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
Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire n...Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.展开更多
Objective:The aim of this study was to assess the effectiveness of mindfulness meditation(MM)on anxiety,depression,stress and mindfulness in nursing students.Methods:A comprehensive search and screening procedures wer...Objective:The aim of this study was to assess the effectiveness of mindfulness meditation(MM)on anxiety,depression,stress and mindfulness in nursing students.Methods:A comprehensive search and screening procedures were conducted to locate all MM interventions implemented with nursing students.For randomized controlled trials(RCTs)in accordance with the inclusion criteria,a search was conducted in PubMed,Embase,Web of Science,Medline,PsycINFO,Cumulative Index to Nursing and Allied Health(CINAHL),Cochrane Central Register of Controlled Trials(CENTRAL),China Biology Medicine(CBM),Chinese National Knowledge Infrastructure(CNKI)and Wanfang.Databases were retrieved from inception through August 2018.Additional studies were identified through hand searches and Internet searches.Two reviewers collected relevant data of eligible articles according to the data extraction tables.Based on Cochrane Handbook,critical appraisal of the methodological quality was assessed by two other reviewers.An Excel form was used to extract main characteristics of included RCTs.Meta-analysis and trial sequential analysis(TSA)were carried out using software RevMan 5.3 and TSA 0.9.Results:Five RCTs with 257 nursing students were included.Only two studies were assessed as high quality and three studies were evaluated as moderate quality.Meta-analysis showed that,comparing with the control group,MM could significantly improve anxiety(SMD=?0.45,95%CI?0.73 to?0.17,P=0.001)and stress(SMD=?0.69,95%CI?0.97 to?0.40,P<0.001).TSA results confirmed that the outcome of the merger is credible.It could also significantly improve depression level of nursing students after 8 weeks intervention duration(SMD=?0.70,95%CI?1.14 to?0.26,P=0.002).However,there was no beneficial effect on depression level of nursing students with 1 week intervention duration(SMD=0.09,95%CI?0.42 to 0.59,P=0.74)and its effects on mindfulness level of nursing students also did not show statistical significance(SMD=0.37,95%CI?0.04 to 0.77,P=0.07).No definitive conclusions were drawn from the TSA.Conclusions:The results of this meta-analysis indicated that MM could effectively reduce the level of anxiety and stress of nursing students.TSA confirmed that the results of meta-analysis are credible.For depression,it could also significantly improve depression of nursing students with 8 weeks intervention,but there was no significant effect on nursing students with 1 week intervention duration.There was also no beneficial effect on mindfulness level of nursing students.However,TSA indicated that the accumulated evidence is still inconclusive.We suggest that more well-designed clinical trials with large sample and higher quality would be required in future to draw a definitive conclusion.展开更多
Objective:To evaluate the efficacy and safety of Rupi Sanjie(RPSJ)capsule plus the conventional surgical operation for treatment of hyperplasia nodule of mammary gland.Methods:A meta-analysis was conducted on randomiz...Objective:To evaluate the efficacy and safety of Rupi Sanjie(RPSJ)capsule plus the conventional surgical operation for treatment of hyperplasia nodule of mammary gland.Methods:A meta-analysis was conducted on randomized controlled trials(RCT)related to RPSJ capsule plus surgical operation in the treatment of hyperplasia nodule of mammary gland.The methodological quality of eligible RCTs was assessed according to the criteria from the Cochrane Handbook for Systematic Reviews of Interventions.RevMan5.3 and Stata14.0 were used for data analyses.Trial sequential analysis was performed to estimate the sample size of systematic review base on TSA software v0.9.Results:Twenty-two RCTs were totally included in this study,involving 2135 patients.The result showed the clinical recurrence rate of RPSJ capsule plus surgical treatment group was significantly lower than surgical treatment alone group(RR:0.25,95%CI[0.17,0.37],P<0.01).The clinical cure rate and total effective rate were higher in RPSJ capsule plus surgical treatment group than the conventional surgical treatment group(RR:1.63,95%CI[1.46,1.82],P<0.01);(RR:1.29,95%CI[1.22,1.37],P<0.01).Application of RPSJ capsule decreased the occurrence of adverse events including nausea,vomiting,irregular menstruation,constipation,dizziness,and headache etc.(RR:0.90,95%CI[0.54,1.49],P=0.68).The results of trial sequential analysis demonstrated that the current available data did not reach the expected value.Conclusion:RPSJ capsule plus the conventional surgical treatment was more effective in reducing the clinical recurrence rate,and improving the total clinical effective rate and clinical cure rate,with a decrease in the occurrence of adverse events.展开更多
Objective:To evaluate the clinical efficacy of warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis.Methods:A search for published randomized controlled trials(RCT)inv...Objective:To evaluate the clinical efficacy of warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis.Methods:A search for published randomized controlled trials(RCT)investigating warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis was performed using the Cochrane Library,PubMed,Embase,and Web of Science databases.According to requirements of the Cochrane systematic review,all evaluations of RCT investigating warming acupuncture with joint mobilization in the treatment of scapulohumeral periarthritis were performed via method quality assessment,data extraction,and data analysis.Revman 5.3 and Stata 12.0 statistical software were used for the meta-analysis,and the trial sequential analysis(TSA)software estimated the required information size for each outcome.Results:A total of 14 articles were retrieved for meta-analysis,which included 551 cases in the treatment group and 539 cases in the control group.Meta-analysis showed that:(1)warming acupuncture combined with joint mobilization improved total efficiency[OR=6.16,95%CI(3.79,10.00),Z=7.34;P<0.001),TSA results confirmed the results of the meta-analysis;(2)warming acupuncture combined with joint mobilization improved the cure rate[OR=2.84,95%CI(2.19,3.70),P<0.001],TSA results revealed that no further tests were needed to verify;(3)warming acupuncture combined with joint mobilization reduced the number of treatments required for healing[MD=-7.49,95%CI(-9.75,-5.23),P<0.001],TSA results confirmed the results of the meta-analysis;(4)in comparing visual analog scale scores before and after treatment,meta-analysis result showed that:SMD=-2.01,95%CI(-2.37,-1.65),P<0.001,the difference was statistically significant,TSA results confirmed the results of the meta-analysis.Conclusion:Warming acupuncture combined with joint mobilization had a significant effect on the treatment of scapulohumeral periarthritis.展开更多
Objective： To evaluate the effect of moxibustion on knee osteoarthritis patients with cumulative meta-analysis, and trial sequential analysis was applied to test the authenticity of results. Methods： We searched Pub...Objective： To evaluate the effect of moxibustion on knee osteoarthritis patients with cumulative meta-analysis, and trial sequential analysis was applied to test the authenticity of results. Methods： We searched PubMed, EMbase, The Cochrane Library, CNKI and CBM to collect RCTs about moxibustion on knee osteoarthritis patients. The selection of literature, data extraction and evaluation of eligible literature were carried out independently by two reviewers. Then Stata11.0 software was used for data analysis. Result： Totally 11 RCTs involved 1005 patients were recruited. The results of meta-analysis showed that no significant differences were found between the two groups in VAS, moxibustion is better than drug therapy in effective rate [OR = 0.40, 95%CI （0.27, 0.60）] and knee score [SMD = -0.70, 95%CI （-1.22, -0.19）]. The result of trial sequential analysis indicated that the sample size didn＇t reach the TSA Boundary on VAS, the sample size of effectiveness achieved Require Information Size. In the indicator of knee score has obtained certain re- sult before reaching the Require Information Size. Conclusion： moxibustion is superior to drug therapy on treatment knee osteoarthritis. However, large sample size and high-quality studies are still needed.展开更多
Background:Traditional Chinese Medicines(TCM)had been indicated to benefit for the chronic non-infectious diseases,such as cancers,hypertension,primary dysmenorrheal,etc.Although randomized controlled trials(RCTs)had ...Background:Traditional Chinese Medicines(TCM)had been indicated to benefit for the chronic non-infectious diseases,such as cancers,hypertension,primary dysmenorrheal,etc.Although randomized controlled trials(RCTs)had been conducted,there was still the controversy on the efficacy of Jinhuang powder for diabetic foot ulcers(DFUs).Objective:This systematic review aimed to objectively evaluate the potential of Jinhuang powder for DFUs.Methods:Seven databases(CNKI,Chongqing VIP,Wanfang database,CBM,the Cochrane Library,PubMed and Web of Science)were searched to retrieve RCTs up to December,2016;and the relevant references of the eligible studies were screened.According to the eligible criteria,the literature was screened;data were extracted;and then the methodological quality was assessed.The meta-analysis,power analysis and trial sequential analysis(TSA)were performed by using Meta analyst software(version beta 3.13),Stata 12.0,Power and Precision statistical software package(Biostat)and TSA software(version0.9),respectively.Results:Finally,three RCTs with 198 participants were included.The results of meta-analysis showed that there were statistically significant differences between groups in(1)the cure rate(RR,1.25;95%CI.1.10to1.41;P=0.00)and(2)the wound healing time(SMD,-3.404;95%CI,-5.821 to -0.987;P=0.00).Three trials presented more than 80% power with 0.05α-errors in both outcomes and the power of two meta-analyses to pool different outcomes presented more than 95%.The TSA showed that the summary results were certain.Conclusion:The external application with Jinhuang powder was an effective and cost-effective therapy for DFUs.The power analysis and TSA showed that the efficacy of Jinhuang powder dressing for the treatment of DFUs is conclusive.展开更多
Objective:To systematically review the efficacy and clinical safety of Qizhi Weitong Granules(气滞胃痛颗粒)(QZWT)in the treatment of irritable bowel syndrome with predominant constipation(IBS-C).Methods:Randomized con...Objective:To systematically review the efficacy and clinical safety of Qizhi Weitong Granules(气滞胃痛颗粒)(QZWT)in the treatment of irritable bowel syndrome with predominant constipation(IBS-C).Methods:Randomized controlled trials(RCTs)of QZWT in patients with IBS-C were retrieved from Pub Med,EMBASE,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),and Chinese Biological Medical Database(CBM)from inception to December 3,2022.Conventional meta-analysis with random-effects model or fixed-effects model and trial sequential analysis(TSA)were performed by Review Manager 5.4,Stata and TSA software.Results:A total of 4 RCTs and 368 patients with IBS-C were included in this study.The findings of the meta-analysis indicated that the cure and efficacy rate of the experimental group was significantly higher than that of the control group[RR=2.19;(95%CI,1.35–3.55),P<0.01;RR=1.14;(95%CI,1.03–1.27),P<0.05],while the result of Bristol Score was negative.The funnel plot was probably symmetry,and the P value was>0.05 in the Egger test,which confirmed the nonexistence of significant publication bias in this outcome.TSA showed the cumulative z-value crossed the traditional threshold and TSA threshold,while it didn't get to the required information size.Finally,2 studies reported adverse events after QZWT treatment,including 3 cases of diarrhea.No serious adverse events were reported.Conclusion:QZWT was an effective and safe complementary therapy in the treatment of IBS-C with no obvious adverse reactions.TSA analysis confirmed our meta-analysis results.Therefore,QZWT may be a potential candidate for the treatment of IBS-C.However,due to the limited quality of current studies,more long-term,randomized,double-blinded clinical trials are needed in future studies.展开更多
BACKGROUND The benefits and risks of Xileisan(XLS)in the treatment of ulcerative colitis(UC)remain unclear.AIM The present study aimed to evaluate the efficacy and safety of the combination of XLS and mesalazine when ...BACKGROUND The benefits and risks of Xileisan(XLS)in the treatment of ulcerative colitis(UC)remain unclear.AIM The present study aimed to evaluate the efficacy and safety of the combination of XLS and mesalazine when treating UC.METHODS We searched eight databases for clinical trials evaluating the combination of XLS and mesalazine in the treatment of UC,up to January 2024.Meta-analysis and trial sequential analysis(TSA)were performed using Revman 5.3 and TSA 0.9.5.10 beta,respectively.RESULTS The present study included 13 clinical studies involving 990 patients,of which 501 patients received XLS combined with mesalazine while 489 patients received mesalazine alone.The meta-analysis showed that,in terms of efficacy,the combination of XLS and mesalazine significantly improved the clinical efficacy rate by 22%[risk ratio(RR)=1.22;95%CI:1.15–1.28;P<0.00001]and mucosal improvement rate by 25%(RR=1.25;95%CI:1.12–1.39;P=0.0001),while significantly reducing the duration of abdominal pain by 2.25 days[mean difference(MD)=-2.25;95%CI:-3.35 to-1.14;P<0.0001],diarrhea by 2.06 days(MD=-2.06;95%CI:-3.92 to-0.20;P=0.03),hematochezia by 2.32 days(MD=-2.32;95%CI:-4.02 to-0.62;P=0.008),tumor necrosis factor alpha by 16.25 ng/mL(MD=-16.25;95%CI:-20.48 to-12.01;P<0.00001),and interleukin-6 by 14.14 ng/mL(MD=-14.14;95%CI:-24.89 to-3.39;P=0.01).The TSA indicated conclusiveness in the meta-analysis of the efficacy endpoints.In terms of safety,the meta-analysis revealed that the combination of XLS and mesalazine did not increase the occurrence of total and gastrointestinal adverse events,abdominal distension,and erythema(P>0.05).The TSA showed non conclusive findings in the meta-analysis of the safety endpoints.Harbord’s test showed no publication bias(P=0.734).CONCLUSION Treatment with XLS alleviated the clinical symptoms,intestinal mucosal injury,and inflammatory response in patients with UC,while demonstrating good safety.展开更多
Objective:To evaluate the efficiency of Bushen Huoxue method with ACEI/ARB in treating diabetic kidney disease(stageⅢ).Methods:A total of 8 major electronic databases(CNKI,WanFang,VIP,Sinomed,Pubmed,Embase,Cochrane L...Objective:To evaluate the efficiency of Bushen Huoxue method with ACEI/ARB in treating diabetic kidney disease(stageⅢ).Methods:A total of 8 major electronic databases(CNKI,WanFang,VIP,Sinomed,Pubmed,Embase,Cochrane Liberary,Web of Science)were retrieved since the establishment of the database to October 9,2019.Two reviewers extracted data,and assessed the methodological quality of the included studies.The analysis was made by Stata 15.0 and TSA 0.9 softwares.Results:A total of 10 RCT studies were obtained,including 711 patients with diabetic kidney disease of stageⅢ.Meta-analysis showed that the method of Bushen Huoxue with ACEI/ARB could reduce UAER[WMD=-31.24,95%CI(-42.98,-19.51)],β2-GM[WMD=-92.95,95%CI(-166.05,-19.85)],LDL-C[WMD=-0.19,95%CI(0.19,-0.30)].However,there were no significant effect for HbAlc[WMD=-0.08,95%CI(-0.17,-0.00)],Scr[WMD=-12.96,95%CI(-39.82,13.90)],BUN[WMD=-0.14,95%CI(-0.44,0.17)].The result of TSA indicated that the method of Bushen Huoxue with ACEI/ARB was effective in the treatment of diabetic kidney disease of stageⅢ.Conclusion:The study show that the method of Bushen Huoxue with ACEI/ARB can reduce urinary protein,renal tubular injury and LDL-C in patients with diabetic kidney disease of stageⅢ,and had no effect on HbAlc and renal function.But the conclusion of this study needs further research of high quality.展开更多
[Objectives]To analyze the efficacy of Compound Qingdai Capsule in the treatment of psoriasis and conduct a systematic evaluation.[Methods]The clinical total effective rate,PASI index score,IL-17 level,IL-23 level,TNF...[Objectives]To analyze the efficacy of Compound Qingdai Capsule in the treatment of psoriasis and conduct a systematic evaluation.[Methods]The clinical total effective rate,PASI index score,IL-17 level,IL-23 level,TNF-level,and adverse reactions were analyzed.TSA 0.9 software was used to conduct sequential analysis of the total effective rate,and subgroup analysis was performed according to the average age of the experimental group.[Results]Single application of Compound Qingdai Capsule or in combination with other methods in the treatment of psoriasis was superior to non-Compound Qingdai Capsule group,and the side effects were less than non-Compound Qingdai Capsule group;the n≥40 year-old group had certain heterogeneity,suggesting that the difference was statistically significant,and the effective rate was higher than that of the control group.The funnel plot showed that the graph was asymmetrical,and there may be publication bias or the possibility of low-quality literature.The TSA results indicated that the actual sample size was far lower than the expected sample size,and the cumulative Z value did not reach the TSA cut-off value and more trials need to be included to confirm the efficacy.[Conclusions]Compound Qingdai Capsule has a clear curative effect on psoriasis,and its safety is high.This study can provide relevant evidence for the effectiveness of Chinese patent drugs(CPD)in treating psoriasis.展开更多
In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysi...In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysis that included 4 randomised controlled trials. The end-point was progression at 3 years while the boundary for non-inferiority was set at ±20% in risk ratio. The results of our trial-sequential analysis indicated the futility of maintenance chemotherapy, i.e. proof of no effectiveness. Consequently, no further trials of this type should be performed to assess the effectiveness of this intervention in this clinical condition.展开更多
Objective:To evaluate the effectiveness and safety of fire needling for herpes zoster from randomized clinical trials (RCTs).Methods:We searched Cochrane Central Register of Controlled Trials,Pubmed,Sino-Med,CNKI,VIP,...Objective:To evaluate the effectiveness and safety of fire needling for herpes zoster from randomized clinical trials (RCTs).Methods:We searched Cochrane Central Register of Controlled Trials,Pubmed,Sino-Med,CNKI,VIP,WanFang databases,and conference proceedings to November,2017.RCTs were eligible if they tested fire needling for treating herpes zoster more than 3 times.Two authors screened all references,assessed the risk of bias,extracted data,independently,and analyzed data using Trial Sequential Analysis (TSA).Treatment effects were presented as risk ratio (RR)for binary data and standardized mean difference (SMD) for continuous data with 95% confidence interval (CI).Results:We included 27 RCTs with a total of 1933 participants.Only one RCT had low risk of bias,and the others were of high or moderate risk of bias.For total effectiveness rate (proportion of total number of people who were cured or significant symptom improved),there was no significant difference between Western medicine (acyclovir,valacyclovir,adenosine cobalamin) and fire needling (risk ratio 1.05,95% CI 0.98 to 1.12;n =5).For pain relief (VAS scale):fire needling used alone showed lower scores than Western medicine (SMD-1.37,95% CI-1.77 to-0.97;n =2) or external medicine (diclofenac) (SMD-2.23,95% CI-2.81 to-1.64;n =1).Combination of fire needling and Western medicine was better than Western medicine alone in relieving pain (VAS scale) (SMD-2.19,95% CI-3.40 to-0.97,I2 =94%;n =4).Patients receiving fire needling had lower incidence of neuralgia than those receiving Western medicine (3.3% vs 26.7%,RR 0.09,95% Cl 0.01 to 0.82;n =1) at follow up for 30 days.No serious adverse events such as infection were reported.Conclusion:Fire needling appears to offer relief for alleviating pain in herpes zoster.As the sample size of included trials was small and the quality of studies was generally low,rigorous clinical trials with robust reporting and appropriate outcome measures are still needed.展开更多
Objective： To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods： Systematic sear...Objective： To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods： Systematic searches on PubMed, EM- BASE, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were performed for randomized controlled trials （RCTs） or quasi-RCTs which explored the effects of heated gel mattress on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria, extracted data and assessed quality. Then, meta-analysis and trial sequential analysis were performed by RevMan 5.3 and TSA vO.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results： This systematic review included 10 studies which comprised 7 RCTs and 3 quasi-RCTs, encompassing 773 patients. The results of meta-analysis showed that in heated gel mattress group admission temperature on neonatal intensive care unit （SMD, 0.63; 95% CI, 0.40 to 0.87; P = 0.00）, incidence of hypothermia （RR, 0.73; 95% CI, 0.57 to 0.93; P = 0.01） and hyperthermia （RR, 1.82; 95% CI, 1.31 to 2.541 P = 0.00） compared with the control group had significantly statistical difference; however, there was no significant difference in admission temperature on exothermic mattresses or TransWarmer mattress group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage Ⅲ/Ⅳ between two groups, trial sequential analysis confirmed that the pooled results of admission temperature on neonatal intensive care unit and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusion： Heated gel mattress is a safe and effective re- warming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia and does not increase the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, and high-quality research.展开更多
目的:评估针灸治疗绝经后骨质疏松症的有效性和安全性。方法:从中国知网、维普资讯中文期刊服务平台、万方数据知识服务平台、中国生物医学文献服务系统、Web of Science、PubMed、Embase以及Cochrane Library等数据库检索针灸治疗绝经...目的:评估针灸治疗绝经后骨质疏松症的有效性和安全性。方法:从中国知网、维普资讯中文期刊服务平台、万方数据知识服务平台、中国生物医学文献服务系统、Web of Science、PubMed、Embase以及Cochrane Library等数据库检索针灸治疗绝经后骨质疏松症的临床随机对照试验。检索时间为各数据库建库起至2024-07-23。使用GRADEprofiler和Cochrane随机对照试验偏倚风险评估工具2.0版对纳入研究的证据质量和偏倚风险进行评估。利用StataSE 15和TSA 0.9.5进行Meta分析、异质性分析、敏感性分析、亚组分析、发表偏倚分析、剪补法分析和试验序贯分析。结果:纳入19项随机对照试验,共涉及1464例患者。①通过Meta分析发现,与常规疗法相比,针灸疗法可显著提升总有效率[RR=1.25,95%CI(1.19,1.32),P<0.001]、腰椎L_(2)-L_(4)骨密度[MD=0.08,95%CI(0.05,0.11),P<0.001]、雌激素水平[SMD=0.55,95%CI(0.30,0.81),P<0.001],也可提高股骨颈、股骨大转子、Ward三角等部位骨密度和促性腺激素水平,降低目测类比评分以及改善骨代谢,且不良事件发生率未显著提高;②主要结局指标的亚组分析显示当体质量指数>23.9 kg/m^(2)、总疗程为6个月时,治疗组与对照组无显著性差异,其余亚组均显示治疗组显著优于对照组;③发表偏倚分析显示总有效率方面存在潜在发表偏倚风险,但通过剪补法分析显示该风险对结论的可靠性没有显著影响,而腰椎L2-L4的骨密度值和雌二醇水平方面不存在显著发表偏倚;④试验序贯分析进一步验证了针灸疗法可显著提高总有效率、腰椎L_(2)-L_(4)的骨密度值和雌二醇水平的确凿性。结论:针灸疗法是治疗绝经后骨质疏松症一种有效、安全的疗法。未来需更多设计严谨、高质量的研究验证该结论。展开更多
Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery fr...Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusions:Deep anesthesia reduced early postoperative pain but increased postoperative delirium.The current evidence does not support the use of deep anesthesia in clinical practice.展开更多
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.
基金Supported by National Natural Science Foundation of China:81460763,81960908.
文摘Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.
文摘Objective:The aim of this study was to assess the effectiveness of mindfulness meditation(MM)on anxiety,depression,stress and mindfulness in nursing students.Methods:A comprehensive search and screening procedures were conducted to locate all MM interventions implemented with nursing students.For randomized controlled trials(RCTs)in accordance with the inclusion criteria,a search was conducted in PubMed,Embase,Web of Science,Medline,PsycINFO,Cumulative Index to Nursing and Allied Health(CINAHL),Cochrane Central Register of Controlled Trials(CENTRAL),China Biology Medicine(CBM),Chinese National Knowledge Infrastructure(CNKI)and Wanfang.Databases were retrieved from inception through August 2018.Additional studies were identified through hand searches and Internet searches.Two reviewers collected relevant data of eligible articles according to the data extraction tables.Based on Cochrane Handbook,critical appraisal of the methodological quality was assessed by two other reviewers.An Excel form was used to extract main characteristics of included RCTs.Meta-analysis and trial sequential analysis(TSA)were carried out using software RevMan 5.3 and TSA 0.9.Results:Five RCTs with 257 nursing students were included.Only two studies were assessed as high quality and three studies were evaluated as moderate quality.Meta-analysis showed that,comparing with the control group,MM could significantly improve anxiety(SMD=?0.45,95%CI?0.73 to?0.17,P=0.001)and stress(SMD=?0.69,95%CI?0.97 to?0.40,P<0.001).TSA results confirmed that the outcome of the merger is credible.It could also significantly improve depression level of nursing students after 8 weeks intervention duration(SMD=?0.70,95%CI?1.14 to?0.26,P=0.002).However,there was no beneficial effect on depression level of nursing students with 1 week intervention duration(SMD=0.09,95%CI?0.42 to 0.59,P=0.74)and its effects on mindfulness level of nursing students also did not show statistical significance(SMD=0.37,95%CI?0.04 to 0.77,P=0.07).No definitive conclusions were drawn from the TSA.Conclusions:The results of this meta-analysis indicated that MM could effectively reduce the level of anxiety and stress of nursing students.TSA confirmed that the results of meta-analysis are credible.For depression,it could also significantly improve depression of nursing students with 8 weeks intervention,but there was no significant effect on nursing students with 1 week intervention duration.There was also no beneficial effect on mindfulness level of nursing students.However,TSA indicated that the accumulated evidence is still inconclusive.We suggest that more well-designed clinical trials with large sample and higher quality would be required in future to draw a definitive conclusion.
基金Standardization Project of Clinical Application Guide for Chinese Patent Medicine in the Treatment of Dominant Diseases(No.SATCM-2015-BZ402)。
文摘Objective:To evaluate the efficacy and safety of Rupi Sanjie(RPSJ)capsule plus the conventional surgical operation for treatment of hyperplasia nodule of mammary gland.Methods:A meta-analysis was conducted on randomized controlled trials(RCT)related to RPSJ capsule plus surgical operation in the treatment of hyperplasia nodule of mammary gland.The methodological quality of eligible RCTs was assessed according to the criteria from the Cochrane Handbook for Systematic Reviews of Interventions.RevMan5.3 and Stata14.0 were used for data analyses.Trial sequential analysis was performed to estimate the sample size of systematic review base on TSA software v0.9.Results:Twenty-two RCTs were totally included in this study,involving 2135 patients.The result showed the clinical recurrence rate of RPSJ capsule plus surgical treatment group was significantly lower than surgical treatment alone group(RR:0.25,95%CI[0.17,0.37],P<0.01).The clinical cure rate and total effective rate were higher in RPSJ capsule plus surgical treatment group than the conventional surgical treatment group(RR:1.63,95%CI[1.46,1.82],P<0.01);(RR:1.29,95%CI[1.22,1.37],P<0.01).Application of RPSJ capsule decreased the occurrence of adverse events including nausea,vomiting,irregular menstruation,constipation,dizziness,and headache etc.(RR:0.90,95%CI[0.54,1.49],P=0.68).The results of trial sequential analysis demonstrated that the current available data did not reach the expected value.Conclusion:RPSJ capsule plus the conventional surgical treatment was more effective in reducing the clinical recurrence rate,and improving the total clinical effective rate and clinical cure rate,with a decrease in the occurrence of adverse events.
文摘Objective:To evaluate the clinical efficacy of warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis.Methods:A search for published randomized controlled trials(RCT)investigating warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis was performed using the Cochrane Library,PubMed,Embase,and Web of Science databases.According to requirements of the Cochrane systematic review,all evaluations of RCT investigating warming acupuncture with joint mobilization in the treatment of scapulohumeral periarthritis were performed via method quality assessment,data extraction,and data analysis.Revman 5.3 and Stata 12.0 statistical software were used for the meta-analysis,and the trial sequential analysis(TSA)software estimated the required information size for each outcome.Results:A total of 14 articles were retrieved for meta-analysis,which included 551 cases in the treatment group and 539 cases in the control group.Meta-analysis showed that:(1)warming acupuncture combined with joint mobilization improved total efficiency[OR=6.16,95%CI(3.79,10.00),Z=7.34;P<0.001),TSA results confirmed the results of the meta-analysis;(2)warming acupuncture combined with joint mobilization improved the cure rate[OR=2.84,95%CI(2.19,3.70),P<0.001],TSA results revealed that no further tests were needed to verify;(3)warming acupuncture combined with joint mobilization reduced the number of treatments required for healing[MD=-7.49,95%CI(-9.75,-5.23),P<0.001],TSA results confirmed the results of the meta-analysis;(4)in comparing visual analog scale scores before and after treatment,meta-analysis result showed that:SMD=-2.01,95%CI(-2.37,-1.65),P<0.001,the difference was statistically significant,TSA results confirmed the results of the meta-analysis.Conclusion:Warming acupuncture combined with joint mobilization had a significant effect on the treatment of scapulohumeral periarthritis.
文摘Objective： To evaluate the effect of moxibustion on knee osteoarthritis patients with cumulative meta-analysis, and trial sequential analysis was applied to test the authenticity of results. Methods： We searched PubMed, EMbase, The Cochrane Library, CNKI and CBM to collect RCTs about moxibustion on knee osteoarthritis patients. The selection of literature, data extraction and evaluation of eligible literature were carried out independently by two reviewers. Then Stata11.0 software was used for data analysis. Result： Totally 11 RCTs involved 1005 patients were recruited. The results of meta-analysis showed that no significant differences were found between the two groups in VAS, moxibustion is better than drug therapy in effective rate [OR = 0.40, 95%CI （0.27, 0.60）] and knee score [SMD = -0.70, 95%CI （-1.22, -0.19）]. The result of trial sequential analysis indicated that the sample size didn＇t reach the TSA Boundary on VAS, the sample size of effectiveness achieved Require Information Size. In the indicator of knee score has obtained certain re- sult before reaching the Require Information Size. Conclusion： moxibustion is superior to drug therapy on treatment knee osteoarthritis. However, large sample size and high-quality studies are still needed.
文摘Background:Traditional Chinese Medicines(TCM)had been indicated to benefit for the chronic non-infectious diseases,such as cancers,hypertension,primary dysmenorrheal,etc.Although randomized controlled trials(RCTs)had been conducted,there was still the controversy on the efficacy of Jinhuang powder for diabetic foot ulcers(DFUs).Objective:This systematic review aimed to objectively evaluate the potential of Jinhuang powder for DFUs.Methods:Seven databases(CNKI,Chongqing VIP,Wanfang database,CBM,the Cochrane Library,PubMed and Web of Science)were searched to retrieve RCTs up to December,2016;and the relevant references of the eligible studies were screened.According to the eligible criteria,the literature was screened;data were extracted;and then the methodological quality was assessed.The meta-analysis,power analysis and trial sequential analysis(TSA)were performed by using Meta analyst software(version beta 3.13),Stata 12.0,Power and Precision statistical software package(Biostat)and TSA software(version0.9),respectively.Results:Finally,three RCTs with 198 participants were included.The results of meta-analysis showed that there were statistically significant differences between groups in(1)the cure rate(RR,1.25;95%CI.1.10to1.41;P=0.00)and(2)the wound healing time(SMD,-3.404;95%CI,-5.821 to -0.987;P=0.00).Three trials presented more than 80% power with 0.05α-errors in both outcomes and the power of two meta-analyses to pool different outcomes presented more than 95%.The TSA showed that the summary results were certain.Conclusion:The external application with Jinhuang powder was an effective and cost-effective therapy for DFUs.The power analysis and TSA showed that the efficacy of Jinhuang powder dressing for the treatment of DFUs is conclusive.
基金supported by National Natural Science Foundation of China:International (regional)cooperation and exchange project (81820108033)China Academy of Chinese Medical Sciences Youth Talent Project (ZZ14-YQ-020)。
文摘Objective:To systematically review the efficacy and clinical safety of Qizhi Weitong Granules(气滞胃痛颗粒)(QZWT)in the treatment of irritable bowel syndrome with predominant constipation(IBS-C).Methods:Randomized controlled trials(RCTs)of QZWT in patients with IBS-C were retrieved from Pub Med,EMBASE,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),and Chinese Biological Medical Database(CBM)from inception to December 3,2022.Conventional meta-analysis with random-effects model or fixed-effects model and trial sequential analysis(TSA)were performed by Review Manager 5.4,Stata and TSA software.Results:A total of 4 RCTs and 368 patients with IBS-C were included in this study.The findings of the meta-analysis indicated that the cure and efficacy rate of the experimental group was significantly higher than that of the control group[RR=2.19;(95%CI,1.35–3.55),P<0.01;RR=1.14;(95%CI,1.03–1.27),P<0.05],while the result of Bristol Score was negative.The funnel plot was probably symmetry,and the P value was>0.05 in the Egger test,which confirmed the nonexistence of significant publication bias in this outcome.TSA showed the cumulative z-value crossed the traditional threshold and TSA threshold,while it didn't get to the required information size.Finally,2 studies reported adverse events after QZWT treatment,including 3 cases of diarrhea.No serious adverse events were reported.Conclusion:QZWT was an effective and safe complementary therapy in the treatment of IBS-C with no obvious adverse reactions.TSA analysis confirmed our meta-analysis results.Therefore,QZWT may be a potential candidate for the treatment of IBS-C.However,due to the limited quality of current studies,more long-term,randomized,double-blinded clinical trials are needed in future studies.
基金Discipline Construction Project of Hunan University of Chinese Medicine,No.22JBZ002.
文摘BACKGROUND The benefits and risks of Xileisan(XLS)in the treatment of ulcerative colitis(UC)remain unclear.AIM The present study aimed to evaluate the efficacy and safety of the combination of XLS and mesalazine when treating UC.METHODS We searched eight databases for clinical trials evaluating the combination of XLS and mesalazine in the treatment of UC,up to January 2024.Meta-analysis and trial sequential analysis(TSA)were performed using Revman 5.3 and TSA 0.9.5.10 beta,respectively.RESULTS The present study included 13 clinical studies involving 990 patients,of which 501 patients received XLS combined with mesalazine while 489 patients received mesalazine alone.The meta-analysis showed that,in terms of efficacy,the combination of XLS and mesalazine significantly improved the clinical efficacy rate by 22%[risk ratio(RR)=1.22;95%CI:1.15–1.28;P<0.00001]and mucosal improvement rate by 25%(RR=1.25;95%CI:1.12–1.39;P=0.0001),while significantly reducing the duration of abdominal pain by 2.25 days[mean difference(MD)=-2.25;95%CI:-3.35 to-1.14;P<0.0001],diarrhea by 2.06 days(MD=-2.06;95%CI:-3.92 to-0.20;P=0.03),hematochezia by 2.32 days(MD=-2.32;95%CI:-4.02 to-0.62;P=0.008),tumor necrosis factor alpha by 16.25 ng/mL(MD=-16.25;95%CI:-20.48 to-12.01;P<0.00001),and interleukin-6 by 14.14 ng/mL(MD=-14.14;95%CI:-24.89 to-3.39;P=0.01).The TSA indicated conclusiveness in the meta-analysis of the efficacy endpoints.In terms of safety,the meta-analysis revealed that the combination of XLS and mesalazine did not increase the occurrence of total and gastrointestinal adverse events,abdominal distension,and erythema(P>0.05).The TSA showed non conclusive findings in the meta-analysis of the safety endpoints.Harbord’s test showed no publication bias(P=0.734).CONCLUSION Treatment with XLS alleviated the clinical symptoms,intestinal mucosal injury,and inflammatory response in patients with UC,while demonstrating good safety.
基金Key research project of capital medical development researcher fund(No.2018-1-4161)。
文摘Objective:To evaluate the efficiency of Bushen Huoxue method with ACEI/ARB in treating diabetic kidney disease(stageⅢ).Methods:A total of 8 major electronic databases(CNKI,WanFang,VIP,Sinomed,Pubmed,Embase,Cochrane Liberary,Web of Science)were retrieved since the establishment of the database to October 9,2019.Two reviewers extracted data,and assessed the methodological quality of the included studies.The analysis was made by Stata 15.0 and TSA 0.9 softwares.Results:A total of 10 RCT studies were obtained,including 711 patients with diabetic kidney disease of stageⅢ.Meta-analysis showed that the method of Bushen Huoxue with ACEI/ARB could reduce UAER[WMD=-31.24,95%CI(-42.98,-19.51)],β2-GM[WMD=-92.95,95%CI(-166.05,-19.85)],LDL-C[WMD=-0.19,95%CI(0.19,-0.30)].However,there were no significant effect for HbAlc[WMD=-0.08,95%CI(-0.17,-0.00)],Scr[WMD=-12.96,95%CI(-39.82,13.90)],BUN[WMD=-0.14,95%CI(-0.44,0.17)].The result of TSA indicated that the method of Bushen Huoxue with ACEI/ARB was effective in the treatment of diabetic kidney disease of stageⅢ.Conclusion:The study show that the method of Bushen Huoxue with ACEI/ARB can reduce urinary protein,renal tubular injury and LDL-C in patients with diabetic kidney disease of stageⅢ,and had no effect on HbAlc and renal function.But the conclusion of this study needs further research of high quality.
基金National Key Research and Development Program"Key Special Project of Traditional Chinese Medicine Modernization Research"(2018YFC1705303)Innovative Talent Promotion Program-Key Technology Innovation Team Program(2017KCT-27)。
文摘[Objectives]To analyze the efficacy of Compound Qingdai Capsule in the treatment of psoriasis and conduct a systematic evaluation.[Methods]The clinical total effective rate,PASI index score,IL-17 level,IL-23 level,TNF-level,and adverse reactions were analyzed.TSA 0.9 software was used to conduct sequential analysis of the total effective rate,and subgroup analysis was performed according to the average age of the experimental group.[Results]Single application of Compound Qingdai Capsule or in combination with other methods in the treatment of psoriasis was superior to non-Compound Qingdai Capsule group,and the side effects were less than non-Compound Qingdai Capsule group;the n≥40 year-old group had certain heterogeneity,suggesting that the difference was statistically significant,and the effective rate was higher than that of the control group.The funnel plot showed that the graph was asymmetrical,and there may be publication bias or the possibility of low-quality literature.The TSA results indicated that the actual sample size was far lower than the expected sample size,and the cumulative Z value did not reach the TSA cut-off value and more trials need to be included to confirm the efficacy.[Conclusions]Compound Qingdai Capsule has a clear curative effect on psoriasis,and its safety is high.This study can provide relevant evidence for the effectiveness of Chinese patent drugs(CPD)in treating psoriasis.
文摘In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysis that included 4 randomised controlled trials. The end-point was progression at 3 years while the boundary for non-inferiority was set at ±20% in risk ratio. The results of our trial-sequential analysis indicated the futility of maintenance chemotherapy, i.e. proof of no effectiveness. Consequently, no further trials of this type should be performed to assess the effectiveness of this intervention in this clinical condition.
文摘Objective:To evaluate the effectiveness and safety of fire needling for herpes zoster from randomized clinical trials (RCTs).Methods:We searched Cochrane Central Register of Controlled Trials,Pubmed,Sino-Med,CNKI,VIP,WanFang databases,and conference proceedings to November,2017.RCTs were eligible if they tested fire needling for treating herpes zoster more than 3 times.Two authors screened all references,assessed the risk of bias,extracted data,independently,and analyzed data using Trial Sequential Analysis (TSA).Treatment effects were presented as risk ratio (RR)for binary data and standardized mean difference (SMD) for continuous data with 95% confidence interval (CI).Results:We included 27 RCTs with a total of 1933 participants.Only one RCT had low risk of bias,and the others were of high or moderate risk of bias.For total effectiveness rate (proportion of total number of people who were cured or significant symptom improved),there was no significant difference between Western medicine (acyclovir,valacyclovir,adenosine cobalamin) and fire needling (risk ratio 1.05,95% CI 0.98 to 1.12;n =5).For pain relief (VAS scale):fire needling used alone showed lower scores than Western medicine (SMD-1.37,95% CI-1.77 to-0.97;n =2) or external medicine (diclofenac) (SMD-2.23,95% CI-2.81 to-1.64;n =1).Combination of fire needling and Western medicine was better than Western medicine alone in relieving pain (VAS scale) (SMD-2.19,95% CI-3.40 to-0.97,I2 =94%;n =4).Patients receiving fire needling had lower incidence of neuralgia than those receiving Western medicine (3.3% vs 26.7%,RR 0.09,95% Cl 0.01 to 0.82;n =1) at follow up for 30 days.No serious adverse events such as infection were reported.Conclusion:Fire needling appears to offer relief for alleviating pain in herpes zoster.As the sample size of included trials was small and the quality of studies was generally low,rigorous clinical trials with robust reporting and appropriate outcome measures are still needed.
文摘Objective： To evaluate the efficacy and safety of the heated gel mattress for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods： Systematic searches on PubMed, EM- BASE, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP were performed for randomized controlled trials （RCTs） or quasi-RCTs which explored the effects of heated gel mattress on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria, extracted data and assessed quality. Then, meta-analysis and trial sequential analysis were performed by RevMan 5.3 and TSA vO.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results： This systematic review included 10 studies which comprised 7 RCTs and 3 quasi-RCTs, encompassing 773 patients. The results of meta-analysis showed that in heated gel mattress group admission temperature on neonatal intensive care unit （SMD, 0.63; 95% CI, 0.40 to 0.87; P = 0.00）, incidence of hypothermia （RR, 0.73; 95% CI, 0.57 to 0.93; P = 0.01） and hyperthermia （RR, 1.82; 95% CI, 1.31 to 2.541 P = 0.00） compared with the control group had significantly statistical difference; however, there was no significant difference in admission temperature on exothermic mattresses or TransWarmer mattress group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage Ⅲ/Ⅳ between two groups, trial sequential analysis confirmed that the pooled results of admission temperature on neonatal intensive care unit and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusion： Heated gel mattress is a safe and effective re- warming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia and does not increase the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, and high-quality research.
基金Jiangsu Government Scholarship for Overseas Studies(No.JS-2018-178)Six Talent Peaks Project in Jiangsu Province(No.WSN-022)。
文摘Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusions:Deep anesthesia reduced early postoperative pain but increased postoperative delirium.The current evidence does not support the use of deep anesthesia in clinical practice.
