BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favo...BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.展开更多
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
BACKGROUND This study seeks to systematically assess the effects of warm acupuncture combined with acupoint massage on the recovery of gastrointestinal function following gastric cancer surgery.AIM To evaluate the imp...BACKGROUND This study seeks to systematically assess the effects of warm acupuncture combined with acupoint massage on the recovery of gastrointestinal function following gastric cancer surgery.AIM To evaluate the impact of warm acupuncture combined with acupoint massage on postoperative gastrointestinal function recovery after gastric cancer surgery,based on a systematic review and meta-analysis.METHODS A comprehensive search was conducted across multiple databases,including PubMed,Cochrane Library,EMBASE,Web of Science,CNKI,Wanfang,and VIP,for relevant studies published up to January 2025.Meta-analyses were carried out using RevMan 5.4,with results presented as standardized mean difference(SMD)or odds ratio with 95%confidence interval(CI).Study heterogeneity was evaluated using the I2 statistic,and sensitivity analyses were performed to assess the stability of the findings.RESULTS A total of 8 randomized controlled trials involving 694 patients were included.The meta-analysis showed that warm acupuncture combined with acupoint massage significantly improved postoperative gastrointestinal function by reducing the time to first flatus(SMD=-2.14,95%CI:-3.14 to-1.14,P<0.0001),time to first bowel movement(SMD=-2.43,95%CI:-3.52 to-1.34,P<0.0001),time to bowel sounds recovery(SMD=-3.15,95%CI:-4.50 to-1.80,P<0.00001),and time to initiate nasogastric or jejunal feeding(SMD=-1.31,95%CI:-2.44 to-0.18,P=0.02).CONCLUSION The combination of warm acupuncture and acupoint massage markedly enhances gastrointestinal recovery following surgery.展开更多
目的系统评价中医外治法治疗子宫腺肌病(AM)的有效性与安全性。方法检索建库至2024年11月中国知网、万方数据库、中国生物医学文献数据库、Pub Med、Web of Science中所有关于中医外治法治疗AM的随机对照试验(RCTs),采用Rev Man 5.4.1...目的系统评价中医外治法治疗子宫腺肌病(AM)的有效性与安全性。方法检索建库至2024年11月中国知网、万方数据库、中国生物医学文献数据库、Pub Med、Web of Science中所有关于中医外治法治疗AM的随机对照试验(RCTs),采用Rev Man 5.4.1软件进行Meta分析。结果纳入文献19篇,总样本量1474例,试验组740例,对照组734例。Meta分析结果显示,与对照组比较,中医外治法可显著提高临床总有效率(OR=3.09,95%CI:1.69~5.67,P=0.0003),改善患者视觉模拟评分法(VAS)评分[均数差(MD)=-1.56,95%CI:-2.47~-0.65,P=0.0008]、痛经程度积分[标准化均数差(SMD)=-0.50,95%CI:-0.94~-0.05,P=0.03]、月经量(SMD=-1.18,95%CI:-1.83~-0.53,P=0.0004)、血清糖类抗原125(CA125)水平(MD=-12.01,95%CI:-15.97~-8.04,P<0.00001)及子宫体积(MD=-17.10,95%CI:-24.49~-9.70,P<0.00001),不良反应发生率(OR=0.18,95%CI:0.09~0.35,P<0.00001)低于对照组。结论中医外治法治疗AM临床疗效显著,不良反应较少。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
目的运用证据图对中成药治疗骨质疏松症的临床研究文献进行总结和梳理,得到相关研究的证据分布。方法检索2012年1月1日至2024年7月1日中国知网、维普、万方、中国生物医学文献数据库(CBM)、PubMed、Web of Science核心合集和the Cochran...目的运用证据图对中成药治疗骨质疏松症的临床研究文献进行总结和梳理,得到相关研究的证据分布。方法检索2012年1月1日至2024年7月1日中国知网、维普、万方、中国生物医学文献数据库(CBM)、PubMed、Web of Science核心合集和the Cochrane Library数据库发表的中成药治疗骨质疏松症相关文献,采用证据图描述证据分布特点。结果共纳入378篇文献,其中355篇临床研究文献、23篇系统评价/Meta分析,涉及46种中成药。结果显示,在临床研究中仙灵骨葆胶囊使用频次最高;研究类型以随机对照试验为主,样本量为80~110例;研究对象以原发性骨质疏松、肾阴虚型骨质疏松患者为主;试验组干预措施以中成药或中成药联合西药为主,疗程多为3~12个月;主要结局指标为骨密度、临床有效率、骨形成标志物。系统评价/Meta分析均显示证据潜在有效或有效,但AMSTAR质量评分较低。结论中成药治疗骨质疏松虽然展现其独特的优势,但缺乏高质量的临床研究证据。未来需开展多中心、大样本、双盲的随机对照试验,以获得高质量研究证据。展开更多
AIM:To investigate the association and quantify the relationship between diabetes mellitus(DM) and gastric cancer(GC) by an updated meta-analysis.METHODS:The initial PubMed search identified 1233publications. Studies ...AIM:To investigate the association and quantify the relationship between diabetes mellitus(DM) and gastric cancer(GC) by an updated meta-analysis.METHODS:The initial PubMed search identified 1233publications. Studies not reporting GC or those not reporting actual number of GC were excluded. Twelve pertinent studies were retrieved from the PubMed database or from a manual search and considered for the meta-analysis. Pooled risk ratios and 95%CI were estimated by a random-effects model. Subgroup analysis was performed according to gender or geographical regions. Heterogeneity and publication bias were evaluated by I2and funnel plot analysis,respectively.RESULTS:DM was significantly associated with GC with a RR of 1.41(P = 0.006)(95%CI:1.10-1.81).Subgroup analyses revealed that both sexes showed a significant association with GC,with a greater magnitude of risk in females(RR = 1.90; 95%CI:1.27-2.85;P = 0.002) than in males(RR = 1.24; 95%CI:1.08-1.43;P = 0.002). In addition,the link between DM and GC was significant in East Asian DM patients(RR = 1.77;95%CI:1.38-2.26; P < 0.00001) but not in Western DM patients(RR = 1.23; 95%CI:0.90-1.68; P = 0.2).There was no evidence of publication bias,but the results indicated significant heterogeneity.CONCLUSION:This updated meta-analysis has provided evidence of positive DM-GC associations. The limited information on potentially important clinical confounding factors in each study deserves further investigation.展开更多
AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched bas...AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion criteria.Postoperative outcomes were compared between patients with and those without routine drainage.Pooled odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects models.RESULTS:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were analyzed.Patients without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two groups.CONCLUSION:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication rates.Future randomized trials should compare routine vs selective drainage.展开更多
AIM: To assess the prognostic value of c-Met status in colorectal cancer. METHODS: We conducted a search in Pub Med, Web of Science, and the Cochrane Library covering all published papers up to July 2014. Only studies...AIM: To assess the prognostic value of c-Met status in colorectal cancer. METHODS: We conducted a search in Pub Med, Web of Science, and the Cochrane Library covering all published papers up to July 2014. Only studies assessing survival in colorectal cancer by c-Met status were included. This meta-analysis was performed by using STATA11.0.RESULTS: Ultimately, 11 studies were included in this analysis. Meta-analysis of the hazard ratios(HR)indicated that patients with high c-Met expression have a significantly poorer overall survival(OR)(HR = 1.33, 95%CI: 1.06-1.59) and progression-free survival(PFS)(HR = 1.47, 95%CI: 1.03-1.91). Subgroup analysis showed a significant association between high c-Met expression and poorer overall survival in the hazard ratio reported(HR = 1.41, 95%CI: 1.08-1.74).CONCLUSION: The present meta-analysis indicated that high c-Met expression was associated with poor prognosis in patients with colorectal cancer.展开更多
BACKGROUND A few randomized clinical trials(RCT)and their meta-analyses have found patent foramen ovale closure(PFOC)to be beneficial in prevention of stroke compared to medical therapy.Whether the benefit is extended...BACKGROUND A few randomized clinical trials(RCT)and their meta-analyses have found patent foramen ovale closure(PFOC)to be beneficial in prevention of stroke compared to medical therapy.Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke,we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed,EMBASE,Cochrane Central,CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs.Ischemic stroke(IS),transient ischemic attack(TIA),a composite of IS,TIA and systemic embolism(SE),mortality,major bleeding,atrial fibrillation(AF)and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS[odds ratio:0.34;95%confidence interval:0.15-0.78;P=0.01]and the composite of IS,TIA and SE[0.55(0.32-0.93);P=0.02]and increased the AF risk[4.79(2.35-9.77);P<0.0001].No statistical difference was observed in the risk of TIA[0.86(0.54-1.38);P=0.54],mortality[0.74(0.28-1.93);P=0.53]and major bleeding[0.81(0.42-1.56);P=0.53]between two strategies.Subgroup analyses showed that compared to medical therapy,PFOC reduced the risk of stroke in persons who were males,≤45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke,PFOC is beneficial in preventing future stroke compared to medical therapy.展开更多
AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorder...AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome(RLS)and periodic limb movements during sleep with CVD,but the results were still contradictory.We performed an extensive literature search on Pub Med,Medline and Web of Science published from inception to December 2014.Additional studies were manually searched from bibliographies of retrieved studies.Meta-analyses were conducted with Stata version 12.0(Stata Corp,College Station,Texas).Pooled odds ratios(ORs)and 95%CIs were calculated to assess the strength of association using the random effects model.Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity.The publication bias was detected using Egger’s test and Begg’s test.RESULTS:A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected.Among these studies,nine are cohort studies;two are case-control studies;and two are cross-sectional studies.The results showed that the summary OR of CVD associated with sleepassociated movement was 1.51(95%CI:1.29-1.77)in a random-effects model.There was significant heterogeneity between individual studies(P for heterogeneity=0.005,I2=57.6%).Further analysis revealed that a large-scale cohort study may account for this heterogeneity.A significant association was also found between RLS and CVD(OR=1.54,95%CI:1.24-1.92).In a fixed-effects model,we determined a significant relationship between sleep-associatedmovement disorders and coronary artery disease(CAD)(OR=1.34,95%CI:1.16-1.54;P for heterogeneity=0.210;I2=30.0%).Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.CONCLUSION:This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.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
文摘BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.
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BACKGROUND This study seeks to systematically assess the effects of warm acupuncture combined with acupoint massage on the recovery of gastrointestinal function following gastric cancer surgery.AIM To evaluate the impact of warm acupuncture combined with acupoint massage on postoperative gastrointestinal function recovery after gastric cancer surgery,based on a systematic review and meta-analysis.METHODS A comprehensive search was conducted across multiple databases,including PubMed,Cochrane Library,EMBASE,Web of Science,CNKI,Wanfang,and VIP,for relevant studies published up to January 2025.Meta-analyses were carried out using RevMan 5.4,with results presented as standardized mean difference(SMD)or odds ratio with 95%confidence interval(CI).Study heterogeneity was evaluated using the I2 statistic,and sensitivity analyses were performed to assess the stability of the findings.RESULTS A total of 8 randomized controlled trials involving 694 patients were included.The meta-analysis showed that warm acupuncture combined with acupoint massage significantly improved postoperative gastrointestinal function by reducing the time to first flatus(SMD=-2.14,95%CI:-3.14 to-1.14,P<0.0001),time to first bowel movement(SMD=-2.43,95%CI:-3.52 to-1.34,P<0.0001),time to bowel sounds recovery(SMD=-3.15,95%CI:-4.50 to-1.80,P<0.00001),and time to initiate nasogastric or jejunal feeding(SMD=-1.31,95%CI:-2.44 to-0.18,P=0.02).CONCLUSION The combination of warm acupuncture and acupoint massage markedly enhances gastrointestinal recovery following surgery.
文摘目的系统评价中医外治法治疗子宫腺肌病(AM)的有效性与安全性。方法检索建库至2024年11月中国知网、万方数据库、中国生物医学文献数据库、Pub Med、Web of Science中所有关于中医外治法治疗AM的随机对照试验(RCTs),采用Rev Man 5.4.1软件进行Meta分析。结果纳入文献19篇,总样本量1474例,试验组740例,对照组734例。Meta分析结果显示,与对照组比较,中医外治法可显著提高临床总有效率(OR=3.09,95%CI:1.69~5.67,P=0.0003),改善患者视觉模拟评分法(VAS)评分[均数差(MD)=-1.56,95%CI:-2.47~-0.65,P=0.0008]、痛经程度积分[标准化均数差(SMD)=-0.50,95%CI:-0.94~-0.05,P=0.03]、月经量(SMD=-1.18,95%CI:-1.83~-0.53,P=0.0004)、血清糖类抗原125(CA125)水平(MD=-12.01,95%CI:-15.97~-8.04,P<0.00001)及子宫体积(MD=-17.10,95%CI:-24.49~-9.70,P<0.00001),不良反应发生率(OR=0.18,95%CI:0.09~0.35,P<0.00001)低于对照组。结论中医外治法治疗AM临床疗效显著,不良反应较少。
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.
文摘目的运用证据图对中成药治疗骨质疏松症的临床研究文献进行总结和梳理,得到相关研究的证据分布。方法检索2012年1月1日至2024年7月1日中国知网、维普、万方、中国生物医学文献数据库(CBM)、PubMed、Web of Science核心合集和the Cochrane Library数据库发表的中成药治疗骨质疏松症相关文献,采用证据图描述证据分布特点。结果共纳入378篇文献,其中355篇临床研究文献、23篇系统评价/Meta分析,涉及46种中成药。结果显示,在临床研究中仙灵骨葆胶囊使用频次最高;研究类型以随机对照试验为主,样本量为80~110例;研究对象以原发性骨质疏松、肾阴虚型骨质疏松患者为主;试验组干预措施以中成药或中成药联合西药为主,疗程多为3~12个月;主要结局指标为骨密度、临床有效率、骨形成标志物。系统评价/Meta分析均显示证据潜在有效或有效,但AMSTAR质量评分较低。结论中成药治疗骨质疏松虽然展现其独特的优势,但缺乏高质量的临床研究证据。未来需开展多中心、大样本、双盲的随机对照试验,以获得高质量研究证据。
文摘AIM:To investigate the association and quantify the relationship between diabetes mellitus(DM) and gastric cancer(GC) by an updated meta-analysis.METHODS:The initial PubMed search identified 1233publications. Studies not reporting GC or those not reporting actual number of GC were excluded. Twelve pertinent studies were retrieved from the PubMed database or from a manual search and considered for the meta-analysis. Pooled risk ratios and 95%CI were estimated by a random-effects model. Subgroup analysis was performed according to gender or geographical regions. Heterogeneity and publication bias were evaluated by I2and funnel plot analysis,respectively.RESULTS:DM was significantly associated with GC with a RR of 1.41(P = 0.006)(95%CI:1.10-1.81).Subgroup analyses revealed that both sexes showed a significant association with GC,with a greater magnitude of risk in females(RR = 1.90; 95%CI:1.27-2.85;P = 0.002) than in males(RR = 1.24; 95%CI:1.08-1.43;P = 0.002). In addition,the link between DM and GC was significant in East Asian DM patients(RR = 1.77;95%CI:1.38-2.26; P < 0.00001) but not in Western DM patients(RR = 1.23; 95%CI:0.90-1.68; P = 0.2).There was no evidence of publication bias,but the results indicated significant heterogeneity.CONCLUSION:This updated meta-analysis has provided evidence of positive DM-GC associations. The limited information on potentially important clinical confounding factors in each study deserves further investigation.
文摘AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion criteria.Postoperative outcomes were compared between patients with and those without routine drainage.Pooled odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects models.RESULTS:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were analyzed.Patients without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two groups.CONCLUSION:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication rates.Future randomized trials should compare routine vs selective drainage.
文摘AIM: To assess the prognostic value of c-Met status in colorectal cancer. METHODS: We conducted a search in Pub Med, Web of Science, and the Cochrane Library covering all published papers up to July 2014. Only studies assessing survival in colorectal cancer by c-Met status were included. This meta-analysis was performed by using STATA11.0.RESULTS: Ultimately, 11 studies were included in this analysis. Meta-analysis of the hazard ratios(HR)indicated that patients with high c-Met expression have a significantly poorer overall survival(OR)(HR = 1.33, 95%CI: 1.06-1.59) and progression-free survival(PFS)(HR = 1.47, 95%CI: 1.03-1.91). Subgroup analysis showed a significant association between high c-Met expression and poorer overall survival in the hazard ratio reported(HR = 1.41, 95%CI: 1.08-1.74).CONCLUSION: The present meta-analysis indicated that high c-Met expression was associated with poor prognosis in patients with colorectal cancer.
文摘BACKGROUND A few randomized clinical trials(RCT)and their meta-analyses have found patent foramen ovale closure(PFOC)to be beneficial in prevention of stroke compared to medical therapy.Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke,we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed,EMBASE,Cochrane Central,CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs.Ischemic stroke(IS),transient ischemic attack(TIA),a composite of IS,TIA and systemic embolism(SE),mortality,major bleeding,atrial fibrillation(AF)and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS[odds ratio:0.34;95%confidence interval:0.15-0.78;P=0.01]and the composite of IS,TIA and SE[0.55(0.32-0.93);P=0.02]and increased the AF risk[4.79(2.35-9.77);P<0.0001].No statistical difference was observed in the risk of TIA[0.86(0.54-1.38);P=0.54],mortality[0.74(0.28-1.93);P=0.53]and major bleeding[0.81(0.42-1.56);P=0.53]between two strategies.Subgroup analyses showed that compared to medical therapy,PFOC reduced the risk of stroke in persons who were males,≤45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke,PFOC is beneficial in preventing future stroke compared to medical therapy.
基金Supported by The National Natural Science Foundation of China,Nos.81470456 and 81170160The priority Academic Program Development of Jiangsu Higher Education Institutions
文摘AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome(RLS)and periodic limb movements during sleep with CVD,but the results were still contradictory.We performed an extensive literature search on Pub Med,Medline and Web of Science published from inception to December 2014.Additional studies were manually searched from bibliographies of retrieved studies.Meta-analyses were conducted with Stata version 12.0(Stata Corp,College Station,Texas).Pooled odds ratios(ORs)and 95%CIs were calculated to assess the strength of association using the random effects model.Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity.The publication bias was detected using Egger’s test and Begg’s test.RESULTS:A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected.Among these studies,nine are cohort studies;two are case-control studies;and two are cross-sectional studies.The results showed that the summary OR of CVD associated with sleepassociated movement was 1.51(95%CI:1.29-1.77)in a random-effects model.There was significant heterogeneity between individual studies(P for heterogeneity=0.005,I2=57.6%).Further analysis revealed that a large-scale cohort study may account for this heterogeneity.A significant association was also found between RLS and CVD(OR=1.54,95%CI:1.24-1.92).In a fixed-effects model,we determined a significant relationship between sleep-associatedmovement disorders and coronary artery disease(CAD)(OR=1.34,95%CI:1.16-1.54;P for heterogeneity=0.210;I2=30.0%).Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.CONCLUSION:This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.
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。
