Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate t...Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate their genetic associations.Using data from the UK Biobank(n=457871),cross-sectional analyses demonstrated that osteoporosis was significantly associated with an increased risk of RCTs(adjusted OR[95%CI]=1.38[1.25–1.52]).A longitudinal analysis of a subset of patients(n=268117)over 11 years revealed that osteoporosis increased the risk of RCTs(adjusted HR[95%CI]=1.56[1.29–1.87]),which is notably varied between sexes in sex-stratified analysis.Causal inference methods,including propensity score matching,inverse probability weighting,causal random forest and survival random forest models further confirmed the causal effect,both from cross-sectional and longitudinal perspectives.展开更多
Objective Randomized controlled trials(RCTs)of Chinese patent medicines and classic tra-ditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023.A p...Objective Randomized controlled trials(RCTs)of Chinese patent medicines and classic tra-ditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023.A preliminary summary and evaluation were conducted on the generation and translation of clinical evidence for these treatments.This analysis aims to inform future research on clinical efficacy evaluation and guide the rational application of evidence.Methods RCTs of Chinese patent medicines and classic traditional Chinese prescriptions published in 2023 were comprehensively retrieved from the Artificial Intelligence Clinical Evi-dence Database for Chinese Patent Medicine(AICED-CPM),with supplementary searches conducted in China National Knowledge Infrastructure(CNKI),Wanfang Data,Chinese Sci-ence and Technology Journal Database(VIP),Chinese Biomedical Literature Database(SinoMed),Cochrane Library,PubMed,Embase,and Web of Science.The study characteris-tics and methodological quality of these RCTs were systematically analyzed and evaluated.Results A total of 1443 RCTs of Chinese patent medicines were included,comprising 1399 Chinese articles and 44 English articles.Additionally,334 RCTs of classic traditional Chinese medicine prescriptions were found,with 331 published in Chinese and 3 in English.196567 participants were included,covering 585 types of Chinese patent medicines(487 oral,61 in-jectable,and 37 topical)and 179 classic traditional Chinese medicine prescriptions.The in-volved studies encompassed 22 types of diseases,with research primarily focusing on dis-eases of the circulatory system,the respiratory system,and the genitourinary system.The sample sizes ranged from 18 to 3777 participants,and most studies were conducted at a sin-gle center.Methodologically,the implementation of allocation concealment and blinding re-mained insufficiently emphasized.Conclusion Overall,compared with 2022,both the number of RCT publications and their methodological quality have improved in 2023,with heightened attention to research on diseases of the genitourinary system.However,quality control and standardized management in the design and implementation processes still require enhancement to produce more high-quality clinical evidence and accelerate the translation and application of this evidence.展开更多
[目的]通过系统评价和Meta分析,评估针刺及针药合用在改善干燥综合征患者口干和眼干症状方面的疗效。[方法]检索中国知网(CNKI)、万方数据库、维普网(VIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、EMbase和Web of Sci...[目的]通过系统评价和Meta分析,评估针刺及针药合用在改善干燥综合征患者口干和眼干症状方面的疗效。[方法]检索中国知网(CNKI)、万方数据库、维普网(VIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、EMbase和Web of Science等数据库,收集截至2024年10月1日的针刺或针药合用治疗干燥综合征口干眼干症状的随机对照试验(RCT)文献。由两名研究者独立筛选文献、提取数据并评估偏倚风险,使用RevMan 5.4软件进行Meta分析,效应量采用标准化均数差(SMD)和优势比(OR),并评估研究间的异质性。[结果]本研究共纳入16项随机对照试验(RCT),涉及1319例干燥综合征患者。Meta分析显示,单纯针刺治疗与对照组相比差异无统计学意义[OR=3.73,95%CI(0.42,33.08),P=0.24],而针药合用治疗显示出明显的临床疗效优势[OR=3.60,95%CI(2.53,5.11),P<0.05]。在客观生物学指标方面,针刺治疗能显著提高患者唾液流率[MD=1.98,95%CI(0.20,3.75),P<0.05],针药合用治疗同样能显著提高患者唾液流率[MD=0.25,95%CI(0.03,0.47),P<0.05]。Schirmer测试结果表明,针药合用治疗能有效改善干燥综合征患者的泪液分泌[MD=1.47,95%CI(0.54,2.40),P<0.05]。但存在异质性,经治疗时长(>4周/≤4周)和干预方案(纯针刺/针药合用)的亚组分析后,异质性仍高于50%,提示潜在异质性来源可能涉及操作者技术差异、穴位配伍特异性及受试人群基线特征等因素。在症状评估维度,治疗组显著降低中医证候积分[SMD=-1.29,95%CI(-1.97,-0.61),Z=-3.74,P<0.05]和ESSPRI评分[SMD=-1.73,95%CI(-2.51,-0.95),Z=-4.34,P<0.05],尽管两者异质性分别达84.90%和90%,但敏感性分析证实结果稳健。所有异质性大的结局指标采用随机效应模型,异质性来源的系统分析表明,操作者资质、干预方案细节(如穴位选择、针刺频数)及疗效评估时点差异可能是影响研究间异质性的关键因素。[结论]针刺及针药合用治疗显著改善了干燥综合征患者的临床疗效、唾液流率、Schirmer测试、中医证候积分及患者汇报指数(ESSPRI)评分,且安全性良好。未来需要更多大规模、高质量的随机对照试验,以进一步验证针刺的长期疗效并探讨不同针刺方案的具体作用机制。展开更多
Background:Acupuncture has been proven to improve the pregnancy rate in infertile women.Endometriosis is a common cause of infertility.So far,there are no studies of the efficacy of acupuncture on endometriosis-associ...Background:Acupuncture has been proven to improve the pregnancy rate in infertile women.Endometriosis is a common cause of infertility.So far,there are no studies of the efficacy of acupuncture on endometriosis-associated infertility(EAI).Therefore,we will conduct a randomized controlled trial(RCT)to investigate whether acupuncture could have higher pregnancy rates in patients with EAI compared with sham acupuncture.The study protocol is reported in this paper.Methods/design:The current trial is a multicenter randomized controlled study undergoing in Shanghai,China.About 224 eligible patients with EAI will be randomly assigned into the acupuncture group and the sham acupuncture group in a 1:1 ratio.In the acupuncture group,patients will be treated with acupuncture on Guanyuan(CV4),Zhongji(CV3),Zigong(EX-CA1),Xuehai(SP10),Zusanli(ST36),Sanyinjiao(SP6),and Taichong(LR3),twice a week,for 3 menstrual cycles,and 12 menstrual cycles will be followed up.The Park sham device will be used to perform non-transdermal acupuncture in the sham acupuncture group.The operation points will be located at 1.5 cm away beside these acupoints in the acupuncture group.The intervention period is the same as that in the acupuncture group.The primary outcome will be pregnancy rate.Secondary outcomes will include ultrasound results,cancer antigen 125(CA125),antiMullerian hormone(AMH),sex hormones,and the Endometriosis Health Profile-5(EHP-5).Outcomes will be collected at baseline,the end of treatment,and follow-up visits at 3,6,and 12 menstrual cycles.All data,including major adverse events,will be recorded in electronic case report forms and analyzed using SPSS V.25.0.Discussion:This study will help to evaluate whether acupuncture is effective in increasing the pregnancy rate of infertile women with endometriosis.展开更多
This study examined the application of the Rumsfeld Matrix to acupuncture clinical trials,particularly those published in leading medical journals such as The Journal of the American Medical Association(JAMA),British ...This study examined the application of the Rumsfeld Matrix to acupuncture clinical trials,particularly those published in leading medical journals such as The Journal of the American Medical Association(JAMA),British Medical Journal(BMJ),The Lancet,and The New Eng-land Journal of Medicine(NEJM).The integration of randomized clinical trials(RCTs)has in-troduced a level of academic rigor to acupuncture research,challenging the classical deter-ministic model and revealing a complex landscape of known knowns,known unknowns,un-known knowns,and unknown unknowns.While RCTs have validated acupuncture’s efficacy in certain conditions,they have also highlighted considerable challenges,including the limi-tations of control group designs and the potential influence of placebo effects.The recurring issue of no significant differences between real and sham acupuncture in many studies un-derscores the need for refined control strategies and a more nuanced understanding of acupuncture’s mechanisms.This investigation calls for continued rigorous research to fully explore acupuncture’s therapeutic potential and its integration into evidence-based medicine,ultimately contributing to improved patient care and broader acceptance within the medical community.展开更多
目的系统评价远隔缺血适应(remote ischemic conditioning,RIC)干预急性缺血性卒中(acute ischemic stroke,AIS)的效果。方法选取中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Ovid、Cochrane Library、Scopus...目的系统评价远隔缺血适应(remote ischemic conditioning,RIC)干预急性缺血性卒中(acute ischemic stroke,AIS)的效果。方法选取中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Ovid、Cochrane Library、Scopus等数据库建库至2023年12月公开发表的RIC干预AIS的中英文RCT研究。对文献进行整理和分析,采用Cochrane偏倚风险评估工具评价文献质量,采用R 4.1.2软件对提取的数据进行meta分析,评估RIC对AIS的干预效果。结果共检索文献1962篇,纳入有效RCT研究20篇,涉及研究对象4030例。20篇文献中18篇文献质量中等、2篇文献质量较低。Meta分析结果显示,干预后与常规西医治疗组相比,RIC联合常规西医治疗组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分较低(MD=-1.82,95%CI:-2.40~-1.24)、改良Rankin量表(modified Rankin scale,mRs)评分较低(MD=-0.54,95%CI:-0.67~-0.40)、Barthel指数较高(Barthel index,BI)(MD=8.7,95%CI:6.80~10.61),神经功能预后较好(RR=1.08,95%CI:1.04~1.13),差异均有统计学意义(P<0.01)。各项研究均未出现严重不良反应。结论RIC干预AIS的疗效显著,具有较好的安全性,值得临床推广。展开更多
In the context of building a country with a strong transportation network,railway container transportation(RCT)is an important means of reducing costs,increasing efficiency,and adjusting transportation structures.Thus...In the context of building a country with a strong transportation network,railway container transportation(RCT)is an important means of reducing costs,increasing efficiency,and adjusting transportation structures.Thus,its impact on regional economic development is important.Based on data from railway container-handling stations and spatial econometric models,this study discusses the differences in the development of RCT and their impact on regional economic development at different leves.This study has three main findings:first,there are significant regional differences in the development of the RCT.The intra-regional differences between the eastern and central regions of China(which do not include Hong Kong,Macao and Taiwan)are gradually narrowing,while the regional differences in the western region are widening.Meanwhile,the intra-regional differences in important economic zones such as Pearl River Delta Economic Zone(PRDEZ),Chengdu-Chongqing Economic Zone(CYEZ),Bohai Rim Economic Zone(BHEZ),and Yangtze River Delta Economic Zone(YRDEZ)are narrowing daily.Second,the development differences of RCT in regional level and important economic regions level show different trends.The unbalanced features of large regions are increasingly evident,whereas the differences in economic regions are decreasing.However,the problem of overlapping RCT remains prominent.Third,the transformation of RCT development mode and fierce competition among transportation modes cause RCT to have a restraining effect on the regional economy at three levels.Rational allocation of resources and other means must be used to guide the transformation from inhibition to promotion,and by formulating targeted policies that will promote the development of RCT,which will improve the transportation structure and help construct a country with a strong transportation system.展开更多
基金the Scientific Research Innovation Capability Support Project for Young Faculty(ZYGXQNJSKYCXNLZCXM-H8)Fundamental Research Funds for the Central Universities(2024ZYGXZR077)+3 种基金Guangdong Basic and Applied Basic Research Foundation(2023B1515120006)Guangzhou Basic and Applied Basic Research Foundation(2024A04J5776)the Research Fund(2023QN10Y421)Guangzhou Talent Recruitment Team Program(2024D03J0004),all related to this study.
文摘Osteoporosis is a known risk factor for rotator cuff tears(RCTs),but the causal correlation and underlying mechanisms remain unclear.This study aims to evaluate the impact of osteoporosis on RCT risk and investigate their genetic associations.Using data from the UK Biobank(n=457871),cross-sectional analyses demonstrated that osteoporosis was significantly associated with an increased risk of RCTs(adjusted OR[95%CI]=1.38[1.25–1.52]).A longitudinal analysis of a subset of patients(n=268117)over 11 years revealed that osteoporosis increased the risk of RCTs(adjusted HR[95%CI]=1.56[1.29–1.87]),which is notably varied between sexes in sex-stratified analysis.Causal inference methods,including propensity score matching,inverse probability weighting,causal random forest and survival random forest models further confirmed the causal effect,both from cross-sectional and longitudinal perspectives.
基金National Multidisciplinary Innovation Team of Traditional Chinese Medicine (ZYYCXTD-D-202204)Science and Technology Project of Haihe Laboratory of Modern Chinese Medicine (22HHZYSS00013)。
文摘Objective Randomized controlled trials(RCTs)of Chinese patent medicines and classic tra-ditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023.A preliminary summary and evaluation were conducted on the generation and translation of clinical evidence for these treatments.This analysis aims to inform future research on clinical efficacy evaluation and guide the rational application of evidence.Methods RCTs of Chinese patent medicines and classic traditional Chinese prescriptions published in 2023 were comprehensively retrieved from the Artificial Intelligence Clinical Evi-dence Database for Chinese Patent Medicine(AICED-CPM),with supplementary searches conducted in China National Knowledge Infrastructure(CNKI),Wanfang Data,Chinese Sci-ence and Technology Journal Database(VIP),Chinese Biomedical Literature Database(SinoMed),Cochrane Library,PubMed,Embase,and Web of Science.The study characteris-tics and methodological quality of these RCTs were systematically analyzed and evaluated.Results A total of 1443 RCTs of Chinese patent medicines were included,comprising 1399 Chinese articles and 44 English articles.Additionally,334 RCTs of classic traditional Chinese medicine prescriptions were found,with 331 published in Chinese and 3 in English.196567 participants were included,covering 585 types of Chinese patent medicines(487 oral,61 in-jectable,and 37 topical)and 179 classic traditional Chinese medicine prescriptions.The in-volved studies encompassed 22 types of diseases,with research primarily focusing on dis-eases of the circulatory system,the respiratory system,and the genitourinary system.The sample sizes ranged from 18 to 3777 participants,and most studies were conducted at a sin-gle center.Methodologically,the implementation of allocation concealment and blinding re-mained insufficiently emphasized.Conclusion Overall,compared with 2022,both the number of RCT publications and their methodological quality have improved in 2023,with heightened attention to research on diseases of the genitourinary system.However,quality control and standardized management in the design and implementation processes still require enhancement to produce more high-quality clinical evidence and accelerate the translation and application of this evidence.
文摘[目的]通过系统评价和Meta分析,评估针刺及针药合用在改善干燥综合征患者口干和眼干症状方面的疗效。[方法]检索中国知网(CNKI)、万方数据库、维普网(VIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library、EMbase和Web of Science等数据库,收集截至2024年10月1日的针刺或针药合用治疗干燥综合征口干眼干症状的随机对照试验(RCT)文献。由两名研究者独立筛选文献、提取数据并评估偏倚风险,使用RevMan 5.4软件进行Meta分析,效应量采用标准化均数差(SMD)和优势比(OR),并评估研究间的异质性。[结果]本研究共纳入16项随机对照试验(RCT),涉及1319例干燥综合征患者。Meta分析显示,单纯针刺治疗与对照组相比差异无统计学意义[OR=3.73,95%CI(0.42,33.08),P=0.24],而针药合用治疗显示出明显的临床疗效优势[OR=3.60,95%CI(2.53,5.11),P<0.05]。在客观生物学指标方面,针刺治疗能显著提高患者唾液流率[MD=1.98,95%CI(0.20,3.75),P<0.05],针药合用治疗同样能显著提高患者唾液流率[MD=0.25,95%CI(0.03,0.47),P<0.05]。Schirmer测试结果表明,针药合用治疗能有效改善干燥综合征患者的泪液分泌[MD=1.47,95%CI(0.54,2.40),P<0.05]。但存在异质性,经治疗时长(>4周/≤4周)和干预方案(纯针刺/针药合用)的亚组分析后,异质性仍高于50%,提示潜在异质性来源可能涉及操作者技术差异、穴位配伍特异性及受试人群基线特征等因素。在症状评估维度,治疗组显著降低中医证候积分[SMD=-1.29,95%CI(-1.97,-0.61),Z=-3.74,P<0.05]和ESSPRI评分[SMD=-1.73,95%CI(-2.51,-0.95),Z=-4.34,P<0.05],尽管两者异质性分别达84.90%和90%,但敏感性分析证实结果稳健。所有异质性大的结局指标采用随机效应模型,异质性来源的系统分析表明,操作者资质、干预方案细节(如穴位选择、针刺频数)及疗效评估时点差异可能是影响研究间异质性的关键因素。[结论]针刺及针药合用治疗显著改善了干燥综合征患者的临床疗效、唾液流率、Schirmer测试、中医证候积分及患者汇报指数(ESSPRI)评分,且安全性良好。未来需要更多大规模、高质量的随机对照试验,以进一步验证针刺的长期疗效并探讨不同针刺方案的具体作用机制。
基金Supported by Shanghai Sailing Program:22YF1444200the National Natural Science Foundation of China:81403429Clinical Research Project of Shanghai Municipal Health Commission:202240054。
文摘Background:Acupuncture has been proven to improve the pregnancy rate in infertile women.Endometriosis is a common cause of infertility.So far,there are no studies of the efficacy of acupuncture on endometriosis-associated infertility(EAI).Therefore,we will conduct a randomized controlled trial(RCT)to investigate whether acupuncture could have higher pregnancy rates in patients with EAI compared with sham acupuncture.The study protocol is reported in this paper.Methods/design:The current trial is a multicenter randomized controlled study undergoing in Shanghai,China.About 224 eligible patients with EAI will be randomly assigned into the acupuncture group and the sham acupuncture group in a 1:1 ratio.In the acupuncture group,patients will be treated with acupuncture on Guanyuan(CV4),Zhongji(CV3),Zigong(EX-CA1),Xuehai(SP10),Zusanli(ST36),Sanyinjiao(SP6),and Taichong(LR3),twice a week,for 3 menstrual cycles,and 12 menstrual cycles will be followed up.The Park sham device will be used to perform non-transdermal acupuncture in the sham acupuncture group.The operation points will be located at 1.5 cm away beside these acupoints in the acupuncture group.The intervention period is the same as that in the acupuncture group.The primary outcome will be pregnancy rate.Secondary outcomes will include ultrasound results,cancer antigen 125(CA125),antiMullerian hormone(AMH),sex hormones,and the Endometriosis Health Profile-5(EHP-5).Outcomes will be collected at baseline,the end of treatment,and follow-up visits at 3,6,and 12 menstrual cycles.All data,including major adverse events,will be recorded in electronic case report forms and analyzed using SPSS V.25.0.Discussion:This study will help to evaluate whether acupuncture is effective in increasing the pregnancy rate of infertile women with endometriosis.
文摘This study examined the application of the Rumsfeld Matrix to acupuncture clinical trials,particularly those published in leading medical journals such as The Journal of the American Medical Association(JAMA),British Medical Journal(BMJ),The Lancet,and The New Eng-land Journal of Medicine(NEJM).The integration of randomized clinical trials(RCTs)has in-troduced a level of academic rigor to acupuncture research,challenging the classical deter-ministic model and revealing a complex landscape of known knowns,known unknowns,un-known knowns,and unknown unknowns.While RCTs have validated acupuncture’s efficacy in certain conditions,they have also highlighted considerable challenges,including the limi-tations of control group designs and the potential influence of placebo effects.The recurring issue of no significant differences between real and sham acupuncture in many studies un-derscores the need for refined control strategies and a more nuanced understanding of acupuncture’s mechanisms.This investigation calls for continued rigorous research to fully explore acupuncture’s therapeutic potential and its integration into evidence-based medicine,ultimately contributing to improved patient care and broader acceptance within the medical community.
文摘目的系统评价远隔缺血适应(remote ischemic conditioning,RIC)干预急性缺血性卒中(acute ischemic stroke,AIS)的效果。方法选取中国知网、万方数据库、维普数据库、SinoMed、PubMed、Web of Science、Ovid、Cochrane Library、Scopus等数据库建库至2023年12月公开发表的RIC干预AIS的中英文RCT研究。对文献进行整理和分析,采用Cochrane偏倚风险评估工具评价文献质量,采用R 4.1.2软件对提取的数据进行meta分析,评估RIC对AIS的干预效果。结果共检索文献1962篇,纳入有效RCT研究20篇,涉及研究对象4030例。20篇文献中18篇文献质量中等、2篇文献质量较低。Meta分析结果显示,干预后与常规西医治疗组相比,RIC联合常规西医治疗组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分较低(MD=-1.82,95%CI:-2.40~-1.24)、改良Rankin量表(modified Rankin scale,mRs)评分较低(MD=-0.54,95%CI:-0.67~-0.40)、Barthel指数较高(Barthel index,BI)(MD=8.7,95%CI:6.80~10.61),神经功能预后较好(RR=1.08,95%CI:1.04~1.13),差异均有统计学意义(P<0.01)。各项研究均未出现严重不良反应。结论RIC干预AIS的疗效显著,具有较好的安全性,值得临床推广。
基金Under the auspices of National Key Research and Development Program of China(No.2023YFB4302200)National Natural Science Foundation of China(No.71831002,72174053)+1 种基金Liaoning Province Xingliao Talent Plan(No.XLYC2008030)Talent Planning in Dalian(No.2022RG05)。
文摘In the context of building a country with a strong transportation network,railway container transportation(RCT)is an important means of reducing costs,increasing efficiency,and adjusting transportation structures.Thus,its impact on regional economic development is important.Based on data from railway container-handling stations and spatial econometric models,this study discusses the differences in the development of RCT and their impact on regional economic development at different leves.This study has three main findings:first,there are significant regional differences in the development of the RCT.The intra-regional differences between the eastern and central regions of China(which do not include Hong Kong,Macao and Taiwan)are gradually narrowing,while the regional differences in the western region are widening.Meanwhile,the intra-regional differences in important economic zones such as Pearl River Delta Economic Zone(PRDEZ),Chengdu-Chongqing Economic Zone(CYEZ),Bohai Rim Economic Zone(BHEZ),and Yangtze River Delta Economic Zone(YRDEZ)are narrowing daily.Second,the development differences of RCT in regional level and important economic regions level show different trends.The unbalanced features of large regions are increasingly evident,whereas the differences in economic regions are decreasing.However,the problem of overlapping RCT remains prominent.Third,the transformation of RCT development mode and fierce competition among transportation modes cause RCT to have a restraining effect on the regional economy at three levels.Rational allocation of resources and other means must be used to guide the transformation from inhibition to promotion,and by formulating targeted policies that will promote the development of RCT,which will improve the transportation structure and help construct a country with a strong transportation system.
