AIM:To conduct a systematic review and Meta-analysis to determine the differential effects of combined lutein and zeaxanthin supplementation on myopia prevention in teenagers.It also investigates the effects of supple...AIM:To conduct a systematic review and Meta-analysis to determine the differential effects of combined lutein and zeaxanthin supplementation on myopia prevention in teenagers.It also investigates the effects of supplements dosage,intervention duration,and geographical variation on intervention results.METHODS:A systematic search and screening of randomized controlled trials(RCTs)completed between 2014 and 2023 was undertaken using the PubMed,EMBASE,Cochrane Library,and Web of Science databases,in accordance with the PRISMA recommendations.The Cochrane risk of bias method was used to assess the quality of the studies.A Meta-analysis was performed using Stata 17.0 to calculate standardized mean differences(SMDs)and 95%confidence intervals(CIs).Subgroup analyses were performed to look at the effects of different doses,intervention periods,and geographic areas.Additionally,publication bias was assessed using Egger’s test.RESULTS:Ten studies including 1035 participants with myopia were analyzed.Supplementation with lutein and zeaxanthin resulted in a significant reduction in axial length elongation among adolescents in the intervention group(SMD=-0.40,P=0.001),an increase in macular pigment optical density(SMD=0.50,P=0.010),and an enhancement in visual sensitivity(SMD=0.53,P=0.008).Subgroup analyses revealed that participants receiving high doses and those undergoing intervention for more than 12mo exhibited significantly improved outcomes compared to those in the low-dose and short-term groups(high-dose vs low-dose:SMD=-0.41 vs-0.22,P=0.003;>12mo vs 6-12mo:SMD=-0.43 vs-0.23,P=0.004,respectively).Furthermore,Egger’s test indicated no significant publication bias(P=0.094).CONCLUSION:Combined lutein and zeaxanthin supplementation has a significant effect on myopia prevention in adolescents,with more pronounced benefits observed in high-dose and long-term interventions.The findings provide scientific evidence for its use as an adjunctive approach in myopia control.展开更多
Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated ne...Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated neuroprotective properties,yet a comprehensive systematic review assessing its efficacy remains absent.This study aims to evaluate the efficacy of Boswellia extract in treating NDs,with a particular focus on its effects in AD and its potential for long-term neurorestoration,thereby supporting further investigation into Boswellia’s therapeutic role in ND management.Methods:A systematic literature search was performed in PubMed,Web of Science,ScienceDirect,and Google Scholar for English-language studies published up to March 2024.Eighteen studies met the inclusion criteria and were included in the meta-analysis.The study protocol was registered on PROSPERO(CRD42024524386).Eligible studies involved rodent models of IS,PD,or AD with post-operative interventions using Boswellia extract.Data extraction focused on mechanisms of action,dosages,treatment durations,and therapeutic outcomes.Studies were excluded if they involved non-ND models,combined treatments,or had incomplete data.Two researchers independently conducted literature screening and data extraction.Statistical analyses were conducted using Stata(version 17)and RevMan(version 5.4),employing fixed or random-effects models based on heterogeneity assessments.Result s:Boswellia extract significantly improved the mean effect size for NDs(ES=1.28,95%CI(1.05,1.51),P<0.001).Specifically,it reduced cerebral infarct volume in IS(SMD=−2.87,95%CI(−3.42,−2.32))and enhanced behavioral outcomes in AD(SMD=3.26,95%CI(2.07,5.14))and PD(SMD=5.37,95%CI(3.93,6.80)).Subgroup analyses revealed that Boswellia extract exhibited superior efficacy in AD when administered orally and via intra-cerebroventricular injection.Long-term treatment with Boswellia extract suggested potential neurorestorative effects.Additionally,Boswellia extract was more effective than its monomeric constituents,highlighting its promising role in ND treatment.Conclusion:Boswellia extract demonstrates significant neuroprotective effects across various NDs,particularly in AD and in promoting long-term neurorestoration.These findings support the need for further research into Boswellia’s potential as a therapeutic agent in the management of neurological disorders.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
[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:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remai...Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.展开更多
Background:Baitouweng decoction is a classic prescription for treating chronic dysentery and mainly used to treat heat-toxic dysentery and is widely used in damp-heat ulcerative colitis(UC)in China.Methods:Meta-analys...Background:Baitouweng decoction is a classic prescription for treating chronic dysentery and mainly used to treat heat-toxic dysentery and is widely used in damp-heat ulcerative colitis(UC)in China.Methods:Meta-analysis and network pharmacology were used to examine the pharmacological properties of Baitouweng decoction in the treatment of UC.Additionally,the potential mechanisms of action were investigated.In the meta-analysis,studies were searched from databases up to March 2024.Data from the included studies were extracted.The results were quantified by calculating the standardized mean difference(SMD).Additionally,95%confidence intervals(CI)were used to assess the precision of the estimates.Results:It was found that 201 components of Baitouweng decoction,including Pulsatillae Radix(Baitouweng),Coptidis Rhizoma(Huanglian),Phellodendri Chinensis Cortex(Huangbo),Fraxini Cortex(Qinpi),and 106 intersecting targets of UC,were obtained from INPUT.PPI and enrichment analyses showed Baitouweng decoction might regulate inflammatory response to improve UC injury.Seventeen included studies were published between 2004 and 2024.The meta-analysis results suggested that Baitouweng decoction may help increase body weight,decrease DAI and CMDI,reduce colon length shortening associated with UC,lower the spleen index,and alleviate tissue damage in colitis.In addition,Baitouweng decoction could inhibit inflammatory response and repair intestinal barrier in UC model.The protective mechanism of Baitouweng decoction was consistent with the predicted targets of network pharmacology,which suggested the results were accurate.Conclusion:Baitouweng decoction could improve UC injury by regulating the inflammatory response,cell apoptosis,and body metabolism through the integration of network pharmacology and meta-analysis.Its protective mechanisms are related to anti-inflammation,regulation of intestinal flora,brain-gut peptides,and protection of the intestinal mucosal barrier,along with modulation of body metabolism,including SCFA,bile acids,and tryptophan metabolism.展开更多
Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interve...Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interventions.Although more patients are turning to supplements to manage osteoarthritis,their actual effectiveness remains uncertain.Objective:This study aims to provide a comprehensive evaluation of the available evidence concerning the efficacy of various dietary supplements in osteoarthritis treatment.Search strategy:We searched PubMed,Embase,Cochrane Library and Web of Science for studies on the use of various dietary supplements in the treatment of osteoarthritis from the creation of each database until Jan 20,2025.Inclusion criteria:(1)Research object:osteoarthritis.(2)Intervention measures:patients in the treatment group received dietary supplements,while the control group received placebos.(3)Research type:randomized controlled trials(RCTs).Data extraction and analysis:Two researchers independently examined the literature and retrieved data based on predefined criteria.The information gathered included the first author,year of publication,sample size,participant demographics,length of the follow-up period,intervention and control measures,and inclusion indications.RCTs comparing dietary supplements to placebo with the pain and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)among patients with osteoarthritis were included.The optimal dietary supplement was identified based on the total ranking by summing the surface under the cumulative ranking curve(SUCRA)of these two scores.Furthermore,the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to confirm the quality of the evidence.Results:Overall,23 studies covering 21 dietary supplements and involving 2455 participants met the inclusion criteria.In the WOMAC pain score,the SUCRA of passion fruit peel extract was 91%(mean difference[MD]:–9.2;95%confidence interval[CI]:[–16.0,–2.3]),followed by methylsulfonylmethane(89%),undenatured type II collagen(87%),collagen(84%),and Lanconone(82%).The SUCRA(99%)of passion fruit peel extract(MD:–41.0;95%CI:[–66.0,–16.0])ranked first in terms of the WOMAC function score,followed by Lanconone(95%),collagen(86%),ParActin(84%),and Lactobacillus casei strain Shirota(83%).The top three total rankings are passion fruit peel extract(95.0%),Lanconone(88.5%),and collagen(85.0%).However,the GRADE revealed low evidence quality.Conclusion:Passion fruit peel extract was the best supplement for improving WOMAC pain and function scores in patients with osteoarthritis,followed by Lanconone and collagen.However,further large-scale,well designed RCTs are required to substantiate these promising findings.展开更多
Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,gly...Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.展开更多
Soil contamination remains a global problem,and numerous studies have been published for investigating soil re-mediation.Thermal desorption remediation(TDR)can significantly reduce the contaminants in the soil within ...Soil contamination remains a global problem,and numerous studies have been published for investigating soil re-mediation.Thermal desorption remediation(TDR)can significantly reduce the contaminants in the soil within a short time and consequently has been used worldwide.However,the soil properties respond to TDR differently and are dependent on the experimental set-up.The causative mechanisms of these differences are yet to be fully elucidated.A statistical meta-analysis was thus undertaken to evaluate the TDR treatment effects on soil properties and plant per-formance.This review pointed out that soil clay was reduced by 54.2%,while soil sand content was enhanced by 15.2% after TDR.This might be due to the release of cementing agents from clay minerals that resulted in the formation of soil aggregates.Soil electrical conductivity enhanced by 69.5% after TDR,which might be due to the heating-induced loss of structural hydroxyl groups and the consequent liberation of ions.The treatment of TDR leads to the reduction of plant germination rate,length,and biomass by 19.4%,44.8%,and 20.2%,respectively,compared to that of control soil.This might be due to the residue of contaminants and the loss of soil fertility during the thermal process that inhibited plant germination and growth.Soil pH and sulfate content increased with heating temperature increased,while soil enzyme activities decreased with thermal temperature increased.Overall,the results suggested that TDR treatment has inhibited plant growth as well as ecological restoration.展开更多
BACKGROUND Attention-deficit hyperactivity disorder(ADHD)and its pharmacological treatments may influence growth in children and adolescents.This meta-analysis aimed to clarify their effects on the physical developmen...BACKGROUND Attention-deficit hyperactivity disorder(ADHD)and its pharmacological treatments may influence growth in children and adolescents.This meta-analysis aimed to clarify their effects on the physical development,especially weight and height.AIM To investigate the effects of ADHD and its treatment on growth in children and adolescents.METHODS Researchers reviewed 18 studies published up to September 2023 from databases such as PubMed,EMBASE,Cochrane,and Web of Science.They analyzed changes in body weight,height,and body mass index(BMI)before and after ADHD treatment,along with the risks of overweight and obesity.RESULTS Children with ADHD undergoing long-term medication therapy showed decreased actual weight[weighted mean difference(WMD)=-9.50]and height(WMD=-0.15),along with a slight increase in weight standard deviation scores(WMD=0.23)and height z scores(WMD=0.10).BMI showed a non-significant downward trend(WMD=-1.72).Regarding overweight and obesity risks,the pooled odds ratios were 1.37 and 1.16,respectively,but these were not statistically significant.CONCLUSION Overall,the study suggests that long-term pharmacological treatment for ADHD may be associated with reduced growth in weight and height among young patients.However,no clear link was found between ADHD and increased risk of overweight or obesity.These findings highlight the importance of monitoring growth in children receiving medication for ADHD.展开更多
Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a...Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.展开更多
OBJECTIVE:To access the effectuveness of four different types of Chinese traditional Qigong exercises in the management of cervical spondylosis.METHODS:Observational studies published up to July 2024 were searched in ...OBJECTIVE:To access the effectuveness of four different types of Chinese traditional Qigong exercises in the management of cervical spondylosis.METHODS:Observational studies published up to July 2024 were searched in online databases:China National Knowledge Infrastructure Database,Wanfang,China Science and Technology Journal Database,Sino Med,Pub Med,Cochrane Library,Embase,and Web of Science).The quality of the included randomized controlled trial(RCT)was evaluated using the Cochrane risk-of-bias tool.A total of 623 studies were retrieved,of which 44 were considered eligible.Four kinds of Chinese traditional Qigong exercises were involved,including Tai Chi,Baduanjin,Yijinjing and Wuqinxi.RESULTS:In the treatment of cervical spondylosis,Baduanjin,Yijinjing,Tai Chi,Wuqinxi plus standard of care(SOC)were more effective than SOC in improving the comprehensive curative effect,reducing the index of neck disability index,visual analogue scale and Yasuhisa Tanaka Cervial Spine Assessment Questionnaire.CONCLUSION:Chinese traditional Qigong exercises are recommended as a treatment option for cervical spondylosis.展开更多
A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mel...A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.展开更多
[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),an...[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),and long-term(>4 wks).[Methods]Six databases(PubMed,EMBASE,CENTRAL,CINAHL,Scopus,Web of Science)until May 2025,were systematically searched,identifying 11 RCTs(n=505)meeting inclusion criteria(adults≥18 yrs old with stroke-related spasticity[MAS≥1]).Risk of bias was rigorously assessed using Cochrane criteria,revealing uniformly low risk across all domains.Random-effects meta-analyses(REML model)calculated Hedges'g with 95%CI for MAS outcomes,with subgroup analyses for joint-specific effects.[Results]ESWT demonstrated non-significant immediate MAS reduction(g=-0.69,p=0.07;=93.95%),but statistically significant short-term(g=-0.58,p=0.02;I^(2)=89.64%)and long-term effects(g=-0.52,p=0.02;I^(2)=78.72%).Effects were driven by composite MAS scores(short-term g=-0.63;long-term g=-0.56,both p<0.05)rather than isolated joints(elbow/finger/wrist all non-significant).Substantial heterogeneity persisted across analyses,particularly in joint-specific subgroups(I^(2)>90%).[Conclusions]ESWT provides statistically significant,clinically relevant reductions in global upper limb spasticity with durable efficacy beyond four weeks,supporting its use as a non-invasive adjunct therapy despite substantial heterogeneity warranting protocol standardization.展开更多
BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate...BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I^(2)=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I^(2)=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.展开更多
Insomnia disorder negatively affects the quality of life of patients.Phototherapy has proven effective in treating sleep problems.This study aimed to summarize the impact of phototherapy on sleep quality in patients w...Insomnia disorder negatively affects the quality of life of patients.Phototherapy has proven effective in treating sleep problems.This study aimed to summarize the impact of phototherapy on sleep quality in patients with insomnia disorder and the factors influencing its effectiveness.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and registered experiments on the PROSPERO website,retrieving 12 randomized controlled trials that included at least one sleep quality outcome measure available for analysis from the four databases.Meta-analysis was conducted using the RevMan software,using Mean Differences(MD)and its 95% Confidence Interval(CI)to evaluate treatment efficacy and the Cochrane bias risk assessment tool to assess bias risk.The results showed that phototherapy prolonged the total sleep time of patients,with the subgroup analysis indicating that this was related to the choice of phototherapy time and light intensity.Using high-intensity(≥2000l×)light in the morning may be more effective in improving sleep-related indicators.In summary,phototherapy improved the sleep quality of patients with insomnia disorder.However,owing to the limited sample size and heterogeneity of the included studies,more comprehensive experiments are needed to explore phototherapy conditions.展开更多
Objectives:Healthcare students experience significant stress due to their rigorous graduate school curricula.These levels of stress are associated with higher risks of depression,self-harm,and exhaustion.Coping interv...Objectives:Healthcare students experience significant stress due to their rigorous graduate school curricula.These levels of stress are associated with higher risks of depression,self-harm,and exhaustion.Coping interventions have been shown to help students develop healthy stress coping strategies.The purpose of this systematic review and meta-analysis was to examine the diverse array of coping interventions and what characteristics of coping interventions were most effective at decreasing stress among healthcare students.Methods:Any intervention designed to address coping for academic stress was included among medical,dental,nursing,physician assistant,allied health,veterinary,psychology,etc.students.A comprehensive literature search was completed to include multiple databases,Ancestry,and hand-searching from EBSCO and Google Scholar articles.A final total of 17 studies were included.Standardized mean difference effect sizes(ES)were synthesized across studies using a random-effects model in the Comprehensive Meta-Analysis Software for changes in coping levels in healthcare students.Moderator analyses were performed to explore the study,intervention,and participants’characteristics.The risk of bias was assessed by RoB2 and ROBINS-I.Results:Coping interventions significantly reduced stress outcomes among healthcare students(d=0.74;95%CI[0.48–1.01],95%PI[−0.41–1.90],p<0.001,Q=228.49,I^(2)=93.0%,T=0.52,T^(2)=0.28,p<0.001).Moderator analysis showed that interventions with stress education,established professional guidance,and fewer hours led to better stress management outcomes.Conclusions:This study demonstrates that coping interventions produce an overall moderate-to-large effect on stress reduction.Future research investigating coping interventions on academic and long-term outcomes would be beneficial.展开更多
BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs ...BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehe...BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.展开更多
Background:Continuous care for children with enterostomy and their families has been gaining popularity in China.Objective:To evaluate the feasibility of continuous care for children with enterostomy and their familie...Background:Continuous care for children with enterostomy and their families has been gaining popularity in China.Objective:To evaluate the feasibility of continuous care for children with enterostomy and their families in China.Methods:The PubMed,Web of Science,Embase,Cochrane Library,EBSCO,CNKI,CBM,VIP,and WanFang were searched for clinical trials until December 30,2025.Two reviewers independently searched articles,evaluated quality and extracted data.This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA).Results:33 studies involving 2774 participants were included.The meta-analysis showed that continuous care strategy can significantly reduce the incidence of complications in children with enterostomy(OR=0.20,95%CI=0.16-0.26,p<0.001,I2=0%),effectively improve the family caregiver ability for enterostomy(MD=-10.34,95%CI=-13.82 to-6.85,p<0.001,I2=99%),shorten the time for family members to replace stoma bags(MD=-13.57,95%CI=-19.66 to-7.49,p<0.001,I2=100%),and alleviate negative emotions such as anxiety(SMD=-1.80,95%CI=-2.36 to-1.23,p<0.001,I2=92%)and depression(SMD=-1.54,95%CI=-2.04 to-1.04,p<0.001,I2=89%)in the families of the affected children.Conclusions:Continuous care can reduce complications of enterostomy in children,improve the family caregiver ability for enterostomy and alleviate negative emotions of family members such as anxiety and depression.展开更多
文摘AIM:To conduct a systematic review and Meta-analysis to determine the differential effects of combined lutein and zeaxanthin supplementation on myopia prevention in teenagers.It also investigates the effects of supplements dosage,intervention duration,and geographical variation on intervention results.METHODS:A systematic search and screening of randomized controlled trials(RCTs)completed between 2014 and 2023 was undertaken using the PubMed,EMBASE,Cochrane Library,and Web of Science databases,in accordance with the PRISMA recommendations.The Cochrane risk of bias method was used to assess the quality of the studies.A Meta-analysis was performed using Stata 17.0 to calculate standardized mean differences(SMDs)and 95%confidence intervals(CIs).Subgroup analyses were performed to look at the effects of different doses,intervention periods,and geographic areas.Additionally,publication bias was assessed using Egger’s test.RESULTS:Ten studies including 1035 participants with myopia were analyzed.Supplementation with lutein and zeaxanthin resulted in a significant reduction in axial length elongation among adolescents in the intervention group(SMD=-0.40,P=0.001),an increase in macular pigment optical density(SMD=0.50,P=0.010),and an enhancement in visual sensitivity(SMD=0.53,P=0.008).Subgroup analyses revealed that participants receiving high doses and those undergoing intervention for more than 12mo exhibited significantly improved outcomes compared to those in the low-dose and short-term groups(high-dose vs low-dose:SMD=-0.41 vs-0.22,P=0.003;>12mo vs 6-12mo:SMD=-0.43 vs-0.23,P=0.004,respectively).Furthermore,Egger’s test indicated no significant publication bias(P=0.094).CONCLUSION:Combined lutein and zeaxanthin supplementation has a significant effect on myopia prevention in adolescents,with more pronounced benefits observed in high-dose and long-term interventions.The findings provide scientific evidence for its use as an adjunctive approach in myopia control.
基金supported by the National Natural Science Foundation of China,specifically through grants(No.8227431382304947)Key Research and Development Project of Shaanxi Province(2023GHZD43).Peer re v iew information。
文摘Background:Neurological disorders(NDs),including ischemic stroke(IS),Parkinson’s disease(PD),and Alzheimer’s disease(AD),are major contributors to global morbidity and mortality.Boswellia extract has demonstrated neuroprotective properties,yet a comprehensive systematic review assessing its efficacy remains absent.This study aims to evaluate the efficacy of Boswellia extract in treating NDs,with a particular focus on its effects in AD and its potential for long-term neurorestoration,thereby supporting further investigation into Boswellia’s therapeutic role in ND management.Methods:A systematic literature search was performed in PubMed,Web of Science,ScienceDirect,and Google Scholar for English-language studies published up to March 2024.Eighteen studies met the inclusion criteria and were included in the meta-analysis.The study protocol was registered on PROSPERO(CRD42024524386).Eligible studies involved rodent models of IS,PD,or AD with post-operative interventions using Boswellia extract.Data extraction focused on mechanisms of action,dosages,treatment durations,and therapeutic outcomes.Studies were excluded if they involved non-ND models,combined treatments,or had incomplete data.Two researchers independently conducted literature screening and data extraction.Statistical analyses were conducted using Stata(version 17)and RevMan(version 5.4),employing fixed or random-effects models based on heterogeneity assessments.Result s:Boswellia extract significantly improved the mean effect size for NDs(ES=1.28,95%CI(1.05,1.51),P<0.001).Specifically,it reduced cerebral infarct volume in IS(SMD=−2.87,95%CI(−3.42,−2.32))and enhanced behavioral outcomes in AD(SMD=3.26,95%CI(2.07,5.14))and PD(SMD=5.37,95%CI(3.93,6.80)).Subgroup analyses revealed that Boswellia extract exhibited superior efficacy in AD when administered orally and via intra-cerebroventricular injection.Long-term treatment with Boswellia extract suggested potential neurorestorative effects.Additionally,Boswellia extract was more effective than its monomeric constituents,highlighting its promising role in ND treatment.Conclusion:Boswellia extract demonstrates significant neuroprotective effects across various NDs,particularly in AD and in promoting long-term neurorestoration.These findings support the need for further research into Boswellia’s potential as a therapeutic agent in the management of neurological disorders.
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[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.
基金supported by The Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(ZYYCXTD-C-202006)the 2025 High-level traditional Chinese medicine key subject construction project of National Administration of Traditional Chinese Medicine–Evidence-based Traditional Chinese Medicine.
文摘Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.
基金supported by the National Natural Science Foundation of China(No.82405237,82373835,82173781)Guangdong Basic and Applied Basic Research Foundation(No.2023A1515110768,2019A1515010806)+3 种基金Foshan Science and Technology Bureau’s self funded project(No.2320001007283)Key Field Projects(Intelligent Manufacturing)of General Universities in Guangdong Province(No.2020ZDZX2057)the Scientific Research Projects(Characteristic Innovation)of General Universities in Guangdong Province(No.2019KTSCX195)Guangdong Provincial Medical Research Foundation(No.A2022061).
文摘Background:Baitouweng decoction is a classic prescription for treating chronic dysentery and mainly used to treat heat-toxic dysentery and is widely used in damp-heat ulcerative colitis(UC)in China.Methods:Meta-analysis and network pharmacology were used to examine the pharmacological properties of Baitouweng decoction in the treatment of UC.Additionally,the potential mechanisms of action were investigated.In the meta-analysis,studies were searched from databases up to March 2024.Data from the included studies were extracted.The results were quantified by calculating the standardized mean difference(SMD).Additionally,95%confidence intervals(CI)were used to assess the precision of the estimates.Results:It was found that 201 components of Baitouweng decoction,including Pulsatillae Radix(Baitouweng),Coptidis Rhizoma(Huanglian),Phellodendri Chinensis Cortex(Huangbo),Fraxini Cortex(Qinpi),and 106 intersecting targets of UC,were obtained from INPUT.PPI and enrichment analyses showed Baitouweng decoction might regulate inflammatory response to improve UC injury.Seventeen included studies were published between 2004 and 2024.The meta-analysis results suggested that Baitouweng decoction may help increase body weight,decrease DAI and CMDI,reduce colon length shortening associated with UC,lower the spleen index,and alleviate tissue damage in colitis.In addition,Baitouweng decoction could inhibit inflammatory response and repair intestinal barrier in UC model.The protective mechanism of Baitouweng decoction was consistent with the predicted targets of network pharmacology,which suggested the results were accurate.Conclusion:Baitouweng decoction could improve UC injury by regulating the inflammatory response,cell apoptosis,and body metabolism through the integration of network pharmacology and meta-analysis.Its protective mechanisms are related to anti-inflammation,regulation of intestinal flora,brain-gut peptides,and protection of the intestinal mucosal barrier,along with modulation of body metabolism,including SCFA,bile acids,and tryptophan metabolism.
基金supported by the Association Foundation Program of the Yunnan Provincial Science and Technology Department and Kunming Medical University(No.202401AY070001-176 and 202401AY070001-180)the Xing Dian Talent Support Plan(to ZC),the Yunnan Province “the 14th Five-Year Plan”Provincial Key Clinical Specialty Construction Project(Traumatology Surgery)the Yunnan University Medical Research Foundation(No.YDYXJJ2024-0029,YDYXJJ2024-0040 and YDYXJJ2024-0017)。
文摘Background:A growing body of research is exploring the role of antioxidant and anti-inflammatory dietary supplements in the treatment of osteoarthritis,highlighting an increasing emphasis on nonpharmacological interventions.Although more patients are turning to supplements to manage osteoarthritis,their actual effectiveness remains uncertain.Objective:This study aims to provide a comprehensive evaluation of the available evidence concerning the efficacy of various dietary supplements in osteoarthritis treatment.Search strategy:We searched PubMed,Embase,Cochrane Library and Web of Science for studies on the use of various dietary supplements in the treatment of osteoarthritis from the creation of each database until Jan 20,2025.Inclusion criteria:(1)Research object:osteoarthritis.(2)Intervention measures:patients in the treatment group received dietary supplements,while the control group received placebos.(3)Research type:randomized controlled trials(RCTs).Data extraction and analysis:Two researchers independently examined the literature and retrieved data based on predefined criteria.The information gathered included the first author,year of publication,sample size,participant demographics,length of the follow-up period,intervention and control measures,and inclusion indications.RCTs comparing dietary supplements to placebo with the pain and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)among patients with osteoarthritis were included.The optimal dietary supplement was identified based on the total ranking by summing the surface under the cumulative ranking curve(SUCRA)of these two scores.Furthermore,the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to confirm the quality of the evidence.Results:Overall,23 studies covering 21 dietary supplements and involving 2455 participants met the inclusion criteria.In the WOMAC pain score,the SUCRA of passion fruit peel extract was 91%(mean difference[MD]:–9.2;95%confidence interval[CI]:[–16.0,–2.3]),followed by methylsulfonylmethane(89%),undenatured type II collagen(87%),collagen(84%),and Lanconone(82%).The SUCRA(99%)of passion fruit peel extract(MD:–41.0;95%CI:[–66.0,–16.0])ranked first in terms of the WOMAC function score,followed by Lanconone(95%),collagen(86%),ParActin(84%),and Lactobacillus casei strain Shirota(83%).The top three total rankings are passion fruit peel extract(95.0%),Lanconone(88.5%),and collagen(85.0%).However,the GRADE revealed low evidence quality.Conclusion:Passion fruit peel extract was the best supplement for improving WOMAC pain and function scores in patients with osteoarthritis,followed by Lanconone and collagen.However,further large-scale,well designed RCTs are required to substantiate these promising findings.
基金funded by the Seed Funding of the Beijing University of Chinese Medicine(90011451310034).
文摘Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.
基金the financial sponsorship from the National Key R&D Program of China(No.2023YFC3905800)Youth Innovation Promotion Association CAS(2021349)+5 种基金Guangdong Youth Talent Support Program(2021TQ06L121)State Key Laboratory of Subtropical Building Science in South China University of Technology(2022ZC01)Shenzhen Science and Technology Program(KCXFZ20211020163816023)financially supported by the Natural Science Foundation of Wuhan(No.2024040801020271)the Fundamental Research Funds for Central Public Welfare Research Institutes(No.CKSF20241004/YT)the support from FINNCERES flagship and tenure track fund(91160169(TT/Bordoloi)。
文摘Soil contamination remains a global problem,and numerous studies have been published for investigating soil re-mediation.Thermal desorption remediation(TDR)can significantly reduce the contaminants in the soil within a short time and consequently has been used worldwide.However,the soil properties respond to TDR differently and are dependent on the experimental set-up.The causative mechanisms of these differences are yet to be fully elucidated.A statistical meta-analysis was thus undertaken to evaluate the TDR treatment effects on soil properties and plant per-formance.This review pointed out that soil clay was reduced by 54.2%,while soil sand content was enhanced by 15.2% after TDR.This might be due to the release of cementing agents from clay minerals that resulted in the formation of soil aggregates.Soil electrical conductivity enhanced by 69.5% after TDR,which might be due to the heating-induced loss of structural hydroxyl groups and the consequent liberation of ions.The treatment of TDR leads to the reduction of plant germination rate,length,and biomass by 19.4%,44.8%,and 20.2%,respectively,compared to that of control soil.This might be due to the residue of contaminants and the loss of soil fertility during the thermal process that inhibited plant germination and growth.Soil pH and sulfate content increased with heating temperature increased,while soil enzyme activities decreased with thermal temperature increased.Overall,the results suggested that TDR treatment has inhibited plant growth as well as ecological restoration.
基金Supported by First-class Undergraduate Course Construction Project of Henan Province(Online and Offline Hybrid Course),No.[2021]21548and 2021 Pingdingshan Smart Nursing Key Laboratory.
文摘BACKGROUND Attention-deficit hyperactivity disorder(ADHD)and its pharmacological treatments may influence growth in children and adolescents.This meta-analysis aimed to clarify their effects on the physical development,especially weight and height.AIM To investigate the effects of ADHD and its treatment on growth in children and adolescents.METHODS Researchers reviewed 18 studies published up to September 2023 from databases such as PubMed,EMBASE,Cochrane,and Web of Science.They analyzed changes in body weight,height,and body mass index(BMI)before and after ADHD treatment,along with the risks of overweight and obesity.RESULTS Children with ADHD undergoing long-term medication therapy showed decreased actual weight[weighted mean difference(WMD)=-9.50]and height(WMD=-0.15),along with a slight increase in weight standard deviation scores(WMD=0.23)and height z scores(WMD=0.10).BMI showed a non-significant downward trend(WMD=-1.72).Regarding overweight and obesity risks,the pooled odds ratios were 1.37 and 1.16,respectively,but these were not statistically significant.CONCLUSION Overall,the study suggests that long-term pharmacological treatment for ADHD may be associated with reduced growth in weight and height among young patients.However,no clear link was found between ADHD and increased risk of overweight or obesity.These findings highlight the importance of monitoring growth in children receiving medication for ADHD.
文摘Objective Epidemiological studies have shown that vitamin D status affects glycemic control in individuals with type 2 diabetes mellitus(T2DM).However,findings from intervention studies remain inconsistent.Therefore,a network meta-analysis was conducted to evaluate the comparative efficacy of various vitamin D supplementation strategies on glucose indicators in adults with T2DM.Methods Eligible studies published before September 12,2024,were retrieved from PubMed,EMBASE,Cochrane Library,and Web of Science.A network meta-analysis of multiple dosage strategies—low(<1,000 IU/day,LDS),medium(1,000–2,000 IU/day,MDS),high(2,000–4,000 IU/day,HDS),and extremely high(≥4,000 IU/day,EHDS)—was performed.Results The network meta-analysis of 40 RCTs indicated that,compared with placebo,vitamin D_(3)supplementation increased 25-hydroxyvitamin D[25-(OH)-D]levels,with pooled mean difference(MD)showing a stepwise increase from LDS to EHDS.Ranking probabilities showed a corresponding rise in 25-(OH)-D levels from LDS(46.7%)to EHDS(91.2%).EHDS reduced fasting blood glucose(FBG)relative to no treatment.LDS significantly decreased hemoglobin A1c(HbA1c),and vitamin D_(2) significantly affected FBG levels.MDS led to a significant change in fasting insulin(FIN)compared to both placebo(MD:-4.76;95%CI-8.91 to-0.61)and no treatment(MD:-7.30;95%CI-14.44 to-0.17).Conclusion The findings suggest that vitamin D supplementation may be a viable approach for improving glycemic control in adults with T2DM,with lower doses potentially offering benefit.The analysis also showed a dose-dependent increase in 25-(OH)-D levels.
基金National Natural Science Foundation of China Project:Investigation of Terahertz Spectral Signatures in the Fluctuation Patterns of Visceral Qi:a Case Study on Four Biased Constitution Types(No.82360893)Science and technology project of Jiangxi Provincial Education Department Project:Investigation on Terahertz Wave Characteristics of Yuan-Source Acupoints Across Different Meridian States(No.GJJ211203)Science and technology plan of Jiangxi Provincial Administration of Traditional Chinese Medicine Project:Study on the Effect of Internal Organs Guiding Technique on College Students’Anxiety and Its Mechanism(No.SZYYB20231376)。
文摘OBJECTIVE:To access the effectuveness of four different types of Chinese traditional Qigong exercises in the management of cervical spondylosis.METHODS:Observational studies published up to July 2024 were searched in online databases:China National Knowledge Infrastructure Database,Wanfang,China Science and Technology Journal Database,Sino Med,Pub Med,Cochrane Library,Embase,and Web of Science).The quality of the included randomized controlled trial(RCT)was evaluated using the Cochrane risk-of-bias tool.A total of 623 studies were retrieved,of which 44 were considered eligible.Four kinds of Chinese traditional Qigong exercises were involved,including Tai Chi,Baduanjin,Yijinjing and Wuqinxi.RESULTS:In the treatment of cervical spondylosis,Baduanjin,Yijinjing,Tai Chi,Wuqinxi plus standard of care(SOC)were more effective than SOC in improving the comprehensive curative effect,reducing the index of neck disability index,visual analogue scale and Yasuhisa Tanaka Cervial Spine Assessment Questionnaire.CONCLUSION:Chinese traditional Qigong exercises are recommended as a treatment option for cervical spondylosis.
基金Jiangsu College of Nursing 2023 Special Fund for Research and Development of Medical-Educational Integration。
文摘A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.
文摘[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),and long-term(>4 wks).[Methods]Six databases(PubMed,EMBASE,CENTRAL,CINAHL,Scopus,Web of Science)until May 2025,were systematically searched,identifying 11 RCTs(n=505)meeting inclusion criteria(adults≥18 yrs old with stroke-related spasticity[MAS≥1]).Risk of bias was rigorously assessed using Cochrane criteria,revealing uniformly low risk across all domains.Random-effects meta-analyses(REML model)calculated Hedges'g with 95%CI for MAS outcomes,with subgroup analyses for joint-specific effects.[Results]ESWT demonstrated non-significant immediate MAS reduction(g=-0.69,p=0.07;=93.95%),but statistically significant short-term(g=-0.58,p=0.02;I^(2)=89.64%)and long-term effects(g=-0.52,p=0.02;I^(2)=78.72%).Effects were driven by composite MAS scores(short-term g=-0.63;long-term g=-0.56,both p<0.05)rather than isolated joints(elbow/finger/wrist all non-significant).Substantial heterogeneity persisted across analyses,particularly in joint-specific subgroups(I^(2)>90%).[Conclusions]ESWT provides statistically significant,clinically relevant reductions in global upper limb spasticity with durable efficacy beyond four weeks,supporting its use as a non-invasive adjunct therapy despite substantial heterogeneity warranting protocol standardization.
文摘BACKGROUND Postoperative delirium(POD)is a common and serious complication in surgical patients,particularly older adults.Alterations in cholinergic function have been implicated in its pathophysiology.AIM To evaluate the association between preoperative serum cholinesterase(ChE)activity—specifically butyrylcholinesterase(BuChE)and acetylcholinesterase(AChE)—and the risk of POD in adult surgical patients in a meta-analysis.METHODS A systematic search was conducted in PubMed,EMBASE,and Web of Science up to March 28,2025 for studies reporting preoperative serum BuChE or AChE activity in relation to subsequent POD incidence.Standardized mean differences(SMDs)and odds ratios(ORs)with 95%confidence intervals(CIs)were pooled using random-effects models.Subgroup and sensitivity analyses were performed based on follow-up duration and analytic models.RESULTS Thirteen studies(n=2730 patients)were included.Patients who developed POD had significantly lower preoperative BuChE activity than those who did not(SMD=-0.28;95%CI:-0.39 to-0.16;I^(2)=18%).Higher BuChE activity was associated with a reduced risk of POD(OR per 100 unit increment=0.97;95%CI:0.95-0.99;I2=0%).In contrast,pooled AChE activity did not differ significantly between POD and non-POD groups(SMD=-0.25;95%CI:-0.53 to 0.03;P=0.08;I^(2)=80%),and the ORs per 1 unit increment in AChE activity were not statistically significant(OR=0.98;95%CI:0.95-1.01).CONCLUSION Lower preoperative serum BuChE activity is associated with an increased risk of POD in adults undergoing surgery.BuChE activity may serve as a potential preoperative biomarker for POD risk stratification.
基金supported by the National Key R&D Program of China(No.2024YFC3505503)the Joint Fund of Tianjin Natural Science Foundation(No.25JCLMJC00370)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2022-I2M-3-002).
文摘Insomnia disorder negatively affects the quality of life of patients.Phototherapy has proven effective in treating sleep problems.This study aimed to summarize the impact of phototherapy on sleep quality in patients with insomnia disorder and the factors influencing its effectiveness.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and registered experiments on the PROSPERO website,retrieving 12 randomized controlled trials that included at least one sleep quality outcome measure available for analysis from the four databases.Meta-analysis was conducted using the RevMan software,using Mean Differences(MD)and its 95% Confidence Interval(CI)to evaluate treatment efficacy and the Cochrane bias risk assessment tool to assess bias risk.The results showed that phototherapy prolonged the total sleep time of patients,with the subgroup analysis indicating that this was related to the choice of phototherapy time and light intensity.Using high-intensity(≥2000l×)light in the morning may be more effective in improving sleep-related indicators.In summary,phototherapy improved the sleep quality of patients with insomnia disorder.However,owing to the limited sample size and heterogeneity of the included studies,more comprehensive experiments are needed to explore phototherapy conditions.
文摘Objectives:Healthcare students experience significant stress due to their rigorous graduate school curricula.These levels of stress are associated with higher risks of depression,self-harm,and exhaustion.Coping interventions have been shown to help students develop healthy stress coping strategies.The purpose of this systematic review and meta-analysis was to examine the diverse array of coping interventions and what characteristics of coping interventions were most effective at decreasing stress among healthcare students.Methods:Any intervention designed to address coping for academic stress was included among medical,dental,nursing,physician assistant,allied health,veterinary,psychology,etc.students.A comprehensive literature search was completed to include multiple databases,Ancestry,and hand-searching from EBSCO and Google Scholar articles.A final total of 17 studies were included.Standardized mean difference effect sizes(ES)were synthesized across studies using a random-effects model in the Comprehensive Meta-Analysis Software for changes in coping levels in healthcare students.Moderator analyses were performed to explore the study,intervention,and participants’characteristics.The risk of bias was assessed by RoB2 and ROBINS-I.Results:Coping interventions significantly reduced stress outcomes among healthcare students(d=0.74;95%CI[0.48–1.01],95%PI[−0.41–1.90],p<0.001,Q=228.49,I^(2)=93.0%,T=0.52,T^(2)=0.28,p<0.001).Moderator analysis showed that interventions with stress education,established professional guidance,and fewer hours led to better stress management outcomes.Conclusions:This study demonstrates that coping interventions produce an overall moderate-to-large effect on stress reduction.Future research investigating coping interventions on academic and long-term outcomes would be beneficial.
文摘BACKGROUND Regorafenib is approved as a second-line treatment for advanced hepatocellular carcinoma(HCC),but its comparative efficacy remains under evaluation.AIM To evaluate the efficacy and safety of regorafenib vs other second-line therapies in advanced HCC.METHODS This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.A comprehensive search of PubMed,EMBASE,Web of Science,and the Cochrane Library was performed on June 6,2025.Studies were included if they reported at least one relevant clinical outcome:Overall survival,progression-free survival,objective response rate,or disease control rate.Data was extracted independently by two reviewers.Quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.Pooled effect estimates were calculated using random-or fixed-effects models depending on the degree of heterogeneity.Sensitivity analyses and Egger’s test were performed to evaluate the robustness of the results and potential publication bias.RESULTS Nine studies met inclusion criteria.Regorafenib significantly improved overall survival compared to controls[weighted mean difference=2.54 months;95%confidence interval(CI):0.26-4.81;P<0.05],but no significant benefit was observed for progression-free survival(weighted mean difference=1.04;95%CI:-1.27 to 3.36).The pooled objective response rate showed no overall difference,though regorafenib was inferior to nivolumab in subgroup analysis(odds ratio=0.34;95% CI:0.20-0.58).Disease control rate did not differ significantly.No publication bias was detected.CONCLUSION Regorafenib offers a survival advantage in advanced HCC but does not significantly improve tumor response rates compared to alternative therapies.
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.
文摘Background:Continuous care for children with enterostomy and their families has been gaining popularity in China.Objective:To evaluate the feasibility of continuous care for children with enterostomy and their families in China.Methods:The PubMed,Web of Science,Embase,Cochrane Library,EBSCO,CNKI,CBM,VIP,and WanFang were searched for clinical trials until December 30,2025.Two reviewers independently searched articles,evaluated quality and extracted data.This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA).Results:33 studies involving 2774 participants were included.The meta-analysis showed that continuous care strategy can significantly reduce the incidence of complications in children with enterostomy(OR=0.20,95%CI=0.16-0.26,p<0.001,I2=0%),effectively improve the family caregiver ability for enterostomy(MD=-10.34,95%CI=-13.82 to-6.85,p<0.001,I2=99%),shorten the time for family members to replace stoma bags(MD=-13.57,95%CI=-19.66 to-7.49,p<0.001,I2=100%),and alleviate negative emotions such as anxiety(SMD=-1.80,95%CI=-2.36 to-1.23,p<0.001,I2=92%)and depression(SMD=-1.54,95%CI=-2.04 to-1.04,p<0.001,I2=89%)in the families of the affected children.Conclusions:Continuous care can reduce complications of enterostomy in children,improve the family caregiver ability for enterostomy and alleviate negative emotions of family members such as anxiety and depression.
