Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention...Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention and treatment.Methods:All studies were searched in online databases and grey literature,including PubMed(Medline),Web of Science,CINAHL,Scopus,IEEE Xplore Digital Library,Journal of Medical Internet Research(JMIR),MedNar,EBSco Open Dissertations.The search period is from inception to June 2023,and the languages are Finnish,English and Swedish.The research quality was evaluated using the web-based data management system Covidence for prevalence studies.The study protocol was registered with PROSPERO(registration number:CRD42021247595).Results:In this review,4,407 studies were screened,and 22 were included.These involved 3,433 participants and 264 child-parent pairs.The digital approaches included multicomponent elements like internet platforms,text messaging,video conferencing,online communities,wearable technology,and mobile apps,allowing one-way,two-way,and face-to-face interactions.Two studies showed statistically significant effects of treatment on BMI and waist-to-hip ratio.Most interventions reported positive outcomes,with no significant differences between groups,and none showed null effects during followup.Conclusions:Digital multicomponents like mobile apps and wearables can help obese children and adolescents adopt healthier lifestyles.While these interventions show promise for obesity management,further research is needed to assess their effectiveness,particularly regarding nurses'perspectives.展开更多
Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The ...Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。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 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
Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of vi...Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of visceral leishmaniasis in children.Methods:The efficacy and safety of visceral leishmaniasis treatments in children were systematically reviewed using literature from PubMed,Cochrane,clinicaltrials.gov,and Google Scholar,focusing on randomised trials with separate pediatric data(published from 2000-2024).The risk of bias of selected trials was assessed using the revised Cochrane risk-of-bias tool for randomised trials(RoB 2).Reporting was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.Results:Of 1186 records,only 7 were eligible for qualitative synthesis.Three trials exclusively included children.The treatment regimens studied showed high heterogeneity and lacked sufficient data for a meta-analysis.Most trial arms reported efficacies over 94%for children across different regimens.Miltefosine monotherapy showed the highest rate of late treatment failures,highlighting that allometric dosing is crucial to ensure proper drug exposure in children.Safety data for children were available in only three studies with varied reporting systems of adverse events.Although regimens in this review were generally considered to be safe in children,antimonial-related cardiac toxicity remains a threat.Conclusions:This review highlights the need for pediatric-specific trials,clear presentation of pediatric data,and systematic documentation of adverse events to enhance evidence for policy-making and pediatric guideline development.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
BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagn...BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.展开更多
Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clini...Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.展开更多
BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only l...BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only limited cases were reported in the literature,certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIM To study the risk factors for cerebral ventricular migration(CVM)on top of visual pathway migration(VPM).METHODS Conforming to the preferred reporting items for systematic reviews and metaanalyses guidelines,literature searches on PubMed,MEDLINE,EMBASE were performed on June 1,2024.Publications on SiO migration to CNS were included in this review.Non-English articles,and studies without neuro-imaging of the CNS were excluded.Patient demographics,SiO filled eyes'ocular characteristics and vitrectomy surgical details were extracted from included studies in this review.VPM and CVM were assigned as group 1 and group 2 respectively.Fisher's exact tests,Mann-Whitney U tests and binary logistic regression were performed.RESULTS Total 68 articles were obtained after searches,48 publications were included for analysis.Total 54 SiO filled eyes were analyzed.Post-vitrectomy intraocular pressure(IOP)was found to be significant in both Mann-Whitney U test(P=0.047)and binary logistic regression(P=0.012).Diabetic was found to be significant in binary logistic regression(P=0.037),but at borderline risk for CVM in Fisher's exact test(P=0.05).Other significant factors include longer SiO tamponade time(P=0.002 in Fisher's exact test)and visual acuity(P=0.011 in binary logistic regression).Optic nerve atrophy or disc cupping(P=1.00,P=0.790)and congenital optic disc anomalies(P=0.424)were all with P>0.05.CONCLUSION SiO migration to CNS is rare with limited case reports only.Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM,followed by patients’diabetic status,longer SiO tamponade time and visual acuity.Optic nerve atrophy,disc cupping and congenital optic disc anomalies were not associated.Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreoretinal surgeons.Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.展开更多
Toxoplasma gondii(T.gondii)is a globally distributed parasite that can infect a diversity of warm-blooded animals,including swine and humans.Infection in swine poses a considerable threat to food safety and public hea...Toxoplasma gondii(T.gondii)is a globally distributed parasite that can infect a diversity of warm-blooded animals,including swine and humans.Infection in swine poses a considerable threat to food safety and public health.The aim of this meta-analysis was to estimate the seroprevalence of T.gondii infection in the swine population in China from 2000 to 2023 and to examine potential factors associated with infection.A total of 112 studies were included,collectively involving 145,152 swine samples originating from 26 provinces.The pooled seroprevalence was 26.0%(95%CI:23.3%–28.7%).Stratified analysis based on diagnostic methods revealed that studies using the indirect hemagglutination assay(IHA)reported a seroprevalence of 19.7%(95%CI:17.2%–22.2%),whereas those utilizing the enzyme-linked immunosorbent assay(ELISA)reported a higher seroprevalence of 35.5%(95%CI:29.1%–41.8%).Geographical analysis indicated higher seroprevalence in the South Central and Southwest regions,whereas the East and Northwest areas reported the lowest seroprevalence.Chongqing Province reported the highest seroprevalence,reaching 44.9%(95%CI:43.4%–46.0%),followed by Xinjiang,Hainan,and Guizhou,whereas the lowest was observed in Shandong Province(3.5%,95%CI:1.7%–6.1%).These findings provide important epidemiological evidence that can inform strategies for the prevention and control of T.gondii infection in swine populations,with a focus on high-risk populations and geographical areas.This imperative contributes substantially to the improvement of both food safety and public health.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
Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search wa...Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search was conducted in databases including PubMed,Scopus,Science Direct,Google Scholar,ProQuest,CINAHL,SID,Iran Doc,and Magiran without time limitation using related keywords.The systematic literature search was performed using a guide provided by York University.Results:From a total of 1883 articles,17 of them finally met the eligibility criteria.According to the findings of this study,HE of diabetic patients was included in four categories:“dynamism,”“consequentialism,”“comprehensive care,”and“access to facilities.”Also,these expectations can be influenced by various factors,including“developments in societies,”“changing the conditions of health care systems,”and“individual factors.”Conclusions:Health professionals should pay attention to the expectations of diabetic patients who are involved in complex disease conditions and consider meeting them as a key factor in providing patient-centered care,improving health outcomes,and patient satisfaction.展开更多
Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pa...Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.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
BACKGROUND Diabetes and hypertension are metabolic disorders that are becoming more prevalent.Breastfeeding is recommended by the World Health Organization for women who have given birth and have been reported to redu...BACKGROUND Diabetes and hypertension are metabolic disorders that are becoming more prevalent.Breastfeeding is recommended by the World Health Organization for women who have given birth and have been reported to reduce the risk of chronic diseases potentially.However,there is no systematic review to explore the relationship between breastfeeding and diabetes/hypertension by consolidating all available evidence on the topic.AIM To investigate the relationship between breastfeeding and maternal diabetes and hypertension.METHODS This review included comparative studies investigating the association between breastfeeding and the risk of type 2 diabetes or hypertension in parous women.Non-English-language articles,reviews,editorials,letters,and protocols were excluded.The Medline,EMBASE,PubMed,Web of Science,and Cochrane databases were searched until May 6,2024.Risk of bias in non-randomized studies-of exposure was used to assess bias in all the included studies.A meta-analysis was conducted to determine the risk of two chronic lactation-related diseases.RESULTS Eighteen studies were included.Five studies discussed hypertension,12 discussed diabetes,and one discussed both.According to a meta-analysis,lactation significantly reduced the risk of postpartum diabetes in women with gestational diabetes mellitus[hazard ratio=0.64(95%CI:0.47-0.89)].In addition,the meta-analysis produced significant results for postpartum diabetes and hypertension in non-gestational diabetes women,both favoring breastfeeding.However,the risk of bias in most included studies was low or unclear.CONCLUSION Breastfeeding has consistently been shown to be associated with a lower incidence of maternal hypertension and diabetes later in life,even among mothers who experienced gestational diabetes during pregnancy.展开更多
BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the d...BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.AIM To identify predictive factors for early diagnosis and treatment,and the association between the diagnosis and maternal/neonatal outcomes.METHODS We searched PubMed,PubMed Central,and Google Scholar.Articles were analyzed following preferred reporting items for systematic reviews and metaanalysis.The search items included:‘ulcer’,‘PUD’,‘pregnancy’,‘puerperium’,‘postpartum’,‘gravid’,‘labor’,‘perforated ulcer’,‘stomach ulcer’,‘duodenal ulcer’,‘peptic ulcer’.Additional studies were extracted by reviewing reference lists of retrieved studies.We included all available full-text cases and case series.Demographic,clinical,obstetric,diagnostic and treatment parameters,and outcomes were collected.RESULTS Forty-three cases were collected.The mean maternal age was 30.9 years;36.6%were multiparous,and 63.4%were nulliparous or primiparous,with multiparas being older than primiparas.Peptic ulcer perforated in 44.2%of postpartum and 55.8%of antepartum patients.Antepartum PPU incidence increased with advancing gestation 2.3%in the first,7%in the second,and 46.5%in the third trimester.The most common clinical findings were abdominal tenderness(72.1%),rigidity(34.9%),and distension(48.8%).Duodenal ulcer predominated(76.7%).In 79.5%,the time from delivery to surgery or vice versa was>24 hours.The maternal mortality during the third trimester and postpartum was 10%and 31.6%,respectively.The trimester of presentation did not influence maternal mortality.The fetal mortality was 34.8%,with all deaths in gestational weeks 24-32.CONCLUSION Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum.Early intervention reduced fetal mortality but without influence on maternal mortality.Maternal mortality did not depend on the use of X-ray imaging,perforation location,delivery type,trimester of presentation,and maternal age.Explorative laparoscopy was never performed during pregnancy,only postpartum.展开更多
We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic ...We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.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:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,i...Objective:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,including Cochrane Library,PubMed,Web of Science,ESC(European Society of Cardiology),and CNKI,as well as professional association websites,were searched using computers,with manual searching as a complement.Relevant literature published from the establishment of the database to February 2025 was retrieved.Two researchers independently screened the literature,extracted data,and evaluated the quality of the literature.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 8 articles were included,involving 843 patients.Meta-analysis results showed that compared with routine nursing,phase I cardiac rehabilitation exercise prescriptions helped increase the 6-minute walking distance in patients after coronary intervention[MD=0.84,95%CI(0.57,1.10),P<0.001],increase the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.67,95%CI(0.33,1.00),P<0.001],and cardiac rehabilitation combined with respiratory rehabilitation exercise could improve the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.58,95%CI(0.40,0.76),P<0.001].Conclusion:The implementation of phase I cardiac rehabilitation exercise prescriptions can help improve cardiac function levels in patients after coronary intervention.However,the standardization of outcome evaluation indicators needs to be improved,and the long-term effects of rehabilitation still require verification through a large number of high-quality studies.展开更多
文摘Objectives:Childhood and adolescent obesity are an increasing global health concern.This study aimed to evaluate the effectiveness of digital components and interaction types in counseling interventions for prevention and treatment.Methods:All studies were searched in online databases and grey literature,including PubMed(Medline),Web of Science,CINAHL,Scopus,IEEE Xplore Digital Library,Journal of Medical Internet Research(JMIR),MedNar,EBSco Open Dissertations.The search period is from inception to June 2023,and the languages are Finnish,English and Swedish.The research quality was evaluated using the web-based data management system Covidence for prevalence studies.The study protocol was registered with PROSPERO(registration number:CRD42021247595).Results:In this review,4,407 studies were screened,and 22 were included.These involved 3,433 participants and 264 child-parent pairs.The digital approaches included multicomponent elements like internet platforms,text messaging,video conferencing,online communities,wearable technology,and mobile apps,allowing one-way,two-way,and face-to-face interactions.Two studies showed statistically significant effects of treatment on BMI and waist-to-hip ratio.Most interventions reported positive outcomes,with no significant differences between groups,and none showed null effects during followup.Conclusions:Digital multicomponents like mobile apps and wearables can help obese children and adolescents adopt healthier lifestyles.While these interventions show promise for obesity management,further research is needed to assess their effectiveness,particularly regarding nurses'perspectives.
文摘Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。
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.
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Objective:To evaluate the dosing,efficacy and safety of the main antileishmanial agents amphotericin B(conventional or liposomal),pentavalent antimonials,miltefosine and paromomycin recommended for the treatment of visceral leishmaniasis in children.Methods:The efficacy and safety of visceral leishmaniasis treatments in children were systematically reviewed using literature from PubMed,Cochrane,clinicaltrials.gov,and Google Scholar,focusing on randomised trials with separate pediatric data(published from 2000-2024).The risk of bias of selected trials was assessed using the revised Cochrane risk-of-bias tool for randomised trials(RoB 2).Reporting was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.Results:Of 1186 records,only 7 were eligible for qualitative synthesis.Three trials exclusively included children.The treatment regimens studied showed high heterogeneity and lacked sufficient data for a meta-analysis.Most trial arms reported efficacies over 94%for children across different regimens.Miltefosine monotherapy showed the highest rate of late treatment failures,highlighting that allometric dosing is crucial to ensure proper drug exposure in children.Safety data for children were available in only three studies with varied reporting systems of adverse events.Although regimens in this review were generally considered to be safe in children,antimonial-related cardiac toxicity remains a threat.Conclusions:This review highlights the need for pediatric-specific trials,clear presentation of pediatric data,and systematic documentation of adverse events to enhance evidence for policy-making and pediatric guideline development.
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BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.
基金supported by Chongqing Science and Technology Bureau Technology Innovation and Application Development Project(No.cstc2019jscx-msxmX0170)Chongqing Science and Health Joint Medical Research Project(No.2021MSXM208).
文摘Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.
文摘BACKGROUND Silicone oil(SiO)migration to the central nervous system(CNS)is a rare complication of SiO tamponade after vitreo-retinal surgeries,it could masquerade hemorrhage on computed tomography neuro-imaging.Only limited cases were reported in the literature,certain intra-operative and post-operative ocular risk factors might contribute to the different extend of SiO migration in the CNS.AIM To study the risk factors for cerebral ventricular migration(CVM)on top of visual pathway migration(VPM).METHODS Conforming to the preferred reporting items for systematic reviews and metaanalyses guidelines,literature searches on PubMed,MEDLINE,EMBASE were performed on June 1,2024.Publications on SiO migration to CNS were included in this review.Non-English articles,and studies without neuro-imaging of the CNS were excluded.Patient demographics,SiO filled eyes'ocular characteristics and vitrectomy surgical details were extracted from included studies in this review.VPM and CVM were assigned as group 1 and group 2 respectively.Fisher's exact tests,Mann-Whitney U tests and binary logistic regression were performed.RESULTS Total 68 articles were obtained after searches,48 publications were included for analysis.Total 54 SiO filled eyes were analyzed.Post-vitrectomy intraocular pressure(IOP)was found to be significant in both Mann-Whitney U test(P=0.047)and binary logistic regression(P=0.012).Diabetic was found to be significant in binary logistic regression(P=0.037),but at borderline risk for CVM in Fisher's exact test(P=0.05).Other significant factors include longer SiO tamponade time(P=0.002 in Fisher's exact test)and visual acuity(P=0.011 in binary logistic regression).Optic nerve atrophy or disc cupping(P=1.00,P=0.790)and congenital optic disc anomalies(P=0.424)were all with P>0.05.CONCLUSION SiO migration to CNS is rare with limited case reports only.Our analysis of the existing literature demonstrated higher post-vitrectomy IOP was associated with CVM,followed by patients’diabetic status,longer SiO tamponade time and visual acuity.Optic nerve atrophy,disc cupping and congenital optic disc anomalies were not associated.Modifiable risk factors of post-vitrectomy IOP and SiO tamponade time should be closely monitored by vitreoretinal surgeons.Lower IOP target post-vitrectomy and earlier SiO removal surgeries should be arranged.
基金supported by the National Key Research and Development Program of China(2022YFE0114400).
文摘Toxoplasma gondii(T.gondii)is a globally distributed parasite that can infect a diversity of warm-blooded animals,including swine and humans.Infection in swine poses a considerable threat to food safety and public health.The aim of this meta-analysis was to estimate the seroprevalence of T.gondii infection in the swine population in China from 2000 to 2023 and to examine potential factors associated with infection.A total of 112 studies were included,collectively involving 145,152 swine samples originating from 26 provinces.The pooled seroprevalence was 26.0%(95%CI:23.3%–28.7%).Stratified analysis based on diagnostic methods revealed that studies using the indirect hemagglutination assay(IHA)reported a seroprevalence of 19.7%(95%CI:17.2%–22.2%),whereas those utilizing the enzyme-linked immunosorbent assay(ELISA)reported a higher seroprevalence of 35.5%(95%CI:29.1%–41.8%).Geographical analysis indicated higher seroprevalence in the South Central and Southwest regions,whereas the East and Northwest areas reported the lowest seroprevalence.Chongqing Province reported the highest seroprevalence,reaching 44.9%(95%CI:43.4%–46.0%),followed by Xinjiang,Hainan,and Guizhou,whereas the lowest was observed in Shandong Province(3.5%,95%CI:1.7%–6.1%).These findings provide important epidemiological evidence that can inform strategies for the prevention and control of T.gondii infection in swine populations,with a focus on high-risk populations and geographical areas.This imperative contributes substantially to the improvement of both food safety and public health.
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.
基金supported by Tehran University of Medical Sciences,Tehran,Iran(no.9711199007).
文摘Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search was conducted in databases including PubMed,Scopus,Science Direct,Google Scholar,ProQuest,CINAHL,SID,Iran Doc,and Magiran without time limitation using related keywords.The systematic literature search was performed using a guide provided by York University.Results:From a total of 1883 articles,17 of them finally met the eligibility criteria.According to the findings of this study,HE of diabetic patients was included in four categories:“dynamism,”“consequentialism,”“comprehensive care,”and“access to facilities.”Also,these expectations can be influenced by various factors,including“developments in societies,”“changing the conditions of health care systems,”and“individual factors.”Conclusions:Health professionals should pay attention to the expectations of diabetic patients who are involved in complex disease conditions and consider meeting them as a key factor in providing patient-centered care,improving health outcomes,and patient satisfaction.
基金supported by grants from Collaborative Research Fund(Ref:C4032-21GF)General Research Grant(Ref:14114822)+1 种基金Group Research Scheme(Ref:3110146)Area of Excellence(Ref:Ao E/M-402/20)。
文摘Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.
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 2023 Guangzhou Municipal Science and Technology Bureau Project,No.2023A03J0873.
文摘BACKGROUND Diabetes and hypertension are metabolic disorders that are becoming more prevalent.Breastfeeding is recommended by the World Health Organization for women who have given birth and have been reported to reduce the risk of chronic diseases potentially.However,there is no systematic review to explore the relationship between breastfeeding and diabetes/hypertension by consolidating all available evidence on the topic.AIM To investigate the relationship between breastfeeding and maternal diabetes and hypertension.METHODS This review included comparative studies investigating the association between breastfeeding and the risk of type 2 diabetes or hypertension in parous women.Non-English-language articles,reviews,editorials,letters,and protocols were excluded.The Medline,EMBASE,PubMed,Web of Science,and Cochrane databases were searched until May 6,2024.Risk of bias in non-randomized studies-of exposure was used to assess bias in all the included studies.A meta-analysis was conducted to determine the risk of two chronic lactation-related diseases.RESULTS Eighteen studies were included.Five studies discussed hypertension,12 discussed diabetes,and one discussed both.According to a meta-analysis,lactation significantly reduced the risk of postpartum diabetes in women with gestational diabetes mellitus[hazard ratio=0.64(95%CI:0.47-0.89)].In addition,the meta-analysis produced significant results for postpartum diabetes and hypertension in non-gestational diabetes women,both favoring breastfeeding.However,the risk of bias in most included studies was low or unclear.CONCLUSION Breastfeeding has consistently been shown to be associated with a lower incidence of maternal hypertension and diabetes later in life,even among mothers who experienced gestational diabetes during pregnancy.
文摘BACKGROUND Peptic ulcer disease(PUD)during pregnancy is extremely rare.Perforated peptic ulcer(PPU)during pregnancy has high maternal and fetal mortality.Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.AIM To identify predictive factors for early diagnosis and treatment,and the association between the diagnosis and maternal/neonatal outcomes.METHODS We searched PubMed,PubMed Central,and Google Scholar.Articles were analyzed following preferred reporting items for systematic reviews and metaanalysis.The search items included:‘ulcer’,‘PUD’,‘pregnancy’,‘puerperium’,‘postpartum’,‘gravid’,‘labor’,‘perforated ulcer’,‘stomach ulcer’,‘duodenal ulcer’,‘peptic ulcer’.Additional studies were extracted by reviewing reference lists of retrieved studies.We included all available full-text cases and case series.Demographic,clinical,obstetric,diagnostic and treatment parameters,and outcomes were collected.RESULTS Forty-three cases were collected.The mean maternal age was 30.9 years;36.6%were multiparous,and 63.4%were nulliparous or primiparous,with multiparas being older than primiparas.Peptic ulcer perforated in 44.2%of postpartum and 55.8%of antepartum patients.Antepartum PPU incidence increased with advancing gestation 2.3%in the first,7%in the second,and 46.5%in the third trimester.The most common clinical findings were abdominal tenderness(72.1%),rigidity(34.9%),and distension(48.8%).Duodenal ulcer predominated(76.7%).In 79.5%,the time from delivery to surgery or vice versa was>24 hours.The maternal mortality during the third trimester and postpartum was 10%and 31.6%,respectively.The trimester of presentation did not influence maternal mortality.The fetal mortality was 34.8%,with all deaths in gestational weeks 24-32.CONCLUSION Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum.Early intervention reduced fetal mortality but without influence on maternal mortality.Maternal mortality did not depend on the use of X-ray imaging,perforation location,delivery type,trimester of presentation,and maternal age.Explorative laparoscopy was never performed during pregnancy,only postpartum.
文摘We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.
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.
基金Science Research Fund Project of Yunnan Provincial Department of Education(Project No.:2024J0832)Science Research Fund Project of Yunnan Provincial Department of Education(Project No.:2025Y1186)。
文摘Objective:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,including Cochrane Library,PubMed,Web of Science,ESC(European Society of Cardiology),and CNKI,as well as professional association websites,were searched using computers,with manual searching as a complement.Relevant literature published from the establishment of the database to February 2025 was retrieved.Two researchers independently screened the literature,extracted data,and evaluated the quality of the literature.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 8 articles were included,involving 843 patients.Meta-analysis results showed that compared with routine nursing,phase I cardiac rehabilitation exercise prescriptions helped increase the 6-minute walking distance in patients after coronary intervention[MD=0.84,95%CI(0.57,1.10),P<0.001],increase the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.67,95%CI(0.33,1.00),P<0.001],and cardiac rehabilitation combined with respiratory rehabilitation exercise could improve the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.58,95%CI(0.40,0.76),P<0.001].Conclusion:The implementation of phase I cardiac rehabilitation exercise prescriptions can help improve cardiac function levels in patients after coronary intervention.However,the standardization of outcome evaluation indicators needs to be improved,and the long-term effects of rehabilitation still require verification through a large number of high-quality studies.
