Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Quality-adjusted life years and surgical waiting list:Systematic review of the literature

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

Review of Maternal Deaths over 3 and a Half Years at the Kara University Hospital Center, Northern Togo: About 65 Cases

Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-Kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-Kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU Kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).

Hot spot tracking of flood remote sensing research over the past 22 years:abibliometric analysis using CiteSpace

Background,aim,and scope In the context of climate change,extreme precipitation and resulting flooding events are becoming increasingly severe.Remote sensing technologies are advantageous for monitoring such disasters due to their wide observation range,periodic revisit capabilities,and continuous spatial coverage.These tools enable real-time and quantitative assessment of flood inundation.Over the past 20 years,the field of remote sensing for floods has seen significant advancements.Understanding the evolution of research hotspots within this field can offer valuable insights for future research directions.Materials and methods This study systematically analyzes the development and hotspot evolution in the field of flood remote sensing,both domestically and internationally during 2000—2021.Data from CNKI(China National Knowledge Infrastructure)and WOS(Web of Science)databases are utilized for this analysis.Results(1)A total of 1693 articles have been published in this field,showing a stable growth trend post-2008.Significant contributors include the Chinese Academy of Sciences,Beijing Normal University,Wuhan University,the Italian National Research Council,and National Aeronautics and Space Administration.(2)High-frequency keywords from 2000 to 2021 include“remote sensing”“flood”“model”“classification”“GIS”“climate change”“area”,and“MODIS”.(3)The most prominent keywords were“GIS”(8.65),“surface water”(7.16),“remote sensing”(7.07),“machine learning”(6.52),and“sentinel-2”(5.86).(4)Thirteen cluster labels were identified through clustering,divided into three phases:2000—2009(initial exploratory stage),2010—2014(period of rapid development),and 2015—2021(steady development of remote sensing for floods and related disasters).Discussion The field exhibits strong phase-based development,with research focuses shifting over time.From 2000 to 2009,emphasis was on remote sensing image application and flood model development.From 2010 to 2014,the focus shifted to accurate interpretation of remote sensing images,multispectral image applications,and long time series detection.From 2015 to 2021,research concentrated on steady development,leveraging large datasets and advanced data processing techniques,including improvements in water body indices,big data fusion,deep learning,and drone monitoring.Early on,SAR data,known for its all-weather capability,was crucial for rapid flood hazard extraction and flood hydrological models.With the rise of high-quality optical satellites,optical remote sensing has become more prevalent,though algorithm accuracy and efficiency for water body index methods still require improvement.Conclusions Data sources and methodologies have evolved from early reliance on radar data to the current exploration of optical image fusion and multi-source data integration.Algorithms now increasingly employ deep learning,super image elements,and object-oriented methods to enhance flood identification accuracy.Recent studies focus on spatial and temporal changes in flooding,risk identification,and early warning for climate change-related flooding,including glacial melting and lake outbursts.Recommendations and perspectives To enhance monitoring accuracy and timeliness,UAV technology should be further utilized.Strengthening multi-source data fusion and assimilation is crucial,as is analyzing long-term flood disaster sequences to better understand their mechanisms.

An overview of acupuncture for the treatment of limb spasticity in cerebral palsy-A mini review

Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.

Coronary artery bypass grafting in diabetic patients: Should we still use the saphenous vein graft? A review of literature in the past 15 years

The burden of diseases associated with diabetes mellitus is dramatic: adults with diabetes mellitus are 2 to 4 times more likely to have cardiovascular diseases than those without it, and at least 65% will die because of diabetes complications. The revascularization strategy in these types of patients included percutaneous coronary interventions with bare metal stents or medicated stents and surgical coronary artery bypass grafting (CABG), but it is well known that in the diabetic patient with two or more vessel disease, the surgical strategy allows the best mid- and long- term results. Moreover, benefits of CABG surgery are limited by life expectancy of the most common type of graft, the saphenous vein (SV). Nearly 40 years after the introduction of bypass surgery, the rate of vein graft failure remains at high levels. Several arterial conduits had been studied as alternative conduits to SV: the Right Internal Thoracic Artery (RITA), the Radial Artery (RA), the Gastroepiploic Artery (GEA) and the Inferior Epigastric Artery (IEA), 40 years ago. The aim of our article is to review the scientific literature of the past 15 years to answer this question: are we ready to treat the diabetic patient, with a completely arterial revascularization, avoiding the use of the great saphenous vein grafts?

Morphological changes of silver and bighead carp in the Yangtze River over the past 50 years

Multivariate analysis was adopted to analyze 30 morphometrical characteristics of 121 one-year-old juvenile silver carp （Hypophthalmichthys molitrix） and bighead carp （Aristichthys nobilis） bred during the 1950s （＂the former population＂） and 2008 （＂the current population＂） and collected from the middle reach of the Yangtze River. The average discriminant accuracies of the former and current silver and bighead carp population were 94.2% and 98.0%, respectively. Discriminant analysis also revealed that significant differences in morphology occurred between the former and current populations of both carp in overall characteristics. One-way analysis of variance indicated that between former and current populations, silver carp showed highly significant differences （P0.01） in twelve of their characteristics and significant differences （P0.05） in eight of their characteristics, while bighead carp showed highly significant differences （P0.01） in eight of their characteristics and significant differences （P0.05） in eight of their characteristics. Six head morphology variables of the current silver and bighead carp were significantly or highly significantly larger than the former populations; fourteen characteristics of silver carp and ten characteristics of bighead carp of the current populations, mainly reflecting truck and tail morphology, were significantly or very significantly smaller than the former populations. Our results indicate that silver and bighead carp have developed a larger head and smaller truck and tail during the last 50 years. Due to such morphological changes, it seems apparent that the heads of these fish species need to be considered in regards to human diets, particularly in relation to economic and nutritious value.

A Review of Academic Divisions'Work over the Past Two Years

In line with the overall Objectives set out in the"Outline Scheme for the Academic Divisions of theChinese Academy of Sciences (CAS) during theNinth Five-year Plan (1996-2000)," CAS has donea good job of the supplementary election of CASmembers and the development of the virtues ofscience and fine style of research. In addihon, con-sultation and appraisal, academic exchanges, andthe popularization of science have progressivelybeen focuses of the academic divisions, and manyaccomplishments have been achieved in these areas.

Milestones of the Past Five Years

The 11th Five-year Plan met its goals, paving the way to new heights for China’s economic, social and environmental development.FROM 2006 to 2010 China implemented its 11th Five-year Plan.

LIANYUNGANG DEVELOPMENT ZONE——A REVIEW OF THE PAST DECAD E CONSTRUCTION OF THE ZONE

Located at the easternextreme of the new Asian-European continental Bridge,the LianyungangDevelopment Zone was anarid and saline seashore tenyears ago,but today it hasbecome one of the mostdynamic opening areas inLianyungang City andJiangsu Province strewn withfactories and thoroughfares,churning out an annualindustrial output value ofRMB1.8 billion. The development zonewas approved by the StateCouncil to be established inthe Zhong Yun Dai area ofLianyungang City inDecember 1984.InSeptember of the followingyear,the city broke theground for the construction.

Infiltration by monocytes of the central nervous system and its role in multiple sclerosis: reflections on therapeutic strategies

Mononuclear macrophage infiltration in the central nervous system is a prominent feature of neuroinflammation. Recent studies on the pathogenesis and progression of multiple sclerosis have highlighted the multiple roles of mononuclear macrophages in the neuroinflammatory process. Monocytes play a significant role in neuroinflammation, and managing neuroinflammation by manipulating peripheral monocytes stands out as an effective strategy for the treatment of multiple sclerosis, leading to improved patient outcomes. This review outlines the steps involved in the entry of myeloid monocytes into the central nervous system that are targets for effective intervention: the activation of bone marrow hematopoiesis, migration of monocytes in the blood, and penetration of the blood–brain barrier by monocytes. Finally, we summarize the different monocyte subpopulations and their effects on the central nervous system based on phenotypic differences. As activated microglia resemble monocyte-derived macrophages, it is important to accurately identify the role of monocyte-derived macrophages in disease. Depending on the roles played by monocyte-derived macrophages at different stages of the disease, several of these processes can be interrupted to limit neuroinflammation and improve patient prognosis. Here, we discuss possible strategies to target monocytes in neurological diseases, focusing on three key aspects of monocyte infiltration into the central nervous system, to provide new ideas for the treatment of neurodegenerative diseases.

The influence of resistance exercise training prescription variables on skeletal muscle mass,strength,and physical function in healthy adults:An umbrella review

Purpose:The aim of this umbrella review was to determine the impact of resistance training(RT)and individual RT prescription variables on muscle mass,strength,and physical function in healthy adults.Methods:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines,we systematically searched and screened eligible systematic reviews reporting the effects of differing RT prescription variables on muscle mass(or its proxies),strength,and/or physical function in healthy adults aged>18 years.Results:We identified 44 systematic reviews that met our inclusion criteria.The methodological quality of these reviews was assessed using A Measurement Tool to Assess Systematic Reviews;standardized effectiveness statements were generated.We found that RT was consistently a potent stimulus for increasing skeletal muscle mass(4/4 reviews provide some or sufficient evidence),strength(4/6 reviews provided some or sufficient evidence),and physical function(1/1 review provided some evidence).RT load(6/8 reviews provided some or sufficient evidence),weekly frequency(2/4 reviews provided some or sufficient evidence),volume(3/7 reviews provided some or sufficient evidence),and exercise order(1/1 review provided some evidence)impacted RT-induced increases in muscular strength.We discovered that 2/3 reviews provided some or sufficient evidence that RT volume and contraction velocity influenced skeletal muscle mass,while 4/7 reviews provided insufficient evidence in favor of RT load impacting skeletal muscle mass.There was insufficient evidence to conclude that time of day,periodization,inter-set rest,set configuration,set end point,contraction velocity/time under tension,or exercise order(only pertaining to hypertrophy)influenced skeletal muscle adaptations.A paucity of data limited insights into the impact of RT prescription variables on physical function.Conclusion:Overall,RT increased muscle mass,strength,and physical function compared to no exercise.RT intensity(load)and weekly frequency impacted RT-induced increases in muscular strength but not muscle hypertrophy.RT volume(number of sets)influenced muscular strength and hypertrophy.

Effectiveness of Music-Based Therapeutic Intervention on People with Dementia: A Rapid Review

Background: Dementia is a condition with progressive cognitive dysfunction and manifestation of both behavioral and psychosocial symptoms. Non-pharmacological measures such as music therapy are gaining importance since efficacy and safety of people with dementia have been questionable for pharmacological measures. Patient’s response to music is persistent even in the later stage of dementia. Aim: This rapid review aims to identify, analyze, evaluate, and summarize the best available evidence on the effectiveness of music-based therapeutic interventions among people with dementia. Method: CINAHL Cochrane Library, internet websites of rapid review producers, and reference lists were searched to identify articles for inclusion. Two reviewers independently screened the literature search results. Effectiveness, music-based therapeutic intervention, dementia, Alzheimer’s disease, systematic review and systematic review with meta-analysis terms were used to abstract data from included studies. Main Findings: 11 SRs and SRs with meta-analysis were reviewed which revealed positive effect of music therapy on five major outcomes with 9 studies effect on behavioral outcome, 6 studies with positive effect on psychosocial outcome reducing anxiety, 6 with improved cognition, 1 study revealed with improved quality of life and 1 study revealed effect on physiological outcomes. Conclusion: Music therapy has positive effect on treatment of dementia but further studies with larger sample size and specified to single intervention should be conducted to provide generalisable and precise results on this topic.

Characteristics of the HIV/AIDS Epidemic among People Aged≥50 Years in China during 2018–2021

Objective This study aimed to determine the current epidemiological status of PLWHA aged≥50 years in China from 2018 to 2021.It also aimed to recommend targeted interventions for the prevention and treatment of HIV/AIDS in elderly patients.Methods Data on newly reported cases of PLWHA,aged≥50 years in China from 2018 to 2021,were collected using the CRIMS.Trend tests and spatial analyses were also conducted.Results Between 2018 and 2021,237,724 HIV/AIDS cases were reported among patients aged≥50 years in China.The main transmission route was heterosexual transmission(91.24%).Commercial heterosexual transmission(CHC)was the primary mode of transmission among males,while non-marital non-CHC([NMNCHC];60.59%)was the prevalent route in women.The proportion of patients with CHC decreased over time(Z=67.716,P<0.01),while that of patients with NMNCHC increased(Z=153.05,P<0.01).The sex ratio varied among the different modes of infection,and it peaked at 17.65 for CHC.The spatial analysis indicated spatial clustering,and the high-high clustering areas were mainly distributed in the southwestern and central-southern provinces.Conclusion In China,PLWHA,aged≥50 years,were predominantly infected through heterosexual transmission.The primary modes of infection were CHC and NMNCHC.There were variations in the sex ratio among different age groups,infected through various sexual behaviors.HIV/AIDS cases exhibited spatial clustering.Based on these results,the expansion of HIV testing,treatment,and integrated behavioral interventions in high-risk populations is recommended to enhance disease detection in key regions.

A Review and Bibliometric Analysis of the Current Studies for the 6G Networks

The race to develop the next generation of wireless networks,known as Sixth Generation(6G)wireless,which will be operational in 2030,has already begun.To realize its full potential over the next decade,6G will undoubtedly necessitate additional improvements that integrate existing solutions with cutting-edge ones.However,the studies about 6G are mainly limited and scattered,whereas no bibliometric study covers the 6G field.Thus,this study aims to review,examine,and summarize existing studies and research activities in 6G.This study has examined the Scopus database through a bibliometric analysis of more than 1,000 papers published between 2017 and 2021.Then,we applied the bibliometric analysis methods by including(1)document type,(2)subject area,(3)author,and(4)country of publication.The study’s results reflect the research 6G community’s trends,highlight important research challenges,and elucidate potential directions for future research in this interesting area.

Effect of a Nutrition Education Intervention on Food Safety Knowledge, Attitudes and Practices of Mothers of Children under 5 Years in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.

Synthesis of Reviews on Auscultation, Approaches, and Methods for Engineering Structures

Topometric auscultation is used to monitor the durability of structures, measure deformations linked to the structure of a structure or to the movement of the ground over a part of the globe, set up warning systems, etc. It first appeared as a visual method and rapidly evolved through the various techniques used. Some of these techniques using topography are used in several fields (civil engineering, geodesy, topography, mechanics, nuclear engineering, hydraulics, physics, etc.). These topometric techniques have undergone major changes as a result of technological advances, growing needs in the monitoring of movements or deformations, increased requirements and new challenges. The methodology adopted depends on the measuring instrument used, the parameters to be estimated and access to the area to be measured. There are two types of methods: destructive and non-destructive. In addition to the visual method, they can also be classified as mechanical, physico-chemical, dynamometric, electrophysical and geometric. The estimated parameter varies according to the methodology adopted. It can be defined by coordinates, distances, potential, electrical resistance, etc.

A systematic review and meta-analysis of the prevalence of Leishmania infantum in sandflies in Iran

Objective:To determine the overall and pooled prevalence of Leishmania(L.)infantum in sandfly vectors in Iran.Methods:The present research conducted a systematic review and meta-analysis and searched regional databases such as PubMed,Scopus,Web of Science(WoS),Embase,PAHO Iris,LILACS,WHO Iris,and local databases named:SID,Magiran,Civilica,and also grey literatures.The current research included studies that were conducted in Iran and examined L.infantum in different sandfly vectors.The studies’quality assessment/risk of bias assessment was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist for prevalence data studies,and the data were analyzed by Stata 14 software.In addition,we examined 22 primary studies to estimate the overall prevalence of L.infantum among various vectors of visceral leishmaniasis.Results:According to the meta-analysis,the pooled prevalence of Phlebotomus(Ph.)tobbi,Ph.alexandri,Ph.kandelaki,Ph.perfiliewi,Ph.major,Ph.keshishiani were 5.34%,4.36%,2.23%,1.79%,4.37%and 1.18%.Ph.tobbi has the highest infection rate(25.00%)of L.infantum among the sandfly vectors.Conclusions:Visceral leishmaniasis is widespread in Fars,Ardebil,and East-Azerbaijan provinces,which are the most important endemic regions in Iran.

Comparing the efficacy and safety of low,medium,and high dosages of selexipag for treating pulmonary hypertension:A systematic review and meta-analysis

Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.