Cerebral microbleeds (CMBs) are important diseases that seriously endanger our national health, and their incidence is positively correlated with age. Meanwhile, CMBs are also an independent risk factor for stroke recurrence and induced hemorrhagic stroke. Understanding the current prevalence of CMBs is of great practical significance for promoting healthy aging and strengthening stroke prevention and treatment in China.
To systematically evaluate the current status of the occurrence of CMBs in China and to provide data support for promoting the process of healthy aging and strengthening the prevention and treatment of stroke in China.
Literature related to the occurrence of the disease of CMBs in our national population was systematically searched through Chinese and English databases such as CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, and Web of Science, with a timeframe of the establishment of the database until November 2023 for all searches. Two researchers separately performed literature screening, data extraction, and evaluation of the risk of bias in the included literature, and meta-analysis was performed using Stata 16.0 software.
A total of 39 studies were included, with a total of 25 877 study subjects. Meta-analysis showed that the overall incidence of CMBs in China was 25.0% (95%CI=21.0%-29.0%). The results of subgroup analysis showed that the prevalence was 27.0% (95%CI=12.0%-44.0%) for those aged 51-60 years, 23.0% (95%CI=16.0%-30.0%) for those aged 61-70 years, and 27.0% (95%CI=20.0%-35.0%) for those aged 71-80 years; the prevalence was 21.0% (95%CI=15.0%-28.0%) in North China, 26.0% (95%CI=21.0%-33.0%) in East China, 21.0% (95%CI=8.0%-39.0%) in South China, 21.0% (95%CI=16.0%-27.0%) in Central China, 24.0% (95%CI=21.0%-27.0%) in Southwest China and 46.0% (95%CI=41.0%-51.0%) in Northwest China by geographic area; the prevalence of CMBs with a history of hypertension was 19.0% (95%CI=13.0%-26.0%) and without a history of hypertension was 8.0% (95%CI=6.0%-11.0%) ; the prevalence of CMBs with a history of smoking was 9.0% (95%CI=5.0%-14.0%) and without a history of smoking was 16.0% (95%CI=12.0%-21.0%) .
The overall prevalence of CMBs in China is high, with significant differences between different age segments, regions, and provinces. Its prevalence was higher in people of advanced age, males, Northwest China, and nationals with a history of hypertension. Due to the limitations in both quantity and quality of the included studies, further confirmation of this conclusion through additional high-quality research is required.
Chronic kidney disease has become a major global concern, and the prevalence of kidney disease in China is the highest in the world. About 89.5% of patients require hemodialysis. In recent years, the prevalence of frailty in maintenance hemodialysis (MHD) patients has risen significantly, seriously affecting the quality of life and prognosis of patients.
To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis.
Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI, VIP, CBM, Wanfang Data, Web of Science, PubMed, Cochrane Library, Embase, and CINAHL databases. The search deadline was from the respective databases to July 2023. Literature screening, data extraction and quality assessment were performed independently by two researchers. Stata 15.0 was used for meta-analysis.
Thirty-two papers were included, and including 6 746 patients, among which 2 566 experienced frailty, involving 37 influencing factors. Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4% (95%CI=30.3%-44.5%). Age (OR=1.09, 95%CI=1.06-1.13), age>60 years (OR=3.81, 95%CI=2.31-6.30), female (OR=2.13, 95%CI=1.47-3.08), living alone (OR=2.42, 95%CI=1.22-4.80), sleep (OR=1.28, 95%CI=1.08-1.50), depression (OR=1.97, 95%CI=1.26-3.08), age on dialysis (OR=3.25, 95%CI=1.82-5.79), social support (low level) (OR=1.99, 95%CI=1.39-2.86), comorbidities (OR=1.79, 95%CI=1.40-2.30), malnutrition (OR=1.17, 95%CI=1.07-1.28), Charlson Comorbidity Index (CCI) (OR=1.32, 95%CI=1.01-1.71), C-reactive protein (CRP) (OR=1.15, 95%CI=1.09-1.21), hemoglobin (Hb<110 g/L) (OR=2.70, 95%CI=1.67-4.36), comorbid diabetes (OR=2.16, 95%CI=1.48-3.16), comorbid cerebrovascular disease (OR=2.66, 95%CI=1.85-3.82), comorbid coronary heart disease (OR=3.50, 95%CI=2.15-5.70) were risk factors for frailty MHD (P<0.05) ; economic income (OR=0.02, 95%CI=0.01-0.14), social support (high level) (OR=0.86, 95%CI=0.76-0.97), well nutrition (OR=0.47, 95%CI=0.26-0.85), ability to perform activities of daily living (ADL) (OR=0.80, 95%CI=0.70-0.91), serum albumin (ALB) (OR=0.84, 95%CI=0.77-0.91), Hb≥110 g/L (OR=0.70, 95%CI=0.54-0.90), 25-hydroxyvitamin D[25- (OH) VD] (OR=0.69, 95%CI=0.49-0.98) were protective factors for MHD frailty (P<0.05) .
The prevalence of frailty in MHD patients in China is at a high level, in which age, female, living alone, economic income, sleep, depression, age on dialysis, social support, comorbidities, nutritional risk scores, ADL, CCI, CRP, ALB, Hb, 25- (OH) VD, comorbid diabetes mellitus, comorbid cerebrovascular disease, and comorbid coronary heart disease are mainly factors influencing of MHD frailty patients in China, and in the future, there is a need for early screening and intervention to slow down or avoid the occurrence of hemodialysis frailty in patients.
Cardiovascular disease (CVD) is the leading cause of death in China and the world as a whole, and lipid metabolism disorder is the key factor for this disease. A comprehensive understanding of the prevalence of dyslipidemia in children and adolescents can contribute to the early prevention of dyslipidemia in adulthood.
To systematically evaluate the status quo of the prevalence of dyslipidemia in Chinese children and adolescents.
Cross-sectional studies on the morbidity rate of dyslipidemia among Chinese children and adolescents and published from January 2015 to July 2023 were retrieved from databases of CBM, CNKI, Wanfang, VIP, Embase, Web of Science and Cochrane Library. Processes of literature screening, data extraction and risk bias analysis were performed by two researchers. A meta-analysis was performed by taking advantage of Stata 17.0.
34 cross-sectional studies were collected and a total of 134 438 children and adolescents were involved. Results of the meta-analysis indicated that the overall morbidity rate of dyslipidemia in Chinese children and adolescents was 19% (95%CI=16%-21%), and the morbidity rates of high cholesterol (TC), high triacylglycerol (TG), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C) were 6% (95%CI=5%-7%), 9% (95%CI=6%-12%), 4% (95%CI=3%-5%) and 10% (95%CI=7%-13%) respectively. Regarding time distribution, the detection rate of dyslipidemia was fluctuant and showed a decreasing trend; the detection rate of high TC and high LDL-C showed an increasing trend in general, but it fell slightly in 2023; the detection rate of high TG and low HDL-C fluctuated greatly: the detection rate of high TG gradually decreased from 2018 to 2022 and rebounded slightly in 2023. The results of subgroup analysis showed that, concerning age, the overall morbidity rate of dyslipidemia in children and adolescents and that of high TC showed an ascending tendency with the increasing of age (10% and 2% for those aged from 3 to 6, 17% and 10% for those aged from 7 to 11, and 27% and 14% for those aged from 12 to18), the morbidity rate of lowered HDL-C was higher among 12-to-18-year olds (20%) than among 7-to-11-year olds (9%), and the morbidity rate of high TC among 3-to-6-year olds (9%) was higher than that among 7-to-11-year olds and 12-to-18-year-olds (4% and 3%) (P<0.05). Concerning region, the morbidity rates of low HDL-C were higher in the West (15%) than in the East (7%), and the morbidity rates of high TC and high LDL-C were higher in the East (7% and 6%) than in the West (3% and 2%) (P<0.05). Concerning BMI, the morbidity rates of dyslipidemia, high TG and high LDL-C were higher in obese children and adolescents (48%, 18%, 25%, and 7%) than in overweight (27%, 6%, 9%, and 4%) and normal children and adolescents (15%, 4%, 3%, and 3%) (P<0.05) .
The morbidity rate of dyslipidemia in Chinese children and adolescents is relatively high and varied across the age, region and BMI of children and adolescents. Due to the limitation of the number and quality of included studies, more high-quality studies are needed to be conducted to further validate these findings.
Ulcerative colitis (UC) is a persistent immune-mediated inflammatory bowel disease characterized by chronic relapses and remissions. The management of UC remains a subject of contention, particularly as approximately half of the patients experience a complex disease progression marked by chronic activity or frequent recurrence of common UC symptoms, significantly impacting their quality of life.
The current landscape presents a growing array of treatment modalities for UC. This study aims to systematically compare the relative efficacy and safety of biologics and small molecule drugs in treating patients with UC.
Two independent researchers meticulously conducted a search for randomized controlled trials involving biologics and small molecule drugs for UC. The search encompassed PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP. The intervention group involved either biologics or small molecule drugs, while the control group received a placebo. The quality of the included studies was assessed using the Cochrane Risk of Bias tool and RevMan 5.4. Paired analyses and network meta-analyses were conducted using R Studio. The surface under the cumulative ranking curve (SUCRA) was employed to rank the included drugs based on each outcome indicator, providing a comparative assessment of the clinical efficacy of diverse treatments for UC.
A total of 25 studies including 9 546 patients with ulcerative colitis and 10 intervention regimens (Filgotinib 100 mg, Filgotinib 200 mg, Upadacitinib, Tofacitinib, Etrolizumab, Adalimumab, Vedolizumab, Golimumab 50 mg, Golimumab 100 mg, Infliximab). The results of SUCRA probability ranking of clinical remission effect of each drug showed that Upadacitinib (94.1%) >Vedolizumab (85.1%) >Tofacitinib (74.3%) >Infliximab (72.7%) >Filgotinib 200 mg (51.5%) >Golimumab 100 mg (44.3%) >Golimumab 50 mg (39.3%) >Etrolizumab (38.9%) >Adalimumab (29.8%) >Filgotinib 100 mg (18.7%) >Placebo (0.7%). The results of SUCRA probability ranking of the effect of each drug on clinical response showed that Upadacitinib (98.4%) >Infliximab (84.4%) >Tofacitinib (67.2%) >Vedolizumab (58.4%) >Golimumab 50 mg (53.3%) >Adalimumab (34.6%) >Golimumab 100 mg (30.1%) >Placebo (0.4%). The results of SUCRA probability ranking of the effect of each drug on endoscopic remission showed that Upadacitinib (98.7%) >Tofacitinib (68.6%) >Filgotinib 200 mg (59.6%) >Adalimumab (55.2%) >Etrolizumab (46.0%) >Vedolizumab (45.9%) >Filgotinib 100 mg (23.4%) >Placebo (2.2%). The results of SUCRA probability ranking of the effect of each drug on mucosal healing showed that Upadacitinib (99.7%) >Tofacitinib (77.2%) >Infliximab (65.2%) >Golimumab 50 mg (46.4%) >Vedolizumab (44.4%) >Adalimumab (33.8%) >Golimumab 100 mg (31.9%) >Placebo (1.0%). The results of the SUCRA probability ranking of the risk of adverse events for each drug showed that Golimumab 100 mg (96.7%) >Golimumab 50 mg (92.1%) >Placebo (68.7%) >Tofacitinib (60.8%) >Adalimumab (60.7%) >Etrolizumab (47.2%) >Upadacitinib (42.2%) >Vedolizumab (41.3%) >Infliximab (27.0%) >Filgotinib 200 mg (6.6%) >Filgotinib 100 mg (6.2%) .
Upadacitinib demonstrated optimal efficacy in clinical response, clinical remission, mucosal healing, and endoscopic remission, and Filgotinib 100 mg demonstrating safer outcomes in terms of adverse events.
China has been already in the stage of deeply aging society, and the health problems of the elderly are getting more and more attention. Depression in the elderly not only affects the quality of life in later life, but also increases the economic burden on society and families, so early identification of the influencing factors of its development is of great significance. However, the existing research conclusions are still controversial, and there are few relevant systematic reviews in China.
To explore the depression detection rate and its influencing factors in the elderly in China since 2018, provide reference for reducing the incidence of depression in the elderly and promoting healthy aging.
In January 2023, PubMed, EmBase, Web of Science, CNKI, Wanfang Date and VIP were searched for publicly available studies on factors influencing depression in Chinese elderly from 2018 to 2022. The data were extracted and the literature quality was evaluated according to the cross-sectional study quality assessment criteria of Agency for Healthcare Research and Quality (AHRQ) and Stata 15.0 was adopted for Meta-analysis.
Twenty-three papers were finally included, with a cumulative study population of 75 599, and a total of 13 815 depressed older adults were detected; the AHRQ quality assessment scores of the papers ranged from 5 to 7. Meta-analysis results showed that the detection rate of depression in the elderly in China was 20.6%〔95%CI (16.6%, 24.8%) 〕, female〔OR=1.46, 95%CI (1.30, 1.64) 〕, advanced age〔OR=1.48, 95%CI (1.13, 1.94) 〕, lower education level〔OR=1.52, 95%CI (1.32, 1.75) 〕, no spouse〔OR=1.60, 95%CI (1.35, 1.91) 〕, living in rural areas〔OR=1.38, 95%CI (1.14, 1.66) 〕, suffering from chronic diseases〔OR=2.75, 95%CI (2.07, 3.66) 〕, 2 chronic diseases〔OR=1.84, 95%CI (1.07, 3.14) 〕, 3 or more chronic diseases〔OR=3.86, 95%CI (2.89, 5.15) 〕, poor self-rated health〔OR=3.47, 95%CI (1.14, 10.53) 〕, insomnia〔OR=2.62, 95%CI (1.88, 3.66) 〕, living alone〔OR=1.86, 95%CI (1.56, 2.21) 〕, no exercise〔OR=1.88, 95%CI (1.60, 2.20) 〕, self-care needs or partial needs〔OR=2.96, 95%CI (1.12, 7.85) 〕were risk factors for depression in the elderly (P<0.05), while drinking〔OR=0.67, 95%CI (0.50, 0.88) 〕and having friends〔OR=0.52, 95%CI (0.38, 0.71) 〕were protective factors (P<0.05) .
Although the detection rate of depression among elderly in China has decreased, it is still at a high level, and the elderly in China who are female, elderly, less educated, without spouse, living in rural areas, suffering from chronic diseases and chronic disease comorbidity, with poor self-rated health, suffering from insomnia, living alone, without exercise, and living in need or partial need of self-care may be more likely to suffer from depression.
With the accumulation of high-quality evidence, the clinical effectiveness of acupuncture for migraine has been increasingly recognized. Numerous acupuncture clinical studies in China highlight and validate various acupuncture intervention schemes through clinical trials. Integrating and selecting these advantageous schemes to guide clinical practice has become a new focus in acupuncture research.
To conduct multicriteria decision making (MCDM) by using technique for order preference by similarity to an ideal solution (TOPSIS) method based on Meta-analysis, screen optimized treatment plan (OTP) of acupuncture for migraine and explore the ideas for constructing OTPs of acupuncture.
Wanfang Data, VIP, CNKI, SinoMed, PubMed, Web of Science, and EmBase were searched by computer for randomized controlled trials (RCTs) on acupuncture treatment for migraine published before April 2022. Two researchers independently screened the literature, extracted basic characteristics of literature〔author, year of publication, sample size, cure rate, efficiency rate and visual analogue score (VAS), etc.〕, and assessed the quality of the RCTs by using modified Jadad scale. Acupuncture treatment plans for migraine were summarized based on the characteristics of the included RCTs, and Meta-analysis was performed. The relative risk (RR) of cure rate and efficiency rate, and the mean difference (MD) of VAS scores for each plan were extracted based on the Meta-analysis results. The treatment frequency and score of the modified Jadad scale were calculated for each plan using sample size as the weight. The data were all included in the MCDM analysis, the weights of different decision criterion were determined using the entropy weight method. The TOPSIS method was finally used to select OTP of acupuncture for migraine.
A total of 17 RCTs were included and categorized into 8 types of treatment plans of acupuncture for migraine (Tongyuan acupuncture, six-spirit points, bone-nearby acupuncture, conventional acupuncture, Gallbladder Meridian acupoints, head acupoints, penetration needling method and Siguan acupoints) according to the results of Meta-analysis. The TOPSIS evaluation indicated that the treatment plan of acupuncture focusing primarily on head acupoints is OTP, involving needling the head acupoints of Fengfu, Touwei, Toulinqi, Taiyang, Shuaigu, and Fengchi once daily or every other day, with an average treatment number of 11, with the main advantages of shorter treatment time and significant reduction in VAS.
The OTP of acupuncture for migraine screened and constructed in the study can provide reference for clinical application. The utilization of the entropy weight-TOPSIS method based on Meta-analysis presents a novel approach for constructing the OTPs of acupuncture for migraine.
China has entered a comprehensive aging society, and stroke is the primary cause of death and disability among adults in China, post-stroke cognitive impairment has become an important cause for long-term disability and quality of life decline in stroke patients.
To analyse and clarify the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China by Meta-analysis.
CNKI, Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched by computer to collect cohort, case-control, and cross-sectional studies on influencing factors of cognitive impairment in elderly stroke patients from inception to 2023-02-12. After independent screening of the literature and data extraction by two investigators, the quality of the literature was assessed and a Meta-analysis of the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China was performed using Stata 14.0 software.
A total of 46 papers were included, with 3 281 cases of cognitive impairment and 27 influencing factors involved. The Meta-analysis results showed that the prevalence of cognitive impairment in elderly stroke patients in China was 42.4%〔95%CI (36.6%, 48.3%) 〕; female〔OR=4.167, 95%CI (1.937, 8.967), P<0.001〕, hypertension〔OR=2.824, 95%CI (2.292, 3.481), P<0.001〕, systolic blood pressure〔OR=1.572, 95%CI (1.444, 1.711), P<0.001〕, diabetes mellitus〔OR=3.344, 95%CI (2.611, 4.284), P<0.001〕, hyperlipidemia 〔OR=2.228, 95%CI (1.091, 4.547), P=0.028〕, carotid plaque 〔OR=2.544, 95%CI (1.076, 6.014), P=0.033〕, infarction location of frontal lobe〔OR=1.615, 95%CI (1.167, 2.235), P=0.004〕, infarction location of temporal lobe〔OR=1.739, 95%CI (1.246, 2.427), P=0.001〕, multiple cerebral infarction〔OR=2.583, 95%CI (2.009, 3.321), P<0.001〕, encephalanalosis 〔OR=2.943, 95%CI (1.938, 4.469), P<0.001〕, homocysteine (Hcy) 〔OR=2.209, 95%CI (1.656, 2.948), P<0.001〕, hyperhomocysteinemia〔OR=3.043, 95%CI (2.092, 4.426), P<0.001〕, high-sensitivity C-reactive protein (hs-CRP) 〔OR=4.331, 95%CI (1.756, 10.685), P=0.001〕, and National Institutes of Health Stroke Scale (NIHSS) score >10〔OR=1.977, 95%CI (1.320, 2.961), P=0.001〕 were influencing factors for cognitive impairment in elderly stroke patients in China.
The prevalence of cognitive impairment in elderly stroke patients in China was high (42.4%), and female, hypertension, systolic blood pressure, diabetes mellitus, hyperlipidemia, carotid plaque, infarction location of frontal lobe and temporal lobe, multiple cerebral infarction, encephalanalosis, Hcy, hyperhomocysteinemia, hs-CRP, and NIHSS score >10 were influencing factors for cognitive impairment in elderly stroke patients in China.
With the rapid development of economy and society in China, the living standards and health care awareness have been improved significantly, the average life expectancy of our population is gradually prolonged, causing increasing population of perimenopausal women, therefore, the health management of perimenopausal women has become more important. Perimenopausal syndrome can be seen in women aged 40-65 years, which can seriously affect the physical and mental health and quality of life of patients.
To systematically review the incidence of perimenopausal syndrome in Chinese women aged 40-65 years.
PubMed, Embase, Web of Science, CNKI, Wanfang Data, CBM and VIP were searched by computer to collect cross-sectional studies on the occurrence of perimenopausal syndrome in Chinese women aged 40-65 years from inception to February 1, 2023. Two investigators independently screened the literature, extracted data and evaluated the quality of included literature. Meta-analysis was performed using Stata 17.0 software.
A total of 62 cross-sectional studies were included, with a total sample size of 82 340 cases. Meta-analysis showed that the incidence of perimenopausal syndrome in Chinese women aged 40-65 years was 61.0%. The results of subgroup analysis showed that the incidence of perimenopausal syndrome in women aged 40-45 years, >45-50 years, >50-55 years, >55-60 years and >60 years was 42.6%, 53.8%, 64.6%, 59.7% and 56.1%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with normal, disordered and postmenopausal menstrual status was 43.6%, 56.9% and 61.3%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with and without chronic diseases was 85.9% and 68.3%, respectively. The incidence of perimenopausal syndrome was highest in women aged 40-65 years in Southwest China at 71.3%, and at 57.4%, 57.9%, 50.5%, 59.2%, 69.5%, and 68.6% in North, East, South, Northwest, Northeast, and Central China, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with education level of junior high school and below, high school or technical secondary school, university and above was 54.1%, 55.7% and 49.6%, respectively. The incidence of perimenopausal syndrome in Han Chinese and ethnic minority women aged 40-65 years was 62.1% and 64.7%, respectively.
The incidence of perimenopausal syndrome is high in women aged 40 to 65 years in China. Among them, women aged >50-55 years, menopausal, suffering from chronic diseases, living in southwest region, with education level of high school or below, and ethnic minorities are at high risk of perimenopausal syndrome. We should pay attention to the prevention, screening and intervention of perimenopausal syndrome in relevant population to lay the foundation of elderly health in women.
Dietary inflammatory index (DII), as a new index for quantitative evaluation of dietary inflammatory potential, has been widely used in various chronic disease studies, but the correlation between DII and different types of obesity has not been uniformly established.
To systematically evaluate the correlation of DII with overweight, obesity and abdominal obesity to provide reference for the prevention of different types of obesity.
CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Cochrane Library and Web of Science were searched by computer for cross-sectional studies of the association of DII with overweight, obesity and abdominal obesity from inception to January 10, 2023. Risk of Bias Rating Scale of AHRQ was used to evaluate the included studies. Meta-analysis was performed using RevMan 5.4.1 to calculate OR and 95%CI of the pooled data to assess the association of DII with overweight, obesity and abdominal obesity. Subgroup analyses were performed based on differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping.
A total of 20 studies from 9 countries with 214 808 subjects were included. Meta-analysis results showed that high levels of DII may be a possible risk factor for overweight 〔OR=1.12, 95%CI (1.03, 1.22), P=0.005〕, obesity 〔OR=1.56, 95%CI (1.34, 1.82), P<0.000 01〕, abdominal obesity 〔OR=1.42, 95%CI (1.14, 1.78), P=0.002〕. Subgroup analysis for differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping in the original studies showed no significant between-group heterogeneity within each subgroup for the correlation between DII and overweight (P>0.05). Among the subgroups for the correlation between DII and obesity, the male population〔OR=1.79, 95%CI (1.13, 2.85) 〕 had a higher proportion of obesity than the other gender groups, the North American population 〔OR=1.57, 95%CI (1.27, 1.83) 〕 had a higher proportion of obesity compared to populations from other geographic regions, and the results of the 24-h recall 〔OR=1.83, 95%CI (1.39, 2.42) 〕 had a higher proportion of obesity compared to studies with other survey methods. Among the subgroups for the correlation between DII and abdominal obesity, the North American population 〔OR=1.87, 95%CI (1.44, 2.44) 〕 had a higher proportion of abdominal obesity compared to populations from other geographic regions, and no significant heterogeneity was found among other groups. The funnel plot distribution in this study had good symmetry, suggesting no significant publication bias.
DII diets may be a risk factor for overweight, obesity and abdominal obesity, and the association is more obvious in North American populations. The association between a high DII diet and obesity was more significant in men. Increasing the intake of anti-inflammatory dietary components is important for the prevention and treatment of overweight, obesity and abdominal obesity.
Renal cell carcinoma (RCC) is characterized by insidious onset, lack of early typical clinical manifestations, metastasis or advanced stage at diagnosis in most patients and poor efficacy of radical nephrectomy. In recent years, with the broadly application of targeted therapies in tumors, the postoperative recurrence and mortality rates have been greatly reduced. However, there is a lack of evidence for the efficacy and safety of clinical treatment due to the existence of certain adverse effects and complications.
To systematically review the efficacy and safety of programmed death-1 (PD-1) /programmed death-1 ligand (PD-L1) inhibitors in the treatment of RCC.
CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials and other English databases were searched by computer and manually for the randomized controlled trials of PD-1/PD-L1 inhibitors for RCC from the inception to 2022-09-30. Two researchers independently extracted and collated the data, evaluated the quality of the included literature according to Cochrane 5.3 manual criteria, and performed meta-analysis using RevMan 5.4 software.
A total of 11 papers were finally included, involving 7 895 study subjects with 3 936 cases in the trial group and 3 959 cases in the control group. Meta-analysis results showed that the overall survival (OS) and progression-free survival (PFS) were better in the trial group than in the control group〔HR=0.87, 95%CI (0.84, 0.90), P<0.000 01; HR=0.85, 95%CI (0.78, 0.92), P<0.000 1〕; the objective response rate (ORR), partial response rate (PR), complete response rate (CR), and disease-control rate (DCR) were higher in the trial group than in the control group〔RR=1.72, 95%CI (1.39, 2.12), P<0.000 01; RR=1.56, 95%CI (1.20, 2.01), P=0.000 7; RR=3.05, 95%CI (2.39, 3.09), P<0.000 01; RR=1.12, 95%CI (1.05, 1.20), P=0.000 5〕; the rate of stable disease (SD) was lower in the trial group than in the control group〔RR=0.66, 95%CI (0.62, 0.72), P<0.000 01〕. The differences were not statistically significant when comparing the rate of PD, total rate of adverse events (AEs), rates of grade Ⅰ-Ⅱ adverse events and grade Ⅲ-Ⅴ adverse events between the trial and control groups〔RR=0.73, 95%CI (0.53, 0.99), P=0.05; RR=1.01, 95%CI (0.89, 1.04), P=0.60; RR=1.02, 95%CI (0.88, 1.17), P=0.82; RR=1.02, 95%CI (0.88, 1.19), P=0.80〕. Egger's tests resulted in P>0.05, indicating no significant publication bias among studies.
PD-1/PD-L1 inhibitors for RCC can significantly improve and enhance OS, PFS, ORR, CR, PR and DCR in patients without increasing the incidence of adverse effects in terms of safety, thus confirming the superiority of PD-1/PD-L1 inhibitors for RCC in terms of clinical efficacy and safety.
Post-stroke insomnia is one of the most common post-stroke complications, which seriously damages the quality of life and delays the process of rehabilitation. Clinical studies have shown that Western medicine alone, Chinese patent medicine alone and the combination of both are effective in the treatment of post-stroke insomnia. However, at present, there is still no network Meta-analysis to compare the efficacy of the three treatments.
To evaluate the efficacy of Western medicine alone, Chinese patent medicine alone and their combination in treating post-stroke insomnia by network Meta-analysis.
Chinese databases such as CNKI, CBM, Wanfang Data, VIP and English databases such as PubMed, Embase and Cochrane Library were researched by computer for randomized controlled trials involving Western medicine alone, Chinese patent medicine alone and the combination of both from inception to December 2022. Two researchers independently performed the evaluation of the risk of bias and quality assessment for the included studies. RevMan5.4、StataMP 14 and R 4.2.3 were used for statistical analysis.
A total of 41 papers (41 two-arm RCT studies) with 3 916 patients were enrolled, including 1 959 cases in the treatment group and 1 957 cases in the control group. Network Meta-analysis results showed that in terms of improving efficiency, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in short-term treatment (duration≤4 weeks), the effective rate of combined treatment and Chinese patent medicine alone was better than that of Western medicine alone (P<0.05) ; in long-term treatment (duration ≥8 weeks), the effective rate of combined treatment was better than that of Western medicine or proprietary Chinese medicine alone (P<0.05). In terms of improving PSQI score, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in terms of safety, the use of Chinese patent medicine can reduce the occurrence of adverse events. The ranking of efficiency improvement was (with rank probability values in parentheses) : combination treatment (0.999) >Chinese patent medicine alone (0.889) >Western medicine alone (0.890). The ranking of short-term treatment efficiency was combination treatment (0.535) >Chinese patent medicine alone (0.526) >Western medicine alone (0.991). The ranking of long-term treatment efficiency was combination treatment (0.989) >Chinese patent medicine alone (0.529) >Western medicine alone (0.537). The ranking of PSQI score improvement was combination treatment (0.982) >Chinese patent medicine alone (0.975) >Western medicine alone (0.992) .
All three treatments for post-stroke insomnia have shown good efficacy and safety in terms of improving clinical efficiency and PSQI scores, and the most significant effect was shown in the combination treatment. However, high-quality, large sample studies are needed to verify the results.
Drug therapy is one of the main treatment approaches for depression, and a consideration of patient preferences can effectively improve patient compliance with medication. Several studies have been conducted to explore the medication choice preferences of patients with depression, but there is a lack of studies to systematically collect and summarize the medication choice preferences of patients with depression.
To systematically review the studies related to the application of discrete choice experiment (DCE) and best-worst scaling (BWS) to the medication choice preferences of patients with depression, in order to provide reference for clinical rational drug use of patients with depression and future studies of preferences.
CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science and EmBase were systematically searched for the studies related to the application of DCE and BWS to the medication choice preferences of patients with depression from inception to 2021-12-31, using "DCE" "BWS" "depression" "discrete choice experiment" "best-worst scaling" as keywords on January 2022. Data were extracted from the included literature, and the PREFS checklist was used for the quality assessment of all studies. The attributes included in the study were classified into three categories of outcome, process and cost, and their relative importance on the impact of medication preferences of patients was assessed.
A total of 7 papers were included, all of which were studies related to DCE, involving 47 attributes, among which 41 were classified as outcome attributes, 5 were classified as process attributes, and 1 was classified as a cost attribute. A total of 9 most important attribute results were obtained from the 7 studies, the outcome attribute was considered most important 8 times and the cost attribute was considered most important 1 time. Among the outcome attributes, adverse effects were considered most important 5 times and effectiveness was considered most important 3 times. Based on the PREFS checklist, one study received a score of four and six studies received a score of three. Most studies need further improvement in terms of respondents and findings.
Outcome attributes are most important in the medicine taking process of patients with depression, which needs attention of clinicians and policy makers. There is room for improvement in the dimensions of variance reporting and experimental design, it is recommended for further improvement of research design in terms of respondents interpretation of findings and experimental design in future research, in order to provide more high-quality evidence for research of medication preferences of patients with depression.
Understanding the real experiences of elderly patients with chronic diseases during hospital-to-home transition and their expectations of care services can help promote the quality improvement of care services during the transition. In recent years, qualitative studies on real experiences of elderly patients with chronic diseases during the hospital-to-home transition and their experience of care services have gradually increased, however, the results of single qualitative study may not be generalizable and representative.
To systematically evaluate qualitative studies on the real experiences of elderly patients with chronic diseases during the hospital-to-home transition and their experience of care services.
In May 2022, PubMed, Web of Science Core Collection, EmBase, CINAHL, CNKI, and Wanfang Data Knowledge Service Platform were searched for the qualitative studies on the real experiences of elderly patients with chronic diseases during hospital-to-home transition and their experience of care services from inception to May 2022. Two researchers separately screened the literature and extracted data, evaluated the quality of included studies according to the Critical Appraisal Skills Programme (CASP) developed by evidence-based medicine center of University of Oxford. Meta synthesis was applied to integrate the results of the studies.
A total of 13 studies were included with 45 research results extracted, and 3 synthesized findings were integrated from 8 categories grouped by similar findings, including barriers to care services during hospital-to-home transition for elderly patients with chronic diseases; facilitators of care services during hospital-to-home transition for elderly patients with chronic diseases; expectations of elderly patients with chronic diseases for care services during hospital-to-home transition.
Hospital-to-home transition of elderly patients with chronic diseases is a challenging process, and there is still much room for improvement in the quality of care services during the transition. Families, communities, medical institutions, government, and society should actively improve the transition conditions for elderly patients at the individual, community, and social levels. The safe hospital-to-home transition of elderly patients with chronic diseases can be promoted by enhancing education for patients during transition, improving self-management abilities of patients, and providing nurse-led care services during transition.
Community-based intervention is an important part of palliative care for advanced cancer patients. However, its role in the health management of advanced cancer patients remains to be supported by medical evidence.
To evaluate the efficacy of community-involved hospice care for patients with advanced cancer.
Wanfang Data Knowledge Service Platform, CNKI, VIP were searched by using Chinese keywords such as "community" "medical model" and "advanced cancer", Cochrane Library, PubMed and Web of Science were searched by using English keywords such as "Community-based" "Model of Palliative Care" "Advanced Cancer" "Quality of Life", to obtain randomized controlled trials (RCTs) related to the efficacy of community-involved hospice care from 2007-01-01 to 2022-05-10 by using Cochrane system evaluation method on 2022-05-22. The quality of RCTs meeting the inclusion criteria was evaluated, and the valid information was extracted for meta-analysis.
A total of 11 RCTs in English and 9 RCTs in Chinese were included in the study, involving 2 356 and 1 238 patients, respectively. Meta-analysis showed that compared with routine cancer care, community-involved hospice care could improve quality of life and symptom severity in patients with advanced cancer, demonstrated by increasing Functional Assessment of Chronic Illness Therapy-Palliative Care scale socre〔MD (95%CI) =3.77 (0.83, 6.71) , P=0.01〕and Quality of Life Instruments for Cancer Patients scale total score〔MD (95%CI) =12.53 (2.36, 22.69) , P=0.02〕, reducing Functional Assessment of Cancer Therapy scale total score〔MD (95%CI) =-2.61 (-3.53, -1.70) , P<0.01〕 and Edmonton Symptom Assessment System score〔MD (95%CI) =-2.45 (-4.70, -0.20) , P=0.03〕. However, the improvement of community-involved hospice care on depressive symptoms and overall survival rates of patients remains controversial, and its effect on economic indicators such as admission rates, hospitalization days/numbers needs to be further explored.
Community-involved hospice care can improve the quality of life and symptom severity of patients with advanced cancer, however, its improvement in hospice care in the depressive symptoms and overall survival rates of the patients remains controversial, and its improvement in economic indicators such as admission rate and hospital stay/inpatients admissions remains to be further explored.
Chronic kidney disease (CKD) is characterized by abnormal urine test or progressive kidney function decline. Patients with CKD are at a higher risk of COVID-19 infection with higher conversion and mortality rates after infection for their reduced kidney function, long-term use of immunosuppressive agents or combination of underlying diseases. Therefore, rational drug use is particularly important for CKD patients combined with COVID-19 infection. This article summarizes special considerations for the use of relevant medications in patients with CKD by integrating the current evidence of medications for the treatment of COVID-19 infection, including antiviral drugs, anti-inflammatory drugs, antithrombotic drugs, convalescent plasma and neutralizing monoclonal antibodies, as well as commonly used symptomatic drugs of respiratory system (such as antfebrile, antisputum and cough medicine and anti-allergic drugs), high lighting the modified medication regiments according to kidney function levels, in order to provide a reference for clinical professionals, assist in clinical decision-making and rational drug use, and ensure clinical efficacy and safety.
Self-management meets the long-term rehabilitation needs of stroke patients and their families. However, there is a lack of relevant evidence, and there is no scientific and standardized self-management program in clinical practice.
To evaluate and summarize the best evidence of self-management in patients with motor dysfunction after stroke.
PubMed, Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, VIP, Chinese Biomedical Literature Database (CBM), American Heart Association/American Stroke Association (AHA/ASA), World Stroke Organization (WSO), Chinese Stroke Association (CSA), Guidelines International Network (GIN), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), and Yimaitong were searched for relevant research evidence on self-management of patients with motor dysfunction after stroke from inception to July 2022, including guidelines, expert consensuses, systematic reviews, quasi-experimental studies, and randomized controlled studies. Two researchers independently evaluated the quality of the retrieved literature by using the 2017 version of the Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the 2016 version of the literature evaluation criteria developed by the Joanna Briggs Institute (JBI) Evidence-based Health Care Center, extracted evidence and graded the quality of the evidence to summarize the best evidence of self-management in patients with motor dysfunction after stroke.
A total of 36 studies were involved, including 9 guidelines, 4 expert consensuses, 5 systematic reviews, 5 quasi-experimental studies, and 13 randomized controlled studies, which were summarized in 6 aspects of organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up, and 34 pieces of best evidence.
The evidence of self-management in patients with motor dysfunction after stroke summarized in this study contains 6 aspects: organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up. Healthcare workers should select the best evidence based on the individual situation and needs of patients in the context of clinical practice, and provide personalized self-management interventions for patients, so as to improve their motor function and self-management ability, promoting the recovery of disease.
The prevalence of comorbidity in the elderly is showing a rising trend year by year with the acceleration of population aging. Comorbidity is a key risk factor for frailty in the elderly. Then frailty only increases the risk of adverse health outcomes for patients with comorbidity, but also significantly increases their family medical expenses. It has a certain guiding value for the management of comorbidity to identify the frailty conditions of elderly patients with comorbidity as early as possible.
To systematically review the prevalence of frailty in elderly patients with comorbidity.
CNKI, VIP, CBM, WanFang, PubMed, EmBase, Web of Science and Cochrane Library were searched in December 2021 for the investigation studies on the current status of frailty in elderly patients with comorbidity published from inception to December 4, 2021. Two researchers performed literature screening and data extraction independently. The cross-sectional study quality rating scale and Newcastle-Ottawa Scale (NOS) recommended by Agency for Healthcare Research and Quality (AHRQ) were used to assess the risk of bias of the included studies and Stata 14.0 was adopted for meta-analysis.
A total of 25 studies involving 16 062 elderly patients with comorbidity were included. Meta-analysis results showed that the prevalence of frailty and pre-frailty in elderly patients with comorbidity was 26.7%〔95%CI (21.9%, 31.5%) 〕and 47.7%〔95%CI (43.9%, 51.4%) 〕. Subgroup analysis showed that the prevalence of frailty in older adults with≥2, ≥3, ≥4, and≥5 chronic diseases was 25.1%〔95%CI (19.3%, 30.8%) 〕, 27.4%〔95%CI (13.7%, 41.0%) 〕, 60.7%〔95%CI (29.0%, 92.4%) 〕, and 23.5%〔95%CI (8.6%, 38.5%) 〕, respectively. The prevalence of frailty in elderly patients with comorbidity in Oceania (52.1%) and Asia (31.3%) were significantly higher than Europe (16.9%) and South America (13.2%) . The prevalence of frailty in elderly patients with comorbidity in hospital (26.2%) was significantly higher than community (23.2%) . The prevalence of frailty in elderly patients with comorbidity screened by Clinical Frailty Scale (CFS) , Fried frailty phenotype scale and FRAIL Scale was 42.8%〔95%CI (38.4%, 47.1%) 〕, 22.2%〔95%CI (17.8%, 26.7%) 〕and 8.5%〔95%CI (6.3%, 10.6%) 〕, respectively. The prevalence of frailty in elderly patients surveyed in 2001—2010, 2011—2015, and 2016—2020 was 21.0%〔95%CI (13.2%, 28.8%) 〕, 19.0%〔95%CI (13.1%, 24.8%) 〕and 37.7%〔95%CI (22.6%, 52.9%) 〕, respectively.
The prevalence of frailty in elderly patients with comorbidity is gradually increasing, with differences by number of co-morbidities, continents, assessment tools and study sites. Therefore, relevant personnel should pay attention to early screening of frailty in elderly patients with comorbidity and take timely measures to prevent the development of frailty in elderly patients with comorbidity.
Patient decision aids (PDAs) are essential tools to assist patients in the process of shared-decision making. However, their effects have been reported to be inconsistent in shared-decision making in the diagnosis and treatment of colorectal cancer.
To assess the core factors in the development of PADs supporting decision-making in colorectal cancer diagnosis and treatment, and their application effects using a systematic review.
In February 2022, randomized controlled trials (RCTs) on PDAs supporting decision-making in colorectal cancer care were searched in databases including PubMed, Web of Science, CIHNAL, Cochrane Library, EmBase, PsycINFO, JBI, Scopus, CNKI, WanFang, CQVIP and SinoMed from inception to January, 2022. Two researchers performed literature screening and data extraction separately. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials (5.1.0) was used to assess the risk of bias. A descriptive analysis was conducted to describe the core factors used in the development of PDAs and to summarize the effect of PDAs.
A total of 11 RCTs were included, involving PDAs for supporting decision-making in colorectal cancer screening, systemic therapy and supportive care for advanced colorectal cancer, chemotherapy for metastatic colorectal cancer, and genetic testing for hereditary nonpolyposis colorectal cancer. The quality was moderate on the whole. Specifically, the quality of one RCT was rated as level A and that of the other 10 was level B. The analysis found that: (1) currently, the development of PDAs for supporting decision-making in colorectal cancer is mainly under the guidance of the quality criteria framework published by the International Patient Decision Aids Standards Collaboration, and the core content of the tool include providing information about options, balanced presentation of options, clarifying and expressing values; (2) The use of PDAs increased patient knowledge (six RCTs) , reduced patient decisional conflicts (eight RCTs) and promoted informed choice (two RCTs) .
The use of PDAs has proven to be effective in improving patient decision-making behavior and results in colorectal cancer. Although the evidence is still insufficient, they have broad prospect in clinical practice. In the future, the PDAs that are applicable to Chinese patients in different stages of colorectal cancer can be developed with the support of foreign theoretical achievements about decision-making and in accordance with the conditions of Chinese population, and the application effects of them need to be assessed further.
Untimely and ineffectively treated breech or transverse lie position of a fetus may increase the rate of cesarean section, and the risk of uterine rupture and other serious childbirth complications, endangering the lives of mothers and newborns. However, at present, there is no conclusion on the effectiveness and selection priority of different interventions for it during childbirth.
To perform a network meta-analysis of the impact of different interventions for breech or transverse lie position on maternal and neonatal outcomes.
We searched the Cochrane Library, PubMed, Web of Science, Embase, CINAHL, CBM, CNKI, VIP, and Wanfang Data Knowledge Service Platform for randomized controlled trials (RCTs) of the effects of different interventions for breech or transverse lie position on maternal and neonatal outcomes from inception to March 2022. Two researchers independently completed literature screening and data extraction, and quality assessment. R 4.1.1 and Stata 16.0 were used for data analysis and graph drawing. Consistency test and convergence analysis of the studies were performed. SUCRA was used to rank the effectiveness of each intervention and determine the most effective one.
A total of 36 RCTs were included, including 7 419 parturients. The interventions involved were: knee-chest position, moxibustion/stimulation of Zhiyin acupoint, and external cephalic version (ECV) under different types of uterine contraction inhibitors/anesthesia. Network meta-analysis showed that compared with moxibustion/stimulation to Zhiyin acupoint, the success rate of moving a breech or transverse lie position to a head position was lower by usual nursing〔RR=0.54, 95%CI (0.32, 0.86) , P<0.05〕. The success rate of moving a breech or transverse lie position to a head position without uterine contraction inhibitor before ECV was lower than that using β2-adrenergic receptor agonists〔RR=0.60, 95%CI (0.38, 0.62) , P<0.05〕. The vaginal delivery rate with calcium channel blockers but without uterine contraction inhibitors was lower than that using β2-adrenergic receptor agonists〔RR=0.60, 95%CI (0.39, 0.89) , P<0.05; RR=0.60, 95%CI (0.39, 0.95) , P<0.05〕. The success rate of moving a breech or transverse lie position to a head position by ECV without anesthesia was lower than that using intravenous anesthesia〔RR=0.71, 95%CI (0.53, 0.96) , P<0.05〕 or intraspinal anesthesia〔RR=0.65, 95%CI (0.49, 0.85) , P<0.05〕. Compared with non-anesthesia, the use of intravenous anesthesia and intraspinal anesthesia during ECV could reduce the post-ECV pain score〔WMD=-1.97, 95%CI (-2.49, -1.46) , P<0.05; WMD=-3.80, 95%CI (-5.10, -2.50) , P<0.05〕. The three top interventions for terms of effectiveness ranked by SUCRA were: moxibustion/stimulation to Zhiyin acupoint, the use of β2-adrenergic receptor agonists to suppress uterine contractions before ECV, and the use of spinal anesthesia during ECV.
Based on the results of network meta-analysis and SUCRA ranking, moxibustion/stimulation to Zhiyin acupoint, the use of β2-adrenergic receptor agonists to inhibit uterine contractions before ECV, and the implementation of ECV under spinal anesthesia for moving a breech or transverse lie position to a head position during late pregnancy have a good effect on improving the maternal and neonatal outcomes, but this conclusion still needs to be further verified by more high-quality, large-sample studies.
Urinary tract infection is the most common complication in patients with neurogenic bladder, which severely affects the treatment effect and quality of life of patients. Early identification of its related factors and delivery of targeted measures of prevention and intervention are of great significance to improve the prognosis of patients. Recent studies on influencing factors of urinary tract infection in neurogenic bladder are increasing but have controversial results, and there is a lack of relevant systematic reviews and support from evidence-based medicine.
To systematically assess the risk factors of urinary tract infection in neurogenic bladder.
Databases of PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, CQVIP, and SinoMed were searched for literature on risk factors of urinary tract infection in patients with neurogenic bladder from inception to June 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale (NOS) . RevMan 5.3 was used for meta-analysis.
A total of 13 articles with 3 319 cases were included. The NOS score of the articles ranged from 6 to 8. Meta-analysis results showed that advanced age〔OR≥60=2.50, 95%CI (1.83, 3.41) , P<0.000 01; OR≥65=2.13, 95%CI (1.40, 3.25) , P=0.000 4〕, diabetes〔OR=3.17, 95%CI (2.58, 3.89) , P<0.000 01〕, hypoalbuminemia〔OR=2.26, 95%CI (1.67, 3.06) , P<0.000 01〕, number of strokes ≥2〔OR=3.30, 95%CI (1.70, 6.41) , P=0.000 4〕, indwelling catheter〔OR=2.88, 95%CI (2.09, 3.95) , P<0.000 01〕, frequency of intermittent catheterization ≥2 times/week〔OR=2.44, 95%CI (1.62, 3.68) , P<0.000 1〕, frequency of bladder irrigation≥3 times/week〔OR=2.63, 95%CI (1.66, 4.17) , P<0.000 1〕, duration of bladder function training intervention≥2 weeks〔OR=2.75, 95%CI (1.69, 4.46) , P<0.000 1〕, duration of rehabilitation intervention >7 d〔OR=3.03, 95%CI (1.42, 6.48) , P=0.004〕were associated with increased risk of urinary tract infection in neurogenic bladder; Male〔OR=0.78, 95%CI (0.63, 0.96) , P=0.02〕was associated with decreased risk of urinary tract infection in neurogenic bladder.
Older age, complicated with diabetes, hypoalbuminemia, number of strokes ≥2, indwelling catheter, frequency of intermittent catheterization ≥2 times/week, frequency of bladder irrigation ≥3 times/week, duration of bladder function training intervention ≥2 weeks, and duration of rehabilitation intervention >7 d may be the risk factors for urinary tract infection in neurogenic bladder. To prevent or reduce the risk of urinary tract infection in these patients, clinical workers should identify the aforementioned high-risk factors as early as possible, and provide the patients with interventions targeting the controllable factors.
The incidence of mucocutaneous lymph node syndrome (MCLS), also known as Kawasaki disease (KD), has been increasing year by year. Coronary artery lesions (CAL) induced by KD has become the main cause of acquired heart disease in children. Many clinical studies show that mycoplasma pneumoniae (MP) is associated with CAL in KD, but the strength of association between them differs across original research on different individuals.
To systematically evaluate the correlation between MP infection and CAL in KD, providing evidence for early and timely delivery of effective clinical treatment to improve the quality of life and to prevent adverse outcomes in children with KD.
Observational studies on KD〔KD patients with MP infection (MP-IgM positive) (exposed group) compared with those with simple KD (control group), with CAL as the outcome measure〕 were retrieved from databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science from inception to April 3, 2022. Two researchers independently performed literature screening and data exaction. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Stata 15.0 and RevMan 5.4 were used for data analysis.
A total of 31 studies involving 6 131 subjects were included. The average quality score of the studies rated using the NOS was 7, indicating a high overall quality. Meta-analysis showed that the risk of CAL in the exposed group was higher than that in the control group〔RR=1.65, 95%CI (1.40, 1.94), P<0.000 01〕. Subgroup analysis based on baseline data revealed that, the risk of CAL in exposed group was higher in studies on exposed and control groups with matched baseline data〔RR=1.92, 95%CI (1.71, 2.16), P<0.000 01〕, but was similar in studies on two groups with unmatched baseline data〔RR=0.98, 95%CI (0.91, 1.06), P=0.65〕. Furthermore, the risk of CAL was found to be higher in the exposed group in subgroup analysis based on MP infection diagnosed serologically with IgM>1∶160, or by quantitative PCR, or undescribed method (P<0.05). And in subgroup analysis based on age, C-creactive protein/procalcitonin ratio, or undescribed method, the risk of CAL was still higher in the exposed group (P<0.05). Egger's and Begg's tests showed that all the studies had publication bias (P<0.05). However, the comparison of the pooled effect size using the random effects model〔RR=1.32, 95%CI (1.13, 1.54), P<0.000 01〕 showed that the results before and after trimming and filling were not reversed, indicating that the results of this study were relatively stable.
MP infection increased the risk of CAL in children with KD. Early detection of MP and timely delivery of effective intervention are very important.
Malnutrition is a common complication in patients with esophageal cancer, which has been validated by domestic and international studies to seriously impact the recovery of patients. While the number of patients receiving home enteral nutrition (HEN) is increasing, the effectiveness and safety of HEN for patients with esophageal cancer remains unclear.
To systematically evaluate the effectiveness and safety of HEN by meta-analysis.
RCTs on the HEN in patients with esophageal cancer were retrieved in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, Wanfang Data, CNKI, VIP and CBM from inception to December 2021. Patients in the experimental group received HEN support〔both enteral tube feeding (ETF) and oral nutritional supplement (ONS) were both acceptable〕, while patients in the control group received conventional oral diet only. Two researchers independently screened the literature and extracted data. The RoB 2.0 recommended by the Cochrane Collaboration was used to evaluate the quality of the included studies, and the RevMan 5.4.1 software was used to perform the meta-analysis.
A total of 14 articles were included, involving 1 040 patients with esophageal cancer. Meta-analysis showed that the increase values of body mass, BMI, hemoglobin, serum total protein, serum prealbumin and serum transferrin in the experimental group were higher than those in the control group〔SMD=0.63, 95%CI (0.40, 0.85), P<0.000 01; SMD=0.60, 95%CI (0.44, 0.76), P<0.000 01; SMD=1.58, 95%CI (1.37, 1.79), P<0.000 01; SMD=1.19, 95%CI (0.79, 1.58), P<0.000 01; SMD=0.97, 95%CI (0.79, 1.14), P<0.000 01; SMD=1.12, 95%CI (0.45, 1.79), P=0.001〕. The increase value of serum albumin in the experimental group was higher than that in the control group in both ETF and ONS subgroups analysis〔SMD=1.25, 95%CI (0.82, 1.68), P<0.000 01; SMD=0.61, 95%CI (0.26, 0.97), P<0.000 01〕. The incidence of malnutrition was lower in the experimental group than in the control group〔OR=0.47, 95%CI (0.33, 0.67), P<0.000 1〕. There was no statistically significant differences in the incidence of gastrointestinal complications〔RR=1.33, 95%CI (1.00, 1.77), P=0.05〕and life quality score〔MD=4.97, 95%CI (0.06, 9.87), P=0.05〕 between the two groups. The physical function score of the experimental group was higher than that of the control group〔MD=6.67, 95%CI (2.86, 10.48), P=0.000 6〕, and the fatigue symptom score was lower than that of the control group〔MD=-7.31, 95%CI (-11.85, -2.77), P=0.002〕. Sensitivity analysis showed that the combined results were stable and reliable.
HEN can significantly improve the nutritional status and physical function, reduce fatigue symptoms of discharged patients after esophageal cancer surgery, and does not increase the incidence of gastrointestinal complications, however, it has not been found to improve the global overall quality of life.
Dietary components can produce a variety of bioactive substances that maintain a low inflammatory state in the body and participate in the formation of the tumor microenvironment. The dietary inflammatory index (DII) is a new indicator to quantify the inflammatory potential of diet. High DII score is closely associated with the risk of colorectal cancer, but its relationship with upper gastrointestinal cancer (UGIC) is unclear.
This study was conducted to assess the relationship between DII and the risk of UGIC, providing a scientific basis for dietary guidance.
We did a systematic search of PubMed, Web of Science, Embase and the Cochrane Library for studies on the association of DII score and UGIC published in English, and Wanfang Data, CNKI and VIP for those published in Chinese, from inception to October 10, 2022. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.4.1 was used for meta-analysis and subgroup analysis.
A total of 11 case-control studies including 9 051 participants were included in this study. Meta-analysis showed that high DII score were associated with an increase in the risk of UGIC〔OR=1.81, 95%CI (1.65, 1.97), P<0.05〕. High DII score also significantly increased the risk of esophageal and gastric cancers〔OR=2.20, 95%CI (1.69, 2.86) ; OR=1.79, 95%CI (1.44, 2.24), P<0.05〕. Subgroup analysis showed that high DII score increased the risk of UGIC by 131% in the European population〔OR=2.31, 95%CI (1.78, 3.00), P<0.05〕, and 98% in the Asian population〔OR=1.98, 95%CI (1.55, 2.53), P<0.05〕. High DII score increased the risk of UGIC by 161% in women〔OR=2.61, 95%CI (1.79, 3.79), P<0.05〕. Moreover, high DII score increased the risk of UGIC by 47% in H. pylori-negative populations〔OR=1.47, 95%CI (1.08, 1.99), P<0.05〕, and 90% in H. pylori-positive populations〔OR=1.90, 95%CI (1.33, 2.71), P<0.05〕. High DII score was associated with a 195% increased risk of UGIC in the population with interviewer-administered Food Frequency Questionnaire (FFQ) 〔OR=2.95, 95%CI (1.96, 4.43), P<0.05〕, and a 68% increased risk of UGIC in the population with self-administered FFQ〔OR=1.68, 95%CI (1.53, 1.85), P<0.05〕. High DII score was associated with a 101% increased risk of UGIC in the population with a higher number of DII components (>30) 〔OR=2.01, 95%CI (1.57, 2.57), P<0.05〕, and a 125% increased risk of UGIC in the population with a lower number of DII components (<30) 〔OR=2.25, 95%CI (1.58, 3.22), P<0.05〕. In addition, high DII score increased the risk of UGIC by 123% in the population with energy-adjusted diet〔OR=2.23, 95%CI (1.85, 2.68), P<0.05〕, and 70% in the population without energy-adjusted diet〔OR=1.70, 95%CI (1.53, 1.88), P<0.05〕. The funnel plot of the literature was asymmetric, showing that there was a certain publication bias.
A pro-inflammatory diet with higher DII score may exacerbate the risk of UGIC, especially in esophageal cancer patients and in the female population.
Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery.
To perform a review of available evidence on the incidence of dysphagia after cardiac surgery.
Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0.
Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged <70 years and ≥70 years was 10.9%〔95%CI (8.6%, 13.5%) 〕 and 28.4%〔95%CI (19.7%, 37.9%) 〕, respectively. And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI (7.4%, 16.3%) 〕 in patients with NYHA classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. In accordance with analysis based on the duration of perioperative endotracheal intubation, the incidence of dysphagia following cardiac surgery in patients with <12 hours, 12-24 hours, 25-48 hours and >48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value<0.05, indicating that publication bias existed in the studies.
Current evidence indicates that the incidence of dysphagia after cardiac surgery is high (13.3%), therefore, prompt postsurgical screening and treatment of dysphagia should be administered.
Prostate cancer is one of the most prevalent cancers that endangers the live and health of elderly Chinese men. Currently, radical prostatectomy (RP) is the predominant treatment for localized prostate cancer, but postoperative positive surgical margins (PSMs) have been detected pathologically in some cases. Studies have shown that PSMs indicate high probability of biochemical recurrence and poor prognosis after RP. There is no consensus of risk factors for PSMs after RP in Chinese men.
To perform a meta-analysis of risk factors for PSMs after RP in Chinese men, providing evidence for the containment of PSMs.
Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, CBM and VIP were searched to collect literature on risk factors for PSMs after RP in Chinese men from the time of database creation to March 1, 2022. The Newcastle-Ottawa scale was adopted to assess the quality of included cohort studies. Stata 16.0 was used to perform meta-analysis.
Twenty-one case-control studies were enrolled, including 6 782 patients, among whom 2 028 had PSMs. Meta-analysis indicated that high pre-RP prostate specific antigen (PSA) 〔OR=1.77, 95%CI (1.18, 2.65) 〕, perineural invasion at puncture time〔OR=5.83, 95%CI (2.05, 16.59) 〕, pre-RP clinical stage T3 or T4〔OR=2.17, 95%CI (1.06, 4.42) 〕, post-RP pathological stage T3 or T4 〔OR=4.30, 95%CI (2.43, 7.63) 〕, high percentage of positive puncture stitches〔OR=1.83, 95%CI (1.35, 2.47) 〕, high Gleason score at the time of puncture〔OR=2.14, 95%CI (1.67, 2.74) 〕, and high Gleason score after RP〔OR=2.33, 95%CI (1.80, 3.01) 〕were risk factors for PSMs after RP (P<0.05) . Subgroup analysis of different surgical approaches in RP showed that pre-RP clinical stage T3 or T4 〔OR=4.57, 95%CI (2.57, 8.12) 〕, post-RP pathological stage T3 or T4 〔OR=4.80, 95%CI (2.20, 10.48) 〕, and high Gleason score after RP〔OR=2.46, 95%CI (1.57, 3.86) 〕were risk factors for PSMs treated with laparoscopic RP (P<0.05) . But in robot-assisted RP, the risk factor was high pre-RP PSA 〔OR=2.17, 95%CI (1.60, 2.94) 〕 (P<0.05) . Sensitivity analysis demonstrated that there was high-level agreement on risks for PSMs in these studies, and the results of meta-analysis was robust. Asymmetric funnel plots showed potential publication bias for the meta-analysis of the impact of pre-RP PSA, post-RP pathological T stage and Gleason score on PSMs, while symmetric funnel plot showed no potential publication bias for the meta-analysis of the impact of pre-RP clinical T stage on PSMs.
PSA, perineural invasion at puncture time, pre-RP clinical stage T3 or T4, post-RP pathological stage T3 or T4, high percentage of positive puncture stitches, high Gleason score at the time of puncture, and high Gleason score after RP were risk factors for PSMs after RP, which should be early recognized and addressed to halt tumor growth and recurrence.
Pain is a common non-motor symptom in patients with Parkinson's disease (PD) , which has a serious impact on patients' quality of life. Current scholars have explored the factors influencing the occurrence of pain in patients with PD, but there is some variability in the findings.
To evaluate the influencing factors of pain in PD patients.
We searched the CNKI, Wanfang Data, VIP, SinoMed, Web of Science, PubMed, Medline, Embase and Cochrane Library databases for studies on factors influencing pain in patients with PD from database establishment to April 12, 2022. Two researchers independently conducted literature screening and relevant information extraction. We used the Agency for Healthcare Research and Quality (AHRQ) Scale and the Newcastle-Ottawa Scale (NOS) to evaluate the risk of bias in cross-sectional studies and case-control studies, respectively. We performed a descriptive analysis of all influencing factors of pain, and implemented a meta-analysis of these influencing factors using RevMan 5.3.
Sixteen studies were finally included, with a total sample size of 2 855 cases, and 24 influencing factors of pain identified. There were two protective factors and 22 risk factors in descriptive analysis. The meta-analysis showed that, female〔OR=3.73, 95%CI (1.75, 7.96) , P=0.000 7〕, long duration of PD〔OR=1.35, 95%CI (1.15, 1.60) , P=0.000 3〕, depressed mood 〔OR=1.14, 95%CI (1.07, 1.22) , P<0.000 01〕, high UPDRS Ⅲ score〔OR=1.07, 95%CI (1.03, 1.11) , P=0.000 2〕, advanced Hoehn-Yahr stages〔OR=2.28, 95%CI (1.28, 4.04) , P=0.005〕, and high NMSS score〔OR=1.68, 95%CI (1.46, 1.93) , P<0.000 01〕 were risk factors for pain in PD patients. The GRADE analysis showed that the quality of evidence for the effects of gender and NMSS score on pain was moderate, and that for the effects of duration of PD, depressed mood and UPDRSⅢ score on pain was low, and that for the effect of Hoehn-Yahr stage on pain was very low.
Female, long duration of PD, depressed mood, motor impairment, advanced Hoehn-Yahr stages and other severe non-motor symptoms (sleep disturbance, fatigue) are risk factors for pain in PD patients, which need to be further validated by high-quality, large-sample studies in the future.
Postpartum depression and personality problems have adverse effects on maternal and infant health. At present, the research results on the relationship between different personality traits and postpartum depression are still controversial, and there is a lack of the systematic reviews on it in China.
To systematically review the relationship between different personality traits and postpartum depression.
The research was performed Web of Science, PubMed, EBSCOhost, Embase, PsycInfo (Proquest) , CNKI, Wanfang Data Knowledge Service Platform, and VIP for studies on the relationship between different personality traits and postpartum depression from inception until June 4, 2021. The relevant data extraction was conducted after the quality evaluation of literature. Stata 16.0 was used for meta-analysis. Subgroup analysis and publication bias tests were performed for the relationship between neuroticism and postpartum depression. Sensitivity analysis of the relationship between different personality traits and postpartum depression was performed using rollover effect models.
A total of 19 articles and 9 personality traits were finally included in the meta-analysis, including neuroticism (14 studies) , extraversion (6 studies) , agreeableness (5 studies) , openness (4 studies) , conscientiousness (4 studies) , vulnerability (3 studies) , obsessive-compulsive personality disorder (2 studies) , avoidant personality disorder (2 studies) and dependent personality disorder (2 studies) . The result of Meta-analysis showed that neuroticism 〔OR=1.30, 95%CI (1.20, 1.40) 〕, vulnerability 〔OR=1.39, 95%CI (1.10, 1.76) 〕, avoidant personality 〔OR=6.27, 95%CI (2.55, 15.40) 〕and dependent personality 〔OR=7.11, 95%CI (1.62, 31.14) 〕 were risk factors of postpartum depression (P<0.05) . Extraversion 〔OR=0.86, 95%CI (0.77, 0.97) 〕 and openness 〔OR=0.94, 95%CI (0.90, 0.98) 〕 were protective factors of postpartum depression (P<0.05) . The results of the subgroup analysis showed that the different threshold value of Edinburgh Postnatal Depression Scale (EPDS≥12 scores: OR=1.71, EPDS≥9 scores: OR=1.14, P=0.028) and different investigation time of postpartum depression (OR=1.13 for <1 week postpartum, OR=1.33 for 2-12 weeks postpartum, OR=2.22 for ≥13 weeks postpartum; P=0.008) were the sources of heterogeneity in the pooled results. Sensitivity analysis showed that the pooled results about personality traits were reliable except for obsessive-compulsive personality disorder.
Personality traits have different effects on postpartum depression, among which neuroticism and vulnerable personality are risk factors of postpartum depression, extraversion and openness are protective factors of postpartum depression. Postpartum depression may be more severe and more likely to occur after 13 weeks postpartum in postpartum women with neuroticism. Due to the inconsistent results of domestic and foreign researches, the relationships between avoidant, dependent, and obsessive-compulsive personality disorders and postpartum depression need to be further explored in the future.
Considering that our country has entered an aging society, the health problems of the older people has evolved into a concern due to the association with a variety of diseases. In recent years, Chinese households and society have suffered a serious economic burden due to the increasing prevalence of dysphagia among the elderly.
The purpose of this study is to evaluate the prevalence of dysphagia in the elderly in China systematically.
PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang Data, and China Biomedical Literature Database were searched for epidemiological studies related to the prevalence of dysphagia in the elderly in China. Searches were conducted from database inception to May 2022. Two researchers were responsible for screening literature and extracting data according to the inclusion and exclusion criteria. The AHRQ scale was used to evaluate the quality of cross-sectional studies. Meta-analysis was performed with Stata 15.0 software.
A total of 22 articles were analyzed, containing 308 289 patients, including 47 940 patients with dysphagia. Meta-analysis revealed that the prevalence of dysphagia in the elderly in China was 66.0%〔95%CI (58.0%, 73.0%) 〕. According to subgroup analysis, among elderly Chinese males and females dysphagia was prevalent in 38.0%〔95%CI (31.0%, 45.0%) 〕 and 38.0%〔95%CI (29.0%, 46.0%) 〕 of cases, respectively. The prevalence of dysphagia was 21.0%〔95 %CI (13.0%, 29.0%) 〕 in 60-69 years old, 28.0%〔95%CI (18.0%, 37.0%) 〕 in those aged 70-79, and 41.0%〔95%CI (31.0%, 50.0%) 〕 in those aged more than 80. In primary, secondary, and technical secondary school, and college and up, dysphagia was observed in 28.0%〔95%CI (20.0%, 35.0%) 〕, 32.0%〔95%CI (17.0%, 53.0%) 〕, 30.0%〔95%CI (18.0%, 42.0%) 〕 of the elderly. The prevalence of elderly dysphagia was 68.0% in the hospital〔95%CI (52.0%, 85.0%) 〕, 56.0%〔95%CI (41.0%, 71.0%) 〕 in the nursing home and 76.0%〔95%CI (56.0%, 97.0%) 〕 in the community. According to the Kubota Drinking Test, 32.0%〔95%CI (21.0%, 43.0%) 〕 of the elderly suffer from dysphagia, 41.0%〔95%CI (16.0%, 66.0%) 〕 exprience it according to the EAT-10 scale, and 35.0%〔95%CI (14.0%, 56.0%) 〕 suffer from it according to the Water Swallowing Test scale.
The prevalence of dysphagia among the elderly in China is 66.0%〔95%CI (58.0%, 73.0%) 〕. The prevalence of dysphagia among those≥80 years old, those with secondary school and technical secondary school education, elderly care in community, and those with dysphagia diagnosed by the EAT-10 scale is high. In order to improve the quality of life and reduce the prevalence of dysphagia among the elderly, we must pay more attention to and understand elderly dysphagia early.
Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice.
To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients.
PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual.
Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term.
Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.
Overweight and obesity are major risk factors for many chronic diseases, with the prevalence of overweight/obesity among Chinese adults reaching 50.7% in 2018. Bariatric surgery is one currently available treatment for obesity, but whether it increases the risk of fracture is still controversial.
To analyze whether weight-loss surgery will increase the risk of fracture.
PubMed, Embase, and Cochrane Library databases were searched for studies (cohort studies, case-control studies, and randomized controlled trial) about the risk of fracture and bariatric surgery published between January 2010 and November 2021. The Newcastle-Ottawa scale (NOS) and Jadad scale were used to evaluate the methodological quality of the studies. RevMan 5.3 and Stata 12.0 were used for data analysis. The Begg's test and Egger's test were conducted to assessing the potential publication bias. Compare the association of bariatric surgery with risk of fracture by comparing risk of fracture between patients with and without bariatric surgery.
A total of 15 studies were included, including 12 cohort studies, two case-control studies, and one randomized controlled trial, all of which were of high quality. Twelve studies compared the risk of fracture between patients with bariatric surgery and those without, 10 of which enrolled patients with bariatric surgery (surgery group, n=137 239) and obese patients without bariatric surgery (obesity group, n=159 066) with no differences in baseline BMI, showing large heterogeneity (P<0.01, I2=94%). Meta-analysis using a random-effects model showed that there was no significant intergroup difference in fracture risk between the two groups〔RR (95%CI) =1.21 (1.00, 1.46), P=0.05〕. Four studies enrolled patients with bariatric surgery (n=14 796) and non-obese patients without bariatric surgery (n=132 124) with significant differences in baseline BMI, showing slight heterogeneity (P=0.26, I2=25%), and a higher risk of fracture was found in those with bariatric surgery revealed by meta-analysis using a fixed effects model〔RR (95%CI) =1.73 (1.59, 1.89), P<0.01〕. The level of heterogeneity decreased significantly after removing 4 of the 10 studies with high heterogeneity with no intergroup difference in baseline BMI (P=0.24, I2=25%), and a higher risk of fracture was found in patients with bariatric surgery indicated by meta-analysis using a fixed effects model〔RR (95%CI) =1.38 (1.31, 1.46), P<0.01〕. Subgroup analysis showed that the risk of fracture was similar in the surgery group and the obesity group within two years〔RR (95%CI) =1.05 (0.89, 1.24), P=0.56〕 and during two to five years〔RR (95%CI) =1.16 (1.00, 1.35), P=0.05〕, but it was higher in the former group five years after surgery〔RR (95%CI) =1.50 (1.23, 1.84), P<0.001〕. The risk of fracture was higher in patients with Roux-en-Y gastric bypass than that of those with adjustable gastric banding〔RR (95%CI) =1.31 (1.15, 1.50), P<0.01〕 or with sleeve gastrectomy〔RR (95%CI) =1.77 (1.55, 2.02), P<0.01〕. The risk of fracture was lower in patients with gastric banding than that of those with gastric bypass〔RR (95%CI) =0.54 (0.41, 0.71), P<0.01〕. Both Begg's test and Egger's test showed that publication bias was less likely in the studies (P=0.631, 0.720) .
Fracture risk is increased by bariatric surgery, which is not influenced by obesity. High risk of fracture did not appear until five years after the operation, with Roux-en-Y gastric bypass and gastric bypass were associated with higher fracture risk.
Previous studies have shown various improvement effects of non-invasive brain stimulation (NIBS) on autism spectrum disorder (ASD), and there is a lack of comparison of the efficacy of different types of NIBS.
To systematically evaluate the effect of NIBS on ASD, and to compare the curative effects of two types of NIBS.
Randomized controlled trials (RCTs) about the effect of NIBS on ASD〔both experimental and control groups received conventional treatments, and the experimental group additionally received transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) 〕 were retrieved from databases of PubMed, Embase, Cochrane Library, Scopus, Web of Science, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to December 2021. Two researchers independently implemented literature screening and data extraction, and used the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0) to assess the risk of bias of the included studies. The statistical analysis was performed using RevMan 5.3 and R 4.0.2.
Ultimately, 22 studies involving 661 patients were included. Meta-analysis showed that NIBS could reduce Autism Behavior Checklist (ABC) score 〔MD=-8.80, 95%CI (-10.98, -6.62), P<0.05〕, Childhood Autism Rating Scale score〔MD=-2.93, 95%CI (-3.63, -2.24), P<0.05〕, Autism Treatment Evaluation Checklist score〔MD=-9.13, 95%CI (-12.79, -5.47), P<0.05〕, Self-rating Anxiety Scale score〔MD=-7.20, 95%CI (-10.55, -3.85), P<0.05〕, Self-rating Depression Scale score〔MD=-8.89, 95%CI (-13.21, -4.57), P<0.05〕 and mismatch negativity latency period 〔MD=-5.97, 95%CI (-9.42, -2.53), P<0.05〕, and increase development quotient score 〔MD=5.22, 95%CI (3.41, 7.04), P<0.05〕 and mismatch negativity amplitude〔MD=1.54, 95%CI (0.57, 2.51), P<0.05〕. No obvious asymmetry was detected in the inverted funnel plot measuring publication bias, but could not exclude the potential for publication bias. Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the ABC score is tDCS (P=0.931) >rTMS (P=0.069) .
Existing evidence shows that NIBS can improve ASD, and the effect of tDCS is better than that of rTMS.
Upper limb motor dysfunction is a common complication after stroke that seriously affects daily living skills of patients. As a common neuroelectrohysiological technique, repetitive transcranial magnetic stimulation (rTMS) has a good effect on post-stroke upper limb motor dysfunction. However, there is still no practice-based evidence on the selection of modalities of rTMS.
To evaluate the clinical efficacy of four rTMS modalities in post-stroke upper limb motor dysfunction by a network meta-analysis.
Randomized controlled trials (RCTs) about rTMS for treating upper limb motor dysfunction after stroke were searched with subject words combined with free words as searching terms in PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang Data, and VIP from inception to February 2022, supplemented by references from retrospective meta-analysis. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.0 and Stata 16.0 were used for statistical analysis.
A total of 17 RCTs with 790 cases were included. Six interventions were involved: high frequency-rTMS (HF-rTMS), low frequency-rTMS (LF-rTMS), intermittent theta burst stimulation (iTBS), continuous theta burst stimulation (cTBS), sham stimulation and conventional therapy. Network meta-analysis results showed that HF-rTMS and LF-rTMS had better effects on increasing the FMA-UE score than sham stimulation and conventional therapy (P<0.05). cTBS increased the FMA-UE score more significantly than conventional therapy (P<0.05). LF-rTMS increased the MBI and BI scores more notably than sham stimulation and conventional therapy (P<0.05). HF-rTMS and LF-rTMS reduced the MEP latency more significantly than sham stimulation (P<0.05). The SUCRA ranking of the six interventions in terms of increasing the FMA-UE score showed the following: LF-rTMS (79.9%) >cTBS (75.3%) >HF-rTMS (71.1%) >iTBS (45.8%) >sham stimulation (20.2%) >conventional therapy (7.7%). The SUCRA ranking of decreasing the MAS score revealed the following: iTBS (77.0%) >LF-rTMS (64.1%) >cTBS (61.0%) >HF-rTMS (38.0%) >sham stimulation (30.6%) >conventional therapy (29.2%). The SUCRA ranking of increasing the MBI and BI scores showed the following: LF-rTMS (96.4%) >iTBS (74.9%) >HF-rTMS (38.6%) >sham stimulation (30.7%) >conventional therapy (9.4%). The SUCRA ranking of reducing the MEP latency showed the following: HF-rTMS (80.0%) >LF-rTMS (78.9%) >conventional therapy (58.8%) >iTBS (24.9%) >sham stimulation (7.5%) .
The available evidence indicates that, among four modalities producing better effects than sham stimulation and conventional therapy, namely LF-rTMS, HF-rTMS, iTBS, and cTBS, LF-rTMS was superior to the other three in improving upper limb motor function and daily living skills of stroke patients, iTBS performed best in decreasing upper limb muscle tension, and HF-rTMS did best in intervening the corticospinal excitability.
Fatigue is one common symptom in stroke patients, which has been validated by studies to be negatively associated with the recovery of these patients. Non-invasive brain stimulation techniques can effectively promote or inhibit the excitability of cerebral cortex and accelerate neuroplasticity, but the efficacy and safety of the treatment for post-stroke fatigue are not clear.
To systematically evaluate the effects of non-invasive brain stimulation on post-stroke fatigue.
We searched randomized controlled trials (RCTs) of the efficacy of non-invasive brain stimulation techniques 〔transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) 〕 (experimental group) compared with that of regular rehabilitation training (control group) in post-stroke fatigue in PubMed, Web of Science, Embase and the Cochrane Library, CBM, CNKI, VIP, Wanfang Data and other databases from database inception to April 2022. The reported outcomes were assessed using the Fatigue Severity Scale (FSS) and Fugl-Meyer Assessment (FMA) scale. Two researchers conducted literature screening, data extraction and quality evaluation. RevMan 5.3 was used for meta-analysis. GRADE was used to evaluate the quality of the evidence for reported outcomes.
A total of five RCTs with 331 subjects were included, among which three studied the efficacy of rTMS, and the other two studied the efficacy of tDCS. The methodological quality of all RCTs was categorized as grade B. Meta-analysis showed that the experimental group had lower mean FSS scores than the control group〔SMD=-2.13, 95%CI (-3.63, -0.63), P=0.005〕, and had higher FMA scores than the control group〔SMD=6.60, 95%CI (4.33, 8.87), P<0.000 01〕. Sensitivity analysis showed that the results were robust. Egger's test suggested that there was little potential publication bias in this meta-analysis (t=-0.88, P=0.445). The quality of reported evidence regarding three primary outcomes, namely, FSS scores after a 4-week and 8-week non-invasive brain stimulation, and FMA score after non-invasive brain stimulation, was rated as "low" by the GRADE system.
Non-invasive brain stimulation techniques have been proven by included RCTs to be effective in relieving fatigue symptoms, and promoting the recovery of motor functions in patients with post-stroke fatigue. However, due to small sample size and low quality of the evidence about reported outcomes after treatment, the conclusion needs to be further verified by high-quality, large-sample and multicenter RCTs.
Diabetes and osteoporosis are common diseases in middle-aged and elderly people. Diabetes can lead to various acute and chronic complications, but its related bone changes are often neglected. Osteoporosis is more common in postmenopausal women, and those with type 2 diabetes mellitus (T2DM) have multiple risk factors for osteoporosis. Therefore, it is particularly important to early identify risk factors of osteoporosis in these women, and to provide them with targeted interventions.
To explore the associated factors of osteoporosis in Chinese postmenopausal women with T2DM through a meta-analysis.
In July 2021, databases of China National Knowledge Infrastructure, CQVIP, WanFang Data, SinoMed, PubMed, EmBase, and the Cochrane Library were searched for literature about factors associated with osteoporosis in Chinese postmenopausal women with T2DM from inception to July 2021. Two researchers independently screened literature and extracted data. RevMan 5.4 and Stata 15.0 were used to conduct a meta-analysis on the data.
Twenty-one studies were finally included, from which 11 osteoporosis-related factors were extracted. The meta-analysis showed that age〔MD (95%CI) =6.56 (5.24, 7.88) 〕, years of postmenopause〔MD (95%CI) =5.93 (4.23, 7.62) 〕, duration of diabetes〔MD (95%CI) =1.94 (0.89, 2.98) 〕, body mass index〔MD (95%CI) =-1.99 (-2.63, -1.36) 〕, serum calcium〔MD (95%CI) =0.03 (0.01, 0.06) 〕, fasting blood glucose〔MD (95%CI) =0.49 (0.09, 0.90) 〕, glycosylated hemoglobin〔MD (95%CI) =0.37 (0.02, 0.71) 〕, and fasting insulin〔MD (95%CI) =3.65 (1.24, 6.06) 〕 were associated factors for osteoporosis in postmenopausal women with T2DM. But no significant association was found between osteoporosis and serum creatinine〔MD (95%CI) =4.02 (0.00, 8.04) 〕, serum phosphorus〔MD (95%CI) =0.00 (-0.05, 0.05) 〕, or serum alkaline phosphatase〔MD (95%CI) =1.26 (-0.06, 2.57) 〕 in these women. Sensitivity analysis revealed that the association of all the above-mentioned factors (except for serum creatinine) with osteoporosis was relatively robust.
Older age, long years of postmenopause, long duration of T2DM, low levels of BMI and serum calcium, and high levels of fasting insulin, fasting blood glucose, and glycosylated hemoglobin are risk factors for osteoporosis in Chinese postmenopausal women with T2DM. But the effects of serum creatinine, phosphorus, and alkaline phosphatase on osteoporosis in this group need to be further verified.
Epidemiological studies have demonstrated that the prevalence of hypertension is higher in postmenopausal women than in elderly men. Increasing attention has been paid to postmenopausal hypertension recently, involving its clinical manifestations, pathological features, pathogenesisand treatment. However, due to disparities in study design, sample size and population characteristics, as well as insufficient resources, the research results of risk factors for postmenopausal hypertension are inconsistent and incomprehensive.
To perform a systematic review of risk factors for postmenopausal hypertension, so as to provide evidence-based basis for better prevention and management of the disease.
From January to May 2022, the databases of CNKI, WanfangData, SinoMed, PubMed, EmBase, the Cochrane Library, and Web of Science were searched for cohort and case-control studies related to risk factors for postmenopausal hypertension from the establishment of the databases to May 20, 2022. Studies were identified using the inclusion and exclusion criteria, then assessed in terms of quality using the Newcastle-Ottawa Scale (NOS) , and those with NOS score≥6 (high quality) were included. RevMan 5.3 was used for meta-analysis.
Ten high-quality studies were included, 5 of which were cohort studies, and the other 5 were case-control studies. Overall, 16 potential risk factors for postmenopausal hypertension were identified in a total sample size of 34 864. Meta-analysis showed that the risk factors for postmenopausal hypertension included elevated hs-CRP〔RR (95%CI) =1.38 (1.04, 1.83) 〕, older age〔OR (95%CI) =1.39 (1.11, 1.74) 〕, elevated BMI〔OR (95%CI) =1.61 (1.19, 2.18) 〕, elevated total cholesterol〔OR (95%CI) =1.35 (1.14, 1.59) 〕, elevated triglyceride〔OR (95%CI) =2.17 (1.03, 4.59) 〕, history of diabetes〔OR (95%CI) =1.70 (1.27, 2.27) 〕. The risk-reducing factors included high adiponectin〔RR (95%CI) =0.83 (0.70, 0.99) 〕and advanced menopausal age〔OR (95%CI) =0.90 (0.82, 0.98) 〕.
Older age, high levels of hs-CRP, BMI, total cholesterol, and triglyceride, and diabetes are independent risk factors for postmenopausal hypertension. Thus, controlling some of the above controllable factors may effectively decrease the risk of postmenopausal hypertension.
The COVID-19 pandemic seriously affects human health and life. COVID-19 has been reportedly associated with a high risk of thrombotic events, which are closely associated with stroke.
To assess the effect and possible mechanism of COVID-19 on stroke morbidity, providing a reliable theoretical basis for scientific prevention and treatment of COVID-19 in stroke.
We searched databases of Web of Science, PubMed, EmBase, Cochrane Library, CNKI and Wanfang Data for cohort studies and case-control studies related to COVID-19 and stroke published from December 2019 to January 2022. Two researchers conducted literature screening and data extraction separately. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Meta-analysis was used to evaluate the impact of COVID-19 on stroke mortality. Funnel plot was used to evaluate the potential publication bias.
A total of 18 studies were included, 12 of them were of good quality, and other 6 were of fair quality. Meta-analysis showed that stroke patients with COVID-19 had higher mortality〔RR=4.16, 95%CI (2.82, 6.13) , P<0.000 01〕, prolonged prothrombin time (PT) 〔MD=0.78, 95%CI (0.35, 1.20) , P=0.000 3〕, higher D-dimer level〔MD=1.34, 95%CI (0.83, 1.84) , P<0.000 01〕 and higher NIHSS score〔MD=6.66, 95%CI (4.54, 8.79) , P<0.000 01〕, as well as younger age〔MD=-2.04, 95%CI (-3.48, -0.61) , P=0.005〕than those without COVID-19. There was no statistically significant difference in activated partial thromboplastin time between stroke patients with and without COVID-19〔MD=2.51, 95%CI (-2.69, 7.71) , P=0.34〕. Funnel plot assessing potential publication bias in the impact of COVID-19 on stroke mortality was basically symmetrical.
COVID-19 could increase the risk of stroke mortality, which may be related to alterations in the coagulation system manifested by abnormal PT and D-dimer level and so on. And the outcomes of stroke patients with COVID-19 were associated with age and NIHSS score at admission.
Bronchopulmonary dysplasia (BPD) is the most common severe lung disease in premature infants, which is the damage to immature lung caused by multiple factors. Identifying risk factors of BPD is important for developing prevention strategies. The risk factors of BPD are still controversial, and there are few systematic reviews.
To systematically analyze the risk factors for BPD in preterm infants.
This study searched CNKI, Wanfang Data, CBM, VIP, PubMed, Embase, Web of Science and Cochrane Library for studies evaluating risk factors of BPD from inception to October 2021. We used RevMan 5.3 software to perform meta-analysis.
We included 23 studies of 33 508 BPD premature infants. The overall NOS scores of included studies were relatively high. The results of meta-analysis showed that mother with chorioamnionitis〔OR=1.46, 95%CI (1.18, 1.80) , P=0.000 6〕, gestational hypertension〔OR=1.26, 95%CI (1.15, 1.37) , P<0.000 01〕, premature rupture of membranes〔OR=1.18, 95%CI (1.10, 1.26) , P<0.000 01〕, preterm infants with small for gestational age (SGA) 〔OR=2.64, 95%CI (1.85, 3.77) , P<0.000 01〕, delivery room intubation of preterm infants〔OR=2.50, 95%CI (1.39, 4.50) , P=0.002〕, premature 5 min Apgar score<7 points〔OR=2.47, 95%CI (1.36, 4.47) , P=0.003〕, male preterm infants〔OR=1.49, 95%CI (1.43, 1.55) , P<0.000 01〕, mechanical ventilation in preterm infants〔OR=1.59, 95%CI (1.28, 1.96) , P<0.000 1〕, mechanical ventilation in preterm infants>7 days〔OR=7.99, 95%CI (4.47, 14.29) , P<0.000 01〕, preterm infants treated with surfactant〔OR=3.46, 95%CI (1.96, 6.11) , P<0.000 1〕, steroids used in preterm infants〔OR=2.42, 95%CI (1.93, 3.03) , P<0.000 01〕, preterm infants with respiratory distress syndrome (RDS) 〔OR=3.40, 95%CI (2.01, 5.75) , P<0.000 01〕, preterm infants with patent ductus arteriosus (PDA) 〔OR=1.96, 95%CI (1.38, 2.79) , P=0.002〕, preterm infants with sepsis〔OR=1.82, 95%CI (1.36, 2.44) , P<0.000 1〕, preterm infants with necrotizing enterocolitis (NEC) 〔OR=1.62, 95%CI (1.18, 2.22) , P=0.003〕were risk factors for BPD in preterm infants. Preterm infants with high birth weight〔OR=0.79, 95%CI (0.76, 0.83) , P<0.000 01〕 and preterm infants with large gestational age〔OR=0.80, 95%CI (0.73, 0.87) , P<0.000 01〕were protective factors for BPD in preterm infants. Funnel plots, Begg's test and Egger's test showed that there was no publication bias (P>0.05) .
Current evidence showed that mother with chorioamnionitis, gestational hypertension, preterm rupture of membranes and preterm infants with SGA, delivery room intubation, 5 min Apgar score <7 points, male, mechanical ventilation, mechanical ventilation>7 days, administration of pulmonary surfactant, steroids, RDS, PDA, sepsis, NEC were risk factors for BPD in preterm infants. High birth weight and large gestational age were protective factors for BPD in preterm infants. Clinicians should identify and address the relevant risk factors of BPD, thus preventing the BPD in premature infants.
Inexpensive and convenient early screening for chronic obstructive pulmonary disease (COPD) is of great significance to identify individuals at high risk of COPD. There are many kinds of COPD screening tools with various diagnostic accuracies, but which one is superior to others has not been identified by evidence-based studies.
To evaluate the diagnostic accuracies of common COPD screening tools using a network meta-analysis.
PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data and VIP databases were searched for diagnostic studies related to COPD screening and tools for early diagnosis COPD included from database establishment to December 31, 2021. Two researchers independently conducted literature screening, quality evaluation and data extraction. Meta-disc 1.4 and Stata 15.0 were used for network meta-analysis.
A total of 46 studies were enrolled, involving seven screening tools: the Lung Function Questionnaire (IFQ) , COPD Diagnostic Questionnaire (CDQ) , COPD Screening Questionnaire (COPD-SQ) , Self-Scored COPD Population Screener Questionnaire (COPD-PS) , spirometer, peak flow meter, questionnaire+peak flow meter. The results of meta-analysis demonstrated combined sensitivity values of the aforementioned seven screening tools for COPD were as follows: 0.79〔95%CI (0.75, 0.83) 〕, 0.85〔95%CI (0.83, 0.86) 〕, 0.68〔95%CI (0.65, 0.70) 〕, 0.60〔95%CI (0.56, 0.63) 〕, 0.58〔95%CI (0.54, 0.61) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.68〔95%CI (0.65, 0.71) 〕. And combined specificity values of them were: 0.67〔95%CI (0.65, 0.68) 〕, 0.59〔95%CI (0.58, 0.59) 〕, 0.81〔95%CI (0.80, 0.82) 〕, 0.84〔95%CI (0.83, 0.85) 〕, 0.88〔95%CI (0.87, 0.89) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.85〔95%CI (0.84, 0.86) 〕. The surface under the cumulative ranking curve (SUCRA) values of the tools ranked in terms of combined sensitivity from highest to lowest were: peak flow meter (72.7%) >CDQ (70.1%) >LFQ (61.8%) >questionnaire+peak flow meter (45.3%) >COPD-SQ (28.5%) >COPD-PS (13.2%) >spirometer (9.1%) . And the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: spirometer (76.8%) >questionnaire+peak flow meter (66.7%) >COPD-SQ (46.7%) >peak flow meter (45.8%) >COPD-PS (39.2%) >LFQ (11.9%) >CDQ (8.2%) .
Among the seven commonly used tools, peak flow meter has higher sensitivity, and spirometer has higher specificity. But this conclusion still needs to be further confirmed by more multicenter, large-sample studies.
Timely and accurate pain assessment is essential for safe and effective management of pain in neonates. Scholars at home and abroad have developed more than 40 pain assessment scales for different neonatal groups and types of pain. However, the reliability and stability of the outcomes vary significantly. In addition, existing single studies or systematic reviews (SRs) can only provide unsystematic evidence of a particular scale or specific psychometric properties, which is not conducive to clinical decision-making.
To overview the SRs of psychometric properties of neonatal pain assessment scales, providing clinical practitioners and researchers with evidence for the best pain assessment scale.
Databases including CNKI, SinoMed, Wanfang DATA, VIP, PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched for SRs about psychometric properties of neonatal pain assessment scales. By screening the references of the included SRs, their associated studies were found. Two researchers independently performed literature screening, and data extraction, then assessed the methodological quality using the JBI systematic review critical appraisal tool, risk of bias using the ROBIS, the reporting quality using the PRISMA statement, and the evidence quality using CERQual.
A total of seven SRs were included. According to the JBI and ROBIS tools, four SRs were of high quality and had a low risk of bias, while three were of relatively low quality and had an increased risk of bias. With the PRISMA checklist, 5 SRs were fairly complete with over 60% of report completion rate (RCR) , 1 SR had certain reporting deficiencies with 45.95% of RCR, and 1 SR had serious information missing with 10.81% of RCR. The results of CERQual showed that there were 22 pieces of evidence in total, including two pieces of high quality (9.09%) , eight pieces of moderate quality (36.36%) , nine pieces of low quality (40.91%) , and three pieces of critically low quality (13.64%) . A synthesis of evidence showed that there were 25 scales with good internal consistency, inter-rater reliability, construct validity, and interpretability. Those scales could be used to measure acute pain, persistent pain, postoperative pain, or mechanically ventilated pain in preterm and/or term infants.
No single pain assessment scale is available to assess all types of pain in neonates. It is recommended that the selection of validated scales for periodic dynamic pain assessment in neonates should be based on clinical situations such as age and pain type. More high-quality, well-designed studies are needed to examine the reliability and stability of the existing scales for measuring different kinds of pain in neonates in China and to explore the feasibility of expanding their applications.
