Association between physical activity and risk of gastroesophageal reflux disease:A systematic review and meta-analysis

Background:Lifestyle plays an important role in preventing and managing gastroesophageal reflux disease(GERD).In response to the conflicting results in previous studies,we performed a systematic review and meta-analysis to investigate this association.Methods:Relevant studies published until January 2023 were retrieved from 6 databases,and the prevalence of symptomatic gastroesophageal reflux(GER)or GERD was determined from the original studies.A random effects model was employed to meta-analyze the association by computing the pooled relative risk(RR)with 95%confidence intervals(95%CIs).Furthermore,subgroup and dose-response analyses were performed to explore subgroup differences and the association between cumulative physical activity(PA)time and GERD.Results:This meta-analysis included 33 studies comprising 242,850 participants.A significant negative association was observed between PA and the prevalence of symptomatic GER(RR=0.74,95%CI:0.66-0.83;p<0.01)or GERD(RR=0.80,95%CI:0.76-0.84;p<0.01),suggesting that engaging in PA might confer a protective benefit against GERD.Subgroup analyses consistently indicated the presence of this association across nearly all subgroups,particularly among the older individuals(RR_(<40 years):RR_(≥40 years)=0.85:0.69,p<0.01)and smokers(RR_(smoker):RR_(non-smoker)=0.67:0.82,p=0.03).Furthermore,a dose-response analysis revealed that individuals who engaged in 150 min of PA per week had a 72.09%lower risk of developing GERD.Conclusion:Maintaining high levels of PA decreased the risk of GERD,particularly among older adults and smokers.Meeting the recommended PA level of 150 min per week may significantly decrease the prevalence of GERD.

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and metaanalysis

BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

Neurophysiological, histological, and behavioral characterization of animal models of distraction spinal cord injury: a systematic review

Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective operation for severe spinal deformity.With the increased degree and duration of distraction,spinal cord injuries become more serious in terms of their neurophysiology,histology,and behavior.Very few studies have been published on the specific characteristics of distraction spinal cord injury.In this study,we systematically review 22 related studies involving animal models of distraction spinal cord injury,focusing particularly on the neurophysiological,histological,and behavioral characteristics of this disease.In addition,we summarize the mechanisms underlying primary and secondary injuries caused by distraction spinal cord injury and clarify the effects of different degrees and durations of distraction on the primary injuries associated with spinal cord injury.We provide new concepts for the establishment of a model of distraction spinal cord injury and related basic research,and provide reference guidelines for the clinical diagnosis and treatment of this disease.

How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

Purpose:The study aimed to examine the reporting completeness of randomized controlled trials(RCTs)of non-pharmacological interventions following concussion.Methods:We searched MEDLINE,Embase,PsycInfo,CINAHL,and Web of Science up to May 2022.Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication(TIDieR),Consensus on Exercise Reporting Template(CERT),and international Consensus on Therapeutic Exercise aNd Training(i-CONTENT)checklists.Additional information was sought my study authors where reporting was incomplete.Risk of bias(ROB)was assessed with the Cochrane ROB-2 Tool.RCTs examining non-pharmacological interventions following concussion.Results:We included 89 RCTs(n=53 high ROB)examining 11 different interventions for concussion:sub-symptom threshold aerobic exercise,cervicovestibular therapy,physical/cognitive rest,vision therapy,education,psychotherapy,hyperbaric oxygen therapy,transcranial magnetic stimulation,blue light therapy,osteopathic manipulation,and head/neck cooling.Median scores were:TIDieR 9/12(75%;interquartile range(IQR)=5;range:5-12),CERT 17/19(89%;IQR=2;range:10-19),and i-CONTENT 6/7(86%;IQR=1;range:5-7).Percentage of studies completely reporting all items was TIDieR 35%(31/89),CERT 24%(5/21),and i-CONTENT 10%(2/21).Studies were more completely reported after publication of TIDieR(t_(87)=2.08;p=0.04)and CERT(t_(19)=2.72;p=0.01).Reporting completeness was not strongly associated with journal impact factor(TIDieR:rs=0.27;p=0.01;CERT:r_(s)=-0.44;p=0.06;i-CONTENT:r_(s)=-0.17;p=0.48)or ROB(TIDieR:rs=0.11;p=0.31;CERT:rs=0.04;p=0.86;i-CONTENT:rs=0.12;p=0.60).Conclusion:RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness,but are often missing key components,particularly modifications,motivational strategies,and qualified supervisor.Reporting completeness improved after TIDieR and CERT publication,but publication in highly cited journals and low ROB do not guarantee reporting completeness.

Fast prototype and rapid construction of three-dimensional and multi-scaled pitcher for controlled drainage by systematic biomimicry

Biomimetic materials that use natural wisdom to solve practical problems are developing rapidly.The trend for systematic biomimicry is towards in-situ characterization of naturalcreatures with high spatial resolutions.Furthermore,rapid reconstruction of digital twin models with the same complex features as the prototype is indispensable.However,it faces bottlenecks and limits in fast characterization and fabrication,precise parameter optimization,geometricdeviations control,and quality prediction.To solve these challenges,here,we demonstrate astate-of-the-art method taking advantage of micro-computed tomography and three-dimensional printing for the fast characterization of the pitcher plant Nepenthes x ventrata and fabrication of its biomimetic model to obtain a superior drainage controller with multiscale structures withprecise surface morphology optimization and geometric deviation control.Thefilm-rupture-based drainage dynamic and mechanisms are characterized by x-ray and high-speed videography,which determines the crucial structures for unique directionaldrainage.Then the optimized artificial pitchers are further developed into sustained drainage devices with novel applications,such as detection,reaction,and smoke control.

Efficacy evaluation of standardized Rheum rhaponticum root extract(ERr 731®)on symptoms of menopause:A systematic review and meta-analysis study

Menopause is characterized by various physical,mental and emotional symptoms.ERr 731®is a standardized extract from Rheum rhaponticum root and has been clinically studied for its role in reducing menopausal symptoms.The current systematic review and meta-analysis aimed to evaluate the efficacy of ERr 731®supplementation in alleviating the severity of menopausal symptoms.In this review,we searched across three online databases up to March 2023,evaluated the quality of the included studies by the Physiotherapy Evidence Database scale,and assessed the risk of bias by the Cochrane Risk of Bias tool.We then performed a metaanalysis using RevMan software to estimate the pooled mean difference(MD).The study protocol was registered in the Prospective Register of Systematic Reviews(CRD42023416808).After screening and evaluation,we included four high-quality studies(a total of 390 participants;the ERr 731®group:193 participants;the control group:197 participants)in the meta-analysis.The results showed that ERr 731®supplementation significantly reduced the Menopause Rating Scale score(MD:–15.12;P<0.001),compared with control therapy.Sensitivity analysis revealed no effect of individual studies on the overall pooled estimate or overall observed heterogeneity.The current review provides evidence that ERr 731®supplementation is effective in reducing menopause symptoms.Potential bias and high heterogeneity in the results warrant further clinical studies.

Pearls of meta-analyses and systematic review in scientific evidence

Scientific evidence develops bit by bit from case reports,case series;to larger casecontrol,case-cohort;and further escalate to randomized controlled trials.This echoed the importance of continue publishing World journal of Clinical Cases,where novel and advancing discoveries start from a single case.In contrast,at the other end of the realm of evidence synthesis,systematic review and meta-analysis represent distinct yet interconnected processes.Butorphanol in epidural labor analgesia has long been studied since 1989,and with 70 publications from MEDLINE searches.However,there was no meta-analysis,nor any systematic review published so far.The latest in-press article published by Tang et al.on the protocol for the systematic review and meta-analysis on the safety and effectiveness of butorphanol in epidural labor analgesia is encouraging.We believe the findings of this study will be valuable for clinical practice as well as for future research.

Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility:A systematic review and meta-analysis

BACKGROUND Acupuncture(AT)is widely used in treatment of ovulatory disorder infertility(ODI),but the safety and efficacy of AT for ODI still lack an evidence-based basis.AIM To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.METHODS The Cochrane Library,Embase,PubMed,VIP,China National Knowledge Infrastructure,WanFang Data,and Chinese biomedical literature databases were searched from inception to January 20,2024.Two reviewers independently selected studies,collected data,and evaluated methodological quality through the Cochrane Risk of Bias tool.Revman 5.4 was used for meta-analysis,and the Grade system was performed to evaluate the level of evidence for the outcomes of the meta-analysis.RESULTS A total of 20 randomized controlled trials with 1677 ODI patients were included.Compared with the clomiphene citrate(CC)group,the AT plus CC group exhibited significant improvement of the pregnancy rate[relative risk(RR)=1.68,95%confidence interval(CI):1.45-1.95,P<0.00001,I^(2)=23%],ovulation rate(RR=1.34,95%CI:1.22-1.47,P<0.00001,I^(2)=32%),serum E2 level[mean difference(MD)=31.36,95%CI:21.83-40.88,P<0.00001,I^(2)=97%],thickness of endometrium(MD=1.76,95%CI:0.71-2.81,P=0.001,I^(2)=98%)and decreasing miscarriage rate(RR=0.25,95%CI:0.09-0.65,P=0.005,I^(2)=0%),serum follicle-stimulating hormone level(MD=-2.10,95%CI:-3.27 to-0.94,P=0.0004,I^(2)=99%),serum luteinizing hormone level(MD=-6.94,95%CI:-9.89 to-4.00,P<0.00001,I^(2)=100%),and serum progesterone level(MD=-1.66,95%CI:-2.98 to-0.34,P=0.01,I^(2)=96%).The AT group had a more favorable effect than CC group for improving pregnancy rate(RR=1.52,95%CI:1.33-1.73,P<0.00001,I^(2)=0%),thickness of endometrium(MD=2.48,95%CI:2.15-2.81,P<0.00001,I^(2)=0%)and reducing miscarriage rate(RR=0.23,95%CI:0.13-0.44,P<0.00001,I^(2)=0%),serum follicle-stimulating hormone level(MD=-0.55,95%CI:-0.86 to-0.24,P=0.0005,I^(2)=0%),and serum progesterone level(MD=-0.24,95%CI:-0.28 to-0.20,P<0.00001).However,the level of evidence was predominantly assessed as very low to moderate.CONCLUSION AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI.However,further studies are needed to confirm these findings.

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.

Impact of D-dimer on in-hospital mortality following aortic dissection:A systematic review and meta-analysis

BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.

Modified Xiaoyao powder for postpartum depression:A systematic review and meta-analysis

Objective:To evaluate the effectiveness and safety of modified Xiaoyao powder for postpartum depression(PPD)by conducting a systematic review of randomized controlled trials(RCTs).Methods:The Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,Google Scholar,the SinoMed,Embase,Cochrane Library,and PubMed databases were searched from their inception to April 25,2023.The Cochrane Risk of Bias tool was used to assess the quality of the trials.We applied the risk ratio to present dichotomous data and the mean difference to present continuous data.Data with similar characteristics were pooled for meta-analysis and heterogeneity was assessed using I2.Results:This review included 35 trials involving 2848 participants.The quality of the included studies was low(unclear randomization processes and insufficient reporting of blinding).Participants treated with modified Xiaoyao powder plus Western medicine showed lower Hamilton Depression Scale(HAMD)depression score than those who used Western medicine alone(mean difference=-2.15;95%confidence interval:-2.52 to 1.78;P<.00001),and higher effective rate(relative risk=1.19;95%confidence interval:1.15 to 1.24;P<.00001),When comparing modified Xiaoyao alone with Western medicine,the HAMD depression score remained low,however,the efficacy rate was higher in the modified Xiaoyao group.Regarding adverse events,the modified Xiaoyao group reported weight gain,nausea,and diarrhea,but no severe adverse events were reported.Conclusion:Modified Xiaoyao may help relieve depression in PPD when used alone or in combination with Western medicine,with minor side effects.Therefore,future high-quality,large-sample size RCTs are warranted.

Systematic Method for Constructing Lewis Representations

The systematic method for constructing Lewis representations is a method for representing chemical bonds between atoms in a molecule. It uses symbols to represent the valence electrons of the atoms involved in the bond. Using a number of rules in a defined order, it is often better suited to complicated cases than the Lewis representation of atoms. This method allows us to determine the formal charge and oxidation number of each atom in the edifice more efficiently than other methods.

Time trends and disparities of obesity and related national policies and programs in Nepal:a systematic review

Objective Overweight and obesity prevalence has increased in low-income countries.This study systematically reviewed the obesity trend,disparities,and prevention and control efforts in Nepal.Methods We searched PubMed and Google Scholar for articles and reports published between January 1,2004 and December 31,2022.Additional information on National policies and programs related to obesity prevention was retrieved from governmental websites and consultation with relevant experts.Overweight and obesity were defined using the World Health Organization body mass index cut points.Thirty-two studies and reports were included.Results Overall,overweight and obesity rates increased in all groups in Nepal although nationally representative data remained limited.The combined overweight and obesity(OW/OB)and obesity rates in women aged 15-49 years increased from 8.5%to 22.2%and from 0.9%to 5.1%between 2006 and 2016,respectively.OW/OB and obesity rates in men were 17.1%and 2.5%based on data from the 2016 Demographic and Health Survey.OW/OB rate in under-five children increased from 0.6%to 2.8%between 2006 and 2016.Obesity rates for school-age(5-9 years)boys and girls in 2016 were 2.4%and 2.8%,respectively,and were 1.1%and 1.4%for male and female adolescents aged 10-19 years,respectively.OW/OB prevalence was much higher among women,residents in urban areas and central provinces,and in higher socioeconomic status groups.Projected prevalence of OW/OB and obesity for 2030 in adults aged 15-49 was 44.7%and 8.3%,respectively,while it was 2.2%for OW/OB in preschool children.Policies and direct interventions that specifically focused on obesity prevention and control are limited.Conclusions OW/OB prevalence in Nepal has increased during the past 1.8 decades,disproportionately affecting population groups.Existing interventions mostly focused on undernutrition with some indirect implications for obesity prevention.In the future,Nepal needs to develop population-based programs for obesity prevention.

Genetic Variations and Nonalcoholic Fatty Liver Disease:Field Synopsis,Systematic Meta-Analysis,and Epidemiological Evidence

Objective To systematically summarize the published literature on the genetic variants associated with nonalcoholic fatty liver disease(NAFLD).Methods Literature from Web of Science,PubMed,and Embase between January 1980 and September 2022 was systematically searched.Meta-analyses of the genetic variants were conducted using at least five data sources.The epidemiologic credibility of the significant associations was graded using the Venice criteria.Results Based on literature screening,399 eligible studies were included,comprising 381 candidate gene association,16 genome-wide association,and 2 whole-exome sequencing studies.We identified 465 genetic variants in 173 genes in candidate gene association studies,and 25 genetic variants in 17 genes were included in the meta-analysis.The meta-analysis identified 11 variants in 10 genes that were significantly associated with NAFLD,with cumulative epidemiological evidence of an association graded as strong for two variants in two genes(HFE,TNF),moderate for four variants in three genes(TM6SF2,GCKR,and ADIPOQ),and weak for five variants in five genes(MBOAT7,PEMT,PNPLA3,LEPR,and MTHFR).Conclusion This study identified six variants in five genes that had moderate to strong evidence of an association with NAFLD,which may help understand the genetic architecture of NAFLD risk.

Association of complement components with risk of colorectal cancer:A systematic review and meta-analysis

BACKGROUND Complement components could contribute to the tumor microenvironment and the systemic immune response.Nevertheless,their role in colorectal cancer(CRC)remains a contentious subject.AIM To elucidate the relationship between complement components and CRC risk and clinical characteristics.METHODS Searches were conducted in PubMed,the Cochrane Library,and the China National Knowledge Infrastructure database until June 1,2023.We included cohort studies encompassing participants aged≥18 years,investigating the association between complement components and CRC.The studies were of moderate quality or above,as determined by the Agency for Healthcare Research and Quality.The meta-analysis employed fixed-effects or random-effects models based on the I^(2)test,utilizing risk ratio(RR)and their corresponding 95%confidence interval(CI)for outcomes.Sensitivity and subgroup analyses were performed to validate the robustness of the collective estimates and identify the source of heterogeneity.RESULTS Data from 15 studies,comprising 1631 participants that met the inclusion criteria,were included in the meta-analysis.Our findings indicated that protein levels of cluster of differentiation 46(CD46)(RR=3.66,95%CI:1.75-7.64,P<0.001),CD59(RR=2.86,95%CI:1.36-6.01,P=0.005),and component 1(C1)(RR=5.88,95%CI:1.75-19.73,P=0.004)and serum levels of C3(standardized mean difference=1.82,95%CI:0.06-3.58,P=0.040)were significantly elevated in patients with CRC compared to healthy controls.Strong expression of CD55 or CD59 was associated with a higher incidence of lymph node metastasis,whereas strong CD46 expression correlated with a higher incidence of tumor differentiation compared to low CD46 expression(P<0.05 for all).Although specific pooled results demonstrated notable heterogeneity,subgroup analyses pointed to regional differences as the primary source of inconsistency among the studies.CONCLUSION Our analysis underscores that increased levels of specific complement components are associated with a heightened risk of CRC,emphasizing the potential significance of monitoring elevated complement component levels.

Diagnostic Accuracy of Computerized Bowel Sound Analysis with Non-Invasive Devices for Irritable Bowel Syndrome:A Systematic Review and Meta-Analysis

Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,and IEEE Xplore databases until September 2023.Cross-sectional and case-control studies on diagnostic accuracy of bowel sound analysis for IBS were identified.We estimated the pooled sensitivity,specificity,positive likelihood ratio,negative likeli-hood ratio,and diagnostic odds ratio with a 95% confidence interval(CI),and plotted a summary receiver operat-ing characteristic curve and evaluated the area under the curve.Results Four studies were included.The pooled diagnostic sensitivity,specificity,positive likelihood ratio,nega-tive likelihood ratio,and diagnostic odds ratio were 0.94(95%CI,0.87‒0.97),0.89(95%CI,0.81‒0.94),8.43(95%CI,4.81‒14.78),0.07(95%CI,0.03‒0.15),and 118.86(95%CI,44.18‒319.75),respectively,with an area under the curve of 0.97(95%CI,0.95‒0.98).Conclusions Computerized bowel sound analysis is a promising tool for IBS.However,limited high-quality data make the results'validity and applicability questionable.There is a need for more diagnostic test accuracy studies and better wearable devices for monitoring and analysis of IBS.

Sorafenib plus transarterial chemoembolization vs sorafenib alone for patients with advanced hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND Although the past decade has seen remarkable advances in treatment options for hepatocellular carcinoma(HCC),the dismal overall prognosis still envelops HCC patients.Several comparative trials have been conducted to study whether transarterial chemoembolization(TACE)could improve clinical outcomes in patients receiving sorafenib for advanced HCC;however,the findings have been inconsistent.AIM To study the potential synergies and safety of sorafenib plus TACE vs sorafenib alone for treating advanced HCC,by performing a systematic review and metaanalysis.METHODS This study was conducted following the PRISMA statement.A systematic literature search was conducted using the Cochrane Library,Embase,PubMed,and Web of Science databases.Data included in the present work were collected from patients diagnosed with advanced HCC receiving sorafenib plus TACE or sorafenib alone.Data synthesis and meta-analysis were conducted using Review Manager software.RESULTS The present study included 2780 patients from five comparative clinical trials(1 was randomized control trial and 4 were retrospective studies).It was found that patients receiving sorafenib plus TACE had better prognoses in terms of overall survival(OS),with a combined hazard ratio(HR)of 0.65[95%confidence interval(95%CI):0.46–0.93,P=0.02,n=2780].Consistently,progression free survival(PFS)and time to progression(TTP)differed significantly between the sorafenib plus TACE arm and sorafenib arm(PFS:HR=0.62,95%CI:0.40–0.96,P=0.03,n=443;TTP:HR=0.73,95%CI:0.64-0.83,P<0.00001,n=2451).Disease control rate(DCR)was also significantly increased by combination therapy(risk ratio=1.36,95%CI:1.02-1.81,P=0.04,n=641).Regarding safety,the incidence of any adverse event(AE)was increased due to the addition of TACE;however,no significant difference was found in grade≥3 AEs.CONCLUSION The combination of sorafenib with TACE has superior efficacy to sorafenib monotherapy,as evidenced by prolonged OS,PFS,and TTP,as well as increased DCR.Additional high-quality trials are essential to further validate the clinical benefit of this combination in the treatment of advanced HCC.

Clinical effect of operative vs nonoperative treatment on humeral shaft fractures:Systematic review and meta-analysis of clinical trials

BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.

Chinese herbal medicine combined with Western medicine for Mycoplasma pneumoniae pneumonia in children:An overview of systematic reviews

Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.

Systematic investigation of Radix Salviae for treating diabetic peripheral neuropathy disease based on network Pharmacology

BACKGROUND Diabetic peripheral neuropathy(DPN)is a debilitating complication of diabetes mellitus with limited available treatment options.Radix Salviae,a traditional Chinese herb,has shown promise in treating DPN,but its therapeutic mech-anisms have not been systematically investigated.AIM Radix Salviae(Danshen in pinin),a traditional Chinese medicine(TCM),is widely used to treat DPN in China.However,the mechanism through which Radix Salviae treats DPN remains unclear.Therefore,we aimed to explore the mechanism of action of Radix Salviae against DPN using network pharmacology.METHODS The active ingredients and target genes of Radix Salviae were screened using the TCM pharmacology database and analysis platform.The genes associated with DPN were obtained from the Gene Cards and OMIM databases,a drug-com-position-target-disease network was constructed,and a protein–protein inter-action network was subsequently constructed to screen the main targets.Gene Ontology(GO)functional annotation and pathway enrichment analysis were performed via the Kyoto Encyclopedia of Genes and Genomes(KEGG)using Bioconductor.RESULTS A total of 56 effective components,108 targets and 4581 DPN-related target genes of Radix Salviae were screened.Intervention with Radix Salviae for DPN mainly involved 81 target genes.The top 30 major targets were selected for enrichment analysis of GO and KEGG pathways.CONCLUSION These results suggested that Radix Salviae could treat DPN by regulating the AGE-RAGE signaling pathway and the PI3K-Akt signaling pathway.Therefore,Danshen may affect DPN by regulating inflammation and apoptosis.