Multivariate anomaly detection plays a critical role in maintaining the stable operation of information systems.However,in existing research,multivariate data are often influenced by various factors during the data co...Multivariate anomaly detection plays a critical role in maintaining the stable operation of information systems.However,in existing research,multivariate data are often influenced by various factors during the data collection process,resulting in temporal misalignment or displacement.Due to these factors,the node representations carry substantial noise,which reduces the adaptability of the multivariate coupled network structure and subsequently degrades anomaly detection performance.Accordingly,this study proposes a novel multivariate anomaly detection model grounded in graph structure learning.Firstly,a recommendation strategy is employed to identify strongly coupled variable pairs,which are then used to construct a recommendation-driven multivariate coupling network.Secondly,a multi-channel graph encoding layer is used to dynamically optimize the structural properties of the multivariate coupling network,while a multi-head attention mechanism enhances the spatial characteristics of the multivariate data.Finally,unsupervised anomaly detection is conducted using a dynamic threshold selection algorithm.Experimental results demonstrate that effectively integrating the structural and spatial features of multivariate data significantly mitigates anomalies caused by temporal dependency misalignment.展开更多
Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide ...Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
Surgical methods for varicocele remain controversial.This study intends to evaluate the efficacy and safety of different surgical approaches for treating varicocele through a network meta-analysis(NMA).PubMed,Embase,C...Surgical methods for varicocele remain controversial.This study intends to evaluate the efficacy and safety of different surgical approaches for treating varicocele through a network meta-analysis(NMA).PubMed,Embase,Cochrane,and Web of Science databases were thoroughly searched.In total,13 randomized controlled trials(RCTs)and 24 cohort studies were included,covering 9 different surgical methods.Pairwise meta-analysis and NMA were performed by means of random-effects models,and interventions were ranked based on the surface under the cumulative ranking curve(SUCRA).According to the SUCRA,microsurgical subinguinal varicocelectomy(MSV;91.6%),microsurgical retroperitoneal varicocelectomy(MRV;78.2%),and microsurgical inguinal varicocelectomy(MIV;76.7%)demonstrated the highest effectiveness in reducing postoperative recurrence rates.In this study,sclerotherapy embolization(SE;87.2%),MSV(77.9%),and MIV(67.7%)showed the best results in lowering the risk of hydrocele occurrence.MIV(82.9%),MSV(75.9%),and coil embolization(CE;58.7%)were notably effective in increasing sperm motility.Moreover,CE(76.7%),subinguinal approach varicocelectomy(SV;69.2%),and SE(55.7%)were the most effective in increasing sperm count.SE(82.5%),transabdominal laparoscopic varicocelectomy(TLV;76.5%),and MRV(52.7%)were superior in shortening the length of hospital stay.The incidence rates of adverse events for MRV(0),SE(3.3%),and MIV(4.1%)were notably low.Cluster analyses indicated that MSV was the most effective in the treatment of varicocele.Based on the existing evidence,MSV may represent the optimal choice for varicocele surgery.However,selecting clinical surgical strategies requires consideration of various factors,including patient needs,surgeon experience,and the learning curve.展开更多
Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effectiv...Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.展开更多
Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in t...Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.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
Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally ...Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.展开更多
Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based ins...Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.展开更多
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
AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMe...AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammator...BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.展开更多
OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife...OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife)in the treatment of nonspecific low back pain(NLBP),providing evidence-based medical support for clinical treatment.METHODS:Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,PubMed,Web of Science,Chinese Biomedical Literature Database,Embase,and the Cochrane Library.Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool,and the data were analyzed using STATA 15.1.RESULTS:This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale(VAS),improvement in dysfunction using the oswestry disability index(ODI),and the effective rate.Blood-letting[surface under the cumulative ranking curve(SUCRA)=81.4]exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator,followed by cupping(SUCRA=70.4)and moxibustion(SUCRA=58.5).Scrapping therapy(SUCRA=77.7)had the most significant effect on improving NLBP-related functional impairment,followed by moxibustion(SUCRA=59.8),and then bloodletting(SUCRA=58.2).The effective rates of warm acupuncture(SUCRA=78.0),scrapping therapy(SUCRA=77.2)and blood-letting(SUCRA=58.6)were better than those of acupuncture(SUCRA=12.0),especially for cold and wet NLBP.These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment.CONCLUSION:Blood-letting was the most effective treatment for relieving pain,and scrapping therapy was the most effective treatment for improving dysfunction.Warm acupuncture was the preferred treatment for cold and wet NLBP.However,further high-quality clinical studies are needed for validation.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
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 evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral h...OBJECTIVE:To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage through a network Meta-analysis.METHODS:A computer-based search was conducted in 8 databases,including China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Pub Med,Cochrane Library,Web of Science,Scopus,and Embase,from their inception until February 19,2023.Randomized controlled trials(RCTs)investigating the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage were included.Two researchers independently screened the literature,extracted data from the included studies,and performed quality assessment using the Cochrane Collaboration's standards.The software Stata 17.0 was used to create a network evidence graph for each combination of Traditional Chinese Medicine external treatment methods and rehabilitation training,and to generate a publication bias funnel plot.Network Meta-analysis was conducted using Rev Man 5.3 to assess the risk of bias in the included studies,with mean difference(MD)used for continuous variables and odds ratio(OR)used for dichotomous variables.If there was good consistency among the included studies(P>0.05),a consistency model was applied for data analysis.If there was poor consistency among the included studies(P<0.05),an inconsistency model was used.RESULTS:A total of 27 studies involving 2113 patients with limb dysfunction caused by cerebral hemorrhage were included.The results of the network Meta-analysis indicated that the combined use of 7 Traditional Chinese Medicine external treatment methods and rehabilitation training was more effective in improving limb function in patients with cerebral hemorrhage compared to rehabilitation training alone.In terms of improving simplified Fugl-Meyer Assessment(FMA)scores,the effectiveness ranking was as follows:acupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>massage+rehabilitation training>electroacupuncture+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training>Chinese herbal fumigation+rehabilitation training.In terms of improving Barthel Index(BI)scores,the effectiveness ranking was as follows:electroacupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>acupuncture+rehabilitation training>massage+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine fumigation+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training.CONCLUSION:Based on existing literature evidence,our findings suggest the following:(a)The combination of the seven commonly used external treatment methods with rehabilitation training is superior to using rehabilitation training alone for the treatment of hemiplegia resulting from cerebral hemorrhage.(b)In terms of improving FMA scores,the combination of acupuncture and rehabilitation training shows the most significant effectiveness.(c)In terms of improving BI scores,the combination of electro-acupuncture and rehabilitation training demonstrates the most significant effectiveness.Therefore,we still need more multicenter,large-sample,high-quality randomized controlled trials to further validate the findings of this study.展开更多
Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(...Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.展开更多
Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic re...Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic review evaluated the efficacy of several therapeutic approaches based on immune checkpoint inhibitors(ICIs).Methods:A comprehensive evaluation of the literature was conducted,looking at randomized controlled trials(RCTs)that were published in Embase,PubMed,and the Cochrane Central Register of Controlled Trials since database establishment.The risk of bias of the enrolled studies was analyzed using The Review Manager(RevMan)5.4.Using network meta-analyses(NMA),the relative treatment effects on overall survival(OS)and progression-free survival(PFS)from qualifying randomized controlled trials were synthesized and evaluated.Results:Regarding OS,compared with nivolumab plus chemotherapy,chemotherapy(Hazard ratio(HR)2.1,95%Confidence interval=(CI):1.2,3.4)showed a treatment disadvantage.Meanwhile,nivolumab plus chemotherapy may represent the most efficient(57.89%)and has a lower cost among all the treatments enrolled in this study for advanced HNSCC.Regarding PFS,compared with nivolumab plus ipilimumab,nivolumab plus chemotherapy(HR 0.4,95%CI:0.2,0.8)showed=treatment superiority.Additionally,nivolumab plus chemotherapy(77.18%)has the longest PFS among all interventions.Conclusion:Taking into account OS and PFS,the combination of nivolumab plus chemotherapy may appear to be the most effective option and is associated with a comparatively lower cost among all treatments included in this network meta-analysis,thereby recommending its use as a first-line therapy for HNSCC.Registration:INPLASY(2024070073).展开更多
Piles are long, slender structural elements used to transfer the loads from the superstructure through weak strata onto stiffer soils or rocks. For driven piles, the impact of the piling hammer induces compression and...Piles are long, slender structural elements used to transfer the loads from the superstructure through weak strata onto stiffer soils or rocks. For driven piles, the impact of the piling hammer induces compression and tension stresses in the piles. Hence, an important design consideration is to check that the strength of the pile is sufficient to resist the stresses caused by the impact of the pile hammer. Due to its complexity, pile drivability lacks a precise analytical solution with regard to the phenomena involved.In situations where measured data or numerical hypothetical results are available, neural networks stand out in mapping the nonlinear interactions and relationships between the system’s predictors and dependent responses. In addition, unlike most computational tools, no mathematical relationship assumption between the dependent and independent variables has to be made. Nevertheless, neural networks have been criticized for their long trial-and-error training process since the optimal configuration is not known a priori. This paper investigates the use of a fairly simple nonparametric regression algorithm known as multivariate adaptive regression splines（MARS）, as an alternative to neural networks, to approximate the relationship between the inputs and dependent response, and to mathematically interpret the relationship between the various parameters. In this paper, the Back propagation neural network（BPNN） and MARS models are developed for assessing pile drivability in relation to the prediction of the Maximum compressive stresses（MCS）, Maximum tensile stresses（MTS）, and Blow per foot（BPF）. A database of more than four thousand piles is utilized for model development and comparative performance between BPNN and MARS predictions.展开更多
Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness ...Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment(MCI)or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.Methods:We searched PubMed,Web of Science,Embase,Cochrane Central Register of Controlled Trials,SPORTDiscus,and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia.Primary outcomes included global cognition,executive cognition,and memory cognition.Secondary outcomes included activities of daily living,neuropsychiatric symptoms,and quality of life.Pairwise analyses and network meta-analyses were performed using a random effects model.Results:A total of 73 articles from 71 trials with 5606 participants were included.All types of exercise were effective in increasing or maintaining global cognition,and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition(standard mean difference(SMD)=1.05,95%confidence interval(95%CI):0.56-1.54),executive function(SMD=0.85,95%CI:0.21-1.49),and memory function(SMD=0.32,95%CI:0.01-0.63)in patients with cognitive dysfunction.Subgroup analyses for patients with MCI revealed different effects,and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition(SMD=0.99,95%CI:0.44-1.54)and executive function(SMD=0.72,95%CI:0.06-1.38).However,only resistance exercise showed significant effects on memory function for patients with MCI(SMD=0.35,95%CI:0.01-0.69).Exercise interventions also showed various effects on the secondary outcomes.Conclusion:Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive declin e in patients withcognitive dysfunction,especially in patients with dementia.Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.展开更多
基金supported by Natural Science Foundation of Qinghai Province(2025-ZJ-994M)Scientific Research Innovation Capability Support Project for Young Faculty(SRICSPYF-BS2025007)National Natural Science Foundation of China(62566050).
文摘Multivariate anomaly detection plays a critical role in maintaining the stable operation of information systems.However,in existing research,multivariate data are often influenced by various factors during the data collection process,resulting in temporal misalignment or displacement.Due to these factors,the node representations carry substantial noise,which reduces the adaptability of the multivariate coupled network structure and subsequently degrades anomaly detection performance.Accordingly,this study proposes a novel multivariate anomaly detection model grounded in graph structure learning.Firstly,a recommendation strategy is employed to identify strongly coupled variable pairs,which are then used to construct a recommendation-driven multivariate coupling network.Secondly,a multi-channel graph encoding layer is used to dynamically optimize the structural properties of the multivariate coupling network,while a multi-head attention mechanism enhances the spatial characteristics of the multivariate data.Finally,unsupervised anomaly detection is conducted using a dynamic threshold selection algorithm.Experimental results demonstrate that effectively integrating the structural and spatial features of multivariate data significantly mitigates anomalies caused by temporal dependency misalignment.
基金The 2022 Ministry of Education General Project for Humanities and Social Sciences Research(Grant No.22YJAZH147)the General Subject of Guangzhou Philosophy and Social Science Development“14th Five-Year Plan”in 2023(Grant No.2023GZYB68)+2 种基金China University Industry-Academia-Research Innovation Fund-Huatong Guokang Medical Research Special Project(Grant No.2023HT017)2024 Guangdong Province General Project for the Planning of Philosophy and Social Sciences(Grant No.GD24CGL29)the Innovation Team Project of Colleges and Universities in Guangdong Province(Grant No.2022WCXTD011).
文摘Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
基金supported by The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine High-level Talent Initiation Programme(No.GYZYYFY-BS-2023[14])The Guizhou Province Science and Technology Plan Project(No.QianKeHeJiChu-ZK[2024]General 405).
文摘Surgical methods for varicocele remain controversial.This study intends to evaluate the efficacy and safety of different surgical approaches for treating varicocele through a network meta-analysis(NMA).PubMed,Embase,Cochrane,and Web of Science databases were thoroughly searched.In total,13 randomized controlled trials(RCTs)and 24 cohort studies were included,covering 9 different surgical methods.Pairwise meta-analysis and NMA were performed by means of random-effects models,and interventions were ranked based on the surface under the cumulative ranking curve(SUCRA).According to the SUCRA,microsurgical subinguinal varicocelectomy(MSV;91.6%),microsurgical retroperitoneal varicocelectomy(MRV;78.2%),and microsurgical inguinal varicocelectomy(MIV;76.7%)demonstrated the highest effectiveness in reducing postoperative recurrence rates.In this study,sclerotherapy embolization(SE;87.2%),MSV(77.9%),and MIV(67.7%)showed the best results in lowering the risk of hydrocele occurrence.MIV(82.9%),MSV(75.9%),and coil embolization(CE;58.7%)were notably effective in increasing sperm motility.Moreover,CE(76.7%),subinguinal approach varicocelectomy(SV;69.2%),and SE(55.7%)were the most effective in increasing sperm count.SE(82.5%),transabdominal laparoscopic varicocelectomy(TLV;76.5%),and MRV(52.7%)were superior in shortening the length of hospital stay.The incidence rates of adverse events for MRV(0),SE(3.3%),and MIV(4.1%)were notably low.Cluster analyses indicated that MSV was the most effective in the treatment of varicocele.Based on the existing evidence,MSV may represent the optimal choice for varicocele surgery.However,selecting clinical surgical strategies requires consideration of various factors,including patient needs,surgeon experience,and the learning curve.
基金supported by the program of Guangdong Provincial Clinical Research Center for Rehabilitation Medicine(2023B110003)the Research Foundation of Traditional Chinese Medicine Bureau of Guangdong Province(20231,067)the Guangdong Hopson-Pearl River Education Development Foundation(No.H20190116202012724).
文摘Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.
基金Supported by National Key Research and Development Program of China:2022YFC3500701。
文摘Background Chemotherapy-induced peripheral neuropathy(CIPN)is a common neurotoxic reaction for patients undergoing anticancer regimens.More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.Objective To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN,with a focus on assessing its effectiveness on improving treatment response rates,alleviating pain,enhancing quality of life(QoL),and improving nerve conduction.Additionally,the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.Methods Six databases(PubMed,Embase,Cochrane Library,Web of Science,OVID,and China National knowledge infrastructure[CNKI])were searched from earliest available dates to December 1,2024,and only randomized controlled trials(RCTs)containing relevant search terms were included.Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome.Nerve conduction,pain scores,and QoL were assessed as secondary outcomes.The version 2 of the Cochrane risk-of-bias tool for randomized trials(RoB 2)was used to examine methodological quality,and Stata 15.1 was used to take network meta-analysis.Results A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included.The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes:effective rate,pain scores,QoL,and nerve conduction.For effective rate,electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve(SUCRA)value of 62.9%,followed by acupoint application(56.9%)and moxibustion(52.3%).Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments(odds ratio[OR]=1.62,95%confidence interval[CI]−5.18 to 8.43).For alleviating pain,auricular acupressure had the highest SUCRA value(85.9%),while electroacupuncture and electroacupuncture combined with three-edged needle ranked second(63.4%)and third(51.0%),respectively.Auricular acupressure significantly reduced pain(SMD=−1.73,95%CI−3.54 to 0.08).For QoL,warming needle ranked first(SUCRA=92.0%),followed by electroacupuncture(48.7%)and filiform needle(43.0%).Warming needle significantly improved QoL scores(SMD=−0.75,95%CI−1.66 to 0.15).For nerve conduction,electroacupuncture combined with three-edged needle had the highest SUCRA value(100%),while moxibustion and filiform needle ranked second(65.3%)and third(39.2%),respectively.Electroacupuncture combined with three-edged had the best neuroprotective effect(SMD=1.85,95%CI 1.23 to 2.47).Conclusion Network meta-analysis based on the primary outcome(effective rate)suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy(CIPN).Secondary outcomes exhibited considerable heterogeneity:auricular acupressure demonstrated superior efficacy in pain relief,electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function,while warm needling was associated with more significant improvements in QoL.Given the variability in interventions across different outcome measures and the methodological limitations of included studies,the current evidence requires cautious interpretation.Systematic review registration:Registration number in PROSPERO:CRD42024560017.
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The Natural Science Foundation of Fujian,China(Grant No.2021J01397)Fujian Provincial Health Technology Project(Grant No.2022GGA010)Fujian Provincial Joint Funding Project of Scientific and Technological Innovation(Grant No.2023Y9347).
文摘Refractory thyroid cancer is frequently associated with a poor prognosis,necessitating alternative therapeutic approaches.Tyrosine kinase inhibitors(TKIs)have emerged as a promising treatment option,showing generally favorable clinical outcomes in these challenging cancer subtypes.However,the existing body of research is constrained by small sample sizes and variable findings,limiting the ability to directly compare the efficacy of different TKI agents.This study aimed to bridge that gap through a network meta-analysis,evaluating the relative efficacy and safety of various TKIs in managing refractory thyroid cancer.Utilizing systematic keyword searches in databases such as PubMed,Cochrane Library,Embase,Scopus,Web of Science,and ClinicalTrials.gov,we identified studies that met predefined inclusion criteria.Extracted data were analyzed using Bayesian network meta-analysis methods via R software to ensure a comprehensive assessment.Our findings highlighted specific advantages of certain TKIs for various clinical outcomes.In terms of progression-free survival(PFS),Anlotinib and Apatinib showed notable efficacy.For the objective response rate(ORR),Cabozantinib and Lenvatinib demonstrated superior effectiveness,while for disease control rate(DCR),Apatinib and Lenvatinib were advantageous.Regarding safety profiles,Cabozantinib emerged as the safest option for all-grade adverse events(AEs),with Anlotinib showing a higher risk.For severe AEs(grade 3 or higher),Sorafenib proved to be the safest,while Apatinib carried the highest risk.In summary,Anlotinib,Apatinib,Lenvatinib,and Cabozantinib offered significant benefits for PFS,ORR,and DCR in patients with refractory thyroid cancer.However,Anlotinib and Apatinib were associated with higher AE rates,underlining the importance of balancing efficacy with safety.Cabozantinib and Vandetanib,while exhibiting comparatively safer profiles,showed moderate efficacy.These insights underscored the necessity for tailored treatment decisions that carefully weigh the benefits and risks of each TKI agent.
基金the Obstetrics and Gynecology Hospital of Fudan University for supporting this project。
文摘Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.
基金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Supported by Natural Science Foundation of Chongqing(No.CSTB2024NSCQ-MSX0900No.CSTB2023NSCQ-MSX0593).
文摘AIM:To assess and rank the efficacy of various nonsteroidal anti-inflammatory drugs(NSAIDs)in preventing postoperative macular edema(PME)after cataract surgery.METHODS:A comprehensive search was conducted across PubMed,Embase,Cochrane Library,and Web of Science databases.Randomized controlled trials(RCTs)comparing different NSAIDs and control treatments for the prevention of PME were included.Data from the studies were synthesized using the“gemtc”package in R.Risk of bias was assessed with the Cochrane RoB 2 tool,and heterogeneity was evaluated using the global I2 statistic.Surface under the cumulative ranking curve(SUCRA)values were calculated for each treatment.RESULTS:Of 132 identified records,9 RCTs met the inclusion criteria.The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME,followed by artificial tear substitute,ketorolac,diclofenac,and bromfenac.The league table comparisons and rankograms corroborated these findings,with nepafenac consistently ranking highest.Heterogeneity analysis yielded high I2 values,indicating substantial variability across studies.CONCLUSION:This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery.Given the substantial heterogeneity observed,further high-quality RCTs are required to confirm these findings and explore the sources of variability.Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.
文摘BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.
基金Supported by the National Natural Science Foundation of China:Novel Dynamic Regulation Method of Acupoint Stimulation Based on Injectable Magnetic Gel for Myocardial Ischemia-Reperfusion Injury (No. 82074560)Effect Evaluation of Different Combinations of Acupuncture Techniques (No. 8207152951)Sanqin Talent Special Support Program:Leading Talent Project for Technological Innovation (No. 2024)
文摘OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies(acupuncture,scrapping therapy,catgut embedding,blood-letting,electro-acupuncture,warm acupuncture,cupping,moxibustion,and needle knife)in the treatment of nonspecific low back pain(NLBP),providing evidence-based medical support for clinical treatment.METHODS:Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,PubMed,Web of Science,Chinese Biomedical Literature Database,Embase,and the Cochrane Library.Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool,and the data were analyzed using STATA 15.1.RESULTS:This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale(VAS),improvement in dysfunction using the oswestry disability index(ODI),and the effective rate.Blood-letting[surface under the cumulative ranking curve(SUCRA)=81.4]exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator,followed by cupping(SUCRA=70.4)and moxibustion(SUCRA=58.5).Scrapping therapy(SUCRA=77.7)had the most significant effect on improving NLBP-related functional impairment,followed by moxibustion(SUCRA=59.8),and then bloodletting(SUCRA=58.2).The effective rates of warm acupuncture(SUCRA=78.0),scrapping therapy(SUCRA=77.2)and blood-letting(SUCRA=58.6)were better than those of acupuncture(SUCRA=12.0),especially for cold and wet NLBP.These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment.CONCLUSION:Blood-letting was the most effective treatment for relieving pain,and scrapping therapy was the most effective treatment for improving dysfunction.Warm acupuncture was the preferred treatment for cold and wet NLBP.However,further high-quality clinical studies are needed for validation.
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.
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Supported by the Key Research and Development Plan Project of Shaanxi Province:Standardized Diagnosis and Treatment Protocol for Cerebral Hemorrhage with Integrated Traditional Chinese and Western Medicine and Research on its Therapeutic Mechanisms(No.2019ZDLSF04-06-01)the National Key Research and Development Plan Project:Development and Implementation of a Clinical Research Information Sharing System for Traditional Chinese Medicine(No.2017YFC1703500,No.2017YFC1703502)the Discipline Innovation Team Building Project of Shaanxi University of Chinese Medicine:Innovative Research Team for the Construction of Integrated Traditional Chinese and Western Medicine Cerebrovascular Disease Diagnosis and Treatment System and Its Clinical Application(No.2019-YL15)。
文摘OBJECTIVE:To evaluate the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage through a network Meta-analysis.METHODS:A computer-based search was conducted in 8 databases,including China National Knowledge Infrastructure Database,Wanfang Database,China Science and Technology Journal Database,Pub Med,Cochrane Library,Web of Science,Scopus,and Embase,from their inception until February 19,2023.Randomized controlled trials(RCTs)investigating the effectiveness of the combined use of 7 commonly used Traditional Chinese Medicine external treatment methods and rehabilitation training in improving limb function in patients with cerebral hemorrhage were included.Two researchers independently screened the literature,extracted data from the included studies,and performed quality assessment using the Cochrane Collaboration's standards.The software Stata 17.0 was used to create a network evidence graph for each combination of Traditional Chinese Medicine external treatment methods and rehabilitation training,and to generate a publication bias funnel plot.Network Meta-analysis was conducted using Rev Man 5.3 to assess the risk of bias in the included studies,with mean difference(MD)used for continuous variables and odds ratio(OR)used for dichotomous variables.If there was good consistency among the included studies(P>0.05),a consistency model was applied for data analysis.If there was poor consistency among the included studies(P<0.05),an inconsistency model was used.RESULTS:A total of 27 studies involving 2113 patients with limb dysfunction caused by cerebral hemorrhage were included.The results of the network Meta-analysis indicated that the combined use of 7 Traditional Chinese Medicine external treatment methods and rehabilitation training was more effective in improving limb function in patients with cerebral hemorrhage compared to rehabilitation training alone.In terms of improving simplified Fugl-Meyer Assessment(FMA)scores,the effectiveness ranking was as follows:acupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>massage+rehabilitation training>electroacupuncture+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training>Chinese herbal fumigation+rehabilitation training.In terms of improving Barthel Index(BI)scores,the effectiveness ranking was as follows:electroacupuncture+rehabilitation training>Acupoint sticking therapy+rehabilitation training>acupuncture+rehabilitation training>massage+rehabilitation training>moxibustion+rehabilitation training>Traditional Chinese Medicine fumigation+rehabilitation training>Traditional Chinese Medicine therapy+rehabilitation training.CONCLUSION:Based on existing literature evidence,our findings suggest the following:(a)The combination of the seven commonly used external treatment methods with rehabilitation training is superior to using rehabilitation training alone for the treatment of hemiplegia resulting from cerebral hemorrhage.(b)In terms of improving FMA scores,the combination of acupuncture and rehabilitation training shows the most significant effectiveness.(c)In terms of improving BI scores,the combination of electro-acupuncture and rehabilitation training demonstrates the most significant effectiveness.Therefore,we still need more multicenter,large-sample,high-quality randomized controlled trials to further validate the findings of this study.
基金supported by the National Natural Science Foundation of China(82305273)the Central High-Level Clinical Research Fund for Traditional Chinese Medicine Hospitals(DZMG-QNGG0010).
文摘Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.
文摘Objectives:Checkpoint inhibitors have significantly improved outcomes in a number of malignancies.To determine the most effective course of treatment for head and neck squamous cell carcinoma(HNSCC),this systematic review evaluated the efficacy of several therapeutic approaches based on immune checkpoint inhibitors(ICIs).Methods:A comprehensive evaluation of the literature was conducted,looking at randomized controlled trials(RCTs)that were published in Embase,PubMed,and the Cochrane Central Register of Controlled Trials since database establishment.The risk of bias of the enrolled studies was analyzed using The Review Manager(RevMan)5.4.Using network meta-analyses(NMA),the relative treatment effects on overall survival(OS)and progression-free survival(PFS)from qualifying randomized controlled trials were synthesized and evaluated.Results:Regarding OS,compared with nivolumab plus chemotherapy,chemotherapy(Hazard ratio(HR)2.1,95%Confidence interval=(CI):1.2,3.4)showed a treatment disadvantage.Meanwhile,nivolumab plus chemotherapy may represent the most efficient(57.89%)and has a lower cost among all the treatments enrolled in this study for advanced HNSCC.Regarding PFS,compared with nivolumab plus ipilimumab,nivolumab plus chemotherapy(HR 0.4,95%CI:0.2,0.8)showed=treatment superiority.Additionally,nivolumab plus chemotherapy(77.18%)has the longest PFS among all interventions.Conclusion:Taking into account OS and PFS,the combination of nivolumab plus chemotherapy may appear to be the most effective option and is associated with a comparatively lower cost among all treatments included in this network meta-analysis,thereby recommending its use as a first-line therapy for HNSCC.Registration:INPLASY(2024070073).
文摘Piles are long, slender structural elements used to transfer the loads from the superstructure through weak strata onto stiffer soils or rocks. For driven piles, the impact of the piling hammer induces compression and tension stresses in the piles. Hence, an important design consideration is to check that the strength of the pile is sufficient to resist the stresses caused by the impact of the pile hammer. Due to its complexity, pile drivability lacks a precise analytical solution with regard to the phenomena involved.In situations where measured data or numerical hypothetical results are available, neural networks stand out in mapping the nonlinear interactions and relationships between the system’s predictors and dependent responses. In addition, unlike most computational tools, no mathematical relationship assumption between the dependent and independent variables has to be made. Nevertheless, neural networks have been criticized for their long trial-and-error training process since the optimal configuration is not known a priori. This paper investigates the use of a fairly simple nonparametric regression algorithm known as multivariate adaptive regression splines（MARS）, as an alternative to neural networks, to approximate the relationship between the inputs and dependent response, and to mathematically interpret the relationship between the various parameters. In this paper, the Back propagation neural network（BPNN） and MARS models are developed for assessing pile drivability in relation to the prediction of the Maximum compressive stresses（MCS）, Maximum tensile stresses（MTS）, and Blow per foot（BPF）. A database of more than four thousand piles is utilized for model development and comparative performance between BPNN and MARS predictions.
基金financial support from the National Natural Science Foundation of Chinafunded by the National Natural Science Foundation of China(81871854)。
文摘Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment(MCI)or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.Methods:We searched PubMed,Web of Science,Embase,Cochrane Central Register of Controlled Trials,SPORTDiscus,and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia.Primary outcomes included global cognition,executive cognition,and memory cognition.Secondary outcomes included activities of daily living,neuropsychiatric symptoms,and quality of life.Pairwise analyses and network meta-analyses were performed using a random effects model.Results:A total of 73 articles from 71 trials with 5606 participants were included.All types of exercise were effective in increasing or maintaining global cognition,and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition(standard mean difference(SMD)=1.05,95%confidence interval(95%CI):0.56-1.54),executive function(SMD=0.85,95%CI:0.21-1.49),and memory function(SMD=0.32,95%CI:0.01-0.63)in patients with cognitive dysfunction.Subgroup analyses for patients with MCI revealed different effects,and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition(SMD=0.99,95%CI:0.44-1.54)and executive function(SMD=0.72,95%CI:0.06-1.38).However,only resistance exercise showed significant effects on memory function for patients with MCI(SMD=0.35,95%CI:0.01-0.69).Exercise interventions also showed various effects on the secondary outcomes.Conclusion:Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive declin e in patients withcognitive dysfunction,especially in patients with dementia.Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.
