Background:Chronic urticaria(CU)is a common skin disease,which has a negative effect on quality of life.Current treatments do not fully control the symptoms of urticaria for many CU patients,thus effective and safe tr...Background:Chronic urticaria(CU)is a common skin disease,which has a negative effect on quality of life.Current treatments do not fully control the symptoms of urticaria for many CU patients,thus effective and safe treatments for CU are still needed.Objective:This review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU.Search strategy:The search strategy looked for the presence of related keywords,such as‘‘chronic urticaria"and‘‘cupping therapy,"in the title and abstract of research articles indexed in major databases.Randomized controlled trials(RCTs)were selected after querying nine electronic databases from their inception to May 2019 with the above search terms.Inclusion criteria:RCTs were included if they recruited patients with CU who were intervened with dry or wet cupping.Publications could be written in Chinese or English.Data extraction and analysis:Data were extracted,and the studies were assessed for the quality of their methodological design and risk of bias.Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome.Skin disease quality of life index score,recurrence rate,and adverse events were assessed as secondary outcomes.Subgroup analyses were conducted based on different interventions.Results:Thirteen comparisons from 12 RCTs involving 842 participants were included.There were no significant differences between wet cupping and medications in total effective rate(n=372;risk ratio[RR]=1.10,95%confidence interval[CI]0.97 to 1.25;P=0.14)or recurrence rate(n=240;RR=0.56,95%CI 0.23 to 1.36;P=0.20).Cupping therapy,in combination with antihistamine treatment was more efficacious than antihistamines alone,with a greater total effective rate(n=342;RR=1.18,95%CI 1.01 to1.39;P=0.03)and lower recurrence rate(n=342;RR=0.52,95%CI 0.32 to 0.84;P=0.007).Cupping therapy combined with acupuncture was more effective than acupuncture alone(n=156;RR=1.25,95%CI 1.07 to 1.46;P=0.006).No serious adverse events were reported.Conclusion:Wet cupping may be as effective as treatment with antihistamines.When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture,it may enhance the efficacy.Results drawn from these studies should be interpreted with caution and applied with care to clinical practice,because of the poor quality among the studies that were reviewed.Systematic review registration:PROSPERO,CRD42019137451.展开更多
Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Num...Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.展开更多
Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy ...Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating,standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.Objective: To improve the accuracy of diagnosing and managing Bell's palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell's palsy, and to improve the quality of acupuncture for patients with Bell's palsy in most instances.Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts' consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions,searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline.Results:(1)The guideline development group made a Grade A recommendation that ①With a course of Bell's palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs,whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable.②Acupuncture should be applied as early as possible for Bell's palsy.③The principle of selecting acupoints for Bell's palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally,the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell's palsy,including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice.(2) The development group formed expert consensus on the principles of acupuncture treatment for Bell' palsy. Bell's palsy is suitably treated according to the stages, differentiation and symptoms.展开更多
基金supported by the National Key Research and Development Program of the China-Key Project“Research on Modernization of Traditional Chinese Medicine”——“International Cooperation Research on Evaluation of Acupuncture Advantage Diseases”(No.2017YFC1703600 and 2017YFC1703605)。
文摘Background:Chronic urticaria(CU)is a common skin disease,which has a negative effect on quality of life.Current treatments do not fully control the symptoms of urticaria for many CU patients,thus effective and safe treatments for CU are still needed.Objective:This review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU.Search strategy:The search strategy looked for the presence of related keywords,such as‘‘chronic urticaria"and‘‘cupping therapy,"in the title and abstract of research articles indexed in major databases.Randomized controlled trials(RCTs)were selected after querying nine electronic databases from their inception to May 2019 with the above search terms.Inclusion criteria:RCTs were included if they recruited patients with CU who were intervened with dry or wet cupping.Publications could be written in Chinese or English.Data extraction and analysis:Data were extracted,and the studies were assessed for the quality of their methodological design and risk of bias.Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome.Skin disease quality of life index score,recurrence rate,and adverse events were assessed as secondary outcomes.Subgroup analyses were conducted based on different interventions.Results:Thirteen comparisons from 12 RCTs involving 842 participants were included.There were no significant differences between wet cupping and medications in total effective rate(n=372;risk ratio[RR]=1.10,95%confidence interval[CI]0.97 to 1.25;P=0.14)or recurrence rate(n=240;RR=0.56,95%CI 0.23 to 1.36;P=0.20).Cupping therapy,in combination with antihistamine treatment was more efficacious than antihistamines alone,with a greater total effective rate(n=342;RR=1.18,95%CI 1.01 to1.39;P=0.03)and lower recurrence rate(n=342;RR=0.52,95%CI 0.32 to 0.84;P=0.007).Cupping therapy combined with acupuncture was more effective than acupuncture alone(n=156;RR=1.25,95%CI 1.07 to 1.46;P=0.006).No serious adverse events were reported.Conclusion:Wet cupping may be as effective as treatment with antihistamines.When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture,it may enhance the efficacy.Results drawn from these studies should be interpreted with caution and applied with care to clinical practice,because of the poor quality among the studies that were reviewed.Systematic review registration:PROSPERO,CRD42019137451.
基金supported by grants from the National Natural Science Foundation of China(No.8207455481774430)the Foundation of the Science and Technology Department of Sichuan Province,China(No.2021YJ0197)。
文摘Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.
基金West-Pacific Region of World Health Organization for financial support
文摘Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating,standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.Objective: To improve the accuracy of diagnosing and managing Bell's palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell's palsy, and to improve the quality of acupuncture for patients with Bell's palsy in most instances.Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts' consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions,searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline.Results:(1)The guideline development group made a Grade A recommendation that ①With a course of Bell's palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs,whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable.②Acupuncture should be applied as early as possible for Bell's palsy.③The principle of selecting acupoints for Bell's palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally,the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell's palsy,including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice.(2) The development group formed expert consensus on the principles of acupuncture treatment for Bell' palsy. Bell's palsy is suitably treated according to the stages, differentiation and symptoms.
