An index of open-access hypertension content relevant to primary care
Effectiveness and Safety of Immunosuppressive Agents Derived from Chinese Medicine with ACEI/ARB in Early- and Middle-stage Diabetic Nephropathy：a Meta-analysis
WU Yu1，2，ZHANG Zheng2，FANG Jinying1，2，WANG Yuedan1，2，LI Wenge1，2*
1.Beijing University of Chinese Medicine，Beijing 100029，China
2.Department of Nephrology，China-Japan Friendship Hospital，Beijing 100029，China
*Corresponding author：LI Wenge，Chief physician，Professor；E-mail：wenge_lee2002@126.com
WU Yu and ZHANG Zheng are the co-first authors
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5684.shtml
Abstract：Background For early-and middle-stage diabetic nephropathy（DN），the efficacies of angiotensin-converting enzyme inhibitor（ACEI）and angiotensin Ⅱ receptor antagonist（ARB）are limited although they are used as first-line drugs. As inflammatory response play a key role in the development of DN，immunosuppressive agents derived from Chinese medicine may be used as adjuvant therapies for DN. Objective To perform a meta-analysis of the effectiveness and safety of immunosuppressive agents derived from Chinese medicine with ACEI/ARB in the treatment of early-and middle-stage DN. Methods Randomized controlled trials（RCTs）about effectiveness and safety in early-and middle-stage DN patients treated with immunosuppressive agents derived from Chinese medicine with ACEI/ARB（experimental group）compared with those treated with ACEI/ARB（control group）published in Chinese were screened from databases of CNKI，Wanfang Data，VIP and CBM，and those published in English from databases of Medline，EMBase，the Cochrane Library，Web of Science，from inception to May 5，2020. RevMan 5.3 software was used to complete the meta-analysis. Outcome indicators were the decrease in serum creatinine，24-hour urinary protein quantification and leukocyte count，improvement in serum albumin，and change in glutamic pyruvic transaminase after treatment，incidence of adverse reactions and overall response rate. Results A total of 23 studies were included，involving 1 878 patients. The analysis revealed that compared to the control group，the experimental obtained greater decreases in serum creatinine level〔MD=-6.06，95%CI（-10.89，-1.22）〕，24-hour urinary protein quantification〔MD=-0.70，95%CI（-0.87，-0.53）〕，and white blood cell count〔MD=-0.42，95%CI（-0.76，-0.08）〕as well as improvement of serum albumin level〔MD=2.83，95%CI（1.66，4.01）〕. The experimental group had higher incidence of adverse reactions〔OR=1.87，95%CI（1.26，2.77）〕and overall response rate〔OR=3.05，95%CI（1.87，4.97）〕（P<0.05）. But there was no significant difference in the change of glutamic pyruvic transaminase level between the two groups〔MD=0.51，95%CI（-0.65，1.66），P=0.39〕. Conclusion In patients with early-and middle-stage DN，the combination use of immunosuppressive agents derived from Chinese medicine and ACEI/ARB may effectively improve the renal function，serum albumin level and overall response rate，but it may result in higher risk of adverse reactions such as decreased white blood cell count，so it should be used cautiously in clinic practice.
Clinical Efficacy of Dangguibuxue Decoction as an Adjuvant Therapy for Diabetic Nephropathy：a Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5704.shtml
CHENG Liying1，WANG Mengxi2，ZHANG Zhu3*，SHAO Fengmin3
1.Henan University of Chinese Medicine，Zhengzhou 450000，China
2.Nanjing University of Chinese Medicine，Nanjing 210029，China
3.Fuwai Central China Cardiovascular Hospital，Zhengzhou 451464，China
*Corresponding author：ZHANG Zhu，Doctoral supervisor；E-mail：zhangzhu1127@163.com
Abstract：Background Excessive inflammatory response and renal fibrosis play key roles in the progression of diabetic nephropathy to end-stage renal disease. However，the usual western treatment for diabetic nephropathy has no significant anti-inflammatory and anti-fibrosis effects. Dangguibuxue Decoction（DD） is often used as an adjuvant therapy clinically due to its notable anti-inflammatory and anti-fibrosis effect，but there is a lack of relevant medical evidence. Objective To systematically study the efficacy and safety of DD as an adjuvant therapy for diabetic nephropathy. Methods Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，The Cochrane Library，EMBase，ChiCTR，and ClinicalTrials.gov were searched from inception to December 2020 to identify randomized controlled trials（RCTs） regarding diabetic nephropathy patients treated by usual integrated treatment and modified DD compared with those treated by usual integrated treatment.Data extraction of the included RCTs were performed. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality. Review Manager 5.4 was used for meta-analysis. Results A total of 10 RCTs meeting the inclusion criteria were included，involving 879 patients. The results of meta-analysis found that the combined therapy of usual integrated treatment with modified DD could further improve the overall response rate〔RR=1.18，95%CI（1.10，1.28），P<0.000 1〕，reduce the 24-hour urinary protein quantification〔MD=-69.22，95%CI（-76.96，-61.48），P<0.000 01〕 and urinary albumin excretion rate〔MD=-31.32，95%CI（-59.87，-2.76），P=0.03〕，decrease the levels of serum creatinine〔MD=-10.24，95%CI（-11.51，-8.98），P<0.000 01〕 and urea nitrogen 〔MD=-0.95，95%CI（-1.61，-0.29），P=0.005〕 with no significant effect on adverse events〔RR=1.00，95%CI（0.30，3.34），P>0.05〕. Conclusion The clinical effect of DD in adjuvant treatment of diabetic nephropathy is significant and has good safety.
A Meta-analysis of the Therapeutic Effects of Intermittent Fasting on Overweight or Obesity
ZHANG Jiapeng1，2*，GUAN Yingjun1，HUANG Qixia1，CHEN Jing2
1.Medical College of Jiaying University，Meizhou 514000，China
2.Guangzhou University of Chinese Medicine，Guangzhou 511400，China
*Corresponding author：ZHANG Jiapeng，Assistant；E-mail：1025973954@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5705.shtml
Abstract：Background Intermittent fasting （IF） is an option for overweight or obesity，a risk factor for many cardiovascular diseases，but it is not recommended as a usual treatment by current international clinical guidelines due to many treatment-emergent adverse reactions. Objective To evaluate the therapeutic effect of IF in overweight or obese people. Methods The electronic databases，PubMed，Web of Science，CNKI，Wanfang Data，CQVIP and SinoMed，were searched from inception to November 8，2020 for randomized control trials（RCTs） about adults with overweight or obesity receiving IF（experimental group） compared with those receiving usual diet（control group）. RCTs enrollment，data extraction，and methodological quality assessment were performed by two reviewers independently. RevMan was used for meta-analysis. Results Seven RCTs were included. Analysis revealed that compared to the control group，the experimental group showed lower mean weight and low-density lipoprotein〔MD=-2.75，95%CI（-3.64，-1.86），P<0.000 01；MD=0.58，95%CI（0，1.16），P<0.000 1〕，but demonstrated insignificantly differences in fat free mass，and blood glucose〔MD=-0.89，95%CI（-1.81，0.04），P=0.06；SMD=-0.56，95%CI（-1.40，0.28），P=0.19〕. GRADE assessment indicated that the quality of evidence on improving weight，blood glucose，fat free mass and low-density lipoprotein was moderate，low，very low，and very low，respectively. Conclusion Current evidence suggests that IF is effective in reducing weight and low-density lipoprotein in overweight or obese people，but it needs to be verified whether it improves blood glucose and fat free mass. Further research is recommended to be conducted in more multi-center and large-sample RCTs.
Efficacy and Safety of Revefenacin in Chronic Obstructive Pulmonary Disease：a Meta-analysis
LI Ling，YANG Ming，LI Xuefeng，LIU Fu*
Pharmacy Department，Affiliated Hospital of North Sichuan Medical College，Nanchong 637000，China
*Corresponding author：LIU Fu，Chief pharmacist；E-mail：nclf91@163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5399.shtml
Abstract：Background Revefenacin is the first anti-muscarinic drug that needs to be administered only once a day for maintenance therapy in patients with chronic obstructive pulmonary disease（COPD）.There is no systematic review of its treatment of COPD in China.Objective To perform a systematic review of the efficacy and safety of revefenacin in COPD，to provide a basis for the selection of drug treatments for COPD.Methods The databases of CNKI，Wanfang Data Knowledge Service Platform，CQVIP，CBM，PubMed，EMBase，The Cochrane Library and ClinicalTrials.gov were searched for clinical studies of revefenacin in treating COPD from inception to May 2019.Literature enrollment was performed using strict inclusion criteria and exclusion criteria.The first author，publication time，NCT number，country（region），intervention，sample size，sex，age，race，course of treatment，indices of efficacy〔trough forced expiratory volume in one second（trough FEV1），peak FEV1，response rate to St.George's Respiratory Questionnaire（SGRQ）〕 and indices of safety（common and serious adverse reactions）regarding the eligible studies were recorded.The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality.RevMan 5.3 was used for meta-analysis.Results A total of 6 randomized controlled trials were included，with a total sample size of 2 175 participants，and high methodological quality.According to the result of meta-analysis：the improvement of trough FEV1 in remifenaxine group was better than that in placebo group 〔MD=146.78，95%CI（133.52，160.05），P<0.000 01〕.Peak FEV1 〔MD=129.50，95%CI（115.69，143.31），P<0.000 01〕，and the SGRQ response rate in remifenaxine group were lower than those of placebo group 〔OR=1.60，95%CI（1.29，1.98），P<0.000 1〕.Both groups showed no significant differences in the incidence of severe adverse reactions〔OR=0.93，95%CI（0.44，1.94），P=0.84〕，upper respiratory tract infection 〔OR=1.42，95%CI（0.72，2.82），P=0.31〕，headache 〔OR=0.88，95%CI（0.49，1.58），P=0.66〕，and cough 〔OR=1.06，95%CI（0.62，1.82），P=0.82〕.The incidence of dyspnea in remifenaxine group was higher than that in placebo group 〔OR=0.54，95%CI（0.33，0.87），P=0.01〕.Conclusion Revefenacin is effective and safe in the treatment of COPD.
Relationship between Blood Pressure Level and Renin-aldosterone System Activity in Patients with Essential Hypertension：a Meta-analysis
YUAN Bo1，MA Qing 2，LI Wenfei3，LI Zhipeng2*
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5398.shtml
1.Department of General Practice，West China Hospital，Sichuan University，Chengdu 610041，China
2.International Medical Center，West China Hospital，Sichuan University，Chengdu 610041，China
3.West China College of Medicine，Sichuan University，Chengdu 610041，China
*Corresponding author：LI Zhipeng，Associate professor；E-mail：13568985243@163.com
Abstract：Background Increased aldosterone is an important risk factor for cardiac hypertrophy，heart failure and renal impairment，leading to more serious damage to the target organs of hypertension such as heart and kidney.Except for primary aldosteronism（PA），clinical evidence shows that plasma rennin activity and aldosterone are elevated in some patients with essential hypertension.However，there are few studies on the correlation between blood pressure level and plasma renin activity and aldosterone levels in patients with essential hypertension，and the conclusions are also inconsistent.Objective To investigate the relationship between blood pressure and renin-aldosterone system activity，and the potential pathophysiological mechanism of hyperaldosteronemia in essential hypertension patients，to provide a theoretical basis for early treatment of essential hypertension and delaying the development of related target organ damages.Methods The databases of PubMed，Embase，CNKI，CQVIP and Wanfang Data Knowledge Service Platform were searched from inception to January 2020 to identify articles about the relationship between blood pressure and renin-aldosterone system activity in patients with essential hypertension.Two researchers independently screened the literature based on the inclusion and exclusion criteria，extracted the data，and evaluated the quality using the Newcastle-Ottawa Scale.RevMan 5.2 was used to conduct meta-analysis.Results A total of 16 articles with Chinese essential hypertensive individuals（n=1 885）compared to healthy controls（n=1 438）as the participants were included.All scored above 5 points on the Newcastle-Ottawa Scale.The results of meta-analysis showed that plasma renin activity〔MD=0.40，95%CI（0.04，0.76）〕in essential hypertensive individuals was significantly higher〔MD=60.03，95%CI（22.28，97.79）〕than that of controls in general（P<0.05）.But the supine and standing values of plasma renin activity 〔MD=-1.27，95%CI（-1.37，-1.16）；MD=-1.67，95%CI（-1.88，-1.46）〕were lower in essential hypertensive individuals（P<0.05）.Essential hypertensive individuals had higher plasma aldosterone level than the controls 〔MD=60.03，95%CI（22.28，97.79）〕on the whole.They also showed higher supine and standing plasma aldosterone levels〔MD=0.07，95%CI（0.06，0.09）；MD=0.22，95%CI（0.05，0.39）〕（P<0.05）.Conclusion （1）Plasma renin activity and aldosterone levels in patients with essential hypertension were different from those with normal blood pressure.The supine and standing values of plasma renin activity were decreased，and supine and standing values of plasma aldosterone were elevated in essential hypertensive patients.（2）In some patients with essential hypertension，the changes of plasma renin and aldosterone are inconsistent，suggesting that elevated aldosterone may be not renin-dependent in essential hypertension，and mineralocorticoid receptor antagonists should be chosen for antihypertension.
Comparisin of Efficacy and Safety of One-stage LCBDE+LC and Sequential Two-stage ERCP/EST+LC in the Treatment of Cholecystolithiasis Complicated with Choledocholithiasis：a Meta-analysis
LIN Qiuman，WANG Guiliang*，WU Zaoxuan，ZHANG Xin，ZHONG Tingxi，GONG Min，LI Xing
Department of Gastroenterology，Southern Medical University Affiliated Pingxiang Hospital，Pingxiang 337000，China
*Corresponding author：WANG Guiliang，Associate chief physician，Master supervisor；E-mail：guiliangwang@126.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5467.shtml
Abstract：Background Cholecystolithiasis complicated with choledocholithias is a common disease in clinical medication.One-stage Laparoscopic common bile duct exploration（LCBDE） + laparoscopic cholecystectomy（LC） and sequential two-stage endoscopic retrograde cholangiopancreatography（ERCP）/endoscopic sphincterotomy（EST） + LC are both accepted as ideal minimally invasive treatment methods，some domastic and foreign scholars have analyzed and compared the advantages and disadvantages of the two methods，but which method is more advantagous still remains uncertain．Objective To compare the efficacy and safety of one-stage LCBDE+LC and sequential two-stage ERCP/EST +LC in the treatment of cholecystolithiasis complicated with choledocholithiasis．Methods Randomized controlled trials（RCTs） comparing the efficacy of one-stage LCBDE+LC and sequential two-stage ERCP/EST+LC were searched from the database including PubMed，EMBase，Web of Science，The Cochrane Library，CNKI and WanFang Data Service Platform from January 2009 to March 2020．The first author's name，country，publishing time，time period of the patients，sample number，age，ratio of female，ratio of multiple stones，common bile duct diameter，ASA grade，follow-up period，outcome indexes（the common bile duct calculi clearance ratio，incidence of postoperative complications，surgical transferation ratio，bile leakage ratio，incidence of pancreatitis，residual stone ratio，calculi recurrence ratio，hospitalization fee，length of hospitalization stay，operation time） were recorde．Meta-analysis was performed using RevMan 5.3 software．Results A total of 20 RCTs were included in this study，and the overall quality of the literatures was good．Choledoch stone clearance ratio 〔OR=1.11，95%CI（0.78，1.58），P=0.55〕，surgical transferance ratio 〔OR=1.11，95%CI（0.64，1.93），P=0.71〕，residual stone ratio 〔OR=0.73，95%CI（0.45，1.19），P=0.21〕，length of hospitalization stay 〔SWD=-0.43，95%CI（-0.87，0.02），P=0.06〕 and operation time 〔SWD=-0.28，95%CI（-1.09，0.53），P=0.50〕 showed no significant differences between the one-stage LCBDE+LC group and sequential two-stage ERCP/EST+LC group．Compared with the sequential two-stage ERCP/EST+LC group，postoperative complication ratio 〔OR=0.57，95%CI（0.43，0.75），P<0.000 1〕，stone recurrence ratio〔OR=0.33，95%CI（0.16，0.69），P=0.003〕，hospitalization cost 〔SWD=-1.07，95%CI（-1.44，-0.69），P<0.000 01〕，pancreatitis ratio 〔OR=0.13，95%CI（0.06，0.27），P<0.000 01〕 significantly decreased，while the bile leakage ratio 〔OR=3.68，95%CI（2.10，6.45），P<0.000 01〕 significantly increased in the one-stage LCBDE+LC group．Conclusion Compared with sequential two-stage ERCP/EST+LC，one-stage LCBDE+LC showed lower incidence of total complications，stone recurrence ratio and hospitalization cost，but showed obvious advantages in perioperative safety．There were no significant differences in the stone clearance ratio，operation time，length of hospitalization stay，surgical transferance ratio and residual stone ratio between the two groups．
Efficacy and Safety of Combination Therapy with Tadalafil and Tamsulosin in Treating Lower Urinary Tract Symptoms and Erectile Dysfunction in Men：a Meta-analysis
LI Jinze，PENG Lei，LI Yunxiang*，WEI Tangqiang，XIONG Wei，NIU Chao，ZHANG Zongping
Department of Urology，the Affiliated Nanchong Central Hospital of North Sichuan Medical College，Nanchong 637000，China
*Corresponding author：LI Yunxiang，Professor，Master supervisor；E-mail：liyunxiang369@126.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5468.shtml
Abstract：Background Tamsulosin and tadalafil（TAD）have been widely used for the treatment of lower urinary tract symptoms（LUTS）and erectile dysfunction（ED）．However，the efficacy and safety of the combination therapy of these two medicines for LUTS and ED in men is still controversial．Objective To systematically investigate the efficacy and safety of TAD plus tamsulosin compared with TAD monotherapy in treating men with LUTS and ED．Methods PubMed，EMBase，Cochrane Central Register of Controlled Trials，SinoMed，CNKI，WanFang Data Service Platform，and CQVIP databases were searched extensively from inception to February 29，2020 to obtain eligible studies comparing the efficacy and safety of TAD plus tamsulosin and TAD monotherapy in treating men with LUTS and ED．Data were extracted，such as the name（s）of the first author（s），year of publication，geographical location（country）of the research setting，types of research，sample size，age and BMI of the subjects，interventions，dosage，follow-up time and outcome indicators 〔total International Prostate Symptom Score（IPSS）score，IPSS storage subscore，IPSS voiding subscore，quality of life score，maximum urinary flow rate，post-void residual urine volume and International Index of Erectile Function-5（IIEF-5）score〕，incidence of adverse events（including total incidence of adverse events，incidence of headache，myalgia，back pain，dizziness，nasopharyngitis and ejaculation dysfunction），and rate of treatment discontinuation due to adverse events．Revman 5.3.0 was used for data evaluation and statistical analysis．Results Six studies were included，all were assessed with high methodological quality，involving 776 cases，394 in the combination group and 382 in the TAD group．The results of the meta-analysis indicated that compared with the TAD group，the combination group obtained more benefits from treatment in aspects of total IPSS score 〔MD=-2.67，95%CI（-3.82，-1.50），P<0.001〕，IPSS storage subscore 〔MD=-0.55，95%CI（-0.85，-0.26），P=0.000 2〕，IPSS voiding subscore 〔MD=-0.97，95%CI（-1.43，-0.51），P<0.001〕，quality of life score 〔MD=-0.37，95%CI（-0.51，-0.23），P<0.001〕，and maximum urinary flow rate 〔MD=1.45，95%CI（0.90，1.99），P<0.000 01〕．However，there were no significant differences in post-void residual urine volume 〔MD=-4.22，95%CI（-12.82，4.39），P=0.34〕，IIEF-5 score 〔MD=0.44，95%CI（-0.23，1.11），P=0.19〕，the incidence of adverse events 〔OR=1.43，95%CI（0.98，2.08），P=0.06〕，the incidence of headache 〔OR=1.34，95%CI（0.66，2.72），P=0.42〕，myalgia 〔OR=1.56，95%CI（0.64，3.82），P=0.33〕，back pain 〔OR=1.45，95%CI（0.40，5.22），P=0.57〕，dizziness 〔OR=1.14，95%CI（0.27，4.76），P=0.86〕，nasopharyngitis 〔OR=0.47，95%CI（0.10，2.21），P=0.34〕，ejaculatory dysfunction 〔OR=3.81，95%CI（0.44，32.97），P=0.22〕，and the rate of treatment discontinuation due to adverse events 〔OR=1.44，95%CI（0.88，2.35），P=0.15〕 between the two groups．Conclusion Both therapies have similar beneficial effects on ED and similar safety，but the combination of TAD plus tamsulosin is more effective for the improvement of the LUTS．Hence，the combination therapy may be recommended as a suitable option for men with both LUTS and ED．However，due to limited evidence，high-quality randomized controlled trials are required to further confirm these findings．
Prevalence Rate of Multiple Chronic Conditions in Middle-aged and Elderly Chinese People from 2010 to 2019：a Meta-analysis
WANG Meijie1，ZHOU Xiang1，LI Yajie1，LIU Fangli1，YAO Zhuoya2*
1.School of Nursing and Health Sciences，Henan University，Kaifeng 475000，China
2.Central Sterile Supply Department，Henan Provincial People's Hospital，Zhengzhou 450000，China
*Corresponding author：YAO Zhuoya，Chief superintendent nurse，Master supervisor；E-mail：13663819365@126.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5513.shtml
Abstract：Background With the acceleration of population aging，an increasing chronic disease prevalence is seen in middle-aged and elderly Chinese people，and a widespread prevalence of multiple chronic conditions is found in this population，which have brought unprecedented challenges to the management of chronic diseases. Objective To systematically evaluate the prevalence rate of multiple chronic conditions in middle-aged and elderly population （≥45 years old） from 2010 to 2019 in China，providing a basis for the prevention of multiple chronic conditions. Methods We searched cross-sectional studies regarding multiple chronic conditions prevalence in middle-aged and elderly Chinese people published from 2010-01-01 to 2020-01-01 in Chinese from databases of CNKI，Wanfang Data and VIP，and those in English from databases of the Cochrane Library，PubMed，Web of Science，and so on. Data extraction and quality evaluation of the included studies were performed. Stata 14.0 was used for statistical analysis. Results A total of 25 studies were included，with a total of 173 085 patients. Meta analysis showed that the prevalence rate of multiple chronic conditions in middle-aged and elderly Chinese people was 41%〔95%CI（35%，46%）〕. Subgroup analysis showed that the prevalence of multiple chronic conditions was 41% in women〔95%CI（33%，50%）〕 and 38% in men〔95%CI（31%，45%）〕. The prevalence of 2 and 3 chronic diseases was 23%〔95%CI（20%，26%）〕，and 11%〔95%CI（9%，14%）〕，respectively. The prevalence of multiple chronic conditions was 41%〔95%CI（34%，47%）〕 from 2010 to 2015，and was 43%〔95%CI（28%，58%）〕 from 2016 to January 1，2020. The prevalence of multiple chronic conditions was 41%〔95%CI（34%，49%）〕 and 38%〔95%CI （27%，49%）〕 in those living in southern and northern China，respectively. Conclusion The prevalence of multiple chronic conditions in this population is relatively high. Therefore，relevant departments should pay attention to early screening of chronic conditions in high-risk groups and provide targeted preventive measures for them.
Prevalence of Chronic Constipation in Chinese Adults：a Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5514.shtml
YANG Zhi，WU Chenxi，GAO Jing*，BAI Dingxi，ZHU Lin，LIU Ruirui，LIANG Yun，WU Qiao
School of Nursing，Chengdu University of TCM，Chengdu 611137，China
*Corresponding author：GAO Jing，Professor，Doctoral supervisor；E-mail：729012934@qq.com
Abstract：Background Constipation has become a common problem among Chinese people along with the quickened pace of life. Although constipation is not fatal，it may increase the mortality rate of cardiovascular and cerebrovascular diseases. There is a lack of comprehensive data from large-scale surveys about chronic constipation prevalence in Chinese adults. Objective To systematically evaluate chronic constipation prevalence in Chinese adults，so as to provide a basis for epidemiological studies of chronic constipation. Methods Cross-sectional studies on chronic constipation in Chinese adults were searched in databases of CNKI，VIP，WanFang Data，CBM，PubMed，EMbase，The Cochrane Library，and Web of Science from inception to December 31，2019. Two reviewers enrolled studies in accordance with the inclusion and exclusion criteria，extracted data，and evaluated methodological quality using the ARHQ methodology checklist（11 items） for cross-sectional studies. Stata 15.0 was used for meta-analysis. Results 19 studies，involving 37 242 subjects were included. Meta-analysis showed that the overall chronic constipation prevalence in Chinese adults was 10.9%〔95%CI（8.8%，13.0%）〕. Subgroup analysis showed that the prevalence was 7.0%〔95%CI（4.1%，10.0%）〕 for men and 11.5%〔95%CI（9.3%，13.7%）〕 for women，and 9.3%〔95%CI（3.7%，14.8%）〕 for urban areas and 10.5%〔95%CI（5.8%，15.1%）〕 for rural areas. The prevalence for subgroups of elementary or below，junior/senior high school，and two-/three-year college education or above was 12.2%〔95%CI（7.4%，17.0%）〕，12.3%〔95%CI（8.1%，16.4%）〕，and 13.2%〔95%CI（8.2%，18.1%）〕，respectively. The prevalence was 7.4%〔95%CI（5.6%，9.2%）〕 for southerners and 15.0%〔95%CI（10.6%，19.4%）〕 for northerners. The prevalence for adults surveyed before 2003，between 2004—2008，2009—2013，and 2014—2018 was 5.0%〔95%CI（3.0%，7.0%）〕，6.3%〔95%CI（1.3%，11.3%）〕，11.2%〔95%CI（4.9%，17.5%）〕 and 13.4%〔95%CI（9.1%，17.7%）〕，respectively. Conclusion The prevalence of chronic constipation among Chinese adults is increasing year by year，with differences by gender，place of residence（rural or urban），level of education and region.
Risk Factors for Breast Cancer-related Lymphedema in Chinese Women：a Meta-analysis
ZHANG Hao，LIU Ruirui，ZHU Lin，BO Dingxi，ZHONG Yizhu，LIANG Yun，GAO Jing*
School of Nursing，Chengdu University of TCM，Chengdu 611137，China
*Corresponding author：GAO Jing，Professor；E-mail：729012934@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5744.shtml
Abstract：Background Breast cancer-related lymphedema （BCRL）is the most common postoperative complication of breast cancer，which cannot be cured clinically at present. Early identification of the risk factors for BCRL may improve the outcome significantly，yet it is still controversial in existing relevant studies，and there is no relevant systematic review in China. Objective To systematically evaluate the risk factors for BCRL in Chinese women. Methods We searched the databases of CINAHL，PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，CQVIP，Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria，extracted data 〔including the first author，time of publication，type of studies，sample size，measurement methods for edema，degree of edema，follow-up time，and BCRL-related factors（age，BMI，hypertension prevalence，lymph node metastasis prevalence，scope of axillary lymph node dissection，having a lymph node dissection，number of lymph nodes dissected，postoperative healing complication，chemotherapy，radiation therapy）〕，and performed risk of bias assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results 31 studies involving 2 618 subjects were included，with moderate or high methodological quality. Meta-analysis showed that older age〔OR=2.59，95%CI（1.95，3.45），P<0.000 01〕，increased BMI〔OR=2.33，95%CI（1.91，2.85），P<0.000 01〕，hypertension〔OR=4.76，95%CI（2.53，8.94），P<0.000 01〕，lymph node metastasis〔OR=1.22，95%CI（1.06，1.39），P=0.005〕，extended axillary lymph node dissection〔OR=2.30，95%CI（1.88，2.81），P<0.000 01〕，having a lymph node dissection〔OR=8.29，95%CI（2.32，29.60），P=0.001〕，number of dissected lymph nodes ≥15〔OR=1.12，95%CI（1.06，1.19），P<0.000 1〕，postoperative healing complication〔OR=4.11，95%CI（3.26，5.17），P<0.000 01〕，chemotherapy〔OR=3.17，95%CI（2.16，4.63），P<0.000 01〕，radiation therapy〔OR=2.69，95%CI（2.32，3.13），P<0.000 01〕were risk factors of BCRL. Conclusion BCRL among Chinese women may be associated with various risk factors，such as age>40，BMI≥24 kg/m2，hypertension，lymph node metastasis，extended axillary lymph node dissection，having a lymph node dissection，number of dissected axillary lymph nodes ≥15，postoperative healing complication，chemotherapy，and radiation therapy. Due to limited quality and quantity of the included studies，more large-sample prospective cohort studies are required to verify the above conclusion.
Efficacy and Safety of Wenyang Lishui Recipes for Heart Failure with Diuretic Resistance：a Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5764.shtml
WANG Mengxi1，2，CAO Peihua1，2，WU Chenjie1，2，CHEN Xiaohu1*
1.Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine，Nanjing 210029，China
2.Nanjing University of Chinese Medicine，Nanjing 210023，China
*Corresponding author：CHEN Xiaohu，Chief physician，Doctoral supervisor；E-mail：chenxhdoctor@126.com
Abstract：Background Diuretics are a cornerstone treatment for heart failure，but some patients will gradually develop reduced sensitivity to diuretics，resulting in weakened or even disappeared diuretic effect after a long-term use of them，which is clinically called diuretic resistance. Diuretic resistance is independently associated with heart failure-related mortality，which cannot be cured by western medicine，but has been proven to be partially improved by Wenyang Lishui Recipes（WLR），a type of Chinese medicine treatment. Objective To systematically evaluate the efficacy and safety of WLR in treating heart failure with diuretic resistance. Methods The authors searched the databases of PubMed，Web of Science，The Cochrane Library，EMBase，CNKI，Wanfang，VIP and CBM to screen randomized controlled trials（RCTs） comparing WLR with western medicine treatment against western medicine treatment in heart failure with diuretic resistance patients from inception to January 2020. The major primary outcome indicators included 24-hour urine collection，and left ventricular ejection fraction （LVEF）. Secondary outcome indicators included N-terminal proB-type natriuretic peptide （NT-proBNP），clinical symptom response rate，and cardiac function improvement rate. Safety indicators included serum potassium and creatinine. The “Risk of bias' tool described in Cochrane Handbook （version 5.1.0） and the modified Jadad Scale were used to evaluate the quality of the included RCTs. RevMan 5.3 and Stata 12.0 were used for meta-analysis. Results Fourteen RCTs were included，involving 932 patients. Meta-analysis revealed that compared with western medicine treatment alone，WLR with western medicine treatment could further increase the 24-hour urine collection〔MD=499.41，95%CI（287.26，711.55），P<0.000 01〕，improve the LVEF〔MD=5.25，95%CI（3.28，7.22），P<0.000 01〕，clinical symptom response rate〔RR=1.26，95%CI（1.16，1.37），P<0.000 01〕，cardiac function improvement rate〔RR=1.25，95%CI（1.14，1.38），P<0.000 01〕，and serum potassium level〔MD=0.19，95%CI（0.14，0.24），P<0.000 01〕，as well as further decrease the NT-proBNP〔MD=-594.14，95%CI（-796.95，-391.33），P<0.000 01〕. Subgroup analysis found that WLR with western medicine treatment showed greater effects on improving LVEF no matter the sample size was greater or less than 80〔MD=2.04，95%CI（0.64，3.44），P=0.004；MD=6.61，95%CI（5.17，8.04），P<0.000 01〕. Conclusion WLR with western medicine treatment may have better clinical efficacy in patients with heart failure with diuretic resistance with good safety.However，more high-quality clinical studies are still needed to verify this conclusion.
Efficacy and Safety of Tumor-treating Fields Versus Angiogenesis Inhibitors in Combination with Stupp Protocol for Newly Diagnosed Glioblastoma：a Network Meta-analysis
SU Dongpo1，ZUO Zhengyao1，LI Mei1，HAN Qian1，ZHANG Weihong2，FU Aijun1，ZHU Jun1，CHEN Tong1*
1.Department of Neurosurgery，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
2.Department of Nursing，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
*Corresponding author：CHEN Tong，Professor，Chief physician；E-mail：ct.1973@ 163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5766.shtml
Abstract：Background Tumor-treating fields（TTFields）with Stupp protocol and angiogenesis inhibitors with Stupp protocol have proved to be effective in the treatment of newly diagnosed glioblastoma，but there are few studies directly comparing their efficacies and safety. Objective To compare the efficacy and safety of TTFields versus angiogenesis inhibitors in combination with Stupp protocol for newly diagnosed glioblastoma. Methods The databases of PubMed，The Cochrane Library，EMBase and OVID were comprehensively searched from January 1，2004 to January 1，2020 for studies about newly diagnosed glioblastoma treated by TTFields with Stupp protocol compared with those treated by angiogenesis inhibitors with Stupp protocol. The literature information was extracted and stored in the Excel file，including the first author，country of the author，year of publication，number and age of participants，treatment scheme（experimental groups：Stupp protocol in combination with bevacizumab，cilengitide，or TTFields combined with other treatment regimens；control group：Stupp protocol），outcome indicators〔overall survival（OS），progression-free survival（PFS）〕 and adverse events. The quality of the included literatures was evaluated. Revman 5.3 and Stata 13.1 were used for network meta-analysis. Results Seven studies were included，involving 1 859 cases and 1 566 controls，with a relatively high methodological quality. Seven therapies from studies were included in the network meta-analysis：TTFields with Stupp protocol，bevacizumab with Stupp protocol，bevacizumab with irinotecan，bevacizumab with irinotecan and Stupp protocol，cilengitide（twice a week）with Stupp protocol，cilengitide（five times a week）with Stupp protocol，and Stupp protocol. Through network meta-analysis，the 6-month OS rate of each treatment modality was ranked from high to low：TTFields with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with Stupp protocol > cliengitide（twice a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > bevacizumab with irinotecan > Stupp protocol. The one-year OS rate was ranked from high to low as follows：TTFields with Stupp protocol > bevacizumab with irinotecan> bevacizumab with Stupp protocol> cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > Stupp protocol. The 6-month PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan> bevacizumab with Stupp protocol > TTFields with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > cliengitide（five times a week）with Stupp protocol > cliengitide（twice a week）with Stupp protocol > Stupp protocol. The one-year PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan > bevacizumab with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > TTFields with Stupp protocol > cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > Stupp protocol. In terms of adverse events，Bevacizumab and irinotecan increased the incidence of treatment-related adverse events，but TTFields and cilengitide did not. Conclusion TTFields with Stupp protocol seems to be safer and more effective，but whether it can be used as an alternative to other six therapies still needs to be verified.
Value of S-Detect in Differential Diagnosis between Benign and Malignant Thyroid Nodules：a Meta-analysis
CHEN Jingtai，HOU Lingmi，TANG Yunhui，QIAN Shuangqiang，PU Hongyu，GAO Yanchun*
Department of Thyroid and Breast Surgery，Affiliated Hospital of North Sichuan Medical College，Nanchong 637000，China
*Corresponding author：GAO Yanchun，Professor；E-mail：boyang11111@163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5775.shtml
Abstract：Background S-Detect is a new computer aided diagnostic technique，which can automatically analyze the ultrasound images qualitatively and quantitatively，helping doctors to identify benign and malignant thyroid modules，but there is no reliable evidence-based practice to verify its differential diagnostic value. Objective To evaluate the value of S-Detect in differential diagnosis between benign and malignant thyroid nodules. Methods We did a literature review of PubMed，EMBase，Web of Science，the Cochrane Library，Wanfang Data，CNKI，VIP and SinoMed databases to identify studies published as of January 6，2021 in which the value of S-Detect in differentially diagnosing thyroid nodules was investigated. Two reviewers independently screened the literature，extracted data，and evaluated the risk of bias and quality of the included studies. Meta-analysis was conducted using Meta-Disc 1.4 and Stata 15. The pooled indicators include：sensitivity and specificity，positive likelihood ratio，negative likelihood ratio，diagnostic odds ratio and area under the curve（AUC）. Results Sixteen studies were included，in which the reported pooled sensitivity，specificity，positive likelihood ratio，negative likelihood ratio，diagnostic odds ratio and AUC of S-Detect in differential diagnosis between benign and malignant thyroid nodules were 0.84〔95%CI（0.81，0.86），P=0.003 6〕，0.71〔95%CI（0.69，0.73），P<0.000 1〕，3.31〔95%CI（2.45，4.47），P<0.000 1〕，0.22〔95%CI（0.17，0.29），P=0.000 6〕，15.93〔95%CI（9.85，25.78），P<0.000 1〕，and 0.89〔95%CI（0.84，0.94）〕，respectively. Conclusion The current evidence shows that S-Detect significantly contributes to distinguishing benign and malignant thyroid nodules，which may be used as an effective auxiliary tool for usual ultrasound examination.
Different Medications for Preventing 131I-induced Salivary Gland Damage in Thyroid Cancer Patients：a Network Meta-analysis
MA Dan1，YIN Xinbo2，LIU Jiahui1，FANG Qunyao1，HE Qiu1，XIONG Yu3*，GONG Fanghua4
1.Medical College，Hunan Normal University，Changsha 410013，China
2.Nursing Teaching and Research Department，Xiangya Hospital of Central South University，Changsha 410013，China
3.Department of Endocrinology，the Second Affiliated Hospital of Hunan Normal University，Changsha 410013，China
4.Department of Nursing，Hunan Provincial People's Hospital，Changsha 410013，China
*Corresponding author：XIONG Yu，Chief superintendent nurse；E-mail：951435416@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5777.shtmlAbstract：Background Although 131I adjunctive therapy can significantly improve the survival rate of patients with thyroid cancer，its induced salivary gland damage seriously affects the quality of life. Currently，there are a variety of drugs for the prevention and treatment of 131I-induced salivary gland damage，but it needs to conduct a network Meta-analysis to fill the gap of comparison of these medications. Objective To perform a network Meta-analysis of different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients. Methods Randomized controlled trials（RCTs） or non-RCTs about different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients were searched in databases of Cochrane Central Register of Controlled Trials，Web of Science，PubMed，and EMBase，VIP，CNKI，Wanfang Data and SinoMed from inception to January 2021. Literature screening and data extraction were performed by two researchers，separately. The literature quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1.0） and MINORS. Consistency test，publication bias analysis and graph drawing were carried out using Stata 16.0. OpenBUGS 3.2.3 was used for network Meta-analysis. Results A total of 11 articles were included，involving 7 intervention schemes：amifostine，vitamin C，amifostine with vitamin C，citric acid，vitamin E，selenium and propylthiouracil. Network Meta-analysis revealed that in terms of preventing 131I-induced loss of salivary excretion fraction in the parotid gland，amifostine with vitamin C was superior to citric acid and propylthiouracil，so was amifostine（P<0.05）. Amifostine was also superior to the regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the parotid gland ranked from highest to lowest was：amifostine with vitamin C> amifostine > vitamin C>regular treatment > vitamin E> selenium >citric acid > propylthiouracil. In terms of preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，propylthiouracil was inferior to vitamin E，amphostine with vitamin C，amphostine and regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the submandibular gland ranked from highest to lowest was：vitamin E>amphostine with vitamin C> amphostine>selenium> vitamin C> citric acid> regular treatment > propylthiouracil. The funnel plot of comparing different medications for preventing 131I-induced loss of salivary excretion fraction in the parotid gland or submandibular gland was obviously symmetrical. Conclusion Amphostine with vitamin C may be the best intervention for preventing 131I-induced loss of salivary excretion fraction in the parotid gland. And vitamin E may be the best scheme for preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，followed by amphostine with vitamin C. Due to limitations of this study，these results should be taken with caution，which still need to be verified by more large-sample，high-quality clinical studies.
Efficacy and Safety of Acupuncture Therapy in Treating Hyperlipidemia：a Systematic Review and Meta-analysis of Randomized Controlled Trials
LIU Meiling1，2，ZHANG Qingying1，GUO Yi1*
1.Tianjin University of Traditional Chinese Medicine，Tianjin 301617，China
2.Jiading District Community Health Center，Shanghai 201801，China
*Corresponding author：GUO Yi，Professor；E-mail：guoyi_168@163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5847.shtml
Abstract：Background Lipid regulation is critical to preventing cardiovascular diseases. Statins recommended by domestic and international guidelines can bring down LDL-C levels. However，adverse reactions，which are observed frequently，affect patients' compliance with the recommended dose. Chinese medicine has a unique advantage in the prevention and treatment of chronic diseases. Clinical studies have revealed that acupuncture therapy is similar to statins in regulating lipids with less adverse reactions. Objective To systematically evaluate the effectiveness and safety of acupuncture therapy in treating hyperlipidemia. Methods Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，and the Cochrane Library were searched from inception to December 31，2019 for randomized controlled trials（RCTs） comparing efficacy and safety in hyperlipidemia patients treated with acupuncture therapy（experimental group） and oral statins recommended by guidelines（control group）. Literature screening，data extraction and quality evaluation were performed according to Cochrane Reviewers' Handbook. Meta-analysis was performed using RevMan 5.4. Results Fifteen RCTs with 1 347 patients were included. Meta-analysis results demonstrated that there were no statistically significant differences in overall response rate，mean post-treatment TC，LDL-C，TG and BMI between the two groups〔OR=1.28，95%CI（0.77，2.15），P=0.34；MD=-0.06，95%CI（-0.13，0.02），P=0.13；MD=0.11，95%CI（-0.07，0.28），P=0.24；MD=0.01，95%CI（-0.09，0.12），P=0.84；MD=-0.81，95%CI（-2.75，1.13），P=0.41〕. The mean HDL-C level in the experimental group was higher〔MD=0.16，95%CI（0.04，0.28），P=0.009〕. The post-treatment mean TCM symptom score and incidence of adverse reactions in the experimental group were lower〔MD=-3.19，95%CI（-4.52，-1.87），P<0.000 01；OR=0.28，95%CI（0.14，0.59），P=0.000 7〕. The clinical TCM efficacy in the experimental group outperformed that of the control group〔OR=3.86，95%CI（1.97，7.56），P<0.000 1〕. Analysis of the RCTs in terms of the overall response rate of participants presented an asymmetrical funnel graphic，indicating the presence of publication bias. Conclusion The available clinical evidence indicates that acupuncture therapy is superior to statins for hyperlipidemia in terms of improving HDL-C and clinical TCM efficacy，reducing TCM symptom score with fewer adverse reactions. However，since quality of the included research was not high，the conclusion still needs to be tested in more high-quality，double-blind RCTs.
Meta-analysis of the Predictive Value of Lipid Metabolism in Children with Henoch-Schonlei Purpura
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5824.shtml
HAN Shanshan1，2，DING Ying1，2，DAI Yanlin2，ZHANG Xia1，2*，WANG Long1，2
1. Department of Pediatrics，the First Affiliated Hospital of Henan University of Traditional Chinese Medicine，Zhengzhou 450003，China
2. College of Pediatrics，Henan University of Traditional Chinese Medicine，Zhengzhou 450046，China
*Corresponding author：ZHANG Xia，Associate professor，Associate chief physician；E-mail：ardar123@sina.com
Abstract：Background Henoch-Schonlein purpura （HSP） is one of the most common vasculitis in children. Some of them may involve the kidney and develop into Henoch Schonlein purpura nephritis，which affects the prognosis. Therefore，it is necessary to find the predictors of renal damage in the early stage of Henoch-Schonlein purpura. In recent years，more and more studies have shown that abnormal lipid metabolism may be a risk factor for HSP renal injury，but there is no systematic evidence-based study. Objective To comprehensively collect relevant literature and evaluate whether lipid abnormalities in the early stage of HSP can be used as a predictor of HSPN. Methods PubMed，EMBase，The Cochrane Library，China National Knowledge Infrastructure（CNKI），Wanfang Data Knowledge Service Platform，VIP and China Biology Medicine disc were searched by computer. The retrieval time were from the establishment of the databases to February 10，2020. The first author，publication year，country，diagnostic criteria，gender，age，number of cases（HSPN group / non HSPN group），observation indexes〔total cholesterol （TC），triglyceride（TG），high density lipoprotein （HDL），low density lipoprotein（LDL），apolipoprotein M（ApoM） in the two groups at the initial stage of onset〕，study type，occurrence （initial onset / recurrence），course of disease and follow-up time were collected to study the risk factors of HSPN in children. Newcastle Ottawa scale （NOS） was used to evaluate the quality of the included literature. Stata 15.1 software was used for Meta-analysis. Results A total of 5 312 cases from 16 literatures were included. Excluding 26 cases lost to follow-up，there were 5 286 children with HSP，and 1 997 cases developed HSPN，with NOS scores ≥6 points. The results of meta-analysis showed that the levels of TC 〔WMD=0.72，95%CI （0.51，0.92）〕，TG 〔WMD=0.61，95%CI （0.45，0.77）〕 and LDL〔WMD=0.65，95%CI （0.41，0.89）〕 in HSPN group were higher than those in non HSPN group，and the level of ApoM 〔OR=0.32，95%CI （0.12，0.85）〕 was lower than those in non HSPN group. Conclusion High levels of TC，TG and LDL may be predictors of HSPN development. The relationship between HDL level and HSPN is still unclear，which needs to be confirmed by further research. ApoM is expected to become a new independent predictor of HSPN.
Meta-analysis of Vitamin D Nutritional Status of Children in Chinese Mainland
SU Jingying1，2，CHEN Xianrui3，LIN Gangxi1，2，3*
1.School of Clinical Medicine，Fujian Medical University，Fuzhou 350122，China
2.Department of Pediatrics，Xinglin Branch of the First Affiliated Hospital of Xiamen University，Xiamen 361022，China 3.Department of Pediatrics，the First Affiliated Hospital of Xiamen University/Pediatric Key Laboratory of Xiamen/Institute of Pediatrics，School of Medicine，Xiamen University，Xiamen 361003，China
*Corresponding author：LIN Gangxi，Chief physician；E-mail：lingangxi@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5823.shtml
Abstract：Background The global vitamin D nutritional status has attracted much attention recently. Vitamin D nutritional status may differ by country or region. There are few multicenter studies with a large sample size on vitamin D nutritional status in Chinese children. Objective To analyze the vitamin D nutritional status in children in Chinese mainland. Methods Studies regarding vitamin D nutritional status in children in Chinese mainland were collected by searching databases of PubMed，Embase，The Cochrane Library，Wanfang Data，CNKI，SinoMed and CQVIP from database inception to 2020-04-08. Two researchers separately extracted information from the eligible studies，encompassing the first author，publication time，the region（northern or southern China）where participants live，size，sex ratio，age of the sample，and outcome indicators〔serum 25（OH）D level，rate of vitamin D deficiency serum 25（OH）D level <20 μg/L〕，and assessed the publication bias. Meta-analysis was carried out using RevMan 5.2 and Stata 14.0. Results A total of 29 studies with 133 441 healthy children and adolescents were enrolled. The average serum 25（OH）D level was （29.62±12.45）μg/L for all participants. Meta-analysis indicated that the prevalence of vitamin D deficiency in all participants，participants from southern and northern China，was 21.4%〔95%CI（17.5%，25.4%）〕，17.5%〔95%CI（13.1%，22.0%）〕，and 29.0%〔95%CI（19.4%，38.6%）〕，respectively. No significant sex-based differences were found in the prevalence of vitamin D deficiency 〔OR=0.99，95%CI（0.95，1.03），P=0.71〕，and average serum 25（OH）D level〔SMD=0.01，95%CI（-0.24，0.26），P=0.95〕. Infants had higher average serum 25（OH）D level than young children〔SMD=0.16，95%CI（0.06，0.27），P=0.002〕，preschool children〔SMD=0.77，95%CI（0.55，1.00），P<0.000 01〕，and school-age children and adolescents〔SMD=0.65，95%CI（0.27，1.04），P=0.000 1〕. In participants from southern China，infants had higher average serum 25（OH）D level than young children〔SMD=1.51，95%CI（0.31，2.72），P=0.01〕，preschool children〔SMD=6.22，95%CI（3.97，8.47），P<0.000 01〕，and school-age children and adolescents〔SMD=6.80，95%CI（2.95，10.65），P<0.000 5〕. In those from northern China，infants had higher average serum 25（OH）D level than young children〔SMD=1.23，95%CI（0.33，2.12），P=0.007〕and preschool children〔SMD=8.41，95%CI（2.04，14.79），P=0.01〕. Young children had higher average serum 25（OH）D level than preschool children〔SMD=0.61，95%CI（0.43，0.80），P<0.000 01〕，and school-age children and adolescents〔SMD=0.65，95%CI（0.27，1.04），P=0.001〕. In those from southern China，young children had higher average serum 25（OH）D level than preschool children〔SMD=5.53，95%CI（3.57，7.49），P<0.000 01〕，and school-age children and adolescents〔SMD=6.07，95%CI（3.04，9.10），P<0.000 1〕. In those from northern China，young children had higher average serum 25（OH）D level than preschool children 〔SMD=6.56，95%CI（1.19，11.92），P=0.02〕. Preschool children had higher average serum 25（OH）D level than school-age children and adolescents〔SMD=0.33，95%CI（0.15，0.51），P=0.000 4〕. In those from southern China，the average serum 25（OH）D level in preschool children was higher than that in school-age children and adolescents〔SMD=1.89，95%CI（0.58，3.21），P<0.005〕. In those from northern China，the average serum 25（OH）D level in preschool children was higher than that in school-age children and adolescents with no statistical difference〔SMD=4.94，95%CI（1.51，8.38），P=0.005〕. Conclusion In Chinese mainland，the prevalence of vitamin D deficiency in children was relatively high. The vitamin D level was not associated with sex，but may be closely related to age. However，our conclusion still needs to be verified by further research.
High-dose Intravenous Gamma Globulin in the Treatment of Severe Viral Pneumonia in Adults：a Meta-analysis
LONG Sidan1，2，JI Shuangshuang1，ZHOU Yuanchen2，YAO Shukun2*
1.Graduate School of Beijing University of Chinese Medicine，Beijing 100029，China
2.Department of Gastroenterology，China-Japan Friendship Hospital，Beijing 100029，China
*Corresponding author：YAO Shukun，Professor，Chief physician；E-mail：yao_sk@163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5181.shtml
Abstract：Background Viral pneumonia prevalence is relatively high recently，among which influenza virus-induced viral pneumonia has high mortality.Previous research have shown intravenous immunoglobulins is an adjuvant treatment for severe pneumonia.However，clinical efficacy of this therapy in studies（consisting of only a few articles and case reports）of severe viral pneumonia is insufficient and lack of systematic evidence to further prove it.Objective To explore the efficacy of high-dose intravenous gamma globulin in adult patients with severe viral pneumonia by a meta-analysis.Methods Databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，Wanfang Data，CMB and VIP were searched from inception to March 5，2020 for randomized controlled trials（RCTs）in which efficacies of routine treatment with high-dose intravenous gamma globulin were compared with routine treatment in adult patients with severe viral pneumonia.Quality evaluation and data extraction of the included RCTs were carried out.Meta-analysis was performed to evaluate the two types of therapies in terms of clinical efficacy，C-reactive protein（CRP），CD4+，CD4+/CD8+ ratio，IL-2，and incidence of treatment-emergent adverse events.Results Nine RCTs involving 1 021 patients were included for analysis.All of them were evaluated as grade B in terms of methodological quality.Meta-analysis showed that the experimental group showed higher mean levels of clinical efficacy〔RR=1.24，95%CI（1.18，1.31）〕，CD4+〔MD=10.05，95%CI（9.19，10.90）〕，CD4+/CD8+ ratio〔MD=0.75，95%CI（0.68，0.82）〕and lower CRP〔MD=-3.64，95%CI（-4.23，-3.05）〕，IL-2〔MD=0.61，95%CI（0.45，0.77）〕，incidence of adverse reactionscompared 〔RR=0.30，95%CI（0.16，0.55）〕with the control group（P<0.000 01）.Conclusion High-dose intravenous infusion of gamma globulin could improve the clinical outcome of severe viral pneumonia in adults.
The Prevalence of Cerebral Palsy in Children Aged 0-6 Years in China：a Meta-analysis
FENG Yuxia1，2，PANG Wei1，2，3*，LI Xin1，2，3，YANG Shunbo1，2，LIU Shiyu1，2，LU Shuqing1，2
1.Rehabilitation Medicine of Jiamusi University，Jiamusi 154003，China
2.Children Neural Rehabilitation Laboratory of Jiamusi University，Jiamusi 154003，China
3.The Third Affiliated Hospital of Jiamusi University/Rehabilitation Center for Child Cerebral Palsy of Heilongjiang Province，Jiamusi 154003，China
*Corresponding author：PANG Wei，Chief physician；E-mail：363406153@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5180.shtml
【Abstract】BackgroundAs one of the main causes of children's disability, cerebral palsy (hereinafter referred to as CP) affects the improvement of our population quality. At present, the results of researches on the prevalence of children suffering from CP in our country are quite different, and there is a lack of epidemiological studies based on larger sample sizes and the current prevalence of CP. ObjectiveTo learn about the prevalence of CP in children aged 0~6 years in China. MethodsLiteratures on the prevalence of CP in children aged 0~6 years in China were retrievaled through computer in PubMed, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service System, VIP Database (VIP), and China Biology Medicine disc(CBM), and the publication date limited from January 1st to January 1st, 2020. Based on established inclusion criteria, literatures were screened. Meta-analysis was performed on the included literatures with Stata 12.0 software, the prevalence was quantitatively combined, and subgroup analysis was carried out on classification indicators, such as gender and age. ResultsThis study finally included 8 papers of medium or above quality, with a total of 527,758 people, including 1,022 CP children.The results of meta-analysis proved that the overall prevalence of CP in children aged 0 to 6 in China was 0.23%〔95%CI(0.17%, 0.29%)〕. The subgroup analysis results revealed that the prevalence of boys was 0.22%〔95%CI(0.14%, 0.29%)〕, the prevalence of girls was 0.12%〔95%CI(0.06 %, 0.19%)〕. The prevalence of CP among children at the ages of below one years, one years, two years, three years, four years, five years, and six years was 0.21%〔95%CI(0.02%, 0.40%)〕, 0.20%〔95%CI(0.10%, 0.30%)〕, 0.19%〔95%CI(0.08%, 0.30%), 0.21%〔95%CI(0.09%, 0.32%)〕, 0.13%〔95%CI(0.02%, 0.24%)〕, 0.20%〔95%CI(0.09 %-0.32 %)〕, 0.32 %〔95%CI(0.14 %-0.50 %)〕, respectively. ConclusionThe prevalence of CP in children aged 0 to 6 in China was 0.23%, and the prevalence of gender and age was different, guiding significance for policy formulation and clinical intervention. It is recommended to conduct more cross-sectional investigations based on the new classification of CP.
Anxiety and Depression Prevalence in Chinese Patients with Gastroesophageal Reflux Disease：a Meta-analysis
ZHOU Jinchi，DOU Weijia，WEI Yan，ZHAO Shuguang，HAN Wei，CHENG Hao，LIU Zhenxiong*
Department of Gastroenterology，Tangdu Hospital，Air Force Medical University，Xi'an 710038，China
*Corresponding author：LIU Zhenxiong，Associate chief physician，Associate professor，Master supervisor；E-mail：liuzhx816@126.com
ZHOU Jinchi and DOU Weijia are co-first authors
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5265.shtml
【Abstract】 Background Gastroesophageal reflux disease（GERD）is a common digestive disease with high global incidence trend，which may cause serious psychological burden on patients，and is closely related to anxiety and depression prevalence in them.Therefore，accurate understanding of the mental state of GERD will contribute to better diagnosis and treatment of GERD.However，there is no systematic analysis of mental status and GERD in Chinese population. Objective To perform a Meta-analysis of studies regarding anxiety and depression prevalence in Chinese GERD patients.Methods Investigative studies on anxiety and depression in Chinese GERD patients published from January 2000 to May 2020 were collected through searching the databases of CBM，CNKI，Wanfang Data，VIP，and PubMed.Meta-analysis was conducted by using Stata 12.0 and Revman 5.1. Results A total of 17 articles involving 90 537 subjects were included，with good methodological quality generally.The result showed that the prevalence of anxiety disorder in GERD，reflux esophagitis（RE）and non-erosive reflux disease（NERD） patients was 41%〔95%CI（31%，51%）〕，36%〔95%CI（25%，48%）〕，and 51%〔95%CI（44%，58%）〕， respectively.The prevalence of depression disorder in GERD patients was 37%〔95%CI（32%，42%）〕.The prevalence of depression disorder in depressive disorder in GERD，RE and NERD patients was 37%〔95%CI（32%，42%）〕，34%〔95%CI（28%，39%）〕，and 45%〔95%CI（23%，67%）〕，respectively. Conclusion Anxiety and depression presents high prevalence in Chinese GERD patients.As this population is more susceptible to anxiety and depression，understanding their mental status may help to better treat GERD.
Traditional Chinese Medicine for the Prevention and Treatment of Bone Marrow Suppression after Chemotherapy Based on AMSTAR 2 and GRADE：an Overview of Systematic Reviews and Meta-Analyses
XUE Mengting1，YANG Min1，PAN Yalan1，TAN Jiani2，HUANG Anle1，BU Zihan1，WANG Qing1，XU Guihua1*
1.School of Nursing，Nanjing University of Chinese Medicine，Nanjing 210023，China
2.The First Clinical Medical College，Nanjing University of Chinese Medicine，Nanjing 210023，China
*Corresponding author：XU Guihua，Professor，Doctoral supervisor；E-mail：xgh_88@126.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5286.shtml
Abstract：Background Bone marrow suppression is one of the common dose-limiting toxic and side effects of chemotherapy.There have been many systematic reviews and Meta-analyses about traditional Chinese medicine（TCM）for preventing and treating bone marrow suppression after chemotherapy，but their quality is uneven，with a lack of systematic evaluation.Objective To evaluate the methodological quality and outcome indicators quality of systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression by AMSTAR 2 and GRADE.Methods The databases such as the Cochrane Library，PubMed，Web of Science，OVID，EBSCO，CBM，CNKI，Wanfang Data and VIP were searched for systematic reviews and Meta-analyses on the topic of TCM in preventing and treating bone marrow suppression after chemotherapy from inception to February，2020.AMSTAR 2 was used to assess the methodological quality，and the evidence quality of the outcome indicators was graded according to the GRADE system.Results A total of 23 systematic reviews and Meta-analyses were enrolled，AMSTAR 2 evaluation results showed that，1 had moderate reliability，2 had low reliability，and the other 20 had extremely low reliability.The GRADE evaluation results showed that，among the totaled 62 outcome indicators from meta-analyses，2 were high-quality，11 were intermediate-quality，13 were low-quality and 36 were critically low-quality，with the main degradation factors of limitation，followed by inconsistency，imprecision and publication bias.Conclusion Methodological quality and quality of evidence of outcome indicators of available systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression are both low，with general reliability of relevant conclusions，thus it is uncertain that TCM can effectively prevent and treat bone marrow suppression after chemotherapy.And more high-quality systematic reviews and Meta-analyses with rigorous design are needed in the future.
Efficacy and Safety of Different Pharmacological Interventions for Progressive IgA Nephropathy：a Network Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5328.shtml
LIU Tongtong，WANG Yuyang，YANG Liping，MAO Huimin，ZHAN Yongli*
Guang'anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China
*Corresponding author：ZHAN Yongli，Professor，Chief physician；E-mail：zhanyongli88@sina.com
Abstract：Background Patients with progressive IgA nephropathy （IgAN）have a significantly increased risk of developing end-stage renal disease.However，many available treatments for progressive IgAN have a high rate of side effects and insignificant long-term benefits.So choosing an appropriate regimen with good safety and efficacy is essential for the treatment of this disease.Objective To evaluate the efficacy and safety of different pharmacological interventions in the treatment of progressive IgAN by network meta-analysis.Methods Randomized controlled trials （RCTs）about different pharmacological interventions for progressive IgAN were searched in PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data，CBM and VIP databases from inception to March 31，2020.Literature screening，data extraction and risk of bias evaluation were performed by two reviewers independently.Stata 14.0 and GeMTC 0.14.3 were used to conduct a network Meta-analysis of the efficacy，improvement in 24 h urinary protein and creatinine levels and treatment-emergent adverse events in these patients with different pharmacological interventions.Results A total of 38 RCTs were included，including 3 034 patients，and 10 intervention programs：Prednisone （Pred），mycophenolate mofetil （MMF）combined with Pred，cyclophosphamide （CTX）combined with Pred，leflunomide （LEF）combined with Pred，cyclosporine （CsA）combined with Pred，traditional Chinese medicine （TCM）combined with immunosuppressant （ISD），TCM，MMF，LEF and supportive treatment.Network meta-analysis showed that：（1）In terms of the overall resonse，TCM combined with ISD was more superior to TCM〔RR=2.27，95%CI（1.14，4.65）〕，LEF combined with Pred〔RR=2.14，95%CI（1.05，4.45）〕，CTX combined Pred〔RR=3.92，95%CI（2.06，7.37）〕，Pred〔RR=3.57，95%CI（2.11，6.32）〕，LEF〔RR=5.88，95%CI（1.03，37.17）〕and supportive support treatment 〔RR=6.25，95%CI（2.86，13.82）〕（P<0.05）.Compared with CTX combined with Pred，CSA combined with Pred 〔RR=3.73，95%CI（1.54，9.10）〕 and MMF combined with Pred 〔RR=2.37，95%CI（1.33，4.44）〕 had more favorable overall resonse（P<0.05）.Compared with Pred，CSA combined with Pred 〔RR=3.37，95%CI（1.52，8.13）〕 and MMF combined with Pred 〔RR=2.13，95%CI（1.24，4.13）〕 had more favorable overall resonse（P<0.05）.（2）The incidence of adverse reactions of MMF combined with Pred〔RR=0.21，95%CI（0.09，0.49）〕，LEF combined with Pred〔RR=0.16，95%CI（0.08，0.34）〕，TCM combined with ISD〔RR=0.31，95%CI（0.13，0.72）〕，TCM〔RR=0.05，95%CI（0.01，0.22）〕，Pred〔RR=0.37，95%CI（0.18，0.73）〕and supportive treatment〔RR=0.24，95%CI（0.06，0.87）〕was lower than that of CTX combined with Pred（P<0.05）.LEF combined with Pred had a lower incidence of adverse reactions than CsA combined with Pred〔RR=0.28，95%CI（0.09，0.90）〕（P<0.05）.（3）For reducing 24 h urinary protein，MMF combined with Pred was more superior to CTX combined with Pred〔MD=0.55，95%CI（0.25，0.85）〕，LEF combined with Pred〔MD=0.53，95%CI（0.10，0.97）〕，supportive treatment〔MD=0.72，95%CI（0.24，1.20）〕，TCM〔MD=0.66，95%CI（0.16，1.15）〕，and MMF〔MD=0.62，95%CI（0.02，1.22）〕（P<0.05）.TCM combined with ISD lowered proteinuria level more significantly than CTX combined with Pred〔MD=0.42，95%CI（0.09，0.75）〕，LEF combined with Pred〔MD=0.40，95%CI（0.03，0.79）〕，Pred〔MD=0.41，95%CI（0.15，0.67）〕，TCM〔MD=0.53，95%CI（0.08，0.98）〕，and supportive treatment〔MD=0.59，95%CI（0.19，0.99）〕（P<0.05）.Compared with CTX combined with Pred〔MD=0.55，95%CI（0.04，1.06）〕，Pred〔MD=0.53，95%CI（0.07，1.01）〕，and supportive treatment〔MD=0.71，95%CI（0.11，1.32）〕，CsA combined with Pred had better effect on reducing proteinuria level （P<0.05）.（4）For reducing serum creatinine level，TCM combined with ISD was better than LEF combined with Pred 〔MD=19.69，95%CI（0.68，39.49）〕 and Pred 〔MD=14.50，95%CI（1.49，28.04）〕（P<0.05）.MMF combined with Pred showed better effects on lowering serum creatinine level than MMF〔MD=45.66，95%CI（0.40，91.16）〕（P<0.05）.Conclusion Considering the results，MMF combined with Pred，TCM combined with ISD， LEF combined with Pred have better clinical efficacy and higher safety in the treatment of progressive IgAN.
Clinical，Anti-hyperuricemic，and Pain-relief Effects of Five Acupuncture and Moxibustion Therapies in Acute Gouty Arthritis：a Network Meta-analysis
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5329.shtml
ZHANG Jinhuan1，CHEN Yirong1，LAN Kai1，HU Liyu1，YU Haibo2*#br#
1.The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine，Shenzhen 518033，China
2.Department of Acupuncture and Moxibustion，Shenzhen Hospital of Traditional Chinese Medicine，Shenzhen 518033，China
*Corresponding author：YU Haibo，Chief TCM physician，Doctoral supervisor；E-mail：13603066098@163.com
Abstract：Background Acute episodes of gout arthritis are the main cause of suffering in patients with gout.Long-term western pharmacological therapies bring obvious adverse reactions to patients.Acupuncture and moxibustion therapies，as alternative therapeutic options，have been proved effective in acute gouty arthritis （AGA），but which one is superior to others has not been identified by evidence-based studies.Objective To compare the clinical efficacy of five acupuncture and moxibustion therapies in AGA using network meta-analysis.Methods We searched for randomized controlled trials （RCTs） of five acupuncture and moxibustion therapies （electroacupuncture，needling，blood-pricking，warm-needling，red-hot needling） compared with the western pharmacological therapy for AGA from databases of PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data，VIP，and CBM from inception to September 10th，2019.We used RevMan 5.3 and Stata 14.0 to analyze the data involved.Results A total of 23 RCTs involving 1 684 patients were eligible for this study.Network meta-analysis results showed that electroacupuncture 〔OR=1.18，95%CI（1.01，1.39），P<0.05〕，warm-needling 〔OR=1.17，95%CI（1.03，1.32）〕，or red-hot needling 〔OR=1.13，95%CI（1.03，1.24），P<0.05〕 showed better overall efficacy than the western pharmacological therapy.Surface under the cumulative ranking curves （SUCRA） values according to the overall effectiveness showed that electroacupuncture was best，followed by blood-pricking，red-hot needling，warm-needling，needling，and western pharmacological therapies.Electroacupuncture 〔SMD=-144.46，95%CI（-248.77，-40.14），P<0.05〕and needling 〔SMD=-98.83，95%CI（-159.51，-38.15），P<0.05〕 were superior to western pharmacological therapies in reducing uric acid.In terms of reducing the VAS score〔only three acupuncture and moxibustion therapies （red-hot needling，needling and blood-pricking） and western pharmacological therapy were included〕，red-hot needling had better efficacy than western pharmacological therapies 〔SMD=-1.40，95%CI（-2.12，-0.68），P<0.05〕.SUCRA values based on VAS reduction showed that red-hot needling was the best，followed by blood-pricking，needling，and western pharmacological therapies.Conclusion Electroacupuncture has the highest possibility to reduce serum uric acid and improve overall efficiency，red-hot needling can effectively relieve pain.However，due to limited quantity and quality of studies，our conclusion needs to be verified by larger sample size，multi-center and high-quality clinical studies.
Diagnostic Value of Circulating Cell-free DNA to Prostate Cancer：a Meta-analysis
LI Fan1，XU Bin1，XIANG Hui2，CHEN Zejia1，PANG Zisen1，ZHANG Tianyu1*
1.Department of Urology，Affiliated Hospital of Guilin Medical University，Guilin 541001，China
2.Department of Respiratory and Critical Care Medicine，Affiliated Hospital of Guilin Medical University，Guilin 541001，China
*Corresponding author：ZHANG Tianyu，Professor，Chief physician，Master supervisor；E-mail：zhangtianyu64@qq.com
LI Fan and XU Bin are co-first authors
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5598.shtml
Abstract：Background Numerous studies have shown that circulating free DNA（cfDNA）has diagnostic value in prostate cancer，but there is no consensus on its accuracy.Objective To evaluate the diagnostic value of cfDNA in prostate cancer by a Meta-analysis.Methods Articles in Chinese and English regarding diagnosing prostate cancer using cfDNA were collected by searching databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，and WANFANG DATA from inception to February 2020，and were enrolled according to the inclusion and exclusion criteria.Data were extracted，including the first author's name，year of publication，country of publication，sample size，detection method and accuracy assessment indices（true-positive，false-positive，false-negative，true-negative）.Spearman correlation was used to assess whether there was a threshold effect.The SROC plot was used to examine whether the diagnostic performance curve of cfDNA presenting a “shoulder-arm” shape.The heterogeneity between the included studies was measured by the Cochran's Q test and I2 test and used for selecting an appropriate model for pooling data.Meta-analysis and Fagan's nomogram were used to estimate the diagnostic efficiency and probability of cfDNA，respectively.Results Twenty-two articles were included，involving 2 774 cases，1 936 of whom were diagnosed with prostatic cancer by cfDNA and 838 were not.The overall quality of the included literature was good.The pooled sensitivity，specificity，positive likelihood ratio，negative likelihood ratio，diagnostic odds ratio of cfDNA for prostate cancer diagnosis were 0.49〔95%CI（0.47，0.51）〕，0.91〔95%CI（0.89，0.92）〕，6.04〔95%CI（4.39，9.31）〕，0.52〔95%CI（0.45，0.60）〕，and 18.19〔95%CI（12.33，26.85）〕，respectively.The AUC of the SROC curve was 0.898 2.Subgroup analysis showed that the AUC value of cfDNA in the diagnosis of prostate cancer did not change significantly in each subgroup（P>0.05）.Fagan's nomogram demonstrated that using cfDNA to detect prostatic cancer increased the posttest probability to 88% from the pretest probability of 20%.Conclusion cfDNA might be a diagnostic biomarker for prostate cancer.It may be used as a helper for prostate-specific antigen screening，but it still needed a large number of prospective stuides to support this.
Influence of Titrated Positive End-expiratory Pressure Using an Esophageal Pressure-guided Strategy on the Early Prognosis of Patients with Acute Respiratory Distress Syndrome：a Meta-analysis
LIU Tian，DU Yuming*，SUN Jianhao，WANG Xiaodi
No.2 Integrated Intensive Care Unit，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
*Corresponding author：DU Yuming，Professor，Associate chief physician；E-mail：duyuming2998@163.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5597.shtml
Abstract：Background Acute respiratory distress syndrome（ARDS） is a common cause of death in the ICU.The strategy used in mechanical ventilation，a major support for sustaining life，is closely related to the prognosis of patients.Currently，it is still a controversy regarding the strength of association of titrated positive end-expiratory pressure（PEEP） using an esophageal pressure-guided strategy with the early prognosis of ARDS patients.Objective To evaluate the effect of titrated PEEP using an esophageal pressure-guided strategy compared with high PEEP on the early prognosis of ARDS patients.Methods The PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data and VIP databases were searched from inception to 2020-06-18 for published randomized controlled trials（RCT） about ARDS patients treated with esophageal pressure-guided PEEP titration.The test group was treated with conventional treatment and peep titration guided by esophageal pressure，while the control group was treated with conventional treatment and high PEEP guided mechanical ventilation；outcome measures: main outcome measures （28 day mortality risk），secondary outcome measures （oxygenation index，peep，days of mechanical ventilation）.The RCTs were included according to the inclusion and exclusion criteria，and evaluated in terms of the quality of methodology，and their references were cited and indexed.Stata 16.0 and RevMan5.3 were used for data analysis.Results A total of 13 RCTs were included，involving 800 cases，of which 12 were single-center，and one was multicenter；9 were published in Chinese，and 4 in English.The analysis revealed that compared to the control group，the test group had lower risk of 28-day mortality〔OR=0.55，95%CI（0.39，0.79），P=0.001〕，higher mean oxygenation index〔SMD=1.86，95%CI（1.65，2.08），P<0.000 01）〕，higher mean PEEP〔SMD=1.27，95%CI（1.04，1.51），P<0.000 01〕，and less mean number of days of mechanical ventilation〔SMD=-1.51，95%CI（-1.79，1.22），P<0.000 01〕.Conclusion Esophageal pressure-guided PEEP titration could reduce the risk of 28-day mortality，and improve clinical symptoms in patients with ARDS，indicating that it may play a positive role in improving early prognosis，so it is recommended to use esophageal manometry in the management of mechanical ventilation in patients with ARDS.
Prognostic Indicators for Severity in COVID-19 Patients：a Meta-analysis
WANG Jiting1，2，LI Jun3，TIAN Yuan1，2，LI Yaling 1*
1.Department of Pharmacy，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
2.School of Pharmacy，Southwest Medical University，Luzhou 646000，China
3.Department of Traditional Chinese Medicine，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
*Corresponding author：LI Yaling，Chief pharmacist，Master supervisor；E-mail：lylapothecary@swmu.edu.cn
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5600.shtml
Abstract：Background The COVID-19 has become a global pandemic declared by the WHO，and the severity of which affects the prognosis of patients.Objective To explore the prognostic indicators for severity and their predictive values in COVID-19 patients，providing a reference for clinical prediction of patients'outcome and prognosis.Methods Eight databases （the Cochrane Library，Embase，PubMed，Web of Science，SinoMed，CNKI，Wanfang Data Knowledge Service Platform，VIP）were searched from inception to 2020-09-03 for randomized controlled trials（RCTs）about severe versus non-severe COVID-19 patients or deceased versus survived COVID-19 patients with prognostic indicators［including procalcitonin （PCT），C-reactive protein （CRP），lymphocyte count （LYM），interleukin-6 （IL-6），D-dimer）studied.The modified Jaded Scale was used to assess the methodological quality.Stata 12.0 was used for meta-analysis.Results Fifteen RCTs were included，involving 1 476 cases，all were assessed with high methodological quality（modified Jadad Scale score ranging from 4 to 5 points）.Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28，95%CI （-3.60，
-0.98），P<0.001〕，CRP〔SMD=-2.23，95%CI （-3.38，-1.07），P<0.001〕，IL-6〔SMD=-2.97，95%CI （-4.94，-1.00），P<0.001〕，and D-dimer〔SMD=-1.22，95%CI （-2.66，0.21），P=0.008〕than non-severe COVID-19 patients.Severe COVID-19 patients had lower mean LYM〔SMD=1.41，95%CI （0.34，2.48），P<0.001〕.The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11，95%CI （-9.98，1.76），P=0.007〕，CRP〔SMD=-2.73，95%CI （-4.21，-1.25），P<0.001〕，IL-6〔SMD=-3.79，95%CI （-4.90，-2.67），P<0.001〕，and D-dimer〔SMD=-0.68，95%CI （-1.46，0.09），P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08，95%CI （0.93，3.22），P<0.001〕.Conclusion Increased PCT，CRP，IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients，indicating that the former three may be positively correlated with severity，while the latter may be negatively correlated with severity.These five indicators may be used as prognostic indicators for severity，too high PCT，CRP，IL-6 and D-dimer，and too low LYM may suggest a poor prognosis.
Influencing Factors of Postpartum Post-traumatic Stress Disorder：a Meta-analysis
CHEN Ying1，QIAN Hongyan2，ZHU Yuting1，WANG Yuanyuan1，QIAN Lihua3，KONG Xiang3，4*
1.School of Nursing，Yangzhou University，Yangzhou 225100，China
2.Department of Obstetrics and Gynecology，Nanjing Yangzi Hospital，Nanjing 210000，China
3.Yangzhou University Medical College，Yangzhou 225100，China
4.Department of Obstetrics and Gynecology，North Jiangsu People's Hospital，Yangzhou 225100，China
*Corresponding author：KONG Xiang，Professor，Chief physician；E-mail：XKong@yzu.edu.cn
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5622.shtml
Abstract：Background Postpartum post-traumatic stress disorder （PTSD） is a serious threat to maternal and child health due to its complex influencing factors.Therefore，it is essential to conduct a Meta-analysis of its influencing factors.Objective We explored the influencing factors of postpartum PTSD through a Meta-analysis，to provide scientific evidence for screening and preventing such diseases in the future.Methods Foreign databases （PubMed，EMBase，Cochrane Library，Web of Science，PsycINFO and Scopus） and domestic databases （CNKI，Wanfang Data，VIP，CBM） were searched systematically from inception to September 2020 for cross-sectional studies and cohort studies on the influencing factors of postpartum PTSD.Snowballing was used to search for the references of the included studies.Literature enrollment and data extraction were performed by two researchers separately according to the literature inclusion and exclusion criteria.AHRQ methodology checklist was used for assessing the quality of cross-sectional studies.The Newcastle-Ottawa Scale was used for assessing the quality of cohort studies.Meta-analysis was performed using Stata 16.0 and RevMan 5.3.Results Finally，6 cross-sectional studies and 6 cohort studies were included，with moderate or high methodological quality.The Meta-analysis found that psychological problems during pregnancy （depression，anxiety） 〔OR=10.73，95%CI （4.91，23.45）〕，pregnancy complications〔OR=4.80，95%CI（1.91，12.03）〕，traumatic delivery experience 〔OR=3.57，95%CI（2.20，5.80）〕，cesarean section 〔OR=3.46，95%CI（2.82，4.24）〕，emergency cesarean section 〔OR=3.05，95%CI （2.11，4.41）〕，instrumental delivery 〔OR=2.47，95%CI（1.65，3.69）〕，low level of psychological consistency 〔OR=2.27，95%CI （1.64，4.51）〕，and epidural anesthesia 〔OR=1.55，95%CI （1.19，2.02）〕 were associated with increased risk of postpartum PTSD （P<0.05）；satisfaction with childbirth services〔OR=0.30，95%CI （0.21，0.44）〕，early mother-infant skin-to-skin contact 〔OR=0.20，95%CI （0.16，0.25）〕，and social support 〔OR=0.13，95%CI （0.03，0.48）〕were associated with decreased risk of postpartum PTSD （P<0.05）.The combined results are relatively stable in the sensitivity analysis except for the emergency cesarean section and with no publication bias.Conclusion Postpartum PTSD is associated with various factors，whose occurrence probability may increase with psychological distress during pregnancy （depression，anxiety），pregnancy complications，traumatic birth experience，cesarean section，instrumental delivery，low level of psychological consistency，and epidural anesthesia.
Network Meta-analysis of Effects of Different Statins on Liver Function
DI Yurong1，FENG Yingna1，YANG Dahong2，HOU Yuli3*
1.First Medical College of Shanxi Medical University，030000 Taiyuan，China
2.Southern Medical University，510000 Guangzhou，China
3.First Hospital of Shanxi Medical University，030000 Taiyuan，China
*Corresponding author：HOU Yuli，Chief physician；E-mail：houyuli63@sina.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5554.shtml
Abstract：Background As one of the most commonly used drugs，statins’ adverse reactions，especially hepatotoxicity，have become a growing concern. However，the assessment of the effects of different statins on liver function still varies at present. Objective To systematically review the effects of different statins on liver function. Methods We searched electronic databases，including Cochrane Library，PubMed，EMBase and Medline to collect randomized controlled trials （RCTs） about abnormal liver function associated with statins as the intervention from inception to September 10th 2020. Literature review，data extraction，and risk of bias evaluation were performed by two researchers. Stata 14 was used for network meta-analysis. Results All in all，46 RCTs were included，containing 6 types of Statins as interventions for 54 499 cases，including 21 with atorvastatin，10 with rosuvastatin，10 with simvastatin，7 with pitavastatin，4 with lovastatin，and 3 with pitavastatin. The results of network meta-analysis were as follows: the incidence of liver dysfunction induced by atorvastatin was higher than that caused by rosuvastatin or pravastatin. The incidence of liver dysfunction induced by atorvastatin was higher than that by placebo，so did that induced by rosuvastatin （P<0.05）. The SUCRA value for Statins and placebo ranked from highest to lowest were: placebo（77.2%）>pitavastatin（70.9%）>pravastatin（64.1%）>simvastatin（60.7%）>rosuvastatin （40.4%）>lovastatin（31.6%）>atorvastatin（5.1%）. The incidence of liver dysfunction caused by statins metabolized by CYP450 enzyme was higher than that by placebo（P<0.05）. The ranking results of statins with different metabolic pathways and placebo by SUCRA were: placebo（95.6%）>statins not metabolized by CYP450 enzyme（51.9%）>statins metabolized by CYP450 enzyme（2.6%）. The incidence of liver dysfunction caused by liposoluble statins was higher than that by placebo（P<0.05）. The ranking results of statins with different solubilities and placebo by SUCRA were: placebo（97.4%）>hydrosoluble statins（48.7%）>liposoluble statins （3.9%）. The incidence of liver dysfunction induced by high-intensity atorvastatin was higher than that by medium-intensity pitavastatin，medium-intensity pravastatin，medium-intensity simvastatin，high-intensity rosuvastatin or medium-intensity rosuvastatin（P<0.05）. The incidence of liver dysfunction caused by high-intensity atorvastatin or high-intensity rosuvastatin was higher than that by placebo（P<0.05）. The ranking results of different doses of statins and placebo by SUCRA were: medium-intensity rosuvastatin（76.4%）>medium-intensity pitavastatin（71.6%）>placebo（69.1%）>medium-intensity simvastatin （67.5%）>medium-intensity pravastatin（55.1%）>low-intensity pravastatin（41.7%）>high-intensity rosuvastatin（40.9%）>medium-intensity atorvastatin（37.9%）>low-intensity lovastatin（31.0%）>high-intensity atorvastatin（8.8%）. Conclusion Liposoluble statins，statins metabolized by CYP450 enzymes and high-dose statins tend to lead to a higher incidence of liver dysfunction. With an analysis of the reports of many fair-quality RCTs，this study may be used as guidance for clinical medication. However，due to some eligible RCTs with low quality，more high-quality RCTs are needed to verify our conclusion.
Preventive Effect of Different Chinese Patent TCM Injections for Activating Blood Circulation and Removing Blood Stasis with Usual Hydration on Contrast-induced Nephropathy：a Network Meta-analysis
HUANG Yingjie1，LIU Jiayue1，ZHAN Qunzhang1，HUANG Lei1，YE Jiajia1，ZHANG Yueyao1，HE Yuchun1，LI Junzhe2*
1.Guangzhou University of Chinese Medicine，Guangzhou 510045，China
2.Daxuecheng Hospital，Guangdong Provincial Hospital of TCM，Guangzhou 510006，China
*Corresponding author：LI Junzhe，Attending physician；E-mail：2015404734@qq.com
http://123.57.154.95:8088/zgqkyx/CN/abstract/abstract5553.shtml
Abstract：Background Many clinical trials have confirmed that a variety of Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration may prevent contrast-induced nephropathy（CIN）to some extent，but there is a lack of systematic review.Objective To evaluate the effect of different Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration on preventing CIN，providing evidence-based evidence for clinical rational use of such medicines.Methods Databases including Cochrane Library，EMBase，PubMed，CNKI，SinoMed，CQVI and Wanfang Data were searched for RCTs about different Chinese patent TCM injections for activating blood circulation and removing blood stasis with hydration（test group）versus usual hydration（control group）in preventing CIN from inception to November 2019.Stata 15.0 was used to conduct network meta-analysis.Results A total of 19 RCTs were included，involving 2 433 patients.The analysis revealed that，the therapies were ranked as follows in terms of effect of decreasing the incidence of CIN：Ligustrazine injection with usual hydration>Xuebijing injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Shenkang injection with usual hydration>Sofren injection with usual hydration>Miltiorrhizae polyphenolate injection with usual hydration>Yinxingdamo injection with usual hydration> usual hydration.For decreasing the Ccr after CAG/PCI，the ranking results were：Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Erigeron breviscapus injection with usual hydration>Yinxingdamo injection with usual hydration>Sofren injection with usual hydration>Xuebijing injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the Scr after CAG/PCI，the ranking results were：Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Ligustrazine injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Yinxingdamo injection with usual hydration>Shenkang injection with usual hydration>Ginseng and aconite injection with usual hydration>Xuebijing injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the BUN after CAG/PCI，the ranking results were：Ginseng and aconite injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Danhong injection with usual hydration>usual hydration.Conclusion The available literature evidence indicates that，Ligustrazine injection with usual hydration may be an optimal therapy for decreasing the incidence of CIN；Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration may be an optimal therapy for decreasing Ccr after CAG/PCI；Erigeron breviscapus injection with usual hydration may be the best therapy in decreasing Scr after CAG/PCI，and Ginseng and aconite injection with usual hydration may be the best therapy in decreasing BUN after CAG/PCI.