Liver chemistries in severe or non-severe cases of COVID-19:A systematic review and meta-analysis

BACKGROUND Coronavirus disease(COVID-19)patients exhibit different patterns of liver impairment,according to growing evidence.AIM In this study,we sought to provide a comprehensive analysis of liver test parameters in patients with severe and non-severe COVID-19.METHODS We performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19.We searched PubMed,Google Scholar,Embase,Cochrane Library,medRxiv,bioRxiv,and three Chinese electronic databases through April 18,2020,in accordance with the Preferred Reporting Items for Meta-Analyses.We analyzed pooled data on liver chemistries stratified by COVID-19 severity using a fixed or random-effects model.RESULTS A meta-analysis of 56 studies,including 11052 patients,found that the pooled mean alanine aminotransferase(ALT)in severe COVID-19 cases was 35.9 IU/L whereas in non-severe COVID-19 cases was 27.3 IU/L.Average aspa-rtate aminotransferase(AST)levels were 44.3 IU/L in severe cases compared to 27.9 IU/L in non-severe cases.In addition,AST levels are often higher than ALT levels regardless of disease severity.The severe cases tended to have a higher gammaglutamyltransferase level but a lower albumin level than the non-severe cases.CONCLUSION Severe COVID-19 was more likely to be associated with abnormal liver test results.Monitoring liver chemistry closely can help detect disease progression early.

Protein induced by vitamin K absence or antagonist-Ⅱ versus alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: A systematic review with meta-analysis

Background: As a promising biomarker of hepatocellular carcinoma(HCC), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-Ⅱ with alpha-fetoprotein(AFP) in the diagnosis of HCC. Data sources: A systematic literature search was conducted to identify the studies from MEDLINE, Embase and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-Ⅱ and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve(ROC) was employed to evaluate the diagnostic accuracy of each marker. Results: Thirty-one studies were included. The pooled sensitivity(95% CI) of PIVKA-Ⅱ and AFP was 0.66(0.65–0.68) and 0.66(0.65–0.67), respectively in diagnosis of HCC; and the corresponding pooled specificity(95% CI) was 0.89(0.88–0.90) and 0.84(0.83–0.85), respectively. The area under the ROC curve(AUC) of PIVKA-Ⅱ and AFP was 0.856(0.817–0.895) and 0.770(0.728–0.811), respectively. Subgroup analysis showed that PIVKA-Ⅱ was superior to AFP in terms of the AUC for both small HCC( < 3 cm) [0.863(0.825–0.901) vs 0.717(0.658–0.776)] and large HCC( ≥ 3 cm) [0.854(0.811–0.897) vs 0.729(0.682–0.776)]; for American [0.926(0.897–0.955) vs 0.698(0.594–0.662)], European [0.772(0.743–0.801) vs 0.628(0.594–0.662)], Asian [0.838(0.812–0.864) vs 0.785(0.764–0.806)] and African [0.812(0.794–0.840) vs 0.721(0.675–0.767)] HCC patients; and for HBV-related [0.909(0.866–0.951) vs 0.714(0.673–0.755)] and mixed-etiology [0.847(0.821–0.873) vs 0.794(0.772–0.816)] HCC. Conclusion: This meta-analysis indicates that PIVKA-Ⅱ is better than AFP in terms of the accuracy for diagnosing HCC, regardless of tumor size, patient ethnic group, or HCC etiology.

Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease:A meta-analysis

AIM:To compare the results of transvaginal cholecystectomy(TVC) and conventional laparoscopic cholecystectomy(CLC) for gallbladder disease.METHODS:We performed a literature search of Pub Med,EMBASE,Ovid,Web of Science,Cochrane Library,Google Scholar,Meta Register of Controlled Trials,Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC.Data were extracted by two authors.Mean difference (MD), standardized mean difference(SMD),odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models.Statistical heterogeneity was evaluated with the χ2 test.The fixed-effects model was used in the absence of statistically significant heterogeneity.The randomeffects model was chosen when heterogeneity was found.RESULTS:There were 730 patients in nine controlled clinical trials.No significant difference was found regarding demographic characteristics(P > 0.5),including anesthetic risk score,age,body mass index,and abdominal surgical history between the TVC and CLC groups.Both groups had similar mortality,morbidity,and return to work after surgery.Patients in the TVC group had a lower pain score on postoperative day 1(SMD:-0.957,95%CI:-1.488 to-0.426,P < 0.001),needed less postoperative analgesic medication(SMD:-0.574,95%CI:-0.807 to-0.341,P < 0.001) and stayed for a shorter time in hospital(MD:-1.004 d,95%CI:-1.779 to 0.228,P = 0.011),but had longer operative time(MD:17.307 min,95%CI:6.789 to 27.826,P = 0.001).TVC had no significant influence on postoperative sexual function and quality of life.Better cosmetic results and satisfaction were achieved in the TVC group.CONCLUSION:TVC is safe and effective for gallbladder disease.However,vaginal injury might occur,and further trials are needed to compare TVC with CLC.

Effect of Na Fe EDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective To assess the effect of sodium iron ethylenediaminetetraacetate （NaFeEDTA）-fortified soy sauce on anemia prevalence in the Chinese population. Methods A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. Results After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 （95% CI 0.19-0.35）. For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L （95% CI 5.96-11.67）. Conclusion NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Exercise interventions for older adults: A systematic review of meta-analyses

Background:The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented.We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of metaanalyses of exercise interventions in older adults.Methods:We searched the Cochrane Database of Systematic Reviews,PsycInfo,MEDLINE,Embase,CINAHL,AMED,SPORTDiscus,and Web of Science for articles that met the following criteria:(1)meta-analyses that synthesized measures of improvement(e.g.,effect sizes)on any outcome identified in studies of exercise interventions;(2)participants in the studies meta-analyzed were adults aged 65+or had a mean age of 70+;(3)meta-analyses that included studies of any type of exercise,including its duration,frequency,intensity,and mode of delivery;(4)interventions that included multiple components(e.g.,exercise and cognitive stimulation),with effect sizes that were computed separately for the exercise component;and(5)meta-analyses that were published in any year or language.The characteristics of the reviews,of the interventions,and of the parameters improved through exercise were reported through narrative synthesis.Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews.The study included 56 meta-analyses that were heterogeneous in relation to population,sample size,settings,outcomes,and intervention characteristics.Results:The largest effect sizes for improvement were found for resistance training,meditative movement interventions,and exercise-based active videogames.Conclusion:The review identified important gaps in research,including a lack of studies investigating the benefits of group interventions,the characteristics of professionals delivering the interventions associated with better outcomes,and the impact of motivational strategies and of significant others(e.g.,carers)on intervention delivery and outcomes.

Fiber and prebiotic supplementation in enteral nutrition： asystematic review and meta-analysis

AIM To determine the preventive effect and safetyof proton pump inhibitors （PPIs） in low-dose aspirin（LDA）-associated gastrointestinal （GI） ulcers andbleeding.METHODS： We searched MEDLINE, EMBASE and theCochrane Controlled Trials Register from inception toDecember 2013, and checked conference abstracts ofrandomized controlled trials （RCTs） on the effect ofPPIs in reducing adverse GI events （hemorrhage, ulcer,perforation, or obstruction） in patients taking LDA.The preventive effects of PPIs were compared with thecontrol group [taking placebo, a cytoprotective agent,or an H2 receptor antagonist （H2RA）] in LDA-associatedupper GI injuries. The meta-analysis was performedusing RevMan 5.1 software.RESULTS： We evaluated 8780 participants in 10 RCTs.The meta-analysis showed that PPIs decreased the riskof LDA-associated upper GI ulcers （OR = 0.16; 95%CI：0.12-0.23） and bleeding （OR = 0.27; 95%CI： 0.16-0.43）compared with control. For patients treated with dualanti-platelet therapy of LDA and clopidogrel, PPIs wereable to prevent the LDA-associated GI bleeding （OR =0.36; 95%CI： 0.15-0.87） without increasing the riskof major adverse cardiovascular events （MACE） （OR =1.00; 95%CI： 0.76-1.31）. PPIs were superior to H2RAin prevention of LDA-associated GI ulcers （OR = 0.12;95%CI： 0.02-0.65） and bleeding （OR = 0.32; 95%CI：0.13-0.79）.CONCLUSION： PPIs are effective in preventing LDAassociatedupper GI ulcers and bleeding. Concomitantuse of PPI, LDA and clopidogrel did not increase therisk of MACE.

Current systematic reviews and meta-analyses of COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.

Systematic review with meta-analysis of the epidemiological evidence relating smoking to type 2 diabetes

BACKGROUND Evidence relating tobacco smoking to type 2 diabetes has accumulated rapidly in the last few years,rendering earlier reviews considerably incomplete.AIM To review and meta-analyse evidence from prospective studies of the relationship between smoking and the onset of type 2 diabetes.METHODS Prospective studies were selected if the population was free of type 2 diabetes at baseline and evidence was available relating smoking to onset of the disease.Papers were identified from previous reviews,searches on Medline and Embase and reference lists.Data were extracted on a range of study characteristics and relative risks(RRs)were extracted comparing current,ever or former smokers with never smokers,and current smokers with non-current smokers,as well as by amount currently smoked and duration of quitting.Fixed-and random-effects estimates summarized RRs for each index of smoking overall and by various subdivisions of the data:Sex;continent;publication year;method of diagnosis;nature of the baseline population(inclusion/exclusion of pre-diabetes);number of adjustment factors;cohort size;number of type 2 diabetes cases;age;length of follow-up;definition of smoking;and whether or not various factors were adjusted for.Tests of heterogeneity and publication bias were also conducted.RESULTS The literature searches identified 157 relevant publications providing results from 145 studies.Fifty-three studies were conducted in Asia and 53 in Europe,with 32 in North America,and seven elsewhere.Twenty-four were in males,10 in females and the rest in both sexes.Fifteen diagnosed type 2 diabetes from selfreport by the individuals,79 on medical records,and 51 on both.Studies varied widely in size of the cohort,number of cases,length of follow-up,and age.Overall,random-effects estimates of the RR were 1.33[95%confidence interval(CI):1.28-1.38]for current vs never smoking,1.28(95%CI:1.24-1.32)for current vs non-smoking,1.13(95%CI:1.11-1.16)for former vs never smoking,and 1.25(95%CI:1.21-1.28)for ever vs never smoking based on,respectively,99,156,100 and 100 individual risk estimates.Risk estimates were generally elevated in each subdivision of the data by the various factors considered(exceptions being where numbers of estimates in the subsets were very low),though there was significant(P<0.05)evidence of variation by level for some factors.Dose-response analysis showed a clear trend of increasing risk with increasing amount smoked by current smokers and of decreasing risk with increasing time quit.There was limited evidence of publication bias.CONCLUSION The analyses confirmed earlier reports of a modest dose-related association of current smoking and a weaker dose-related association of former smoking with type 2 diabetes risk.

Systematic reviews and meta-analyses: Why are they clinically significant?

This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.

Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. Should You Be Sceptical?

A narrative review of the data provided by Randomised Controlled clinical trials and meta-analyses was undertaken to assess how much reliance a clinician could place on these in selecting a treatment for patients with disease of the Femoral artery. An attempt was made to detect and review every clinical trial and meta-analysis published on treatments relating to disease of the femoral artery but not relating to drug treatment. Disease of the femoral artery in >65 years age group occurs in approximately 20% of the population but symptomatology was present in 40%. In almost all trials the predominant (>90%) indication for treatment was intermittent claudication. In this setting, clinical benefit was limited and did not extend beyond 12 months. Mortality, from co-morbidities was high. The Basil Trial was the only one to examine intervention for critical limb ischemia. The results for Bypass surgery and Percutaneous transarterial balloon angioplasty (PTA) were equivalent. There is little evidence to support the use of PTA or stenting other than in the treatment of patients with critical limb ischemia.

Systematic review with meta-analysis of the epidemiological evidence in Europe,Israel,America and Australasia on smoking and COVID-19

BACKGROUND Previous meta-analyses related smoking to death or severe infection from coronavirus disease 2019(COVID-19)in hospitalized patients,but considered only a few studies,did not adjust for demographics and comorbidities,and inadequately defined smoking.AIM To review and meta-analyse epidemiological evidence on smoking and COVID-19,considering a range of endpoints,populations and smoking definitions and the effect of adjustment.METHODS Studies were identified from publications in English up to 30 September,2020 involving at least 100 individuals,carried out in Europe,Israel,America or Australasia,not restricted to those with specific other diseases,and providing information relating smoking to various COVID-related endpoints.Meta-analyses were carried out for combinations of population and endpoint,with variation studied by smoking definition,adjustment level and other factors.RESULTS From 96 publications,74 studies were identified,37 in the United States,10 in the United Kingdom,with up to four in the other countries.Three involved over a million individuals,and 37 involved less than a thousand.Adjusted results for smoking were available in 42 studies,with adjustment not considered in 20 studies.Results were considered by endpoint.No significant effect of smoking on COVID-19 positivity was seen in the general population,but there was a reduced risk in those tested.Best-adjusted estimates for current(vs never)smoking were 0.87(95%confidence interval:0.52-1.47)in the general population and 0.52(0.43-0.64)in those tested.For those hospitalized due to COVID-19,unadjusted rates were significantly increased in current smokers(1.20,1.01-1.42)and ever smokers(1.64,1.41-1.91),but those adjusted for comorbidities showed no increase for current(0.82,0.52-1.30)or ever smokers(1.00,0.76-1.32).There was little evidence to suggest that smoking was associated with intensive care admission.For those hospitalized with COVID-19,best-adjusted estimates were 0.88(0.72-1.08)for current smokers and 1.10(0.99-1.22)for ever smokers.In those hospitalized with COVID-19,smoking was not significantly related to subsequent mechanical ventilation,with best-adjusted estimates of 1.12(0.60-2.09)for current smokers and 1.05(0.88-1.25)for ever smokers.For those hospitalized with severe COVID-19,best-adjusted estimates were 0.74(0.49-1.12)for current smokers and 1.15(0.87-1.51)for ever smokers;few estimates were adjusted for comorbidities.While smoking was associated with increased mortality in unadjusted analyses,the association disappeared after adjustment for comorbidities.For example,in those hospitalized with COVID-19,the unadjusted estimate for ever smokers of 1.59(1.37-1.83)reduced to 1.07(0.82-1.38)when adjusted for comorbidities.Studies on those with severe COVID-19 showed that smoking tended to be associated with worsening of the disease.However,no estimate was adjusted,even for demographics.Estimates did not clearly vary by location or study size,and there was too little evidence to usefully study variations by age,amount smoked or years quit.CONCLUSION The increased COVID-19 death rate in smokers seen in unadjusted analyses disappears following adjustment for demographics and comorbidities.Among those tested,smoking is associated with lower COVID-19 infection rates.

Reporting quality evaluation of meta-analyses for cognitive interventions among Alzheimer's dementia

Background:To appraise the reporting quality of systematic reviews as well as meta-analyses of cognitive interventions among Alzheimer's disease using the PRISMA statement,and to investigate the related factors influencing the reporting quality.Method:Web of Science,Pubmed,Embase,Medline,as well as Cochrane Library were searched to collect the systematic reviews as well as meta-analyses of cognitive interventions among Alzheimer's disease from inception to September 17th 2019.The PRISMA statement was used to appraise their reporting quality and investigate the compliance with each PRISMA item.Furthermore,the potential factors affecting the reporting quality were analyzed based on the univariate analysis.Results:Seventeen articles were included.The mean compliance with the PRISMA statement was 74.86% and the standard deviation was 0.13.The univariate analysis indicated that the number of authors(P=0.019)might be a factor affecting the reporting quality.However,the journal impact factor(P=0.133),the number of studies included(P=0.170),the number of databases retrieved(P=0.201),funding report(P=0.228),and original studies(randomized controlled trials only)(P=0.322)might not affect the reporting quality.Conclusion:The overall reporting quality was high,but the compliance with the 11 PRISMA items,such as"structured summary"and"protocol and registration"was low.Future research should focus on adequate reporting of these items in the hope that readers will be better able to discern the accuracy and reliability of relevant information and make correct decisions.

Pollutant exposure and health outcomes:protocol for a comprehensive umbrella review of meta-analyses and evidence mapping

Background:Many systematic reviews and meta-analyses(MAs)regarding the association between pollutant(e.g.,air pollution,noise pollution,and heavy metal pollution)exposure and health outcomes have been published recently,but there is still a lack of comprehensive research based on these MAs,and the evidence quality of these MAs are unknown.Therefore,we designed an umbrella review to address these gaps in knowledge.Methods:MAs that evaluated the association between pollutant exposure and health outcomes will be systematically searched through the PubMed and Embase databases in May 2021.Pairs of reviewers will conduct the study screening and data extraction independently,and cross-check the results.PRISMA and AMSTAR 2 will be used to evaluate the reporting and methodological quality of MAs included,respectively,and an evidence mapping method will be used to present the results.The corrected cover area(CCA)method will be used to assess the degree of overlap for included primary studies among MAs.The outcomes will be reanalyzed based on the random-effects model using the appropriate effect size,and the corresponding 95%confidence intervals will be reported.Meanwhile,sensitivity analysis and subgroup analysis will be used to explore heterogeneity.The GRADE method will be used to evaluate the evidence quality of outcome indicators.Stata 16.0 and Excel 2019 will be used for data analysis,and P<0.05 will be considered to indicate statistical significance.Results:The results of this umbrella review will be submitted to a peer-reviewed English journal for publication.Conclusion:We designed the first umbrella review to summarize evidence from MAs on the association between common pollutant exposure and health conditions.The results of this study will provide evidence for health policy makers to formulate appropriate health policies and researchers to conduct new studies.

Methodological quality assessment of meta-analyses of cognitive interventions among Alzheimer's disease

Aims:The current study is designed to assess the methodological quality of the meta-analyses of cognitive interventions among Alzheimer's disease,and to investigate the compliance with 16 AMSTAR 2 items.Method:We searched Web of Scie nce,Sino med,PubMed,Embase,and Cochra ne Library from 2016 to 2021,to get the meta-a nalyses of cog nitive in terve nti ons in Alzheimer's disease.The AMSTAR 2 was used to assess the methodological quality.Furthermore,we also explored the complia nce with AMSTAR.Resul ts:We in cluded 9 studies in our research.Of them,6 articles were rated as"extremely low",2 articles as"low"and 1 article as"high".Furthermore,the reporting rates for 16 AMSTAR 2 items ranged from 22.22%to 100%.Conclusion:The methodological quality of meta-analyses of cognitive interventions in Alzheimer's disease is not ideal,and there is still room for improvement.Future studies are supposed to explore the releva nt factors that possibly in flue nce the methodological quality.

Current treatment for male infertility:an umbrella review of systematic reviews and meta-analyses

This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for male infertility and assess the quality of evidence and possible biases.An umbrella review of systematic reviews and meta-analyses available in PubMed,Web of Science,and Scopus,covering studies published up to October 2023,was conducted.Sperm concentration,morphology,and motility were used as endpoints to evaluate the effectiveness of the treatments.Of 2998 studies,18 published meta-analyses were extracted,yielding 90 summary effects on sperm concentration(n=36),sperm morphology(n=26),and sperm motility(n=28)on 28 interventions.None of the meta-analyses were classified as having low methodological quality,whereas 12(66.7%)and 6(33.3%)had high and moderate quality,respectively.Of the 90 summary effects,none were rated high-evidence quality,whereas 53.3%(n=48),25.6%(n=23),and 21.1%(n=19)were rated moderate,low,and very low,respectively.Significant improvements in sperm concentration,morphology,and motility were observed with pharmacological interventions(N-acetyl-cysteine,antioxidant therapy,aromatase inhibitors,selective estrogen receptor modulators,hormones,supplements,and alpha-lipoic acid)and nonpharmacological interventions(varicocele repair and redo varicocelectomy).In addition,vitamin supplementation had no significant positive effects on sperm concentration,motility,or morphology.Treatments for male infertility are increasingly diverse;however,the current evidence is poor because of the limited number of patients.Further well-designed studies on single treatment and high-quality meta-analysis of intertreatment comparisons are recommended.

Liuwei Dihuang Pills(六味地黄丸) Enhance the Effect of Western Medicine in Treating Type 2 Diabetes:A Meta-Analysis of Randomized Controlled Trials

Objective： To perform meta-analyses evaluating the efficacy of adding Liuwei Dihuang Pills （六味地黄丸 LDP） to Western medicine in improving treatment outcomes for type 2 diabetes. Methods： Medline, PubMed, Cochrane Library, and Chinese databases, including the Chinese National Knowledge Infrastructure were searched to identify eligible studies; i.e., if the study involved a randomized clinical trial in which the experimental group combined LDP with Western drugs and the control group used the corresponding Western drugs alone to treat type 2 diabetes. Outcomes were measured in terms of fasting blood glucose （FBG）, postprandial blood glucose （2hPG） and HbAlc level. Efficacy was also measured by using control and response rates. The combined odds ratio （OR）, mean difference （MD）, and 95% confidence intervals （95% CI） were calculated. Results： Studies included in the analysis were less adequate than expected in terms of methodological qualify. A total of 1,609 patients from 18 studies were included. We found that adding LDP can lower patients＇ FBG （MD=0.54 mmol/L, 95% CI [0.15, 0.93], P=0.007）, 2hPG （MD=1.05 mmol/L, 95% CI [0.29, 1.81], P〈0.01） and HbAlc （MD=0.23, 95% CI [0.02, 0.45], P=0.008）. There were also improvements in treatment response rates （OR=3.41, 95% CI [2.38, 4.90], P〈0.01） and control rates （OR=2.47, 95% CI [1.91, 3.20], P〈0.01）. Conclusion： Adding LDP to Western medicine might improve treatment outcomes of diabetes, including FBG, 2hPG, response rates and control rates.

Acupuncture and related therapies used as add-on to conventional treatments for heart failure:A systematic review of pairwise and network meta-analyses

Objective: This study aimed to assess and compare the clinical efficacy and safety of acupuncture and related therapies(ARTs) add-on to conventional treatment(CT) for heart failure(HF) through pairwise and network meta-analyses.Methods: Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials(CENTRAL), EMBASE, Chinese Biomedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI) and Wanfang Database were searched from inceptions to December 2017. Randomized controlled trials(RCTs) regarding ARTs combining with CT for HF were eligible. The primary outcomes were changes in heart function classification(HFC) according to New York Heart Association class and left ventricular ejection fraction(LVEF). Risk of bias assessment was conducted by two independent authors.Pairwise and network meta-analyses were performed using STATA 13.0 and WinBUGS 1.4.3 software.Results: A total of 26 RCTs were enrolled for analyses, with 5 kinds of ARTs and 2116 patients in all. Pairwise meta-analyses showed that acupoint application(OR: 3.28, 95%CI[2.26, 4.76]), acupuncture(OR: 2.78, 95%CI[1.21, 6.41]), acupoint injection(OR: 3.33, 95%CI[1.85, 6.00]) and moxibustion(OR: 2.51,95%CI[1.02, 6.21]) could significantly improve HFC when they were used as add-on to CT. Acupoint application(MD: 3.57, 95%CI[ 1.45, 5.70]),acupuncture(MD: 7.75, 95%CI[2.33. 13.17]). acupoint injection(MD:4.81, 95%CI[2.99, 6.63]) and moxibustion(MD: 6.99, 95%CI[3.62, 10.36]) were significantly beneficial in improving LVEF. Network meta-analyses showed that acupoint injection(SUCRA = 70.0%) and acupuncture(SUCRA = 90.4%) respectively had the greatest probability in improving HFC and LVEF.Conclusion: Most of the included ARTs add-on to CT was effective in improving HFC and LVEF. Acupoint injection and acupuncture may respectively have better effect than others for HFC and LVEF. However,due to the small sample size and poor quality of the included studies, hence well-designed RCTs are needed to confirm our findings.This study was registered in PROSPERO, CRD42018087700.

Methological Quality of Systematic Reviews and Meta-Analyses on Acupuncture for Stroke: A Review of Review

Objective： To assess the methodological quality of systematic reviews and meta-analyses regarding acupuncture intervention for stroke and the primary studies within them. Methods： Two researchers searched Pub Med, Cumulative index to Nursing and Allied Health Literature, Embase, ISI Web of Knowledge, Cochrane, Allied and Complementary Medicine, Ovid Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Traditional Chinese Medical Database to identify systematic reviews and meta-analyses about acupuncture for stroke published from the inception to December 2016. Review characteristics and the criteria for assessing the primary studies within reviews were extracted. The methodological quality of the reviews was assessed using adapted Oxman and Guyatt Scale. The methodological quality of primary studies was also assessed. Results： Thirty-two eligible reviews were identified, 15 in English and 17 in Chinese. The English reviews were scored higher than the Chinese reviews（P=0.025）, especially in criteria for avoiding bias and the scope of search. All reviews used the quality criteria to evaluate the methodological quality of primary studies, but some criteria were not comprehensive. The primary studies, in particular the Chinese reviews, had problems with randomization, allocation concealment, blinding, dropouts and withdrawals, intent-to-treat analysis and adverse events. Conclusions： Important methodological flaws were found in Chinese systematic reviews and primary studies. It was necessary to improve the methodological quality and reporting quality of both the systematic reviews published in China and primary studies on acupuncture for stroke.

Efficacy and safety of Yinchenwuling powder for hyperlipidemia: a systematic review and Meta-analysis

OBJECTIVE:To assess the clinical effectiveness and adverse effects of Yinchenwuling powder(YCWLP)in the treatment of hyperlipidemia using Meta-analysis.METHODS:Seven electronic databases were searched for randomized controlled trials designed to evaluate the clinical effectiveness of YCWLP for hyperlipidemia published in any language prior to February 2015.Two reviewers independently identified articles,extracted data,assessed quality,and cross-checked the results.Revman 5.3 was used to analyze the data.RESULTS:Only five randomized controlled trials with poor methodology were included in the analy-sis.The five trials compared YCWLP with conventional lipid-lowering drugs.Meta-analysis indicated that YCWLP was more effective at the levels of total cholesterol and triglycerides,while increasing the level of high-density lipoprotein cholesterol without serious adverse effects.However,it was not more effective than lipid-lowering drugs in reducing low-density lipoprotein cholesterol and improving hemorheology.CONCLUSION:YCWLP appeared to improve lipid levels.However,given the high risk of bias among the trials,we could not conclude that YCWLP was beneficial to patients with hyperlipidemia.More rigorous trials are required to provide stronger evidence for the conclusion.

重审高等教育学史

长期以来,高等教育学史不仅薄弱,而且对其性质、对象、意义等关键核心问题的认识仍然存在一些偏差与误区。从性质来看,高等教育学史研究应从史论纷争到史论统一,确认历史研究和元理论研究的双重性质,追求历史与逻辑的有机统一。从对象来看,高等教育学史研究应从内外分隔到内外兼修,要兼顾乃至融合学科的内外部历史,深入探讨知识与制度的双向联动关系,以此把握高等教育学史的完整谱系、内在机制与总体规律。从意义来看,高等教育学史研究应从单一向度到多维观照,不再局限于历史学的单一向度,而是要追寻理论建设、制度建设、文化建设的多重意义。未来高等教育学史的研究视域不能只限定于中国的高等教育学而沦为地方知识,整个世界高等教育研究的历史都应该纳入其研究范围。新时代的中国高等教育学只有通过加强学科史研究,才能提升理论建设与学科反思的主动性和自觉性,为建构高等教育学自主知识体系奠定坚实的基础。