Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Trends and hotspots of global ultra-processed food research(2010-2023):A scientometric study

Background:Recently,ultra-processed foods(UPFs)have attracted considerable attention,leading to numerous studies worldwide.Scientometrics is currently gaining popularity among scientific communities,offering advantage of providing critical references to scholars of specific fields.Methods:This scientometric study aimed to analyze trends and hotspots of UPF research using English articles or reviews related to UPFs retrieved from the Web of Science Core Collection on March 5,2023.Two independent researchers selected the identified records on titles,abstracts,and author’s keywords,and the data were analyzed using R-bibliometrix,CiteSpace,and VOSviewer.Results:A total of 1018 publications(901 articles and 117 reviews)published from 2010 to 2023 were included.The result showed a significant increase in UPF publications over the past decades.Brazil published the highest number of papers(n=473),with over half of the top 10 active institutions were located in Brazil.The University of São Paulo contributed the most publications(n=206)and the 10 most productive authors belonged to this institution,with Monteiro CA and Levy RB contributing the most publications.The main research foundations included the NOVA system,the definition of UPFs,the prevalence of UPFs,and the impact of UPFs on dietary quality and health status.The main research frontiers included topics such as“systematic review,”“NOVA food classification,”“COVID-19,”“diabetes,”“pregnancy,”“food addiction,”“warning labels,”“plant-based diet,”and“commercial determinants of health”.Conclusions:This study provided a comprehensive overview of development trends and research hotspots of global UPF studies.

International experts consensus guidelines on robotic liver resection in 2023

The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.

International consensus statement on robotic hepatectomy surgery in 2018

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Comparison between laparoscopic uncut Roux-en-Y and Billroth Ⅱ with Braun anastomosis after distal gastrectomy:A meta-analysis

BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

Neoadjuvant chemotherapy for patients with resectable colorectal cancer liver metastases: A systematic review and meta-analysis

BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases(CRLM)are still controversial.AIM To assess the efficacy and application value of NAC in patients with resectable CRLM.METHODS We searched PubMed,Embase,Web of Science,and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC.Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software.RESULTS In total,32 studies involving 11236 patients were included in this analysis.We divided the patients into two groups,the NAC group(that received neoadjuvant chemotherapy)and the non-NAC group(that received no neoadjuvant chemotherapy).The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups.The hazard ratio(HR)and 95%confidence interval(CI)were HR=0.49,95%CI:0.39-0.61,P=0.000 and HR=0.4895%CI:0.36-0.63,P=0.000.The duration of surgery in the NAC group was longer than that of the non-NAC group[standardized mean difference(SMD)=0.41,95%CI:0.01-0.82,P=0.044)].The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group(SMD=0.73,95%CI:0.02-1.43,P=0.043).The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group(SMD=1.24,95%CI:1.07-1.43,P=0.004).CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM.At the same time,the NAC group did not increase the risk of any adverse event compared to the non-NAC group.

Efficacy and safety of intraoperative radiotherapy in rectal cancer:A systematic review and meta-analysis

BACKGROUND In recent years,intraoperative radiotherapy(IORT)has been increasingly used for the treatment of rectal cancer.However,the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.AIM To evaluate the value of IORT for patients with rectal cancer.METHODS We searched PubMed,Embase,Cochrane Library,Web of Science databases,and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer.Dichotomous variables were evaluated by odds ratio(OR)and 95%confidence interval(CI),hazard ratio(HR)and 95%CI was used as a summary statistic of survival outcomes.Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.RESULTS In this study,3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients,who are mainly residents of Europe,the United States,and Asia.Our results did not show significant differences in 5-year overall survival(HR=0.80,95%CI=0.60-1.06;P=0.126);5-year disease-free survival(HR=0.94,95%CI=0.73-1.22;P=0.650);abscess(OR=1.10,95%CI=0.67-1.80;P=0.713),fistulae(OR=0.79,95%CI=0.33-1.89;P=0.600);wound complication(OR=1.21,95%CI=0.62-2.36;P=0.575);anastomotic leakage(OR=1.09,95%CI=0.59-2.02;P=0.775);and neurogenic bladder dysfunction(OR=0.69,95%CI=0.31-1.55;P=0.369).However,the meta-analysis of 5-year local control was significantly different(OR=3.07,95%CI=1.66-5.66;P=0.000).CONCLUSION The advantage of IORT is mainly reflected in 5-year local control,but it is not statistically significant for 5-year overall survival,5-year disease-free survival,and complications.

The preferences and values of patients treated with acupuncture for cancer pain:a qualitative systematic review

Background:Understanding values and preferences in the context of personal,physical,emotional,relational,and social factors is important in optimizing cancer patient counselling,facilitating treatment decision-making,and improving guideline recommendations in treating cancer pain patients.Objective:To systematically review the available evidence regarding the values,preferences,and expectations of acupuncture for patients with cancer pain.Methods:A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)statement was conducted.Eight databases were searched without time limits for eligible studies up to April 26,2021.Reference lists of included articles were also searched manually and authors were contacted to inquire about other relevant papers.The quality of the studies was appraised using the Critical Appraisal Skill Program Qualitative Appraisal Checklist(CASP)for studies.This research was registered on PROSPERO with number CRD42020213396.Results:A total of eight studies published in period from 2002 to 2020 were identified from 8 studies involving 2,835 patients.The number of participants in each study ranged from 76 to 706.The quality of the eight included studies was considered high as judged by the CASP tool.Safety is the main factor influencing patients'willingness and preference to accept acupuncture treatment.Human race,education,gender,and knowledge of acupuncture were potentially correlated with patients'preferences.Patients with moderate to severe pain were more likely to use acupuncture than those with mild pain.Conclusion:The preferences and values of patients with cancer pain to receive acupuncture treatment are mainly related to the safety of acupuncture,the degree of cancer pain and demographic characteristics.It is hoped that future high-quality studies could further confirm our conclusions.

Vaccine Research in COVID-19: A Living Scoping Review Protocol

Objective:This scoping review will summarize COVID-19 vaccine research activities and describe the extent,range,and nature of evidence in the research of COVID-19 vaccines.Methods:Following Arksey and O’Malley’s framework and the methodological guidance of Joanna Briggs Institute(JBI),we propose a scoping review to summarize the extent,range,and na-ture of evidence in research related to COVID-19 vaccines.Based on research questions developed by us,a comprehensive search will be performed using the PubMed,Cochrane Library,Embase,Web of Science,CNKI,CBM,VIP,and WanFang databases by two independent reviewers.According to our predefined inclusion criteria,pairs of reviewers will independently assess theeligibility of the identified studies from the databases.Following literature selection,pairs of reviewers will extract relevant information related to our research questions.Subsequently,methodological quality and reporting quality of key evidence types(i.e.,random-ized controlled trials,systematic reviews,and meta-analyses)will be evaluated using commonly used tools,if possible.Qualitative synthesis and descriptive statistics will be used to summarize and present the results.In addition,new or updated meta-analysis will be conducted to pool the available data in included primary studies where possible.To track the trends in COVID-19 vaccine research,we plan to update our results approximately every 2-3 months.For preparing this scoping review protocol,we referred to the PRISMA-P checklist,and for reporting the following full texts,we will be following PRISMA-ScR guidelines.Conclusion:We believe that the results of this scoping review on COVID-19 vaccine will contribute to providing foundational knowledge and will have significant value in the research and practice concerning COVID-19 vaccines.The findings will also allow us to identify research gaps on this topic and also help us guide future research on COVID-19 vaccines.

环境证据协作网及环境治理系统评价指南简介

环境证据协作网在2007年始创于英国,是全球可持续环境和生物多样性保护领域中的科学家和管理者工作的开放性学术组织,致力于合成与环境政策和实施最相关的证据。随着环境治理理念在全球的发展,在全球逐渐成立了6个分中心,并与全世界7个组织一起合作在环境治理方面进行循证实践和促进。由环境证据协作网出版的环境治理证据合成标准和指南目前广泛应用于通过科学提供决策信息的各个社会领域,并已成为获取、评价和整合科学信息的公认标准。本文将介绍环境证据协作网的发展和功能,并对环境治理系统评价制作进行阐述。

Reporting and methodological quality of meta-analyses of acupuncture for patients with migraine:A methodological investigation with evidence map

Background:Acupuncture has been widely used to relieve migraine-related symptoms.However,the findings of previous systematic reviews(SRs)and meta-analyses(MAs)are still not completely consistent.Their quality is also unknown,so a comprehensive study is needed.Objective:To evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine,and summarize evidence about the efficacy and safety of acupuncture for migraine.Search strategy:Pub Med,Embase,Cochrane Library,China National Knowledge Infrastructure,Chinese Biomedical Databases,Wanfang Data,and VIP databases were searched from inception to September 2020,with a comprehensive search strategy.Inclusion criteria:The pairwise MAs of randomized controlled trials(RCTs)concerning migraine treated by acupuncture or acupuncture-based therapies,with a control group that received sham acupuncture,medication,no treatment,or acupuncture at different acupoints were included.Data extraction and analysis:Two independent investigators screened studies,extracted relevant data,and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2009 and A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),then all results were cross-checked.Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores.Results:A total of 20 MAs were included in this study.The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention.There was a high correlation between reporting and methodological quality scores(rs=0.87,P<0.001).The quality of the included SRs needs to be improved mainly with regard to protocol and prospective registration,using a comprehensive search strategy,summarizing the strength of evidence body for key outcomes,a full list of excluded studies with reasons for exclusion,reporting of RCTs’funding sources,and assessing the potential impact of risk of bias in RCTs on MA results.Conclusion:Acupuncture is an effective and safe intervention for preventing and treating migraine,and could be considered as a good option for patients with migraine.However,the reporting and methodological quality of MAs included in this overview is suboptimal.In the future,AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.