BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)the...BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)therapy,swallowed topical corticosteroids(STC)are effective as induction therapy for EoE.However,out-come data for STC as a maintenance strategy is limited.RESULTS Three randomized control trials and one observational study were included,involving 303 patients(189 in the STC group,114 in the placebo-controlled group).Analysis showed that histologic recurrence was significantly lower with STC(OR:0.04,95%CI:0.01-0.28,P<0.00001,I^(2)=78%).Overall symptom recurrence was similar between groups(OR:0.23,95%CI:0.02-3.54,P=0.29,I^(2)=92%).On sensitivity analysis,symptom recurrence was significantly lower in the STC group(OR:0.05,95%CI:0.02-0.17,P=0.00001,I^(2)=39%).Odds of repeat dilation were significantly lower in the STC group(OR:0.14,95%CI:0.02-0.91,P=0.04,I^(2)=0%).Candida infection rates were similar between groups(OR:6.13,95%CI:0.85-44.26,P=0.07,I^(2)=24%).Proportion of concomitant PPI use was similar between groups(OR:1.64,95%CI:0.83-3.21,P=0.15,I^(2)=0%).CONCLUSION For patients who successfully achieved remission of EoE with STC induction therapy,maintaining treatment is effective in sustaining histologic remission,while newer regimens may be effective in preventing symptom recurrence compared to placebo.We found no significant difference for oropharyngeal/esophageal candidiasis with STC maintenance therapy.Future studies with longer follow-up periods are needed.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therape...BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.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
BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase bra...Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
[Objectives]To systematically evaluate the effects of electroacupuncture(EA)on post-stroke apoptosis in animal models,focusing on key apoptotic markers(TUNEL-positive cells,caspase-3,Bcl-2/Bax ratio)and exploring pote...[Objectives]To systematically evaluate the effects of electroacupuncture(EA)on post-stroke apoptosis in animal models,focusing on key apoptotic markers(TUNEL-positive cells,caspase-3,Bcl-2/Bax ratio)and exploring potential sources of heterogeneity related to EA parameters and the timing of interventions.[Methods]A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library(from inception to July 2025)was conducted to identify randomized controlled animal studies investigating EA in ischemic stroke models(tMCAO/pMCAO).Data pertaining to apoptotic outcomes were extracted,and the methodological quality was assessed using the CAMARADES checklist.A meta-analysis was conducted using random-or fixed-effects models in Stata 17.0,with subgroup analyses for EA timing(pre-vs.post-ischemia)and waveforms(continuous vs.disperse).Heterogeneity among studies was quantified via the I 2 statistic.[Results]Thirty-two studies were included in the analysis.EA significantly reduced apoptosis,as evidenced by a decrease in TUNEL-positive cells(Hedges'g=-3.38,95%CI:-4.09 to-2.67),reduced caspase-3 expression(g=-2.67,95%CI:-3.35 to-2.00),and an increased Bcl-2/Bax ratio(g=2.60,95%CI:1.72 to 3.47).Subgroup analyses showed comparable efficacy between pre-and post-ischemia EA(p=0.50)and revealed a non-significant trend favoring continuous over disperse waveforms(p=0.09).High heterogeneity(I 2>50%)was observed,which was attributed to variations in animal models,EA protocols,and outcome assessments.[Conclusions]EA demonstrates robust anti-apoptotic effects in stroke models,likely mediated through the PI3K/Akt,NF-κB,and TRPV1 pathways.While both timing and waveforms show promise,standardizing EA protocols and conducting translational clinical trials are essential to optimize neuroprotective applications in stroke rehabilitation.展开更多
BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a n...BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.展开更多
BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this m...BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this make the mothers to seek medical care when all effort of theirs have failed.Yet,this behavioral and anxiety disorders among mothers still persists several years after the word“Fever phobia”was coined.AIM To document the knowledge of fever among Nigerian mothers and to determine heterogeneity in these practices across the nation.METHODS A search of articles on fever phobias among mothers or caregivers in Nigeria was performed via the Cochrane Database of Systematic Reviews,PubMed,Google Scholar,and MEDLINE.Articles published between 2008,and 2023 were included in the study.The keywords used in the literature search included fever,phobias,perceptions,mothers,caregivers,perceptions,drugs,knowledge,and practices.Boolean operators were also used in the search for items,such as“fever AND phobia”,“fever AND perception”,“fever AND mothers”,“fevers AND/OR phobia”,“AND OR mothers/caregivers”,to help narrow parameters in the search engine and enhance reproducibility.Studies that fulfilled the inclusion criteria were presented via the PRISMA model.I2 statistics were used to assess heterogeneity.RESULTS The studies show wide variation in the reported levels of knowledge about fever,with proportions ranging from as low as 35%to as high as 94%.The pooled proportion estimate using the common effect model is 65%(95%CI:64%-67%),assuming that all studies reflect a single underlying value.However,the random effects model,which accounts for differences among studies,yields a higher estimate of 70%(95%CI:56%-82%).This divergence reflects significant heterogeneity in the data,with a Tau^(2)of 0.7007,I²of 95.7%,and,an H statistic of 4.80,all indicating that most of the variability is due to actual differences among studies rather than random chance.The Q test further confirms this,with a P value less than 0.0001,reinforcing that the variability across studies is statistically significant.The subgroup analysis revealed that studies in Group A(six studies)reported a pooled knowledge proportion of 75%,with a confidence interval ranging from 56%to 88%,and relatively lower heterogeneity(Tau^(2)=0.5709,Tau=0.7556),indicating greater consistency in their findings.In contrast,Group B(four studies)had a lower pooled estimate of 62%,but with a much wider confidence interval(27%to 88%)and greater heterogeneity(Tau^(2)=0.8380,Tau=0.9154),suggesting greater variation across studies in that group.Fear of brain damage,convulsions,witches/wizards,and death was high in many of the studies.Herbal concoctions,and prayers were the mostly used measures to cure fever by mothers.CONCLUSION Mothers’knowledge of fever detection in children is low.There was heterogeneity in the sample size of the studies,which may have affected the knowledge of fever.展开更多
Resistant starch(RS)has attracted much researchers'attention because of its health-beneficial effects.Gut microbiota obviously shapes human health,but the effects of RS supplementation on the changes of human gut ...Resistant starch(RS)has attracted much researchers'attention because of its health-beneficial effects.Gut microbiota obviously shapes human health,but the effects of RS supplementation on the changes of human gut microbiota remain unclear.This observational meta-analysis aimed to reveal the effects of RS intake onα-diversity and composition of gut microbiota through meta-analysis.Two independent authors systematically searched articles from inception until February 2023 on four electronic databases.Twenty-four highly relevant trials were included conforming to Preferred Reporting Items for Systematic reviews and MetaAnalysis protocol,and a total of 816 individuals were included.Significant heterogeneity analyses revealed that RS intake notably decreased Shannon index(weighted mean difference(WMD):-0.11;95%confidence interval(CI):-0.21,-0.01),and stimulated the composition of health promoting bacteria genera,including Bifidobacterium(relative abundance:WMD:1.75;95%CI:0.39,3.11;bacterial populations:WMD:0.36;95%CI:0.04,0.69),Faecalibacterium(relative abundance:WMD:0.70;95%CI:0.20,1.20;fold change:effect size:0.91;95%CI:0.60,1.23),and Prevotella(relative abundance:WMD:0.35;95%CI:0.01,0.69).Taken together,the present study revealed that changes in the gut microbiota diversity and genera were correlated with RS supplementation,which may contribute to benefits in human health.展开更多
Objective: To explore the factors affecting the psychological pain of patients with enterostomy through meta-analysis, with the aim of reducing psychological pain and improving patients’ quality of life. Methods: Pub...Objective: To explore the factors affecting the psychological pain of patients with enterostomy through meta-analysis, with the aim of reducing psychological pain and improving patients’ quality of life. Methods: Published literature on psychological pain in enterostomy patients was retrieved from Chinese and English databases, including CNKI, Wanfang, VIP, China Biomedical Network, PubMed, Embase, Ovid, and Web of Science. The search period covered the establishment of the databases until October 2024. Literature was screened based on inclusion and exclusion criteria, and its quality was evaluated. Data analysis was performed using R Studio software. Results: A total of 2,237 articles involving 1,221 patients with enterostomy and 11 influencing factors were identified. The results of the meta-analysis indicated that age, marital status, ostomy complications, self-care ability, pain severity, and sleep quality were the primary contributors to psychological distress. Conclusion: Multiple factors influence psychological pain in enterostomy patients. Medical staff should prioritize addressing these factors to alleviate psychological pain and enhance patients’ quality of life.展开更多
Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of pro...Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.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
Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web...Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.展开更多
BACKGROUND Previous research yielded conflicting results regarding the association between prediabetes and colorectal cancer(CRC).AIM To systematically assess the incidence of CRC in individuals with prediabetes compa...BACKGROUND Previous research yielded conflicting results regarding the association between prediabetes and colorectal cancer(CRC).AIM To systematically assess the incidence of CRC in individuals with prediabetes compared with individuals with normoglycemia via a meta-analysis.METHODS Relevant cohort studies were acquired by searching MEDLINE,Web of Science,and EMBASE.A random-effects model was applied to combine the findings after accounting for heterogeneity.Several subgroup analyses were conducted to assess the impact of study characteristics on the results.RESULTS Eleven cohort studies involving 4996352 participants,including 383917(7.7%)with prediabetes at baseline,were analyzed in this meta-analysis.Over a mean follow-up period of 6.5 years,the combined findings revealed that individuals with prediabetes at baseline had a higher likelihood of developing CRC than those with normoglycemia[risk ratio(RR)=1.18,95%confidence interval=1.11 to 1.25,P<0.001]with low statistical heterogeneity(I2=27%).Subgroup analyses indicated that the association between prediabetes and an increased risk of CRC was mainly observed in studies defining prediabetes using impaired fasting glucose(RR=1.24)and slightly elevated hemoglobin A1c levels(RR=1.18)but not in those that defined prediabetes using impaired glucose tolerance(RR=1.06).Other study characteristics such as design,country,participant age and sex,the duration of follow-up,or adjustment for body mass index did not significantly impact the results(all P>0.05).CONCLUSION People with prediabetes might have a higher likelihood of developing CRC than individuals with normoglycemia.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
Objective:Breast cancer is the second most prevalent cause of mortality in women and the predominant malignancy type.However,breast cancer treatment faces challenges in managing aromatase inhibitor-induced arthralgia....Objective:Breast cancer is the second most prevalent cause of mortality in women and the predominant malignancy type.However,breast cancer treatment faces challenges in managing aromatase inhibitor-induced arthralgia.Aromatase inhibitors have been shown to decrease recurrence risk in hormone receptor-positive cases;however,joint discomfort remains the primary adverse effect.Randomized clinical trials have evaluated the therapeutic outcomes of acupuncture for medication-related musculoskeletal complications.This comprehensive analysis sought to elucidate both the therapeutic efficacy and placebo responses associated with acupuncture intervention.Methods:Two reviewers searched for randomized controlled trials(RCTs)in four English(PubMed,Embase,Web of Science,and the Cochrane Library)and four Chinese databases(CNKI,Wanfang Database,VIP,and SinoMed)from their inception to May 31,2024.Methodological quality was assessed using the Cochrane risk of bias tool.Data were synthesized using random effects models and presented with forest plots.Results:Seven trials involving 604 patients were included.The primary outcome and Brief Pain Inventory(BPI)score differed between the acupuncture and control groups(sham acupuncture or usual medication)in three subscales over the course of 6 weeks:worst pain:standardized mean difference(SMD)=-1.18,95%confidence interval(CI):-1.74,-0.63,P<0.001;painrelated interference:SMD=-0.87,95%CI:-1.70,-0.05,P=0.038;pain severity:SMD=-0.63,95%CI:-1.22,-0.04,P=0.036.No severe adverse events were reported in any study.Conclusions:This meta-analysis showed that acupuncture is a safe and effective treatment for patients with breast cancer with aromatase inhibitor-induced arthralgia during the course of 6 weeks.Improvements in the blinding method and clarification of the total treatment recommendations and intervals need to be explored further.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
BACKGROUND Chronic hepatitis B(CHB)affects millions worldwide,and many patients develop depression and anxiety.The disease’s long-term nature,potential complications,and social stigma contribute to these mental-healt...BACKGROUND Chronic hepatitis B(CHB)affects millions worldwide,and many patients develop depression and anxiety.The disease’s long-term nature,potential complications,and social stigma contribute to these mental-health issues.However,previous studies on this link differed in their methods and results,making it hard to draw clear conclusions.This study aimed to analyze factors associated with CHB through meta-analysis of previous studies to help improve patients’mental health.AIM To systematically search,screen,and comprehensively analyze existing relevant research through meta-analysis of previous studies to assess the correlation of the previously identified factors found to be associated with comorbid depression and anxiety in patients with CHB,with the goal of improving the patients'mental-health status.METHODS This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Relevant literature from the inception of the PubMed,EMBASE,Cochrane Library,and Web of Science databases up to January 2025 was comprehensively searched.The search used medical subject headings combined with free-text terms,supplemented by literature tracing.The search terms covered vocabulary related to CHB,such as depression,anxiety,and risk factors.The literature was selected according to strict inclusion and exclusion criteria.Two researchers independently and blindly screened the literature and extracted key information.STATA12.0 and RevMan 5.3 software were used to perform meta-analysis of the extracted data,and an appropriate model based on the heterogeneity of the studies was selected.RESULTS The study included 14 articles from five countries(China,United States,Turkey,Australia,and Vietnam),involving 4494 patients with CHB.The analysis revealed that the incidence of comorbid depression in patients with CHB was 30.1%[95%confidence interval(95%CI):0.182-0.420],the incidence of comorbid anxiety was 40.2%(95%CI:0.126-0.678),and the overall incidence of negative emotions was 33.7%(95%CI:0.182-0.420).Further research identified eight factors significantly associated with depression and anxiety.Among them,high educational level was a protective factor against comorbid anxiety and depression in patients with CHB[odds ratio(OR)=0.43,95%CI:0.20-0.93,P<0.05].The risk of comorbid depression and anxiety was higher for older patients(OR=3.05,95%CI:1.90-4.90,P<0.05),longer treatment duration(OR=3.11,95%CI:1.72-5.62,P>0.05),presence of comorbidities(OR=2.65,95%CI:1.21-5.77,P<0.05),poor sleep quality(Fisher’s Z=0.48,95%CI:0.41-0.55,Summary r=0.447,P<0.05),emotional instability(Fisher’s Z=0.42,95%CI:0.29-0.55,summary r=0.393,P<0.05),a high number of hepatitis relapses(OR=4.07,95%CI:2.81-5.89,P<0.05),and a high degree of hepatitis(OR=4.28,95%CI:1.76-10.41,P<0.05).CONCLUSION Multiple factors were significantly associated with comorbid depression and anxiety in patients with CHB.Clinically,it is essential to identify high-risk patients at the earliest opportunity and implement effective intervention to enhance patients’mental health and optimize CHB disease management and treatment.展开更多
文摘BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)therapy,swallowed topical corticosteroids(STC)are effective as induction therapy for EoE.However,out-come data for STC as a maintenance strategy is limited.RESULTS Three randomized control trials and one observational study were included,involving 303 patients(189 in the STC group,114 in the placebo-controlled group).Analysis showed that histologic recurrence was significantly lower with STC(OR:0.04,95%CI:0.01-0.28,P<0.00001,I^(2)=78%).Overall symptom recurrence was similar between groups(OR:0.23,95%CI:0.02-3.54,P=0.29,I^(2)=92%).On sensitivity analysis,symptom recurrence was significantly lower in the STC group(OR:0.05,95%CI:0.02-0.17,P=0.00001,I^(2)=39%).Odds of repeat dilation were significantly lower in the STC group(OR:0.14,95%CI:0.02-0.91,P=0.04,I^(2)=0%).Candida infection rates were similar between groups(OR:6.13,95%CI:0.85-44.26,P=0.07,I^(2)=24%).Proportion of concomitant PPI use was similar between groups(OR:1.64,95%CI:0.83-3.21,P=0.15,I^(2)=0%).CONCLUSION For patients who successfully achieved remission of EoE with STC induction therapy,maintaining treatment is effective in sustaining histologic remission,while newer regimens may be effective in preventing symptom recurrence compared to placebo.We found no significant difference for oropharyngeal/esophageal candidiasis with STC maintenance therapy.Future studies with longer follow-up periods are needed.
基金Hubei Province Top Medical Youth Talent Program,Wuhan Knowledge Innovation Special Basic Research Project,No.2023020201020558Clinical Research Project of Affiliated Hospital of Guangdong Medical University,No.LCYJ2021B004 and No.LCYJ2019B010Science and Technology Plan Project of Zhanjiang,No.2022A01191.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.
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.
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
基金supported by the STI 2030-Major Projects,No. 2021ZD0200500 (to XS)。
文摘Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
文摘[Objectives]To systematically evaluate the effects of electroacupuncture(EA)on post-stroke apoptosis in animal models,focusing on key apoptotic markers(TUNEL-positive cells,caspase-3,Bcl-2/Bax ratio)and exploring potential sources of heterogeneity related to EA parameters and the timing of interventions.[Methods]A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library(from inception to July 2025)was conducted to identify randomized controlled animal studies investigating EA in ischemic stroke models(tMCAO/pMCAO).Data pertaining to apoptotic outcomes were extracted,and the methodological quality was assessed using the CAMARADES checklist.A meta-analysis was conducted using random-or fixed-effects models in Stata 17.0,with subgroup analyses for EA timing(pre-vs.post-ischemia)and waveforms(continuous vs.disperse).Heterogeneity among studies was quantified via the I 2 statistic.[Results]Thirty-two studies were included in the analysis.EA significantly reduced apoptosis,as evidenced by a decrease in TUNEL-positive cells(Hedges'g=-3.38,95%CI:-4.09 to-2.67),reduced caspase-3 expression(g=-2.67,95%CI:-3.35 to-2.00),and an increased Bcl-2/Bax ratio(g=2.60,95%CI:1.72 to 3.47).Subgroup analyses showed comparable efficacy between pre-and post-ischemia EA(p=0.50)and revealed a non-significant trend favoring continuous over disperse waveforms(p=0.09).High heterogeneity(I 2>50%)was observed,which was attributed to variations in animal models,EA protocols,and outcome assessments.[Conclusions]EA demonstrates robust anti-apoptotic effects in stroke models,likely mediated through the PI3K/Akt,NF-κB,and TRPV1 pathways.While both timing and waveforms show promise,standardizing EA protocols and conducting translational clinical trials are essential to optimize neuroprotective applications in stroke rehabilitation.
文摘BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.
文摘BACKGROUND There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers.Although,fever is commonly seen in children and this make the mothers to seek medical care when all effort of theirs have failed.Yet,this behavioral and anxiety disorders among mothers still persists several years after the word“Fever phobia”was coined.AIM To document the knowledge of fever among Nigerian mothers and to determine heterogeneity in these practices across the nation.METHODS A search of articles on fever phobias among mothers or caregivers in Nigeria was performed via the Cochrane Database of Systematic Reviews,PubMed,Google Scholar,and MEDLINE.Articles published between 2008,and 2023 were included in the study.The keywords used in the literature search included fever,phobias,perceptions,mothers,caregivers,perceptions,drugs,knowledge,and practices.Boolean operators were also used in the search for items,such as“fever AND phobia”,“fever AND perception”,“fever AND mothers”,“fevers AND/OR phobia”,“AND OR mothers/caregivers”,to help narrow parameters in the search engine and enhance reproducibility.Studies that fulfilled the inclusion criteria were presented via the PRISMA model.I2 statistics were used to assess heterogeneity.RESULTS The studies show wide variation in the reported levels of knowledge about fever,with proportions ranging from as low as 35%to as high as 94%.The pooled proportion estimate using the common effect model is 65%(95%CI:64%-67%),assuming that all studies reflect a single underlying value.However,the random effects model,which accounts for differences among studies,yields a higher estimate of 70%(95%CI:56%-82%).This divergence reflects significant heterogeneity in the data,with a Tau^(2)of 0.7007,I²of 95.7%,and,an H statistic of 4.80,all indicating that most of the variability is due to actual differences among studies rather than random chance.The Q test further confirms this,with a P value less than 0.0001,reinforcing that the variability across studies is statistically significant.The subgroup analysis revealed that studies in Group A(six studies)reported a pooled knowledge proportion of 75%,with a confidence interval ranging from 56%to 88%,and relatively lower heterogeneity(Tau^(2)=0.5709,Tau=0.7556),indicating greater consistency in their findings.In contrast,Group B(four studies)had a lower pooled estimate of 62%,but with a much wider confidence interval(27%to 88%)and greater heterogeneity(Tau^(2)=0.8380,Tau=0.9154),suggesting greater variation across studies in that group.Fear of brain damage,convulsions,witches/wizards,and death was high in many of the studies.Herbal concoctions,and prayers were the mostly used measures to cure fever by mothers.CONCLUSION Mothers’knowledge of fever detection in children is low.There was heterogeneity in the sample size of the studies,which may have affected the knowledge of fever.
基金financially supported by the National Key R&D Program of China(2022YFF1100600,2022YFF1100605)the Science and Technology Support Program(Modern Agriculture)of Jiangsu Province(BE2022323)the National Natural Science Foundation of China(32302011)。
文摘Resistant starch(RS)has attracted much researchers'attention because of its health-beneficial effects.Gut microbiota obviously shapes human health,but the effects of RS supplementation on the changes of human gut microbiota remain unclear.This observational meta-analysis aimed to reveal the effects of RS intake onα-diversity and composition of gut microbiota through meta-analysis.Two independent authors systematically searched articles from inception until February 2023 on four electronic databases.Twenty-four highly relevant trials were included conforming to Preferred Reporting Items for Systematic reviews and MetaAnalysis protocol,and a total of 816 individuals were included.Significant heterogeneity analyses revealed that RS intake notably decreased Shannon index(weighted mean difference(WMD):-0.11;95%confidence interval(CI):-0.21,-0.01),and stimulated the composition of health promoting bacteria genera,including Bifidobacterium(relative abundance:WMD:1.75;95%CI:0.39,3.11;bacterial populations:WMD:0.36;95%CI:0.04,0.69),Faecalibacterium(relative abundance:WMD:0.70;95%CI:0.20,1.20;fold change:effect size:0.91;95%CI:0.60,1.23),and Prevotella(relative abundance:WMD:0.35;95%CI:0.01,0.69).Taken together,the present study revealed that changes in the gut microbiota diversity and genera were correlated with RS supplementation,which may contribute to benefits in human health.
文摘Objective: To explore the factors affecting the psychological pain of patients with enterostomy through meta-analysis, with the aim of reducing psychological pain and improving patients’ quality of life. Methods: Published literature on psychological pain in enterostomy patients was retrieved from Chinese and English databases, including CNKI, Wanfang, VIP, China Biomedical Network, PubMed, Embase, Ovid, and Web of Science. The search period covered the establishment of the databases until October 2024. Literature was screened based on inclusion and exclusion criteria, and its quality was evaluated. Data analysis was performed using R Studio software. Results: A total of 2,237 articles involving 1,221 patients with enterostomy and 11 influencing factors were identified. The results of the meta-analysis indicated that age, marital status, ostomy complications, self-care ability, pain severity, and sleep quality were the primary contributors to psychological distress. Conclusion: Multiple factors influence psychological pain in enterostomy patients. Medical staff should prioritize addressing these factors to alleviate psychological pain and enhance patients’ quality of life.
基金supported by the National Natural Science Foundation of China(82360801,82460822)Natural Science Foundation of Inner Mongolia Autonomous Region(2022LHQN08001,2023QN08050,2025LHMS08061)+4 种基金the Scientific Research Project of Higher Education Institutions in Inner Mongolia Autonomous Region(NJZY23135)the Laboratory Open Fund of Inner Mongolia Medical University(2024ZN23)and the General Project of Inner Mongolia Medical University(YKD2025MS047Inner Mongolia Medical University Undergraduate Science and Technology Innovation"Talent Cultivation"Project(YCPY2025028,YCPY2025024)Inner Mongolia Medical University Undergraduate Innovation and Entrepreneurship Training Program Project(101322025034).
文摘Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.
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Supported by the Capital Health Development Research Special Program:2022-4-7016。
文摘Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.
基金Supported by National High Level Hospital Clinical Research Funding,No.2023-NHLHCRF-YXHZ-ZRMS-06.
文摘BACKGROUND Previous research yielded conflicting results regarding the association between prediabetes and colorectal cancer(CRC).AIM To systematically assess the incidence of CRC in individuals with prediabetes compared with individuals with normoglycemia via a meta-analysis.METHODS Relevant cohort studies were acquired by searching MEDLINE,Web of Science,and EMBASE.A random-effects model was applied to combine the findings after accounting for heterogeneity.Several subgroup analyses were conducted to assess the impact of study characteristics on the results.RESULTS Eleven cohort studies involving 4996352 participants,including 383917(7.7%)with prediabetes at baseline,were analyzed in this meta-analysis.Over a mean follow-up period of 6.5 years,the combined findings revealed that individuals with prediabetes at baseline had a higher likelihood of developing CRC than those with normoglycemia[risk ratio(RR)=1.18,95%confidence interval=1.11 to 1.25,P<0.001]with low statistical heterogeneity(I2=27%).Subgroup analyses indicated that the association between prediabetes and an increased risk of CRC was mainly observed in studies defining prediabetes using impaired fasting glucose(RR=1.24)and slightly elevated hemoglobin A1c levels(RR=1.18)but not in those that defined prediabetes using impaired glucose tolerance(RR=1.06).Other study characteristics such as design,country,participant age and sex,the duration of follow-up,or adjustment for body mass index did not significantly impact the results(all P>0.05).CONCLUSION People with prediabetes might have a higher likelihood of developing CRC than individuals with normoglycemia.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
基金supported by the National Key R&D Program of China(2019YFC1712200-2019YFC1712204)the National Natural Science Foundation of China(82004467,82030125)the Youth Project of Traditional Chinese Medicine-Integration of Traditional and Western Medicine Projects of Tianjin Health Commission(No.2025027).
文摘Objective:Breast cancer is the second most prevalent cause of mortality in women and the predominant malignancy type.However,breast cancer treatment faces challenges in managing aromatase inhibitor-induced arthralgia.Aromatase inhibitors have been shown to decrease recurrence risk in hormone receptor-positive cases;however,joint discomfort remains the primary adverse effect.Randomized clinical trials have evaluated the therapeutic outcomes of acupuncture for medication-related musculoskeletal complications.This comprehensive analysis sought to elucidate both the therapeutic efficacy and placebo responses associated with acupuncture intervention.Methods:Two reviewers searched for randomized controlled trials(RCTs)in four English(PubMed,Embase,Web of Science,and the Cochrane Library)and four Chinese databases(CNKI,Wanfang Database,VIP,and SinoMed)from their inception to May 31,2024.Methodological quality was assessed using the Cochrane risk of bias tool.Data were synthesized using random effects models and presented with forest plots.Results:Seven trials involving 604 patients were included.The primary outcome and Brief Pain Inventory(BPI)score differed between the acupuncture and control groups(sham acupuncture or usual medication)in three subscales over the course of 6 weeks:worst pain:standardized mean difference(SMD)=-1.18,95%confidence interval(CI):-1.74,-0.63,P<0.001;painrelated interference:SMD=-0.87,95%CI:-1.70,-0.05,P=0.038;pain severity:SMD=-0.63,95%CI:-1.22,-0.04,P=0.036.No severe adverse events were reported in any study.Conclusions:This meta-analysis showed that acupuncture is a safe and effective treatment for patients with breast cancer with aromatase inhibitor-induced arthralgia during the course of 6 weeks.Improvements in the blinding method and clarification of the total treatment recommendations and intervals need to be explored further.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
基金Supported by Beihai City Science and Technology Program Projects,No.Beikehe 2023158020。
文摘BACKGROUND Chronic hepatitis B(CHB)affects millions worldwide,and many patients develop depression and anxiety.The disease’s long-term nature,potential complications,and social stigma contribute to these mental-health issues.However,previous studies on this link differed in their methods and results,making it hard to draw clear conclusions.This study aimed to analyze factors associated with CHB through meta-analysis of previous studies to help improve patients’mental health.AIM To systematically search,screen,and comprehensively analyze existing relevant research through meta-analysis of previous studies to assess the correlation of the previously identified factors found to be associated with comorbid depression and anxiety in patients with CHB,with the goal of improving the patients'mental-health status.METHODS This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Relevant literature from the inception of the PubMed,EMBASE,Cochrane Library,and Web of Science databases up to January 2025 was comprehensively searched.The search used medical subject headings combined with free-text terms,supplemented by literature tracing.The search terms covered vocabulary related to CHB,such as depression,anxiety,and risk factors.The literature was selected according to strict inclusion and exclusion criteria.Two researchers independently and blindly screened the literature and extracted key information.STATA12.0 and RevMan 5.3 software were used to perform meta-analysis of the extracted data,and an appropriate model based on the heterogeneity of the studies was selected.RESULTS The study included 14 articles from five countries(China,United States,Turkey,Australia,and Vietnam),involving 4494 patients with CHB.The analysis revealed that the incidence of comorbid depression in patients with CHB was 30.1%[95%confidence interval(95%CI):0.182-0.420],the incidence of comorbid anxiety was 40.2%(95%CI:0.126-0.678),and the overall incidence of negative emotions was 33.7%(95%CI:0.182-0.420).Further research identified eight factors significantly associated with depression and anxiety.Among them,high educational level was a protective factor against comorbid anxiety and depression in patients with CHB[odds ratio(OR)=0.43,95%CI:0.20-0.93,P<0.05].The risk of comorbid depression and anxiety was higher for older patients(OR=3.05,95%CI:1.90-4.90,P<0.05),longer treatment duration(OR=3.11,95%CI:1.72-5.62,P>0.05),presence of comorbidities(OR=2.65,95%CI:1.21-5.77,P<0.05),poor sleep quality(Fisher’s Z=0.48,95%CI:0.41-0.55,Summary r=0.447,P<0.05),emotional instability(Fisher’s Z=0.42,95%CI:0.29-0.55,summary r=0.393,P<0.05),a high number of hepatitis relapses(OR=4.07,95%CI:2.81-5.89,P<0.05),and a high degree of hepatitis(OR=4.28,95%CI:1.76-10.41,P<0.05).CONCLUSION Multiple factors were significantly associated with comorbid depression and anxiety in patients with CHB.Clinically,it is essential to identify high-risk patients at the earliest opportunity and implement effective intervention to enhance patients’mental health and optimize CHB disease management and treatment.
