AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic m...AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.展开更多
AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and publishe...AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and published systematic reviews, we identifed 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis . We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and inter-ventions evaluated.RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly （P 〈 0.05） more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Signifcant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofoxacin （ P 〈 0.01）, which may be caused by different types of carriers and different doses of ciprofoxacin.CONCLUSIONA range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics （ciprofoxacin or rifampin） recommended by the current guidelines.展开更多
Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A datab...Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.展开更多
OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials...OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials(RCTs)that used GIs to treat AP were searched in SinoMed,PubMed,China National Knowledge Infrastructure Database,Chinese Scientific Journals Database,Wanfang Database,Embase and Cochrane Library until March 2017.The Cochrane "risk of bias" method was used to evaluate the methodological quality of RCTs.Data were analyzed using Stata v13.1 and WinBUGS v1.4.3.RESULTS:A total of 73 RCTs involving 7621 patients were included.A Bayesian network Meta-analysis of RCTs was undertaken,and the advantages of four types of Gl-supplemented CT in AP treatment were determined.CONCLUSION:Gl-assisted CT was more effective against AP than CT alone.However,based on the limitations of the study,additional high-quality RCTs are required to confirm our findings.展开更多
OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) tr...OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) treatment.METHODS: A systematic retrieval was conducted in several literature databases to identify randomized controlled trials focusing on the different regimens of SMICs for UAP treatment until January2016. The quality assessment was accomplished according to the Cochrane risk of bias tool. Pair-wise meta-analyses were carried out by Rev Man 5.3. A random-effects model of NMA was used to compare the different regimens of SMICs with regard to efficacy by STATA 13.0.RESULTS: A total of 111 studies involving 10 500patients were included in the NMA. The methodological quality of included studies was not high.Current evidence shows that salvianolate(SI) is the optimal treatment for UAP in improving the total efficacy against UAP. Guanxingning(GXN) is the optimal treatment for UAP for improving the total effectiveness of electrocardiography.CONCLUSION: SMICs have advantages in preventing cardiovascular events. GXN, SI, and Danhong had the greatest probability of being the best treatment in the total efficacy against UAP and for improving the total effectiveness of electrocardiography.展开更多
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To deter...BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.展开更多
OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub ...OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub Med,the Cochrane Library,and Web of Science)and Chinese-language databases(China National Knowledge Infrastructure,Wan Fang Data,VIP Chinese periodical service platform),and China Biology Medicine disc from their inception to September 2017.Randomized controlled trials comparing the effectiveness of Traditional Chinese Medicine therapies(alone or in combination)and conventional clinical medicine therapies among older adult patients with osteoporosis were identified.We conducted a network Meta-analysis with a Bayesian hierarchical random-effects model using RStudio software,Version 3.4.1.RESULTS:Forty-three randomized controlled trials assessing the differences between Traditional Chinese Medicine and conventional clinical medicine were identified,including 15 treatments and involving 3316 patients.The results of the network Meta-analysis indicated that alendronate(odds ratio[OR]=0.20,95%confidence interval[CI]:0.047-0.73)and calcium(OR=0.18,95%CI:0.11-0.30)are significantly more effective if combined with oral CHMIK.CHMIK alone is significantly more effective than both alendronate(OR=0.34,95%CI:0.10-1.0)and calcium(OR=0.13,95%CI:0.056-0.28).Moreover,CHMIK+tuina+calcium is more effective than CHMIK+calcium+vitamin D+alendronate(OR=18.0,95%CI:1.1-2.7 e+02).CONCLUSION:The present network Meta-analysis found that alendronate and calcium are more effective if combined with oral CHMIK and that oral CHMIK alone may be more effective than alendronate or calcium.Tuina may have an advantage over oral medicines.Oral CHMIK and calcitonin show the most potential for treating senile osteoporosis.展开更多
Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascul...Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.展开更多
Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medlin...Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.展开更多
AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through...AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through systematic review and random-effects Bayesian network Meta-analysis.METHODS:PubMed,Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants.ORs for postoperative best corrected visual acuity(BCVA)improvement and primary macular hole closure rates were compared between the different adjuvants.RESULTS:Twenty-seven eligible articles were included.For postoperative BCVA improvement,results of BBGassisted peeling were significantly more favorable than those of ICG(WMD 0.08,95%credible interval 0.01-0.16)and TA ranked highest.No significant differences were found between any other two groups in postoperative BCVA improvement.For postoperative primary macular hole closure rates,BBG ranked highest.However,no significant differences were shown between any two groups.CONCLUSION:TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling.Among all adjuvants,the use of BBG is associated with the highest postoperative macular hole closure rate.展开更多
BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant...BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial. AIM To identify the most effective approach for pancreatic cancer using network meta-analysis. METHODS Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach. RESULTS We included 13 high quality trials with 1591 participants in this network metaanalysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89;P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival. CONCLUSION Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.展开更多
目的:探讨髓芯减压联合不同治疗策略对早中期股骨头坏死患者的疗效及安全性评价。方法:系统检索PubMed、Web of Science、Cochrane Library、EMbase、中国知网、维普、万方和中国生物医学文献数据库,纳入截至2025-01-19发表的关于髓芯...目的:探讨髓芯减压联合不同治疗策略对早中期股骨头坏死患者的疗效及安全性评价。方法:系统检索PubMed、Web of Science、Cochrane Library、EMbase、中国知网、维普、万方和中国生物医学文献数据库,纳入截至2025-01-19发表的关于髓芯减压联合治疗早中期股骨头坏死的随机对照试验。采用Cochrane偏倚风险评估工具对文献质量进行评价,运用GRADE系统评价证据等级,基于贝叶斯框架构建网状Meta分析模型。采用标准化均数差进行效应估计,结果以累积排序概率曲线下面积进行干预优效性排序。敏感性分析采用逐项剔除法评估模型稳健性,并通过基线协变量评估传递性假设。结果:最终纳入73项随机对照试验,共计5148例患者、5777个髋关节,涵盖15种联合治疗方法。结果显示:①在提高综合临床疗效方面,髓芯减压联合自体骨髓单核细胞浓缩注射、骨髓间充质干细胞移植、支撑性植骨及补肾活血类中药复方汤剂等均优于单纯髓芯减压,其中髓芯减压联合自体骨髓单核细胞浓缩注射显示出最优的干预效果(累积排序概率曲线下面积=96.23%);②在髋关节功能改善方面,髓芯减压联合中医药序贯治疗疗效最优(累积排序概率曲线下面积=93.85%);③在疼痛缓解方面,髓芯减压联合中成药(补肾活血+活血化瘀)与活血化瘀类中药复方汤剂效果突出;④在影像学改善方面,髓芯减压联合自体源性干细胞局部植入效果最佳(累积排序概率曲线下面积=82.56%);⑤在临床安全性方面,髓芯减压联合活血化瘀类中药复方汤剂在降低不良事件发生率方面具有相对优势(P<0.05)。为评估结果稳健性,采用逐项剔除法进行敏感性分析,显示模型稳定,主要干预结果对单项研究不敏感,传递性假设成立。结论:髓芯减压联合干细胞移植、中医药序贯治疗等多种治疗方案在改善早中期股骨头坏死临床疗效方面优于单纯髓芯减压,表现为关节功能保护、结构重建与疼痛控制等多重优势。考虑部分干预文献数量有限及研究质量差异,仍需高质量、多中心、大样本随机对照试验进一步验证。展开更多
目的:传统Meta分析证实运动干预可有效改善慢性腰背痛,但哪种特定的运动方式疗效更好目前证据还不够充分。鉴于此,此次研究通过网状Meta分析探讨不同运动要素改善成年人慢性腰背痛影响的差异。方法:检索PubMed、Web of Science、Embase...目的:传统Meta分析证实运动干预可有效改善慢性腰背痛,但哪种特定的运动方式疗效更好目前证据还不够充分。鉴于此,此次研究通过网状Meta分析探讨不同运动要素改善成年人慢性腰背痛影响的差异。方法:检索PubMed、Web of Science、Embase、Cochrane、中国知网、万方、维普数据库中运动干预非特异性慢性腰痛的随机对照试验,其中试验组进行任何形式的运动类型干预,对照组进行药物治疗、物理治疗等非运动干预,检索时限设为各数据库建库至2025-03-01,使用布尔逻辑运算符(AND/OR)组合关键词进行检索。由2位评价员独立完成文献筛选、信息提取及偏倚风险评估后,使用Stata 17.0软件进行网状Meta分析,利用累计排序概率图下面积(SUCRA)对运动剂量变量的影响效果进行排序。结果:①共纳入40项随机对照试验,网状Meta分析结果显示,核心稳定性训练、垫上运动、传统功法运动、组合运动、其他运动改善慢性腰背痛的效果优于对照组[SMD=-0.76,95%CI(-1.39,-0.13),P<0.05;SMD=-1.67,95%CI(-2.48,-0.86),P<0.05;SMD=-2.09,95%CI(-3.37,-0.80),P<0.05;SMD=-1.60,95%CI(-2.71,-0.49),P<0.05;SMD=-1.40,95%CI(-2.40,-0.40),P<0.05],悬吊训练改善慢性腰背痛的效果弱于传统功法运动和垫上运动[SMD=1.50,95%CI(0.05,2.95),P<0.05;SMD=1.09,95%CI(0.11,2.06),P<0.05],传统功法运动改善慢性腰背痛的效果优于核心稳定性训练[SMD=-1.32,95%CI(-2.64,-0.01),P<0.05];单次运动15-20 min、30-40 min的干预效果优于对照组[SMD=-1.96,95%CI(-3.55,-0.36),P<0.05;SMD=-1.44,95%CI(-2.12,-0.76),P<0.05],每周运动3次、六七次的干预效果优于对照组[SMD=-1.03,95%CI(-1.69,-0.37),P<0.05;SMD=-1.83,95%CI(-2.75,-0.91),P<0.05],每周运动六七次的干预效果优于每周运动一二次[SMD=-1.30,95%CI(-2.61,-0.06),P<0.05],运动4周、12-13周和≥16周的干预效果均显著优于对照组[SMD=-0.81,95%CI(-1.50,-0.12),P<0.05;SMD=-1.63,95%CI(-2.82,-0.43),P<0.05;SMD=-2.14,95%CI(-3.36,-0.92),P<0.05],运动≥16周的干预效果显著优于运动6周[SMD=-1.55,95%CI(-3.03,-0.07),P<0.05]。SUCRA结果显示,传统功法运动、单次运动15-20 min、每周运动六七次、运动≥16周在各自对应的因素中排名最高。结论:干预类型为传统功法(太极拳、气功、五禽戏、八段锦)、单次运动15-20 min、每周运动六七次、运动≥16周可能对成年人慢性腰背痛的缓解效果最佳。然而,由于纳入的研究数量有限,需要进一步的研究来提供更有力证据。展开更多
背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考...背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、SinoMed、PubMed、CINAHL、Web of Science、Embase、Cochrane Library、FMRS等数据库中关于运动提高老年人跌倒效能的相关文献,检索时限为建库至2025-08-15。结局指标为国际版跌倒效能量表(FES-I)、Berg平衡量表(BBS)、计时起立-行走测试(TUGT)。采用Cochrane偏倚评估工具进行文献质量评价,采用Stata 18.0软件进行网状Meta分析,采用累积概率排名曲线下面积(SUCRA)对不同方案的效果进行排名。结果共纳入35项研究,包括2627例研究对象、13种运动方式。在跌倒效能方面,奥塔戈(MD=8.94,95%CI=3.51~14.38)、太极拳(MD=9.24,95%CI=4.96~13.51)、方步运动(MD=8.60,95%CI=2.56~14.64)、普拉提(MD=6.86,95%CI=1.19~12.53)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=81.2)。在平衡功能方面,奥塔戈(MD=3.87,95%CI=2.71~5.02)、太极拳(MD=3.87,95%CI=1.71~6.03)、抗阻+平衡训练(MD=3.26,95%CI=0.53~6.00)的效果优于常规护理组(P<0.05),奥塔戈成为最佳干预措施的可能性最大(SUCRA=68.1)。在移动能力方面,奥塔戈(MD=3.90,95%CI=2.77~5.04)、太极拳(MD=4.44,95%CI=3.50~5.39)、八段锦(MD=2.25,95%CI=1.47~3.02)、八卦掌(MD=2.35,95%CI=1.26~3.43)、步态平衡操(MD=3.60,95%CI=2.15~5.05)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=95.0)。结论太极拳、奥塔戈运动在改善老年人跌倒效能、平衡功能、移动能力方面效果较好。临床医护人员应结合老年人健康状况及需求,合理选择运动方式,以提高老年人跌倒效能,有效预防跌倒,促进患者健康。未来仍需进一步开展更多高质量的研究以验证此结论。展开更多
目的:大量研究表明,非侵入性神经调控技术能够有效改善脑卒中后非流畅性失语的症状,然而,针对该类技术的最优刺激方案仍有待深入验证与探究。此次研究借助网状Meta分析方法,系统评价不同非侵入性神经调控技术改善脑卒中后非流畅性失语...目的:大量研究表明,非侵入性神经调控技术能够有效改善脑卒中后非流畅性失语的症状,然而,针对该类技术的最优刺激方案仍有待深入验证与探究。此次研究借助网状Meta分析方法,系统评价不同非侵入性神经调控技术改善脑卒中后非流畅性失语患者言语功能的效应。方法:检索CNKI、万方、维普、CBM、PubMed、Cochrane图书馆、Embase和Web of Science数据库,筛选有关非侵入性神经调控技术治疗脑卒中后非流畅性失语的随机对照试验,检索时限截至2025-06-01。对照组采用常规治疗或假刺激,试验组在对照组治疗的基础上加入非侵入性神经调控技术,结局指标为西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表。采用Stata 17.0软件对结局指标进行传统Meta分析和网状Meta分析,采用GRADE对结局指标进行证据等级评价。结果:共纳入33篇随机对照试验,涉及10种非侵入性神经调控方式。①传统Meta分析结果显示,低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、经颅直流电刺激左侧Broca区可改善患者西方失语成套测验评分(P<0.001),低频重复经颅磁刺激右侧Broca区、低频重复经颅磁刺激颞上回后部、低频重复经颅磁刺激右侧Broca区联合高频重复经颅磁刺激左侧Broca区可改善患者汉语失语成套测验评分(P<0.05),低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、连续性θ爆发刺激右侧Broca区联合间歇性θ爆发刺激左侧Broca区、高频重复经颅磁刺激刺激右侧Broca区、低频重复经颅磁刺激右侧Broca区联合高频刺激左侧Broca区可改善患者日常生活交流能力评定量表评分(P<0.05)。②网状Meta分析结果显示,低频重复经颅磁刺激右侧Broca区改善患者西方失语成套测验评分和汉语失语成套测验评分的疗效更佳[SMD=1.13,95%CI(0.59,1.67),P<0.05;SMD=4.73,95%CI(1.28,8.18),P<0.05],经颅直流电刺激双侧Broca区在改善患者日常生活交流能力评定量表评分的疗效更佳[SMD=1.81,95%CI(0.51,2.12),P<0.05]。③GRADE证据等级评价结果显示,西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表结局指标的证据等级均为低级。结论:不同非侵入性神经调控方式均能改善脑卒中后非流畅性失语患者的言语功能,低频重复经颅磁刺激右侧Broca区在改善多维度言语功能方面,尤其在自发言语连贯性、听觉理解准确性及命名流畅性等方面疗效显著;经颅直流电刺激双侧Broca区更侧重改善患者的日常生活交流能力,但研究结果受纳入研究的数量及质量影响,证据等级较低,仍需更多高质量的研究进一步验证。展开更多
基金Supported by the National Natural Science Foundation of China (No.81870686)the Natural Science Foundation of Beijing Municipal (No.7184201)the Capital’s Funds for Health Improvement and Research (No.2018-12021)
文摘AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.
基金Supported by Partly the UK Medical Research Council,No.G0701607
文摘AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and published systematic reviews, we identifed 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis . We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and inter-ventions evaluated.RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly （P 〈 0.05） more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Signifcant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofoxacin （ P 〈 0.01）, which may be caused by different types of carriers and different doses of ciprofoxacin.CONCLUSIONA range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics （ciprofoxacin or rifampin） recommended by the current guidelines.
文摘Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.
基金Supported by National Natural Science Foundation of China(Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection No.81473547and Multidimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris,No.81673829)
文摘OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials(RCTs)that used GIs to treat AP were searched in SinoMed,PubMed,China National Knowledge Infrastructure Database,Chinese Scientific Journals Database,Wanfang Database,Embase and Cochrane Library until March 2017.The Cochrane "risk of bias" method was used to evaluate the methodological quality of RCTs.Data were analyzed using Stata v13.1 and WinBUGS v1.4.3.RESULTS:A total of 73 RCTs involving 7621 patients were included.A Bayesian network Meta-analysis of RCTs was undertaken,and the advantages of four types of Gl-supplemented CT in AP treatment were determined.CONCLUSION:Gl-assisted CT was more effective against AP than CT alone.However,based on the limitations of the study,additional high-quality RCTs are required to confirm our findings.
基金Supported by National Natural Science Foundation of China:Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection(No.81473547)Multi-dimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris(No.81673829)
文摘OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) treatment.METHODS: A systematic retrieval was conducted in several literature databases to identify randomized controlled trials focusing on the different regimens of SMICs for UAP treatment until January2016. The quality assessment was accomplished according to the Cochrane risk of bias tool. Pair-wise meta-analyses were carried out by Rev Man 5.3. A random-effects model of NMA was used to compare the different regimens of SMICs with regard to efficacy by STATA 13.0.RESULTS: A total of 111 studies involving 10 500patients were included in the NMA. The methodological quality of included studies was not high.Current evidence shows that salvianolate(SI) is the optimal treatment for UAP in improving the total efficacy against UAP. Guanxingning(GXN) is the optimal treatment for UAP for improving the total effectiveness of electrocardiography.CONCLUSION: SMICs have advantages in preventing cardiovascular events. GXN, SI, and Danhong had the greatest probability of being the best treatment in the total efficacy against UAP and for improving the total effectiveness of electrocardiography.
文摘BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
基金Supported by the National Natural Science Foundation of China"Kidney Health Bone,Marrow Link Brain",a Study of Chinese Nourishing Kidney Herbs’Mechanism of Treatment of Osteoporosis Based on Neuropeptide Network"Too Salty to Hurt the Bone",A Study on the Molecular Mechanism of High Salt Affecting Bone Metabolism Based on Related Ion Channels and Intervention of A Compound Chinese Medicine for Reinforcing Kidney(No.81473509,81673837).
文摘OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub Med,the Cochrane Library,and Web of Science)and Chinese-language databases(China National Knowledge Infrastructure,Wan Fang Data,VIP Chinese periodical service platform),and China Biology Medicine disc from their inception to September 2017.Randomized controlled trials comparing the effectiveness of Traditional Chinese Medicine therapies(alone or in combination)and conventional clinical medicine therapies among older adult patients with osteoporosis were identified.We conducted a network Meta-analysis with a Bayesian hierarchical random-effects model using RStudio software,Version 3.4.1.RESULTS:Forty-three randomized controlled trials assessing the differences between Traditional Chinese Medicine and conventional clinical medicine were identified,including 15 treatments and involving 3316 patients.The results of the network Meta-analysis indicated that alendronate(odds ratio[OR]=0.20,95%confidence interval[CI]:0.047-0.73)and calcium(OR=0.18,95%CI:0.11-0.30)are significantly more effective if combined with oral CHMIK.CHMIK alone is significantly more effective than both alendronate(OR=0.34,95%CI:0.10-1.0)and calcium(OR=0.13,95%CI:0.056-0.28).Moreover,CHMIK+tuina+calcium is more effective than CHMIK+calcium+vitamin D+alendronate(OR=18.0,95%CI:1.1-2.7 e+02).CONCLUSION:The present network Meta-analysis found that alendronate and calcium are more effective if combined with oral CHMIK and that oral CHMIK alone may be more effective than alendronate or calcium.Tuina may have an advantage over oral medicines.Oral CHMIK and calcitonin show the most potential for treating senile osteoporosis.
基金supported by the Natural Science Foundation of Liaoning Province of China,No.20170541036(to HYL)
文摘Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.
基金supported by the National Natural Science Foundation of China[No.81302508,71673003,81473067,and 91646107].
文摘Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.
文摘AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through systematic review and random-effects Bayesian network Meta-analysis.METHODS:PubMed,Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants.ORs for postoperative best corrected visual acuity(BCVA)improvement and primary macular hole closure rates were compared between the different adjuvants.RESULTS:Twenty-seven eligible articles were included.For postoperative BCVA improvement,results of BBGassisted peeling were significantly more favorable than those of ICG(WMD 0.08,95%credible interval 0.01-0.16)and TA ranked highest.No significant differences were found between any other two groups in postoperative BCVA improvement.For postoperative primary macular hole closure rates,BBG ranked highest.However,no significant differences were shown between any two groups.CONCLUSION:TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling.Among all adjuvants,the use of BBG is associated with the highest postoperative macular hole closure rate.
基金Supported by the Medical Scientific Research Foundation of Guangdong Province,No.A2017229
文摘BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial. AIM To identify the most effective approach for pancreatic cancer using network meta-analysis. METHODS Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach. RESULTS We included 13 high quality trials with 1591 participants in this network metaanalysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89;P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival. CONCLUSION Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.
文摘目的:探讨髓芯减压联合不同治疗策略对早中期股骨头坏死患者的疗效及安全性评价。方法:系统检索PubMed、Web of Science、Cochrane Library、EMbase、中国知网、维普、万方和中国生物医学文献数据库,纳入截至2025-01-19发表的关于髓芯减压联合治疗早中期股骨头坏死的随机对照试验。采用Cochrane偏倚风险评估工具对文献质量进行评价,运用GRADE系统评价证据等级,基于贝叶斯框架构建网状Meta分析模型。采用标准化均数差进行效应估计,结果以累积排序概率曲线下面积进行干预优效性排序。敏感性分析采用逐项剔除法评估模型稳健性,并通过基线协变量评估传递性假设。结果:最终纳入73项随机对照试验,共计5148例患者、5777个髋关节,涵盖15种联合治疗方法。结果显示:①在提高综合临床疗效方面,髓芯减压联合自体骨髓单核细胞浓缩注射、骨髓间充质干细胞移植、支撑性植骨及补肾活血类中药复方汤剂等均优于单纯髓芯减压,其中髓芯减压联合自体骨髓单核细胞浓缩注射显示出最优的干预效果(累积排序概率曲线下面积=96.23%);②在髋关节功能改善方面,髓芯减压联合中医药序贯治疗疗效最优(累积排序概率曲线下面积=93.85%);③在疼痛缓解方面,髓芯减压联合中成药(补肾活血+活血化瘀)与活血化瘀类中药复方汤剂效果突出;④在影像学改善方面,髓芯减压联合自体源性干细胞局部植入效果最佳(累积排序概率曲线下面积=82.56%);⑤在临床安全性方面,髓芯减压联合活血化瘀类中药复方汤剂在降低不良事件发生率方面具有相对优势(P<0.05)。为评估结果稳健性,采用逐项剔除法进行敏感性分析,显示模型稳定,主要干预结果对单项研究不敏感,传递性假设成立。结论:髓芯减压联合干细胞移植、中医药序贯治疗等多种治疗方案在改善早中期股骨头坏死临床疗效方面优于单纯髓芯减压,表现为关节功能保护、结构重建与疼痛控制等多重优势。考虑部分干预文献数量有限及研究质量差异,仍需高质量、多中心、大样本随机对照试验进一步验证。
文摘背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、SinoMed、PubMed、CINAHL、Web of Science、Embase、Cochrane Library、FMRS等数据库中关于运动提高老年人跌倒效能的相关文献,检索时限为建库至2025-08-15。结局指标为国际版跌倒效能量表(FES-I)、Berg平衡量表(BBS)、计时起立-行走测试(TUGT)。采用Cochrane偏倚评估工具进行文献质量评价,采用Stata 18.0软件进行网状Meta分析,采用累积概率排名曲线下面积(SUCRA)对不同方案的效果进行排名。结果共纳入35项研究,包括2627例研究对象、13种运动方式。在跌倒效能方面,奥塔戈(MD=8.94,95%CI=3.51~14.38)、太极拳(MD=9.24,95%CI=4.96~13.51)、方步运动(MD=8.60,95%CI=2.56~14.64)、普拉提(MD=6.86,95%CI=1.19~12.53)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=81.2)。在平衡功能方面,奥塔戈(MD=3.87,95%CI=2.71~5.02)、太极拳(MD=3.87,95%CI=1.71~6.03)、抗阻+平衡训练(MD=3.26,95%CI=0.53~6.00)的效果优于常规护理组(P<0.05),奥塔戈成为最佳干预措施的可能性最大(SUCRA=68.1)。在移动能力方面,奥塔戈(MD=3.90,95%CI=2.77~5.04)、太极拳(MD=4.44,95%CI=3.50~5.39)、八段锦(MD=2.25,95%CI=1.47~3.02)、八卦掌(MD=2.35,95%CI=1.26~3.43)、步态平衡操(MD=3.60,95%CI=2.15~5.05)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=95.0)。结论太极拳、奥塔戈运动在改善老年人跌倒效能、平衡功能、移动能力方面效果较好。临床医护人员应结合老年人健康状况及需求,合理选择运动方式,以提高老年人跌倒效能,有效预防跌倒,促进患者健康。未来仍需进一步开展更多高质量的研究以验证此结论。
文摘目的:大量研究表明,非侵入性神经调控技术能够有效改善脑卒中后非流畅性失语的症状,然而,针对该类技术的最优刺激方案仍有待深入验证与探究。此次研究借助网状Meta分析方法,系统评价不同非侵入性神经调控技术改善脑卒中后非流畅性失语患者言语功能的效应。方法:检索CNKI、万方、维普、CBM、PubMed、Cochrane图书馆、Embase和Web of Science数据库,筛选有关非侵入性神经调控技术治疗脑卒中后非流畅性失语的随机对照试验,检索时限截至2025-06-01。对照组采用常规治疗或假刺激,试验组在对照组治疗的基础上加入非侵入性神经调控技术,结局指标为西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表。采用Stata 17.0软件对结局指标进行传统Meta分析和网状Meta分析,采用GRADE对结局指标进行证据等级评价。结果:共纳入33篇随机对照试验,涉及10种非侵入性神经调控方式。①传统Meta分析结果显示,低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、经颅直流电刺激左侧Broca区可改善患者西方失语成套测验评分(P<0.001),低频重复经颅磁刺激右侧Broca区、低频重复经颅磁刺激颞上回后部、低频重复经颅磁刺激右侧Broca区联合高频重复经颅磁刺激左侧Broca区可改善患者汉语失语成套测验评分(P<0.05),低频重复经颅磁刺激右侧Broca区、经颅直流电刺激双侧Broca区、连续性θ爆发刺激右侧Broca区联合间歇性θ爆发刺激左侧Broca区、高频重复经颅磁刺激刺激右侧Broca区、低频重复经颅磁刺激右侧Broca区联合高频刺激左侧Broca区可改善患者日常生活交流能力评定量表评分(P<0.05)。②网状Meta分析结果显示,低频重复经颅磁刺激右侧Broca区改善患者西方失语成套测验评分和汉语失语成套测验评分的疗效更佳[SMD=1.13,95%CI(0.59,1.67),P<0.05;SMD=4.73,95%CI(1.28,8.18),P<0.05],经颅直流电刺激双侧Broca区在改善患者日常生活交流能力评定量表评分的疗效更佳[SMD=1.81,95%CI(0.51,2.12),P<0.05]。③GRADE证据等级评价结果显示,西方失语成套测验、汉语失语成套测验、日常生活交流能力评定量表结局指标的证据等级均为低级。结论:不同非侵入性神经调控方式均能改善脑卒中后非流畅性失语患者的言语功能,低频重复经颅磁刺激右侧Broca区在改善多维度言语功能方面,尤其在自发言语连贯性、听觉理解准确性及命名流畅性等方面疗效显著;经颅直流电刺激双侧Broca区更侧重改善患者的日常生活交流能力,但研究结果受纳入研究的数量及质量影响,证据等级较低,仍需更多高质量的研究进一步验证。
