BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroa...Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.展开更多
Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and d...Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.展开更多
Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the t...Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.展开更多
BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a n...BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.展开更多
Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web...Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.展开更多
BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy ...BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.展开更多
Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are ...Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.展开更多
Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,gly...Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.展开更多
Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key...Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.展开更多
Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its eff...Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its efficacy remains uncertain.To evaluate this,researchers conducted a search of EMBASE,Web of Science,PubMed,and the Cochrane Library for relevant articles.They included 33 studies with 17 cohorts,assessed the quality using the Newcastle-Ottawa Scale,and performed statistical analyses with Review Manager and STATA software.The results showed that cancer patients receiving CHM had a significantly reduced mortality risk(relative risk=0.79,95%confidence interval=0.72–0.86;P<0.00001).Both the unadjusted hazard ratio(HR)and the adjusted HR indicated a substantially and consistently lowered mortality risk for CHM-treated patients(unadjusted:P=0.00,I2=98.1%,HR=0.57,95%confidence interval=0.52–0.62;adjusted:P<0.00001,I2=98%,HR=0.59,95%confidence interval=0.53–0.66).Subgroup analysis by tumor type showed that CHM reduced mortality risk in patients with respiratory and digestive cancers.In conclusion,CHM treatment,either alone or in combination with chemotherapy,significantly decreases mortality risk in cancer patients.However,these findings need further verification through large-scale,multicenter,high-quality,long-term trials.展开更多
Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its ef...Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its efficacy in advanced stage remains limited. This systematic review and meta-analysis aimed to quantify the effects of exercise on CRF and its common complications in patients with advanced lung cancer.Methods: A systematic search of 4 databases(Pub Med, Embase, Cochrane, and Web of Science) was conducted up to July 10, 2024 to identify relevant randomized controlled trials(RCTs). Studies were selected based on predefined eligibility criteria, including adult patients with advanced lung cancer reporting fatigue as an outcome. Study selection followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses(PRISMA) 2020 guidelines, and the risk of bias was assessed using the Cochrane Risk of Bias tool(Ro B 2.0). The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation(GRADE) system. Random-or fixed-effects models were used for meta-analyses based on heterogeneity levels.Results: Eight RCTs involving 749 patients were included. Meta-analysis revealed that exercise significantly improved CRF in patients with advanced lung cancer(standardized mean difference(SMD) =-0.33;95% confidence interval(95%CI):-0.54 to-0.12);p = 0.00;I2= 0.00%).Subgroup analysis showed greater efficacy in patients aged ≤60 years(p = 0.028), those engaging in traditional Chinese exercise(p = 0.003),and interventions lasting fewer than 12 weeks(p = 0.017). Exercise also significantly improved quality of life(SMD = 0.29;95%CI: 0.02-0.55;p = 0.04;I2= 0.00%) and reduced dyspnea(SMD =-0.43;95%CI:-0.71 to-0.16;p = 0.00;I2= 0.00%). No significant effects were observed on sleep quality, anxiety, or depression. The risk of bias across studies was moderate, and the quality of evidence, as evaluated by GRADE, was rated as low due to study limitations. Adverse events were minimal, with only one mild, exercise-related event reported.Conclusion: Exercise significantly alleviates CRF in patients with advanced lung cancer, improves certain complications, and enhances quality of life. The intervention's effectiveness varies by age, type of exercise, and duration. Further high-quality studies are needed to validate these findings.展开更多
Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis...Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis sought to thoroughly examine the direct and indirect relationships betweenmindfulness and learning burnout.Methods:a comprehensive literature search was conducted in Scopus,Google Scholar,and Web of Science databases until 07 July 2024.A comprehensive literature review analysis of 19 articles was included,which identified three dimensions of learning burnout:emotions,behaviors,and outcomes,determined the indirect and direct relationships between mindfulness and learning burnout,and outlined the indirect relationship between mindfulness and learning burnout.This meta-analysis incorporated data from nine studies,encompassing a total of 5227 university students experiencing learning burnout.Results:the findings revealed a significant negative correlation between mindfulness and learning burnout,with a correlation coefficient of r=-0.396,(98.6%CI[-0.521,-0.272]).Additionally,a notable negative relationship was observed between mindfulness and emotional exhaustion,characterized by a correlation coefficient of r=-0.281,(98.0%CI[-0.438,-0.123]).It also found that mindfulness indirectly influenced learning burnout by other factors(such as self-efficacy,social support,and so on).However,the empirical analysis of the indirect relationship is not supported by sufficient meta-data.Conclusion:this study indicates that there is a significant and negative direct relationship or some indirect correlation between learning burnout and mindfulness,which may affect learning burnout through internal and external factors.These results also highlight the urgent need for a more in-depth exploration of the indirect mechanisms influencing the relationship between mindfulness and learning burnout.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow fr...BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.展开更多
BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes ...BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus.Nursing interventions are crucial for managing the disease and preventing complications.AIM To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.METHODS This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables,such as glycated haemoglobin and fasting plasma glucose.RESULTS After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables,a descriptive analysis of the studies with the most significant changes was conducted.Based on this,an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient’s technological skills.CONCLUSION The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.展开更多
A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysi...A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysis were conducted to estimate candidemia prevalence and identify patterns of Candida species in South-eastern Asia.Systematic electronic-databases literature search was performed on published studies recorded candidemia prevalence in South-Eastern Asia.Using meta-analysis of proportions,the overall pooled prevalences of candidemia by Candida(C.)albicans,C.tropicalis,C.parapsilosis and C.glabrata were calculated as 28.4%(95%CI 24.9-31.8),29.2%(95%CI 24.7-33.7),19.1%(95%CI 14.8-23.4)and 14.0%(95%CI 10.4-17.5),respectively.Based on publication year and country,subgroup analyses were conducted on Candida species to determine heterogeneity source.The findings may not precisely reflect true candidemia prevalence in different countries.Therefore,it highlights continuous need to conduct prevalence studies,assess and monitor growing burden,control effect of potential risk factors and implement regional surveillance programs to prevent further rise.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the hear...BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the heart,has been proposed as a good preventive against POAF.However,evidence on its effectiveness remains incon-sistent.AIM To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.METHODS This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was conducted across PubMed,Cochrane,ScienceDirect,and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords.Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies-of Interventions tools.Study analysis was performed using Review Manager version 5.4,with heterogeneity assessed via I^(2) values and appropriate fixed-or randomeffects models applied.RESULTS Five studies(N=1266)were included,with 627 patients undergoing cardiac denervation and 639 serving as controls.Denervation did not significantly reduce overall POAF[odds ratio=0.71;95%confidence interval(CI):0.32-1.58;P=0.40;I^(2)=83%],but was associated with a significant reduction in persistent atrial fibrillation(odds ratio=0.19;95%CI:0.10-0.36;P<0.00001;I^(2)=0%).Among secondary outcomes,only postoperative serum magnesium levels significantly reduced the denervation group(mean difference:-0.07 mmol/L;95%CI:-0.08 to-0.06;P<0.00001).Other outcomes,such as reoperation for bleeding,stroke/transient ischemic attack,length of hospital stay,30-day mortality,and postoperative drainage,did not show any significant difference.CONCLUSION Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation.It is also shown to decrease serum magnesium levels.Other outcomes,such as stroke,reoperation,and hospital stay,showed no significant differences.展开更多
BACKGROUND Pediatric short bowel syndrome(SBS)poses management challenges,and teduglutide is a potential therapy.However,comprehensive data on its pediatric safety are lacking.AIM To evaluate the impact of teduglutide...BACKGROUND Pediatric short bowel syndrome(SBS)poses management challenges,and teduglutide is a potential therapy.However,comprehensive data on its pediatric safety are lacking.AIM To evaluate the impact of teduglutide on infection and gastrointestinal adverse events in pediatric SBS patients via systematic review and meta-analysis.METHODS Following PRISMA 2009 guidelines and PROSPERO registration,we searched PubMed,Web of Science,and EMBASE for randomized controlled trials(RCTs)(pediatric SBS patients≤18 years;teduglutide vs placebo/standard care).Two reviewers screened studies,extracted data,and assessed bias(ROB2).Metaanalyses used RevMan 5.4(Mantel-Haenszel method,random-effects if I^(2)≠0).Trial sequential analysis and GRADE were applied.RESULTS Three RCTs involving 115 pediatric patients were included.Pooled analysis revealed no statistically significant differences between the teduglutide and control groups for the primary outcome of infection events[RR=0.83;(95%CI:0.44-1.56);P=0.57;I^(2)=0%;2 studies,n=55].Similarly,no significant differences were found for secondary outcomes:Upper respiratory tract infection[RR=0.68;(95%CI:0.32-1.47);P=0.33;I^(2)=0%],catheter site infection[RR=1.86;(95%CI:0.23-14.78);P=0.56;I^(2)=0%],vomiting[RR=1.35;(95%CI:0.10-18.23);P=0.82;I^(2)=72%],abdominal pain[RR=2.47;(95%CI:0.50-12.16);P=0.27;I^(2)=0%],nausea[RR=1.31;(95%CI:0.24-7.22);P=0.75;I^(2)=0%],diarrhea[RR=1.02;(95%CI:0.23-4.43);P=0.98;I^(2)=0%],and abdominal distension[RR=1.49;(95%CI:0.18-12.35);P=0.71;I^(2)=0%].The overall certainty of evidence assessed by GRADE was moderate.CONCLUSION Teduglutide does not increase infection or gastrointestinal adverse event risk in pediatric SBS,but small sample sizes limit conclusions.Larger studies are needed.展开更多
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+2 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
基金supported by the National Natural Science Foundation of China,Nos.82174496(to NW),82374574(to NW),82302865(to LL)Shanghai Science and Technology Committee Sailing Program,Nos.23YF1403800(to LL),23YF1405200(to YX)Shanghai Hospital Development Center Foundation-Shanghai Municipal Hospital Rehabilitation Medicine Specialty Alliance,No.SHDC22023304(to YW).
文摘Stroke remains a leading cause of death and disability worldwide,and electroacupuncture has a long history of use in stroke treatment.This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke.The PubMed,EMBASE,Web of Science,CENTRAL,and CINAHL databases were comprehensively searched up to May 1,2024.This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke.Data from 70 eligible studies were analyzed in Stata 18.0,using a random-effects model to calculate the standardized mean difference(Hedge’s g).The risk of bias was assessed using RevMan 5.4 software,and the quality of evidence was rated according to the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)system.Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness.The quality assessment revealed that most studies adequately handled incomplete data and selective reporting.However,several methodological limitations were identified:only 4 studies demonstrated a low risk of allocation concealment,26 achieved a low risk of outcome assessment bias,and 9 had a high risk of randomization bias.Additionally,there was an unclear risk regarding participant blinding and other methodological aspects.The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality.The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways:(1)Electroacupuncture significantly reduced infarct volume and apoptotic cell death(P<0.01)in ischemic stroke models;(2)electroacupuncture significantly decreased the levels of pro-inflammatory factors(P<0.01)while increasing the levels of anti-inflammatory factors(P=0.02);(3)electroacupuncture reduced the levels of oxidative stress indicators(P<0.01)and enhanced the expression of antioxidant enzymes(P<0.01);(4)electroacupuncture significantly promoted nerve regeneration(P<0.01);and(5)electroacupuncture influenced blood flow remodeling(P<0.01)and angiogenesis(P<0.01).Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model(P<0.01)and in post-middle cerebral artery occlusion intervention(P<0.01).Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects(P<0.01),while scalp acupoints demonstrated greater efficacy than body acupoints(P<0.01).The heterogeneity among the included studies was minimal,and sensitivity analyses indicated stable results.Their methodological quality was generally satisfactory.In conclusion,electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis,oxidative stress,inflammation,stroke-induced nerve regeneration,blood flow remodeling,and angiogenesis.The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model,the timing of intervention onset,waveform,and acupoint selection.Despite the moderate to low quality of evidence,these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.
文摘Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.
文摘Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.
文摘BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.
基金Supported by the Capital Health Development Research Special Program:2022-4-7016。
文摘Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.
文摘BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.
基金Supported by Capital's Funds for Health Improvement and Research:CFH2024-2-2235China National Natural Science Foundation:82074179,82374575+3 种基金Beijing Natural Science Foundation:7232270Outstanding Young Talents Program of Capital Medial University:B2207Beijing Hospital Management Center "peak" Talent Training Plan Team:DFL20241001Fifth Batch of National TCM Clinical Outstanding Talents Project。
文摘Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.
基金funded by the Seed Funding of the Beijing University of Chinese Medicine(90011451310034).
文摘Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.
文摘Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.
基金supported by the National Natural Science Foundation of China(No.82060519,81760519,81560429)the Yunnan Provincial Department of Science and Technology-Yunnan University of Chinese Medicine Applied Basic Research Joint Special Key Project(2019FF002(-011))+3 种基金Yunnan Province 10,000 people plan young top-notch talents(YNWR-QNBJ-2018-212)Yunnan Provincial Department of Science and Technology-Yunnan University of Chinese Medicine Applied Basic Research Joint Special Project(202301AZ070001-062)State Administration of Traditional Chinese Medicine High-level Chinese Medicine Key Discipline Construction Project“Dai Medicine”Yunnan Science and Technology Talent and Platform Program(202105AG070012).
文摘Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its efficacy remains uncertain.To evaluate this,researchers conducted a search of EMBASE,Web of Science,PubMed,and the Cochrane Library for relevant articles.They included 33 studies with 17 cohorts,assessed the quality using the Newcastle-Ottawa Scale,and performed statistical analyses with Review Manager and STATA software.The results showed that cancer patients receiving CHM had a significantly reduced mortality risk(relative risk=0.79,95%confidence interval=0.72–0.86;P<0.00001).Both the unadjusted hazard ratio(HR)and the adjusted HR indicated a substantially and consistently lowered mortality risk for CHM-treated patients(unadjusted:P=0.00,I2=98.1%,HR=0.57,95%confidence interval=0.52–0.62;adjusted:P<0.00001,I2=98%,HR=0.59,95%confidence interval=0.53–0.66).Subgroup analysis by tumor type showed that CHM reduced mortality risk in patients with respiratory and digestive cancers.In conclusion,CHM treatment,either alone or in combination with chemotherapy,significantly decreases mortality risk in cancer patients.However,these findings need further verification through large-scale,multicenter,high-quality,long-term trials.
基金supported by funding from the National Key Research and Development Program of China(Research Project of Modernization on TCM,Grant number:2018YFC1707406)。
文摘Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its efficacy in advanced stage remains limited. This systematic review and meta-analysis aimed to quantify the effects of exercise on CRF and its common complications in patients with advanced lung cancer.Methods: A systematic search of 4 databases(Pub Med, Embase, Cochrane, and Web of Science) was conducted up to July 10, 2024 to identify relevant randomized controlled trials(RCTs). Studies were selected based on predefined eligibility criteria, including adult patients with advanced lung cancer reporting fatigue as an outcome. Study selection followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses(PRISMA) 2020 guidelines, and the risk of bias was assessed using the Cochrane Risk of Bias tool(Ro B 2.0). The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation(GRADE) system. Random-or fixed-effects models were used for meta-analyses based on heterogeneity levels.Results: Eight RCTs involving 749 patients were included. Meta-analysis revealed that exercise significantly improved CRF in patients with advanced lung cancer(standardized mean difference(SMD) =-0.33;95% confidence interval(95%CI):-0.54 to-0.12);p = 0.00;I2= 0.00%).Subgroup analysis showed greater efficacy in patients aged ≤60 years(p = 0.028), those engaging in traditional Chinese exercise(p = 0.003),and interventions lasting fewer than 12 weeks(p = 0.017). Exercise also significantly improved quality of life(SMD = 0.29;95%CI: 0.02-0.55;p = 0.04;I2= 0.00%) and reduced dyspnea(SMD =-0.43;95%CI:-0.71 to-0.16;p = 0.00;I2= 0.00%). No significant effects were observed on sleep quality, anxiety, or depression. The risk of bias across studies was moderate, and the quality of evidence, as evaluated by GRADE, was rated as low due to study limitations. Adverse events were minimal, with only one mild, exercise-related event reported.Conclusion: Exercise significantly alleviates CRF in patients with advanced lung cancer, improves certain complications, and enhances quality of life. The intervention's effectiveness varies by age, type of exercise, and duration. Further high-quality studies are needed to validate these findings.
文摘Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis sought to thoroughly examine the direct and indirect relationships betweenmindfulness and learning burnout.Methods:a comprehensive literature search was conducted in Scopus,Google Scholar,and Web of Science databases until 07 July 2024.A comprehensive literature review analysis of 19 articles was included,which identified three dimensions of learning burnout:emotions,behaviors,and outcomes,determined the indirect and direct relationships between mindfulness and learning burnout,and outlined the indirect relationship between mindfulness and learning burnout.This meta-analysis incorporated data from nine studies,encompassing a total of 5227 university students experiencing learning burnout.Results:the findings revealed a significant negative correlation between mindfulness and learning burnout,with a correlation coefficient of r=-0.396,(98.6%CI[-0.521,-0.272]).Additionally,a notable negative relationship was observed between mindfulness and emotional exhaustion,characterized by a correlation coefficient of r=-0.281,(98.0%CI[-0.438,-0.123]).It also found that mindfulness indirectly influenced learning burnout by other factors(such as self-efficacy,social support,and so on).However,the empirical analysis of the indirect relationship is not supported by sufficient meta-data.Conclusion:this study indicates that there is a significant and negative direct relationship or some indirect correlation between learning burnout and mindfulness,which may affect learning burnout through internal and external factors.These results also highlight the urgent need for a more in-depth exploration of the indirect mechanisms influencing the relationship between mindfulness and learning burnout.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
文摘BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.
文摘BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus.Nursing interventions are crucial for managing the disease and preventing complications.AIM To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.METHODS This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables,such as glycated haemoglobin and fasting plasma glucose.RESULTS After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables,a descriptive analysis of the studies with the most significant changes was conducted.Based on this,an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient’s technological skills.CONCLUSION The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.
文摘A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysis were conducted to estimate candidemia prevalence and identify patterns of Candida species in South-eastern Asia.Systematic electronic-databases literature search was performed on published studies recorded candidemia prevalence in South-Eastern Asia.Using meta-analysis of proportions,the overall pooled prevalences of candidemia by Candida(C.)albicans,C.tropicalis,C.parapsilosis and C.glabrata were calculated as 28.4%(95%CI 24.9-31.8),29.2%(95%CI 24.7-33.7),19.1%(95%CI 14.8-23.4)and 14.0%(95%CI 10.4-17.5),respectively.Based on publication year and country,subgroup analyses were conducted on Candida species to determine heterogeneity source.The findings may not precisely reflect true candidemia prevalence in different countries.Therefore,it highlights continuous need to conduct prevalence studies,assess and monitor growing burden,control effect of potential risk factors and implement regional surveillance programs to prevent further rise.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
文摘BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the heart,has been proposed as a good preventive against POAF.However,evidence on its effectiveness remains incon-sistent.AIM To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.METHODS This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was conducted across PubMed,Cochrane,ScienceDirect,and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords.Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies-of Interventions tools.Study analysis was performed using Review Manager version 5.4,with heterogeneity assessed via I^(2) values and appropriate fixed-or randomeffects models applied.RESULTS Five studies(N=1266)were included,with 627 patients undergoing cardiac denervation and 639 serving as controls.Denervation did not significantly reduce overall POAF[odds ratio=0.71;95%confidence interval(CI):0.32-1.58;P=0.40;I^(2)=83%],but was associated with a significant reduction in persistent atrial fibrillation(odds ratio=0.19;95%CI:0.10-0.36;P<0.00001;I^(2)=0%).Among secondary outcomes,only postoperative serum magnesium levels significantly reduced the denervation group(mean difference:-0.07 mmol/L;95%CI:-0.08 to-0.06;P<0.00001).Other outcomes,such as reoperation for bleeding,stroke/transient ischemic attack,length of hospital stay,30-day mortality,and postoperative drainage,did not show any significant difference.CONCLUSION Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation.It is also shown to decrease serum magnesium levels.Other outcomes,such as stroke,reoperation,and hospital stay,showed no significant differences.
文摘BACKGROUND Pediatric short bowel syndrome(SBS)poses management challenges,and teduglutide is a potential therapy.However,comprehensive data on its pediatric safety are lacking.AIM To evaluate the impact of teduglutide on infection and gastrointestinal adverse events in pediatric SBS patients via systematic review and meta-analysis.METHODS Following PRISMA 2009 guidelines and PROSPERO registration,we searched PubMed,Web of Science,and EMBASE for randomized controlled trials(RCTs)(pediatric SBS patients≤18 years;teduglutide vs placebo/standard care).Two reviewers screened studies,extracted data,and assessed bias(ROB2).Metaanalyses used RevMan 5.4(Mantel-Haenszel method,random-effects if I^(2)≠0).Trial sequential analysis and GRADE were applied.RESULTS Three RCTs involving 115 pediatric patients were included.Pooled analysis revealed no statistically significant differences between the teduglutide and control groups for the primary outcome of infection events[RR=0.83;(95%CI:0.44-1.56);P=0.57;I^(2)=0%;2 studies,n=55].Similarly,no significant differences were found for secondary outcomes:Upper respiratory tract infection[RR=0.68;(95%CI:0.32-1.47);P=0.33;I^(2)=0%],catheter site infection[RR=1.86;(95%CI:0.23-14.78);P=0.56;I^(2)=0%],vomiting[RR=1.35;(95%CI:0.10-18.23);P=0.82;I^(2)=72%],abdominal pain[RR=2.47;(95%CI:0.50-12.16);P=0.27;I^(2)=0%],nausea[RR=1.31;(95%CI:0.24-7.22);P=0.75;I^(2)=0%],diarrhea[RR=1.02;(95%CI:0.23-4.43);P=0.98;I^(2)=0%],and abdominal distension[RR=1.49;(95%CI:0.18-12.35);P=0.71;I^(2)=0%].The overall certainty of evidence assessed by GRADE was moderate.CONCLUSION Teduglutide does not increase infection or gastrointestinal adverse event risk in pediatric SBS,but small sample sizes limit conclusions.Larger studies are needed.
