 to 6.44,P<0.00001).Furthermore,the combined therapy significantly reduced pain intensity(MD=-1.00,95%CI:-1.19 to-0.80,P<0.00001),breakthrough pain frequency(MD=-0.43,95%CI:-0.51 to-0.36,P<0.00001),and adverse reactions(RR=0.60,95%CI:0.53 to 0.68,P<0.00001)in CIBP patients.Based on the GRADE assessment,the level of evidence varied from low to moderate.Conclusion EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life.Additionally,the EA-TCM can effectively reduce the incidence of adverse reactions associated with threestep analgesic therapy.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
Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key...Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.展开更多
Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online data...Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.展开更多
Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databa...Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.展开更多
To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These incl...To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These included the Cochrane Library, Wanfang Database, PubMed, CNKI, Embase, and Clinical Trials. The search encompassed studies published from the inception of the databases to March 2024. Randomized controlled studies meeting the inclusion criteria were assessed for bias using the Cochrane risk of bias assessment tool. Data were analyzed using Review Manager 5.4, with relative risk (RR) as the effect indicator. Depending on the heterogeneity of the studies, either a fixed-effects model or a random-effects model was employed to combine effect sizes. Seven studies met the inclusion criteria. Compared with ARB drugs, sacubitril/valsartan showed a reduction in the deterioration of renal function (RR = 0.70, 95% CI: 0.44–1.12, P = 0.14) and acute renal function injury (RR = 0.77, 95% CI: 0.59–1.00, P = 0.05). The risk of end-stage renal disease was also lower (RR = 0.53, 95% CI: 0.30–0.96, P = 0.16). For serum creatinine levels greater than 2.5 mg/dL, the RR was 0.88 (95% CI: 0.68–1.15, P = 0.37). For a reduction in eGFR of more than 25%, the RR was 0.89 (95% CI: 0.57–1.41, P = 0.63). The incidence of serum potassium levels greater than 5.5 mmol/L was not significantly different between the groups (RR = 1.23, 95% CI: 0.86–1.75, P = 0.26), nor was the incidence of serum potassium levels greater than 6.0 mmol/L (RR = 1.06, 95% CI: 0.58–1.93, P = 0.86). However, the incidence of eGFR decreasing by more than 50% was significantly reduced (RR = 0.58, 95% CI: 0.34–0.99, P < 0.05). In conclusion, sacubitril/valsartan demonstrated a protective effect on the kidneys, effectively reducing the risk of renal deterioration and presenting a potential alternative to ARB drugs.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)ranks sixth globally in cancer incidence and third in mortality rates.Unfortunately,over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation...BACKGROUND Hepatocellular carcinoma(HCC)ranks sixth globally in cancer incidence and third in mortality rates.Unfortunately,over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations,poor physical condition,and limited organ availability upon diagnosis.Clinical guidelines endorse transarterial chemoembolization(TACE)as the frontline treatment for intermediate to advanced-stage HCC.Cryoablation(CRA)is an emerging local ablative therapy increasingly used in HCC management.Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects,potentially improving long-term survival rates.However,the superiority of combined TACE+CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of≥5 cm.METHODS PubMed,EMBASE,Cochrane Library,CNKI,Wanfang,and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022.Meta-analysis was performed using RevMan 5.3 software.RESULTS After screening according to the inclusion and exclusion criteria,6 articles were included,including 2 randomized controlled trials and 4 nonrandomized controlled trials,with a total of 575 patients included in the meta-analysis.The results showed that the objective response rate[odds ratio(OR)=2.56,95%confidence interval(CI):1.66-3.96,P<0.0001],disease control rate(OR=3.03,95%CI:1.88-4.89,P<0.00001),1-year survival rate(OR=3.79,95%CI:2.50-5.76,P<0.00001),2-year survival rate(OR=2.34,95%CI:1.43-3.85,P=0.0008),and 3-year survival rate(OR=3.34,95%CI:1.61-6.94,P=0.001)were all superior to those of the control group;the postoperative decrease in alpha-fetoprotein value(OR=295.53,95%CI:250.22-340.85,P<0.0001),the postoperative increase in CD4 value(OR=10.59,95%CI:8.78-12.40,P<0.00001),and the postoperative decrease in CD8 value(OR=6.47,95%CI:4.44-8.50,P<0.00001)were also significantly higher than those in the TACE-alone treatment group.CONCLUSION Compared with TACE-alone treatment,TACE+CRA combined treatment not only improves the immune function of HCC patients with a diameter of≥5 cm,but also enhances the therapeutic efficacy and long-term survival rate,without increasing the risk of complications.Therefore,TACE+CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of≥5 cm.展开更多
Background: Studies of gastrointestinal (GIT) cancers have shown that circZFR could be involved in the development and progression of various GIT cancers. However, small sample sizes limit the clinical significance of...Background: Studies of gastrointestinal (GIT) cancers have shown that circZFR could be involved in the development and progression of various GIT cancers. However, small sample sizes limit the clinical significance of these studies. Here, a meta-analysis was conducted to ascertain the actual involvement of circZFR in the development and prognosis of GIT cancers. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched up to December 31, 2023. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled to evaluate the association between circZFR expression and overall survival (OS). Publication bias was measured using the funnel plot and Egger’s test. Results: 10 studies having 659 participants were enrolled for meta-analysis. High circZFR expression was associated with poor OS (HR = 1.4, 95% CI: 1.20, 1.70). High circZFR expression also predicted larger tumor size (OR = 4.38, 95% CI 2.65, 7.25), advanced clinical stage (OR = 5.33, 95% CI 3.10, 9.16), and tendency for distant metastasis (OR = 2.89, 95% CI: 1.62, 5.11), but was not related to age, gender, and histological grade. Conclusions: In summary, high circZFR expression was associated with poor OS, larger tumor size, advanced stage cancer and tendency for distant metastasis. These findings suggested that circZFR could be a prognostic marker for GIT cancers.展开更多
文摘[Objectives]To evaluate the impact of nasal insulin administration on postoperative delirium(POD)through meta-analysis.[Methods]The Cochrane Library,PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(CSTJ)were systematically searched for relevant literature published prior to February 27,2025.Literature screening and data extraction were conducted by two independent researchers in accordance with predetermined inclusion and exclusion criteria.The primary observation indicator was the incidence of POD across various treatment populations.The risk ratio for the primary outcome was calculated using the Mantel-Haenszel method.The secondary outcomes included the adverse effects associated with insulin treatment,which encompassed the glycemic variability indices,the incidence of nasal irritation symptoms following administration,hypoglycemic reactions,and insulin allergic reactions.The study protocol was registered on PROSPERO(CRD420250607492)before data extraction.[Results]A total of five randomized controlled trials involving 357 patients were included in the analysis.In the adult population undergoing surgical procedures,the administration of insulin via nasal delivery was found to significantly reduce the incidence of POD[RR=0.35,95%CI(0.23-0.53),P<0.001].The results of the subgroup analysis indicated that there were notable differences in the effectiveness of various doses of insulin administered nasally in preventing POD.Specifically,both the 20 U dose group[RR=0.45,95%CI:(0.29,0.70),P<0.001]and the 30 U dose group[RR=0.01,95%CI:(0.03,0.42),P<0.001]showed a significantly lower incidence of POD compared to the control group,with statistically significant conclusions.Conversely,the 40 U dose group[RR=0.47,95%CI:(0.17,1.34),P=0.16]yielded no statistically significant difference.Furthermore,the efficacy in preventing POD was found to be greater in the 30 U dose group compared to the 20 U dose group.Additionally,two cases of hypoglycemic reactions and increased nasal irritation symptom scores were reported in the 40 U dose group across the entire study population(P<0.05),suggesting potential adverse risks associated with this dosage.[Conclusions]The nasal administration of insulin significantly decreases the incidence of POD at a specific dosage,with optimal efficacy and high safety observed at a dosage of 30 U.
文摘We highly commend Dr Souza et al.1for their systematic review research.The authors conducted a detailed investigation into the effects of ischemic preconditioning(IPC)on athletic performance,comparing it with placebo and no-intervention conditions.The study found that while IPC demonstrated superior effects over the no-intervention group in certain metrics(e.g.,time to exhaustion),its performance did not significantly surpass that of the placebo group.This suggests that the potential benefits of IPC may partially stem from participants’psychological expectations,or placebo effects.The study also highlighted the significant impact of placebo interventions on athletic performance,emphasizing the importance of distinguishing between placebo and no-intervention conditions in experimental designs.
文摘Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a comprehensive qualitative synthesis of six studies meeting their inclusion criteria,we believe that additional quantitative analysis would strengthen the evidence base for foot reflexology in managing nausea and vomiting.We conducted a complementary meta-analysis to provide quantitative evidence supporting the qualitative findings presented in the systematic review.
文摘We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.
基金supported by the National Natural Science Foundation of China(No.82170327&No.82370332)the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A).
文摘BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related cardiotoxicity remain understudied.We investigated the association between SGLT2i and cardiac outcomes in cancer patients.METHODS PubMed,Embase,and the Cochrane Library were searched from their inception until September 30,2024 for studies evaluating the effects of SGLT2i in patients with cancer.The primary outcomes included incident heart failure(HF),HF exacerbation,HF hospitalization,atrial fibrillation/atrial flutter(AF/AFL),myocardial infarction,and all-cause mortality.The secondary outcomes included acute kidney injury and sepsis.Odds ratio(OR)with 95%CI was pooled.RESULTS Thirteen studies with 85,596 patients were included.Compared to non-SGLT2i use,SGLT2i treatment was associated with lower risks of incident HF(OR=0.51,95%CI:0.32-0.79,P=0.003),HF exacerbation(OR=0.74,95%CI:0.63-0.87,P<0.001),AF/AFL(OR=0.67,95%CI:0.55-0.82,P<0.001),myocardial infarction(OR=0.61,95%CI:0.41-0.90,P=0.01),and all-cause mortality(OR=0.44,95%CI:0.28-0.69,P<0.001),but not for HF hospitalization(OR=0.58,95%CI:0.22-1.55,P=0.28).As for safety outcomes,SGLT2i use was associated with lower risks of acute kidney injury(OR=0.68,95%CI:0.57-0.81,P<0.001)and sepsis(OR=0.32,95%CI:0.23-0.44,P<0.001).CONCLUSIONS SGLT2i were associated with lower risks of incident HF,HF exacerbation,AF/AFL,myocardial infarction,allcause mortality,acute kidney injury,and sepsis in cancer patients.
文摘BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.
文摘Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,equipment,and expertise needed to conduct laboratory cardiopulmonary exercise testing(CPET)to determine the maximal rate of oxygen uptake(VO2max)as an objective measure of CRF.Alternatively,indirect estimates of CRF have been applied by measuring maximal duration on treadmill or cycle ergometer tests,2,3 extrapolating maximal CRF from workload or heart rate during submaximal fitness tests,4,5 and using non-exercise algorithms to estimate CRF from an individual’s age,sex,body mass,and physical activity habits.6 It is assumed that objectively measured VO2max is superior to extrapolated and estimated values due to errors associated with the estimated values;7,8 however,until Singh et al.9 newly released article in the Journal of Sport and Health Science,the comparability of these methods in identifying risks for all-cause and cardiovascular disease(CVD)mortality was unknown.
基金supported by the‘Double First-Class’Construction Specialized Discipline Project at Zhejiang University(No HL2024012).
文摘Objectives:This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth(PTG)in patients with colorectal cancer(CRC).Methods:PubMed,Web of Science,Embase,PsycINFO,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang database,China Science and Technology Journal Database(VIP)and SinoMed were searched for studies that reported data on the correlated factors associated with PTG in patients with CRC from inception to September 3,2024.The methodological quality of the included studies was assessed via the Agency for Healthcare Research and Quality(AHRQ)methodology checklist and the Newcastle-Ottawa Scale(NOS).Pearson correlation coefficient(r)was utilized to indicate effect size.Meta-analysis was conducted in R Studio.Results:Thirty-one eligible studies encompassing 6,400 participants were included in this review.Correlated factors were identified to be significantly associated with PTG in patients with CRC including demographic factors:residential area(r=0.13),marital status(r=0.10),employment status(r=0.18),education level(r=0.19),income level(r=0.16);disease-related factors:time since surgery(r=0.17),stoma-related complications(r=0.14),health-promoting behavior(r=0.46),and sexual function(r=0.17);psychosocial factors:confrontation coping(r=0.68),avoidance coping(r=-0.65),deliberate rumination(r=0.56),social support(r=0.47),family function(r=0.50),resilience(r=0.53),selfefficacy(r=0.91),self-compassion(r=-0.32),psychosocial adjustment(r=0.39),gratitude(r=0.45),stigma(r=-0.65),self-perceived burden(r=-0.31),fear of cancer recurrence(r=-0.45);and quality of life(r=0.32).Conclusions:This meta-analysis identified 23 factors associated with PTG in CRC patients.Medical workers can combine those relevant factors from the perspective of positive psychology,further explore the occurrence and development mechanism of PTG,and establish targeted interventions to promote PTG.
基金supported by the Key Research and Development Program of Yunnan Science and Technology Department(Grant No.202303AC100326)the National Natural Science Foundation of China(Grant No.81960863)the Education Department of Yunnan Province(Grant No.2023Y0463 and 2024Y380).
文摘This study aimed to systematically evaluate the clinical efficacy of combining wax therapy with conventional drug therapy for rheumatoid arthritis(RA)and to provide evidence supporting its clinical application.A comprehensive search was conducted across PubMed,Cochrane Library,China Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases from their inception to May 2024.Randomized controlled trials(RCTs)investigating the combination of wax therapy and conventional drug therapy for RA were included in the analysis.Statistical analysis was performed using Review Manager 5.3 software.Nine studies,encompassing a total of 843 patients,were included.The results demonstrated that the combination therapy significantly improved clinical efficacy compared to conventional drug therapy alone[RR=1.22,95%CI(1.11,1.34)].Moreover,the combination therapy led to notable improvements in DAS 28 scores[MD=-0.90,95%CI(-1.23,-0.57),P<0.00001],VAS scores[MD=-0.90,95%CI(-1.13,-0.66),P<0.00001],reduction in joint tenderness[MD=-1.27,95%CI(-1.81,-0.72),P<0.00001],decreased duration of morning stiffness[MD=-25.47,95%CI(-34.33,-16.61),P<0.00001],and lowered C-reactive protein levels[MD=-6.29,95%CI(-12.02,-0.57),P<0.05].In conclusion,wax therapy combined with conventional anti-rheumatic drugs significantly enhanced the clinical outcomes for RA patients by alleviating symptoms,reducing joint pain and morning stiffness,and decreasing inflammatory markers more effectively than conventional drug therapy alone.
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Provincial Key Research and Development Project of Hunan(2018SK2127)Hunan Province Traditional Chinese Medicine Research and Development Project(201946).
文摘Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain(CIBP).Methods We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems.It included four Chinese databases[Chinese Biomedical Literature Database(SinoMed),China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(VIP)],six English databases(Scopus,Embase,Web of Science,PubMed,Cochrane Library,and OpenGrey),and two registration systems(Chinese Clinical Trial Registry and ClinicalTrials.gov).The timeframe for the literature search extended from the inception of each database to December 31,2023.Meta-analysis was performed using RevMan(v5.4.1),and the outcome indicators(pain relief rate,analgesic duration,quality of life,pain intensity,breakthrough pain frequency,and adverse reactions)were graded using GRADE profiler(v3.6).Results According to the established inclusion and exclusion criteria,a total of 43 studies was deemed eligible,involving 3142 participants with CIBP.The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone,the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate[risk ratio(RR)=1.32,95%confidence interval(CI):1.24 to 1.41,P<0.00001],analgesic duration[mean difference(MD)=1.33,95%CI:0.97 to 1.69,P<0.00001],and quality of life(MD=5.66,95%CI:4.88 to 6.44,P<0.00001).Furthermore,the combined therapy significantly reduced pain intensity(MD=-1.00,95%CI:-1.19 to-0.80,P<0.00001),breakthrough pain frequency(MD=-0.43,95%CI:-0.51 to-0.36,P<0.00001),and adverse reactions(RR=0.60,95%CI:0.53 to 0.68,P<0.00001)in CIBP patients.Based on the GRADE assessment,the level of evidence varied from low to moderate.Conclusion EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life.Additionally,the EA-TCM can effectively reduce the incidence of adverse reactions associated with threestep analgesic therapy.
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.
文摘Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.
基金supported by Major Scientific Research Special Project for High-level Talents in Health and Wellness,Hunan Province(R2023072)Project of Hunan Provincial Department of Finance(2050205)Hunan Provincial Department of Finance Project(050205).
文摘Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.
基金funded by the Young Clinical Research Special Fund Project of Peking University First Hospital(No.2024YC05)。
文摘Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.
基金Hebei Medical Science Research Project(Grant No.20221849)。
文摘To evaluate the effects of sacubitril/valsartan and ARB on renal function in patients with and without heart failure, we conducted a comprehensive literature search using both Chinese and English databases. These included the Cochrane Library, Wanfang Database, PubMed, CNKI, Embase, and Clinical Trials. The search encompassed studies published from the inception of the databases to March 2024. Randomized controlled studies meeting the inclusion criteria were assessed for bias using the Cochrane risk of bias assessment tool. Data were analyzed using Review Manager 5.4, with relative risk (RR) as the effect indicator. Depending on the heterogeneity of the studies, either a fixed-effects model or a random-effects model was employed to combine effect sizes. Seven studies met the inclusion criteria. Compared with ARB drugs, sacubitril/valsartan showed a reduction in the deterioration of renal function (RR = 0.70, 95% CI: 0.44–1.12, P = 0.14) and acute renal function injury (RR = 0.77, 95% CI: 0.59–1.00, P = 0.05). The risk of end-stage renal disease was also lower (RR = 0.53, 95% CI: 0.30–0.96, P = 0.16). For serum creatinine levels greater than 2.5 mg/dL, the RR was 0.88 (95% CI: 0.68–1.15, P = 0.37). For a reduction in eGFR of more than 25%, the RR was 0.89 (95% CI: 0.57–1.41, P = 0.63). The incidence of serum potassium levels greater than 5.5 mmol/L was not significantly different between the groups (RR = 1.23, 95% CI: 0.86–1.75, P = 0.26), nor was the incidence of serum potassium levels greater than 6.0 mmol/L (RR = 1.06, 95% CI: 0.58–1.93, P = 0.86). However, the incidence of eGFR decreasing by more than 50% was significantly reduced (RR = 0.58, 95% CI: 0.34–0.99, P < 0.05). In conclusion, sacubitril/valsartan demonstrated a protective effect on the kidneys, effectively reducing the risk of renal deterioration and presenting a potential alternative to ARB drugs.
文摘BACKGROUND Hepatocellular carcinoma(HCC)ranks sixth globally in cancer incidence and third in mortality rates.Unfortunately,over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations,poor physical condition,and limited organ availability upon diagnosis.Clinical guidelines endorse transarterial chemoembolization(TACE)as the frontline treatment for intermediate to advanced-stage HCC.Cryoablation(CRA)is an emerging local ablative therapy increasingly used in HCC management.Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects,potentially improving long-term survival rates.However,the superiority of combined TACE+CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of≥5 cm.METHODS PubMed,EMBASE,Cochrane Library,CNKI,Wanfang,and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022.Meta-analysis was performed using RevMan 5.3 software.RESULTS After screening according to the inclusion and exclusion criteria,6 articles were included,including 2 randomized controlled trials and 4 nonrandomized controlled trials,with a total of 575 patients included in the meta-analysis.The results showed that the objective response rate[odds ratio(OR)=2.56,95%confidence interval(CI):1.66-3.96,P<0.0001],disease control rate(OR=3.03,95%CI:1.88-4.89,P<0.00001),1-year survival rate(OR=3.79,95%CI:2.50-5.76,P<0.00001),2-year survival rate(OR=2.34,95%CI:1.43-3.85,P=0.0008),and 3-year survival rate(OR=3.34,95%CI:1.61-6.94,P=0.001)were all superior to those of the control group;the postoperative decrease in alpha-fetoprotein value(OR=295.53,95%CI:250.22-340.85,P<0.0001),the postoperative increase in CD4 value(OR=10.59,95%CI:8.78-12.40,P<0.00001),and the postoperative decrease in CD8 value(OR=6.47,95%CI:4.44-8.50,P<0.00001)were also significantly higher than those in the TACE-alone treatment group.CONCLUSION Compared with TACE-alone treatment,TACE+CRA combined treatment not only improves the immune function of HCC patients with a diameter of≥5 cm,but also enhances the therapeutic efficacy and long-term survival rate,without increasing the risk of complications.Therefore,TACE+CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of≥5 cm.
文摘Background: Studies of gastrointestinal (GIT) cancers have shown that circZFR could be involved in the development and progression of various GIT cancers. However, small sample sizes limit the clinical significance of these studies. Here, a meta-analysis was conducted to ascertain the actual involvement of circZFR in the development and prognosis of GIT cancers. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched up to December 31, 2023. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled to evaluate the association between circZFR expression and overall survival (OS). Publication bias was measured using the funnel plot and Egger’s test. Results: 10 studies having 659 participants were enrolled for meta-analysis. High circZFR expression was associated with poor OS (HR = 1.4, 95% CI: 1.20, 1.70). High circZFR expression also predicted larger tumor size (OR = 4.38, 95% CI 2.65, 7.25), advanced clinical stage (OR = 5.33, 95% CI 3.10, 9.16), and tendency for distant metastasis (OR = 2.89, 95% CI: 1.62, 5.11), but was not related to age, gender, and histological grade. Conclusions: In summary, high circZFR expression was associated with poor OS, larger tumor size, advanced stage cancer and tendency for distant metastasis. These findings suggested that circZFR could be a prognostic marker for GIT cancers.
