BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection c...BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection criteria,and meta-analyses reporting overall survival outcomes across different ACLF severity grades are lacking.AIM To depict a comprehensive postoperative picture of patients with ACLF of varying severity and contribute to updating LT selection.METHODS Systematic searches in Web of Science,EMBASE,PubMed,and Cochrane databases were performed,from inception to December 26,2023,for studies exploring post-transplant outcomes among ACLF patients,stratified by severity grades as identified by the European Association for the Study of the Liver-Chronic Liver Failure criteria.The primary outcome of interest was the survival rate within one year,with post-transplant complications as secondary outcomes.Additionally,the subgroup analysis examined region-specific one-year survival rates.RESULTS A total of 17 studies involving 28025 participants were included.Patients with ACLF-1 and ACLF-2 have favorable survival within one year,with survival rates reaching 87%[95%confidence interval(CI):84%-91%]and 86%(95%CI:81%-91%),respectively.Despite the relatively lower survival(73%,95%CI:66%-80%)and higher incidence of infection(48%,95%CI:29%-67%)observed in ACLF-3 patients,their survival exceeds that of those who do not undergo LT.Moreover,post-transplant survival was highest in North America across all ACLF grades.CONCLUSION LT can provide survival advantages for ACLF patients.To optimize the utilization of scarce donor organs and improve prognosis,comprehensive preoperative health evaluations are essential,especially for ACLF-3 patients.展开更多
BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the ther...BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the therapeutic effects of beinaglutide in patients with overweight/obesity with/without type 2 diabetes.METHODS RCTs involving patients receiving beinaglutide in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The change from baseline in body weight was the primary outcome;secondary outcomes included changes in body mass index(BMI),waist circumference(WC),blood pressure,glycemic parameters,lipids,and adverse events(AEs).RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MDs),odds ratios(ORs),or risk ratios(RRs)with 95%confidence intervals(95%CIs).RESULTS Six RCTs(n=800)with mostly some concerns about the risk of bias were included.Over 12-24 weeks,beinaglutide 0.1-0.2 mg thrice daily was superior to the control group in reducing total(MD=-3.25 kg,95%CI:-4.52 to-1.98,I^(2)=84%,P<0.00001)and percent(MD=-4.13%,95%CI:-4.87 to-3.39,I^(2)=54%,P<0.00001)body weight reduction.Beinaglutide also outperformed the control group in achieving weight loss by 5%(OR 4.61)and 10%(OR=5.34).The superiority of beinaglutide vs the control group was also found in reducing BMI(MD=-1.22 kg/m^(2),95%CI:-1.67 to-0.77)and WC(MD=-2.47 cm,95%CI:-3.74 to-1.19]).Beinaglutide and the control group had comparable impacts on blood pressure,glycemic parameters,insulin resistance,hepatic transaminases,and lipid profile.Beinaglutide posed higher risks of treatment discontinuation due to AEs(RR=3.15),nausea(RR=4.51),vomiting(RR=8.19),palpitation(RR=3.95),headache(RR=2.87),and dizziness(RR=6.07)than the control.However,the two groups had identical risks of total and serious AEs,diarrhea,fatigue,and hypoglycemia.CONCLUSION Short-term data from RCTs suggested that beinaglutide causes modest benefits in reducing body weight,BMI,and WC,with no significant difference in glycemic and other metabolic endpoints compared to the control arm.Safety data were consistent with those of the other drugs in the glucagon-like polypeptide-1 receptor agonist class.Larger RCTs are warranted to prove the longer-term metabolic benefits of beinaglutide.展开更多
为系统研究城市绿色空间对人群的心理健康的影响,文章将城市绿色空间分为3类,探讨不同类型城市绿色空间在情绪效价、唤醒度和主观恢复性等心理指标上的作用差异。在CNKI和Web of Science数据库中对相关文献进行检索,筛选文献16篇,对筛...为系统研究城市绿色空间对人群的心理健康的影响,文章将城市绿色空间分为3类,探讨不同类型城市绿色空间在情绪效价、唤醒度和主观恢复性等心理指标上的作用差异。在CNKI和Web of Science数据库中对相关文献进行检索,筛选文献16篇,对筛选出的16篇文献中的数据样本进行荟萃分析,分析结果表明:不同类型城市绿色空间对情绪效价、唤醒度、主观恢复性均有促进作用,在情绪效价层面,不同类型自然环境对情绪调节存在互补现象;在唤醒度层面,3类自然环境均能缓解压力,森林康养类自然环境在血压调节方面表现效果更佳;在主观恢复性层面,风景游憩类和森林康养类自然环境具有较好调节效果。展开更多
目的:通过循证医学方法系统评价电针治疗突发性耳聋的临床疗效。方法:系统检索中国知网、万方、维普、Pubmed、Embase、Web of Science、Cochrane Library数据库中自建库至2024年10月7日以来电针治疗突发性耳聋的随机对照试验,由2名研...目的:通过循证医学方法系统评价电针治疗突发性耳聋的临床疗效。方法:系统检索中国知网、万方、维普、Pubmed、Embase、Web of Science、Cochrane Library数据库中自建库至2024年10月7日以来电针治疗突发性耳聋的随机对照试验,由2名研究者参考Cochrane协作网提供的偏倚风险评估工具,采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献,样本量为638例,试验组321例,对照组317例。Meta分析结果显示,试验组电针治疗突发性耳聋的总有效率(RR=1.23,95%CI[1.07,1.41],P=0.003)、治愈率(RR=1.73,95%CI[1.28,2.34],P=0.0004)、眩晕总有效率(RR=1.25,95%CI[0.99,1.57],P=0.06)均高于对照组;试验组平均听阈值低于对照组(MD=-6.29,95%CI[-9.01,-3.56],P<0.00001),差异均有统计学意义(P<0.05)。结论:电针治疗突发性耳聋可以提高突发性耳聋总有效率、治愈率、眩晕总有效率,改善平均听阈值。展开更多
目的:通过收集血流限制训练法联合抗阻训练的相关文献,依照系统评价和Meta分析的范式,分析血流限制训练法联合抗阻训练与抗阻训练对运动者肌肉相关指标和专项能力的不同影响,旨在为运动者在训练实践中运用血流限制训练提供数据支持。方...目的:通过收集血流限制训练法联合抗阻训练的相关文献,依照系统评价和Meta分析的范式,分析血流限制训练法联合抗阻训练与抗阻训练对运动者肌肉相关指标和专项能力的不同影响,旨在为运动者在训练实践中运用血流限制训练提供数据支持。方法:检索中外数据库(中国知网、万方、PubMed、Web of Science和SPORTDiscus),应用血流限制训练法联合抗阻训练对对象为运动者中大学生运动者肢体围度、肌肉质量、肌肉力量和专项运动能力影响的随机对照试验,检索起止时间为2000-01-01/2023-10-12。至少2名研究者采用Cochrane协作网偏倚风险评估工具和标准对纳入文献进行质量评价。使用RevMan 5.4软件进行异质性检验、数据合并、亚组分析、绘制森林图和敏感性分析,绘制漏斗图并进行发表偏倚评价和敏感性分析。评价指标为肢体围度、肌肉厚度、肌肉力量和专项能力等,对不同专项运动能力进行亚组分析。结果:①共纳入18项随机对照试验,共403例受试者,根据Cochrane协作网偏倚风险评估工具,纳入文献中文献质量为A级的有16篇,B级有2篇。②将血流限制训练法联合抗阻训练与抗阻训练之间的效果进行对比,在肢体围度方面,两组间无显著性差异(SMD=0.03,95%CI:-0.16-0.21,P=0.78);在肌肉厚度方面(SMD=0.14,95%CI:0.01-0.27,P=0.03)及肌肉力量方面(SMD=0.37,95%CI:0.14-0.60,P=0.001)两组间有显著性差异。③对专项能力指标进行亚组分析结果显示,距离指标的分析结果存在高异质性(I2=73%),时间指标的分析结果存在高异质性(I2=55%),分析可能原因是各研究的测试方法及评估指标意义的不同导致;功率指标的分析结果显示无异质性(I2=0%);血流限制训练法联合抗阻训练对距离指标具有显著影响(P<0.01)。④合并效应结果显示,血流限制训练法联合抗阻训练比较抗阻训练对于专项能力的影响(P=0.41),提示不同训练方法对于专项能力不存在显著性影响。结论:①两种训练方法均能够促进大学生运动者的肌肉厚度、肌肉力量和专项能力,血流限制训练法联合抗阻训练相较于抗阻训练在促进运动员肌肉厚度、肌肉力量和部分专项能力方面具有显著性效果。因此,可以在专项训练之中科学合理地融合血流限制训练法,以差异性的生理刺激综合作用于肌肉,以取得更好的训练效果。②然而,由于纳入的研究数量较少,以及其他可能存在的局限性,今后需要纳入更多的高质量、多项目类型和性别的随机对照试验来证实。展开更多
Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroa...Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.展开更多
BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effec...BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.AIM To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.METHODS Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm.The primary outcome was adverse events(AEs)during Ramadan for both groups;other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.RESULTS Four studies[three randomized-controlled trials with low risk of bias(RoB)and one prospective observational study with serious RoB]involving 754 subjects were analyzed.GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group[mean difference(MD):-0.31%,95%CI:-0.61 to-0.01,P=0.04,I2=77%]with a lower risk of documented symptomatic hypoglycemia(risk ratio=0.38,95%CI:0.16 to 0.88,P=0.02).Any AEs,serious AEs,or AEs that led to treatment discontinuation were comparable between the two groups.The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group(MD:-2.0 kg,95%CI:-3.37 to-0.63,P=0.004,I2=95%).There were comparable changes in blood pressure and lipid profile between the two groups.GLP-1RA users experienced higher risks of gastrointestinal AEs,nausea,and vomiting;however,the risks of heartburn,abdominal pain,and diarrhea were similar in both groups.CONCLUSION Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan,offering modest benefits in blood sugar control and weight loss.Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations,improving clinical practice decision-making.展开更多
BACKGROUND In recent years,emerging clinical research has prioritized assessment of combined therapeutic efficacy and safety parameters when programmed death 1 or its ligand(PD-1/L1)inhibitors are incorporated into fi...BACKGROUND In recent years,emerging clinical research has prioritized assessment of combined therapeutic efficacy and safety parameters when programmed death 1 or its ligand(PD-1/L1)inhibitors are incorporated into first-line standard-of-care(SOC)therapy for metastatic colorectal cancer(mCRC).However,data obtained from these trials demonstrated conflicting evidence concerning survival benefits and clinical outcomes.AIM To evaluate the therapeutic impact and safety parameters of combining PD-1/L1 inhibitors with SOC protocols as first-line treatment for mCRC.METHODS Four biomedical databases(PubMed,Embase,Cochrane Library,Web of Science)were systematically interrogated to identify eligible studies published up to October 12,2024.The analysis focused on evaluating the primary outcome of overall survival(OS)in the mCRC population with secondary outcomes of progression-free survival(PFS),overall response rate(ORR),and incidence rate of grade≥3 adverse events.Additionally,we performed exploratory analyses in the microsatellite stable/mismatch repair-proficient(MSS/pMMR)subpopulation,based on a subset of the included studies.Subgroup analyses according to PD-1/L1 inhibitor use were conducted in both the overall population and the MSS/pMMR subgroup.RESULTS This pooled analysis incorporated six randomized controlled trials involving 675 patients with mCRC receiving first-line therapy.The combination of PD-1/L1 inhibitors with SOC regimens demonstrated a significant PFS advantage over SOC monotherapy in intention-to-treat populations[hazard ratio(HR)=0.8,95%confidence interval(CI):0.65-0.98,P=0.033].Nevertheless,the MSS/pMMR subgroup showed no PFS benefit(HR=0.83,95%CI:0.67-1.03,P=0.091),and no cohort exhibited OS improvement(intention-to-treat:HR=0.84,95%CI:0.66-1.05,P=0.124;MSS/pMMR:HR=0.79,95%CI:0.60-1.03,P=0.083).Comparable outcomes were observed for ORR(risk ratio=1.03,95%CI:0.90-1.17,P=0.711)and incidence rate of grade≥3 adverse events(risk ratio=1.12,95%CI:0.93-1.36,P=0.245)between treatment arms.CONCLUSION The findings indicated that integrating PD-1/L1 blocking agents with SOC regimens for mCRC as first-line treatment failed to demonstrate significant improvements in ORR.Existing clinical data remain inadequate to establish OS advantages,particularly in patients with MSS/pMMR,despite exhibiting manageable toxicity profiles.Subsequent confirmation through rigorously designed phase III clinical trials remains essential to verify these therapeutic outcomes.展开更多
OBJECTIVE:To update the current best evidence on the effectiveness and safety of cupping therapy in pain management.METHODS:The protocol of this systematic review was registered at PROSPERO(CRD42021261308).An updated ...OBJECTIVE:To update the current best evidence on the effectiveness and safety of cupping therapy in pain management.METHODS:The protocol of this systematic review was registered at PROSPERO(CRD42021261308).An updated literature searching in 7 databases was conducted from January 2014 to January 2023.Two authors extracted data and assessed the risk of bias independently.Statistical analysis was performed using RevMan 5.4.1 software(Cochrane Collaboration,London,UK).Meta-analysis with a random effect model was conducted when there was no serious statistical heterogeneity among trials(I^(2) ≤ 75%).Grading of Recommendations Assessment,Development,and Evaluation was also conducted to assess the quality of evidence.RESULTS:Seventy-two trials with 5720 participants were included.All included trials were assessed as having high risk of bias.The majority of the included trials reported the benefit of cupping plus other therapy or cupping alone on improving cure rate(average risk ratio more than 1.15) and reducing visual analogue scale [average mean difference(MD) reduction 0.16 to 7.0 cm],improving quality of life,quality of sleep or other symptoms related to pain condition.And there was low/very low quality evidence that the incidence of adverse events in the cupping groups were lower than that in the control groups.Although the heterogeneity between studies and the methodological quality of the study itself lead to the low evidence strength of the current conclusions,the results of this study are a valuable supplement to the founding of previous review.CONCLUSION:Cupping therapy alone or combined with other therapy was considered benefit in relieving pain,improving the quality of life,and increasing the cure rate of patients with pain conditions,though supported by the low quality of evidence.According to the limited evidence,cupping therapy seems to have less harm than drugs when treating pain conditions.展开更多
目的比较三角瓣设计和封套瓣设计在缓解下颌第三磨牙拔除术后并发症方面的效果,为口腔颌面外科医生提供翻瓣选择的科学依据。方法通过检索CNKI、万方、PubMed、Embase、Web of Science、Cochrane和Springer数据库,筛选1984年1月至2022年...目的比较三角瓣设计和封套瓣设计在缓解下颌第三磨牙拔除术后并发症方面的效果,为口腔颌面外科医生提供翻瓣选择的科学依据。方法通过检索CNKI、万方、PubMed、Embase、Web of Science、Cochrane和Springer数据库,筛选1984年1月至2022年4月发表的随机对照试验和对照临床试验,分析三角瓣和封套瓣对下颌第三磨牙拔除术后面部肿胀、张口受限和干槽症等并发症的影响。结果Meta分析显示,三角瓣组术后第7天的面部肿胀程度显著大于封套瓣组(MD=-0.69,95%CI:-0.93~-0.45;P<0.00001),但2组术后第14天的面部肿胀程度比较差异无统计学意义(MD=-0.07,95%CI:-0.18~0.04;P=0.22)。亚组分析表明,在Pell and Gregory A/B分类中,封套瓣在改善张口受限方面效果优于三角瓣(MD=2.95,95%CI:0.11~5.79),但在其他分类亚组及总体分析中未观察到显著差异。在分侧随机对照试验中封套瓣干槽症发生的风险更高(RR=3.53,95%CI:1.67~7.48),而在随机对照试验中未见明显差异(RR=0.78,95%CI:0.43~1.43)。结论与三角瓣相比,封套瓣在缓解术后早期面部肿胀改善张口受限方面具有优势,但其干槽症发生风险较高。展开更多
目的:系统评价益气养阴活血法治疗糖尿病心肌病(DCM)的疗效。方法:计算机检索中国知网全文数据库(CNKI)、万方数据、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、Cochrane Library、Web of Science核心数据库中益...目的:系统评价益气养阴活血法治疗糖尿病心肌病(DCM)的疗效。方法:计算机检索中国知网全文数据库(CNKI)、万方数据、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、Cochrane Library、Web of Science核心数据库中益气养阴活血法治疗DCM的相关文献,检索时限为自建库至2024年1月25日。根据纳入与排除标准筛选文献,按照Cochrane系统评价手册对纳入的文献进行质量评价及原始数据提取,使用RevMan 5.3软件分析益气养阴活血法联合常规西药及常规西药治疗DCM的有效率,采用敏感性分析对结果的稳定性进行评估,采用漏斗图对文献的发表偏倚进行评估。结果:纳入符合要求的文献13篇,涉及病例1044例,其中试验组523例,对照组521例。采用固定效应模型合并总效应值,Meta分析结果显示,益气养阴活血法联合常规西药治疗DCM的临床总有效率[RR=1.27,95%CI(1.20,1.35),P<0.00001]优于单纯西药治疗且纳入文献的发表偏倚较小。结论:益气养阴活血法联合常规西药治疗DCM优于单纯西药治疗,临床治疗DCM应重视中医药,充分发挥中西医结合的优势。展开更多
基金Supported by National Natural Science Foundation of China,No.82300857.
文摘BACKGROUND Liver transplantation(LT)is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure(ACLF).However,controversies remain regarding the LT selection criteria,and meta-analyses reporting overall survival outcomes across different ACLF severity grades are lacking.AIM To depict a comprehensive postoperative picture of patients with ACLF of varying severity and contribute to updating LT selection.METHODS Systematic searches in Web of Science,EMBASE,PubMed,and Cochrane databases were performed,from inception to December 26,2023,for studies exploring post-transplant outcomes among ACLF patients,stratified by severity grades as identified by the European Association for the Study of the Liver-Chronic Liver Failure criteria.The primary outcome of interest was the survival rate within one year,with post-transplant complications as secondary outcomes.Additionally,the subgroup analysis examined region-specific one-year survival rates.RESULTS A total of 17 studies involving 28025 participants were included.Patients with ACLF-1 and ACLF-2 have favorable survival within one year,with survival rates reaching 87%[95%confidence interval(CI):84%-91%]and 86%(95%CI:81%-91%),respectively.Despite the relatively lower survival(73%,95%CI:66%-80%)and higher incidence of infection(48%,95%CI:29%-67%)observed in ACLF-3 patients,their survival exceeds that of those who do not undergo LT.Moreover,post-transplant survival was highest in North America across all ACLF grades.CONCLUSION LT can provide survival advantages for ACLF patients.To optimize the utilization of scarce donor organs and improve prognosis,comprehensive preoperative health evaluations are essential,especially for ACLF-3 patients.
文摘BACKGROUND Beinaglutide,a short-acting glucagon-like polypeptide-1 receptor agonist,has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials(RCTs).AIM To summarize the therapeutic effects of beinaglutide in patients with overweight/obesity with/without type 2 diabetes.METHODS RCTs involving patients receiving beinaglutide in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases.The change from baseline in body weight was the primary outcome;secondary outcomes included changes in body mass index(BMI),waist circumference(WC),blood pressure,glycemic parameters,lipids,and adverse events(AEs).RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as mean differences(MDs),odds ratios(ORs),or risk ratios(RRs)with 95%confidence intervals(95%CIs).RESULTS Six RCTs(n=800)with mostly some concerns about the risk of bias were included.Over 12-24 weeks,beinaglutide 0.1-0.2 mg thrice daily was superior to the control group in reducing total(MD=-3.25 kg,95%CI:-4.52 to-1.98,I^(2)=84%,P<0.00001)and percent(MD=-4.13%,95%CI:-4.87 to-3.39,I^(2)=54%,P<0.00001)body weight reduction.Beinaglutide also outperformed the control group in achieving weight loss by 5%(OR 4.61)and 10%(OR=5.34).The superiority of beinaglutide vs the control group was also found in reducing BMI(MD=-1.22 kg/m^(2),95%CI:-1.67 to-0.77)and WC(MD=-2.47 cm,95%CI:-3.74 to-1.19]).Beinaglutide and the control group had comparable impacts on blood pressure,glycemic parameters,insulin resistance,hepatic transaminases,and lipid profile.Beinaglutide posed higher risks of treatment discontinuation due to AEs(RR=3.15),nausea(RR=4.51),vomiting(RR=8.19),palpitation(RR=3.95),headache(RR=2.87),and dizziness(RR=6.07)than the control.However,the two groups had identical risks of total and serious AEs,diarrhea,fatigue,and hypoglycemia.CONCLUSION Short-term data from RCTs suggested that beinaglutide causes modest benefits in reducing body weight,BMI,and WC,with no significant difference in glycemic and other metabolic endpoints compared to the control arm.Safety data were consistent with those of the other drugs in the glucagon-like polypeptide-1 receptor agonist class.Larger RCTs are warranted to prove the longer-term metabolic benefits of beinaglutide.
文摘为系统研究城市绿色空间对人群的心理健康的影响,文章将城市绿色空间分为3类,探讨不同类型城市绿色空间在情绪效价、唤醒度和主观恢复性等心理指标上的作用差异。在CNKI和Web of Science数据库中对相关文献进行检索,筛选文献16篇,对筛选出的16篇文献中的数据样本进行荟萃分析,分析结果表明:不同类型城市绿色空间对情绪效价、唤醒度、主观恢复性均有促进作用,在情绪效价层面,不同类型自然环境对情绪调节存在互补现象;在唤醒度层面,3类自然环境均能缓解压力,森林康养类自然环境在血压调节方面表现效果更佳;在主观恢复性层面,风景游憩类和森林康养类自然环境具有较好调节效果。
文摘目的:通过循证医学方法系统评价电针治疗突发性耳聋的临床疗效。方法:系统检索中国知网、万方、维普、Pubmed、Embase、Web of Science、Cochrane Library数据库中自建库至2024年10月7日以来电针治疗突发性耳聋的随机对照试验,由2名研究者参考Cochrane协作网提供的偏倚风险评估工具,采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献,样本量为638例,试验组321例,对照组317例。Meta分析结果显示,试验组电针治疗突发性耳聋的总有效率(RR=1.23,95%CI[1.07,1.41],P=0.003)、治愈率(RR=1.73,95%CI[1.28,2.34],P=0.0004)、眩晕总有效率(RR=1.25,95%CI[0.99,1.57],P=0.06)均高于对照组;试验组平均听阈值低于对照组(MD=-6.29,95%CI[-9.01,-3.56],P<0.00001),差异均有统计学意义(P<0.05)。结论:电针治疗突发性耳聋可以提高突发性耳聋总有效率、治愈率、眩晕总有效率,改善平均听阈值。
文摘目的:通过收集血流限制训练法联合抗阻训练的相关文献,依照系统评价和Meta分析的范式,分析血流限制训练法联合抗阻训练与抗阻训练对运动者肌肉相关指标和专项能力的不同影响,旨在为运动者在训练实践中运用血流限制训练提供数据支持。方法:检索中外数据库(中国知网、万方、PubMed、Web of Science和SPORTDiscus),应用血流限制训练法联合抗阻训练对对象为运动者中大学生运动者肢体围度、肌肉质量、肌肉力量和专项运动能力影响的随机对照试验,检索起止时间为2000-01-01/2023-10-12。至少2名研究者采用Cochrane协作网偏倚风险评估工具和标准对纳入文献进行质量评价。使用RevMan 5.4软件进行异质性检验、数据合并、亚组分析、绘制森林图和敏感性分析,绘制漏斗图并进行发表偏倚评价和敏感性分析。评价指标为肢体围度、肌肉厚度、肌肉力量和专项能力等,对不同专项运动能力进行亚组分析。结果:①共纳入18项随机对照试验,共403例受试者,根据Cochrane协作网偏倚风险评估工具,纳入文献中文献质量为A级的有16篇,B级有2篇。②将血流限制训练法联合抗阻训练与抗阻训练之间的效果进行对比,在肢体围度方面,两组间无显著性差异(SMD=0.03,95%CI:-0.16-0.21,P=0.78);在肌肉厚度方面(SMD=0.14,95%CI:0.01-0.27,P=0.03)及肌肉力量方面(SMD=0.37,95%CI:0.14-0.60,P=0.001)两组间有显著性差异。③对专项能力指标进行亚组分析结果显示,距离指标的分析结果存在高异质性(I2=73%),时间指标的分析结果存在高异质性(I2=55%),分析可能原因是各研究的测试方法及评估指标意义的不同导致;功率指标的分析结果显示无异质性(I2=0%);血流限制训练法联合抗阻训练对距离指标具有显著影响(P<0.01)。④合并效应结果显示,血流限制训练法联合抗阻训练比较抗阻训练对于专项能力的影响(P=0.41),提示不同训练方法对于专项能力不存在显著性影响。结论:①两种训练方法均能够促进大学生运动者的肌肉厚度、肌肉力量和专项能力,血流限制训练法联合抗阻训练相较于抗阻训练在促进运动员肌肉厚度、肌肉力量和部分专项能力方面具有显著性效果。因此,可以在专项训练之中科学合理地融合血流限制训练法,以差异性的生理刺激综合作用于肌肉,以取得更好的训练效果。②然而,由于纳入的研究数量较少,以及其他可能存在的局限性,今后需要纳入更多的高质量、多项目类型和性别的随机对照试验来证实。
基金supported by the National Natural Science Foundation of China,Nos.82174496(to NW),82374574(to NW),82302865(to LL)Shanghai Science and Technology Committee Sailing Program,Nos.23YF1403800(to LL),23YF1405200(to YX)Shanghai Hospital Development Center Foundation-Shanghai Municipal Hospital Rehabilitation Medicine Specialty Alliance,No.SHDC22023304(to YW).
文摘Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.
基金thankful to Dr.Marina George Kudiyirickal MSc,MJDF-RCS,PhD for providing us the audio core tip of this article.
文摘BACKGROUND Data on the use of glucagon-like peptide-1 receptor agonists(GLP-1RAs)in individuals with type 2 diabetes mellitus(T2DM)during Ramadan fasting is limited.No meta-analysis has summarized the safety and effectiveness of GLP-1RAs in these situations.AIM To evaluate the safety and efficacy of GLP-1RA in patients with T2DM fasting during Ramadan.METHODS Electronic databases were systematically searched for relevant studies that featured GLP-1RA in the intervention arm and other glucose-lowering medications in the control arm.The primary outcome was adverse events(AEs)during Ramadan for both groups;other outcomes included changes in glycemic and anthropometric measures during the peri-Ramadan period.RESULTS Four studies[three randomized-controlled trials with low risk of bias(RoB)and one prospective observational study with serious RoB]involving 754 subjects were analyzed.GLP-1RA group achieved greater glycated hemoglobin reduction than the non-GLP-1RA group[mean difference(MD):-0.31%,95%CI:-0.61 to-0.01,P=0.04,I2=77%]with a lower risk of documented symptomatic hypoglycemia(risk ratio=0.38,95%CI:0.16 to 0.88,P=0.02).Any AEs,serious AEs,or AEs that led to treatment discontinuation were comparable between the two groups.The GLP-1RA group experienced greater weight loss compared to the non-GLP-1RA group(MD:-2.0 kg,95%CI:-3.37 to-0.63,P=0.004,I2=95%).There were comparable changes in blood pressure and lipid profile between the two groups.GLP-1RA users experienced higher risks of gastrointestinal AEs,nausea,and vomiting;however,the risks of heartburn,abdominal pain,and diarrhea were similar in both groups.CONCLUSION Limited evidence suggests that GLP-1RAs are safe for T2DM management during Ramadan,offering modest benefits in blood sugar control and weight loss.Large multicenter trials are needed to confirm their safety and efficacy in at-risk populations,improving clinical practice decision-making.
文摘BACKGROUND In recent years,emerging clinical research has prioritized assessment of combined therapeutic efficacy and safety parameters when programmed death 1 or its ligand(PD-1/L1)inhibitors are incorporated into first-line standard-of-care(SOC)therapy for metastatic colorectal cancer(mCRC).However,data obtained from these trials demonstrated conflicting evidence concerning survival benefits and clinical outcomes.AIM To evaluate the therapeutic impact and safety parameters of combining PD-1/L1 inhibitors with SOC protocols as first-line treatment for mCRC.METHODS Four biomedical databases(PubMed,Embase,Cochrane Library,Web of Science)were systematically interrogated to identify eligible studies published up to October 12,2024.The analysis focused on evaluating the primary outcome of overall survival(OS)in the mCRC population with secondary outcomes of progression-free survival(PFS),overall response rate(ORR),and incidence rate of grade≥3 adverse events.Additionally,we performed exploratory analyses in the microsatellite stable/mismatch repair-proficient(MSS/pMMR)subpopulation,based on a subset of the included studies.Subgroup analyses according to PD-1/L1 inhibitor use were conducted in both the overall population and the MSS/pMMR subgroup.RESULTS This pooled analysis incorporated six randomized controlled trials involving 675 patients with mCRC receiving first-line therapy.The combination of PD-1/L1 inhibitors with SOC regimens demonstrated a significant PFS advantage over SOC monotherapy in intention-to-treat populations[hazard ratio(HR)=0.8,95%confidence interval(CI):0.65-0.98,P=0.033].Nevertheless,the MSS/pMMR subgroup showed no PFS benefit(HR=0.83,95%CI:0.67-1.03,P=0.091),and no cohort exhibited OS improvement(intention-to-treat:HR=0.84,95%CI:0.66-1.05,P=0.124;MSS/pMMR:HR=0.79,95%CI:0.60-1.03,P=0.083).Comparable outcomes were observed for ORR(risk ratio=1.03,95%CI:0.90-1.17,P=0.711)and incidence rate of grade≥3 adverse events(risk ratio=1.12,95%CI:0.93-1.36,P=0.245)between treatment arms.CONCLUSION The findings indicated that integrating PD-1/L1 blocking agents with SOC regimens for mCRC as first-line treatment failed to demonstrate significant improvements in ORR.Existing clinical data remain inadequate to establish OS advantages,particularly in patients with MSS/pMMR,despite exhibiting manageable toxicity profiles.Subsequent confirmation through rigorously designed phase III clinical trials remains essential to verify these therapeutic outcomes.
基金National Natural Science Foundation of China Project:Research on the Correlation between Traditional Chinese Medicine Constitution,Cupping Marks Color,and Clinical Efficacy Based on Regression Models (No.81804000)。
文摘OBJECTIVE:To update the current best evidence on the effectiveness and safety of cupping therapy in pain management.METHODS:The protocol of this systematic review was registered at PROSPERO(CRD42021261308).An updated literature searching in 7 databases was conducted from January 2014 to January 2023.Two authors extracted data and assessed the risk of bias independently.Statistical analysis was performed using RevMan 5.4.1 software(Cochrane Collaboration,London,UK).Meta-analysis with a random effect model was conducted when there was no serious statistical heterogeneity among trials(I^(2) ≤ 75%).Grading of Recommendations Assessment,Development,and Evaluation was also conducted to assess the quality of evidence.RESULTS:Seventy-two trials with 5720 participants were included.All included trials were assessed as having high risk of bias.The majority of the included trials reported the benefit of cupping plus other therapy or cupping alone on improving cure rate(average risk ratio more than 1.15) and reducing visual analogue scale [average mean difference(MD) reduction 0.16 to 7.0 cm],improving quality of life,quality of sleep or other symptoms related to pain condition.And there was low/very low quality evidence that the incidence of adverse events in the cupping groups were lower than that in the control groups.Although the heterogeneity between studies and the methodological quality of the study itself lead to the low evidence strength of the current conclusions,the results of this study are a valuable supplement to the founding of previous review.CONCLUSION:Cupping therapy alone or combined with other therapy was considered benefit in relieving pain,improving the quality of life,and increasing the cure rate of patients with pain conditions,though supported by the low quality of evidence.According to the limited evidence,cupping therapy seems to have less harm than drugs when treating pain conditions.
文摘目的比较三角瓣设计和封套瓣设计在缓解下颌第三磨牙拔除术后并发症方面的效果,为口腔颌面外科医生提供翻瓣选择的科学依据。方法通过检索CNKI、万方、PubMed、Embase、Web of Science、Cochrane和Springer数据库,筛选1984年1月至2022年4月发表的随机对照试验和对照临床试验,分析三角瓣和封套瓣对下颌第三磨牙拔除术后面部肿胀、张口受限和干槽症等并发症的影响。结果Meta分析显示,三角瓣组术后第7天的面部肿胀程度显著大于封套瓣组(MD=-0.69,95%CI:-0.93~-0.45;P<0.00001),但2组术后第14天的面部肿胀程度比较差异无统计学意义(MD=-0.07,95%CI:-0.18~0.04;P=0.22)。亚组分析表明,在Pell and Gregory A/B分类中,封套瓣在改善张口受限方面效果优于三角瓣(MD=2.95,95%CI:0.11~5.79),但在其他分类亚组及总体分析中未观察到显著差异。在分侧随机对照试验中封套瓣干槽症发生的风险更高(RR=3.53,95%CI:1.67~7.48),而在随机对照试验中未见明显差异(RR=0.78,95%CI:0.43~1.43)。结论与三角瓣相比,封套瓣在缓解术后早期面部肿胀改善张口受限方面具有优势,但其干槽症发生风险较高。
文摘目的:系统评价益气养阴活血法治疗糖尿病心肌病(DCM)的疗效。方法:计算机检索中国知网全文数据库(CNKI)、万方数据、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、Cochrane Library、Web of Science核心数据库中益气养阴活血法治疗DCM的相关文献,检索时限为自建库至2024年1月25日。根据纳入与排除标准筛选文献,按照Cochrane系统评价手册对纳入的文献进行质量评价及原始数据提取,使用RevMan 5.3软件分析益气养阴活血法联合常规西药及常规西药治疗DCM的有效率,采用敏感性分析对结果的稳定性进行评估,采用漏斗图对文献的发表偏倚进行评估。结果:纳入符合要求的文献13篇,涉及病例1044例,其中试验组523例,对照组521例。采用固定效应模型合并总效应值,Meta分析结果显示,益气养阴活血法联合常规西药治疗DCM的临床总有效率[RR=1.27,95%CI(1.20,1.35),P<0.00001]优于单纯西药治疗且纳入文献的发表偏倚较小。结论:益气养阴活血法联合常规西药治疗DCM优于单纯西药治疗,临床治疗DCM应重视中医药,充分发挥中西医结合的优势。
