Quality assessment of systematic reviews assessing the effects of traditional Chinese exercises in the control of diabetes mellitus

Objective:To assess the quality of systematic reviews assessing the effects of traditional Chinese exercises on controlling blood indices,anthropometric indices,psychological indices,and quality of life in patients with diabetes.Methods:Systematic studies/meta-analyses of intervention with traditional Chinese exercises on diabetes mellitus were searched in the Pub Med,Web of Science,the China National Knowledge Infrastructure Databases(CNKI),Wan Fang Database,and Chinese Scientific Journal Database(VIP).Two researchers independently screened the studies and extracted the data.The methodology and quality of evidence of the included studies were assessed using A Measurement Tool to Assess Systematic Reviews2(AMSTAR-2)and Grading of Recommendations Assessment,Development and Evaluation(GRADE)criteria,respectively.Results:A total of 32 systematic reviews/meta-analyses were included in the present study.Of them,the methodological quality of 4 studies was graded as low,while that of the other 28 was graded as extremely low.The most common quality flaws in key items included a lack of preliminary proposals for systematic reviews,failure to explain the reasons for the inclusion criteria,failure to provide a list of excluded studies and reasons for exclusion,failure to report potential conflicts of interest,and inadequate assessment of publication bias.The quality of evidence for most of the 18 outcomes was subsequently graded as medium or low.Overall,the results of these studies indicated that Tai Chi,health qigong,and other traditional Chinese exercises lowered fasting blood glucose(FBG),2-h postprandial blood glucose(2hPBG),hemoglobin A_(1c)(HbA_(1c)),and body mass index,and relieved anxiety and depression in patients with diabetes.Conclusion:Our findings indicate that the methodological quality of systematic reviews related to traditional Chinese exercises in the diabetic population is generally low,and the quality of evidence is also relatively poor.Therefore,we suggest that the quality of systematic reviews and meta-analyses on traditional Chinese exercises for controlling diabetes mellitus needs to be improved.In the future,researchers should conduct higher-quality clinical studies with reference to the AMSTAR2 checklist and GRADE system.

Acupuncture and/or moxibustion for the treatment of lumbar disc herniation:quality assessment of systematic reviews

Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.

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.

Acupuncture for post-stroke dysphagia: An overview of systematic reviews

Objective: To overview the systematic reviews of acupuncture for Post-stroke Dysphagia. Methods: The Chinese and English databases were searched for the systematic reviews of dysphagia after acupuncture treatment. The retrieval time was until October 30, 2019. The final literature was evaluated for bias risk, methodology quality and evidence quality by using ROBIS tool, AMSTER-2 scale and GRADE method. Results: 9 systematic reviews and 36 outcomes were included. ROBIS bias risk assessment results show that all the studies are high bias risk;AMSTER-2 methodology quality assessment results show that all the systems are of very low quality;GRADE grading shows that there are only 7 intermediate evidences in 36 clinical evidences, the rest are low-level evidences or very low-level evidences, and there are multiple intermediate evidences in the clinical efficacy of acupuncture in the treatment of dysphagia after stroke. In addition, acupuncture can significantly improve the scores of all kinds of swallowing function related scales, such as Tengdao food intake swallowing function grade, swallowing disorder specific quality of life score, standard swallowing function evaluation scale, and the incidence of adverse reactions is low. Conclusion: Acupuncture is effective in the treatment of dysphagia after stroke. It can improve the scores of various swallowing function scales and has high safety. However, the risk of systematic evaluation bias is high, the quality of methodology is low, and the level of clinical evidence is low as a whole. In the future, the relevant research design should be more rigorous, and the research report should be written in strict accordance with the PRISMA statement.

JSON-ASR:A lightweight data storage and exchange format for automatic systematic reviews of TCM

Objectives:The aim of this study was to investigate and develop a data storage and exchange format for the process of automatic systematic reviews(ASR)of traditional Chinese medicine(TCM).Methods:A lightweight and commonly used data format,namely,JavaScript Object Notation(JSON),was introduced in this study.We designed a fully described data structure to collect TCM clinical trial information based on the JSON syntax.Results:A smart and powerful data format,JSON-ASR,was developed.JSON-ASR uses a plain-text data format in the form of key/value pairs and consists of six sections and more than 80 preset pairs.JSON-ASR adopts extensible structured arrays to support the situations of multi-groups and multi-outcomes.Conclusion:JSON-ASR has the characteristics of light weight,flexibility,and good scalability,which is suitable for the complex data of clinical evidence.

Development of the Documentation and Appraisal Review Tool for systematic reviews

AIM:To develop a tool to more explicitly assess and document the quality of systematic reviews.METHODS:We developed the Documentation and Appraisal Review Tool(DART)using epidemiologic principles of study design and the following resources:the modified Overview Quality Assessment Questionnaire(modified OQAQ),Assessment of Multiple Systematic Reviews(AMSTAR),the Cochrane Handbook,and the standards promoted by the Agency for Healthcare Research and Quality,and the Institutes of Medicine(IOM).We designed the DART tool to include the following:more detail to provide guidance and improve standardization of use,an approach to assess quality of systematic reviews addressing a variety of research designs,and additional space for recording notes to facilitate recall.DART underwent multiple rounds of testing with methodologists of varying levels of training and experience.Based on the results of six phases of pilot testing,we revised DART to improve performance,clarity and consistency.Pilot testing also included comparisons between DART,and the two most commonly used tools to evaluate the quality of systematic reviews,the modified OQAQ and AMSTAR.RESULTS:Compared to AMSTAR and modified OQAQ,DART includes two unique questions and several questions covered by modified OQAQ or AMSTAR but not both.Modified OQAQ and DART had the highest reporting consistency.Four AMSTAR questions were unclear and elicited inconsistent responses.Identifying reviewer rationale was most difficult using the modified OQAQ tool,and easiest using DART.DART allowsfor documentation of reviewer rationale,facilitating reconciliation between reviewers and documentation for future updates.DART also provides a comprehensive,systematic approach for reviewers with limited experience with systematic review methodology,to critically analyze systematic reviews.In addition,DART is the only one of the three tools to explicitly include quality review for biases specific to observational studies.This is now more widely recognized as important for assessing risk in order to generate recommendations that balance benefit to harm.The tool also includes the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.CONCLUSION:This comprehensive tool improves upon existing tools for assessing the quality of systematic reviews and guides reviewers through critically analyzing a systematic review.

Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.

An overview of systematic reviews of clinical evidence for cupping therapy

Background:As a traditional treatment method,cupping therapy is widely used in Asian countries.This overview of systematic reviews (SRs) investigated the effectiveness and safety of cupping therapy through an evidence-based approach.Methods:SRs that assessed the effectiveness of cupping therapy for any type of disease were searched through 6 electronic databases.Target diseases,cupping methods,numbers and types of included studies,quality of included trials,main results (including meta-analysis re sults),and authors' conclusions of SRs were extracted.The Assessment of Multiple Systematic Reviews measurement was used to evaluate methodologic quality of the SRs.Results Eight SRs met the inclusion criteria and effectiveness and safety of cupping therapy for 11 diseases were assessed.All included SRs were of good methodologic quality.However,quality of trials included in the SRs was generally poor.Meta-analysis was performed in 4 studies.Results:showed cupping therapy (alone or combined with other interventions) was better than medications (or other interventions alone) for herpes zoster,acne,facial paralysis,low back pain,or cervical spondylosis.One review reported adverse events,including hematoma,increased pain and tingling following cupping treatment.Conclusions:Cupping therapy may be beneficial for pain-related conditions,acne,and facial paralysis.However,a firm conclusion could not be drawn due to the insufficient number of included reviews and the low quality of the original studies.

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.

Retrieval,reporting and methodological characteristics for systematic reviews/meta-analyses of animal models:a meta-epidemiological study

The study aimed to analyze the reporting and methodological quality of systematic reviews(SRs)/meta-analyses(MAs)of animal models to provide references for later studies and avoid the waste of medical resources.EMBASE and MEDLINE databases were searched from inception to November 2017,with no language restriction.Two reviewers selected inclusion dependently and extracted the basic characteristics.Review Manager 5.3,stata 12.0,and SPSS 21 software were used to conduct analyses.A total of 46 SRs/MAs were included.The results showed that the English databases with high retrieval frequency are PubMed/MEDLINE,EMBASE,and Web of Science.67.31%(31/46)of the articles reported the search strategy in the full text or the appendix.65.22%(30/46)reported the literature screening flow diagram,and only 19.57%(9/46)reported the number of works of literature retrieved in each database.60.87%(28/46)illustrated supplement retrieval.Through 2 subgroup analyses,it was found that there were no significant differences in the quality of reports of PRISMA items.But referring to the methodological quality or reporting of PRESS items,SCI was better than that of non-SCI,while there seemed a source of funding to have no significant impact on the methodological quality or the items of PRESS.The results of PRESS,AMSTAR 2,and PRISMA were correlated,and the correlation between PRISMA and AMSTAR 2 was strong.These results demonstrated that search strategies of animal model SRs/MAs are still not enough comprehensive,report specification and methodological quality still need to be ameliorated.To show users the scientificity and rigor of the study,future research should focus on these various guidelines like PRESS,PRISMA,and AMSTAR 2 checklists that have been issued,it can help to increase the value of research and improve the utilization of medical resources.

Quality evaluation of systematic reviews of the effects of Baduanjin on diabete

Objective:Recently,the effects of Baduanjin(a traditional Chinese mind-body exercise)on diabetes have attracted increasing attention,and relevant systematic reviews(SRs)have emerged.However,the qualities of these SRs vary markedly,and their conclusions are inconsistent,which is not conducive to guiding decision-making.We sought to assess the quality of these SRs and provide more evidence for diabetes treatment.Methods:A literature search was conducted in 7 databases from inception to December 1st,2021.SRs of randomized controlled trials investigating the effects of Baduanjin were identified.A Measurement Tool to Assess Systematic Reviews 2(AMSTAR-2)checklist,Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)statement,and Grading of Recommendations Assessment,Development and Evaluation(GRADE)system were applied to evaluate the quality of the SRs.Results:Ten SRs were identified.All SRs were judged as critically low methodological quality by the AMSTAR-2 checklist.The total PRISMA score of the included SRs ranged from 15 to 21,and the mean score was 18.60(1.90),indicating that all SRs had partial reporting deficits.Sixty outcomes were reported in the included studies,of which 25(41.67%)were judged as low quality,and 34(56.67%)as very low quality according to the GRADE system,indicating that the overall evidence quality of outcomes was not high.Conclusion:Baduanjin seems to be an effective therapy for diabetes in improving glucose and lipid metabolism,mental health,quality of life,and waist-hip ratio(WHR).The overall quality of the SRs was less than optimal.This conclusion should be treated with caution,and researchers should conduct higher-quality clinical studies following AMSTAR-2checklist,PRISMA statement,and GRADE system in the future.

Duplicates in systematic reviews: A critical, but often neglected issue

The number of systematic reviews is gradually increasing over time. Also, the methods to perform a systematic review are being improved. However, little attention has been paid for the issue regarding how to find duplicates in systematic reviews. On the basis of the survey and systematic reviews by our team and others, we review the prevalence, significance and classification of duplicates and the method to find duplicates in a systematic review. Notably, although a preliminary method to find duplicates is established, its usefulness and convenience need to be further confirmed.

Oral Contraceptives and Health Outcomes:an Umbrella Review of Systematic Reviews and Meta-analyses in Women and Offspring

Aim We herein provide an umbrella review of systematic reviews(SR)and meta-analyses(MAs)of studies of the association of oral contraceptives(OCs)with the risks of multiple health outcomes in women and their descendants.Methods Two investigators retrieved publications from four electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Database of Systematic Reviews up to March 15,2021.For each association,random/fixed-effects summary effect size and 95%CIs were estimated.Heterogeneity and publication bias were also assessed.The method quality and evidence level for each publication were respectively assessed utilizing the AMSTAR and GRADE checklists.Results A total of 68 articles with 82 unique outcomes were included based on the eligibility criteria.Numerous lines of evidence indicated that OCs had effects on nearly all cardiovascular disease-related outcomes,especially for cerebral venous sinus thrombosis(OR=7.59,95%CI:3.82-15.09).Harmful associations were also found for vulvar vestibulitis(OR=2.31,95%CI:1.03-5.16),preterm birth(OR=1.17,95%CI:1.07-1.27),miscarriage(OR=1.13,95%CI:1.02-1.72),ulcerative colitis(OR=1.22,95%CI:1.06-1.41),Crohn's disease(OR=1.24,95%CI:1.09-1.40),alveolar osteitis(RR=1.86,95%CI:1.66-2.08),dry socket(RR=1.8,95%CI:1.33-2.43),and interstitial cystitis(OR=2.1,95%CI:1.26-3.49).However,oral contraceptives did not increase the risk of cancer except breast and cervical cancer.Maternal exposure to OCs was linked to an increased risk for the development of respiratory atopic disorders such as asthma(OR=1.1,95%CI:1.02-1.19)and rhinitis(OR=1.34,95%CI:1.07-1.68).Conclusion In summary,although their use obviously reduces the risk of pregnancy-and parturition-related morbidity and mortality for women,OCs were frequently related to more harm than benefit in terms of other health outcomes.This was true for both women and their descendants in this umbrella review.More large-scale prospective studies analysing different doses,structures,and durations of treatment with estrogen and progestin are needed to confirm these effects.

A Re-evaluation of Systematic Reviews and Meta-analysis of Acupuncture and Moxibustion for Chronic Constipation by AMSTAR 2 and GRADE System

Objective:To evaluate the methodological quality of the systematic reviews(SRs)of acupuncture and moxibustion for chronic constipation and rate the evidence bodies of their Meta-analysis.Methods:We searched MEDLINE,EMBASE,Chinese Biomedical Literature Database(CBM),the China National Knowledge Infrastructure(CNKI),the VIP Database and the WanFang Database.Systematic Aseviews and Meta-analysis of all Randomized Controlled Trials(RCTs)of acupuncture and moxibustion for chronic constipation were included.Data from the included studies were extracted by two independent reviewers and were re-evaluated with AMSTAR 2 and Grades of Recommendation,Assessment,Development,and Evaluation(GRADE).Results:We included 12 SRs/Meta-analysis with only one conducted outside China.Evaluated with AMSTAR 2,methodology of one SR was of medium quality,methodologies of 7 SRs were of low quality,and methodologies of 4 SRs were of critical low quality.Among 54 outcome measures screened from included SRs,7 outcome measures introduced evidence bodies of moderate quality,22 outcome measures were of low quality and 25 outcome measures were of very low quality.No high level of quality was awarded to any evidence body.Conclusion:Overall,the quality level of SR/Meta-analysis of acupuncture/moxibustion for chronic constipation is low.The SRs/Meta-analysis of acupuncture/moxibustion for chronic constipation can be used for guideline formulation and clinical decision making by taking into account the experience of clinical experts,patients'preference,medical policies and other factors.

Methodological quality evaluation of systematic reviews of music therapy for Alzheimer’s disease in the recent five years

Aims:This study aims to investigate the methodological quality of the systematic reviews of music therapy for Alzheimer’s Disease in the past five years,and to explore their compliance with each AMSTAR(A Measure Tool to Assess Systematic Reviews)item.Based on the above,this study is intended to facilitate the evidence transformation of music therapy in Alzheimer's Disease.Method:Cochrane Library,Web of Science,Embase and PubMed were searched from 2017-2021,to obtain the systematic reviews of music therapy among Alzheimer’s Disease.We used the AMSTAR,to evaluate their methodological quality.Additionally,their compliance with 16 AMSTAR items was investigated.Results:12 systematic reviews were included in this study.The methodological quality of 10 articles was“very low”,1 article was“low”,and 1 article was“high”.The 12 systematic reviews had 25%to 100%compliance with 16 AMSTAR items.Conclusion:The methodological quality of systematic reviews of music therapy among Alzheimer’s Disease in the recent five years is not high,and needs to be further improved.Future research should continue to explore the factors that affect their methodological quality,to promote the transformation of evidence-based evidence.

Report quality assessment for systematic reviews of music intervention in Alzheimer’s Disease

Aims:The purpose of this study is to assess the report quality for systematic reviews of music intervention in Alzheimer’s Disease,and reveal their compliance with PRISMA,to facilitate evidence transformation.Method:We searched Web of Science,PubMed,Cochrane Library,and Embase databases to collect systematic reviews and metaanalyses of music intervention for Alzheimer’s Disease.The PRISMA was used to assess their report quality.Furthermore,the compliance with each PRISMA item was explored.Compliance with PRISMA above 70%was considered adequately reported.Results:A total of 18 articles were included in this study.Of them,11 articles had compliance with PRISMA greater than 70%.Furthermore,of the 27 PRISMA items,14 had more than 70%compliance with PRISMA.Conclusion:The overall report quality for systematic reviews of music intervention in Alzheimer’s Disease was good.However,the compliance with each PRISMA item,such as“structured summary”and“protocol and registration”,could be further improved.

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.

Efficacy and safety of acupuncture for polycystic ovary syndrome:An overview of systematic reviews

Background:Polycystic ovary syndrome(PCOS)is the primary cause of anovulatory infertility,bringing serious harm to women’s physical and mental health.Acupuncture may be an effective treatment for PCOS.However,systematic reviews(SRs)on the efficacy and safety of acupuncture for PCOS have reported inconsistent results,and the quality of these studies has not been adequately assessed.Objective:To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS,as well as to assess the quality and risks of bias of the available SRs.Search strategy:Nine electronic databases(Cochrane Library,MEDLINE,Embase,PsycINFO,CINAHL,Chinese National Knowledge Infrastructure,Wanfang Data,Chongqing VIP Chinese Science and Technology Periodical Database,and China Biology Medicine disc)were searched from their establishment to July 27,2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“acupuncture,”“polycystic ovary syndrome,”and“systematic review.”Inclusion criteria:SRs of randomized controlled trials that explored the efficacy and(or)safety of acupuncture for treating patients with PCOS were included.Data extraction and analysis:Two authors independently extracted study data according to a predesigned form.Tools for evaluating the methodological quality,risk of bias,reporting quality,and confidence in study outcomes,including A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),Risk of Bias in Systematic Reviews(ROBIS),Preferred Reporting Items for Systematic Reviews and Metaanalyses for Acupuncture(PRISMA-A),and the Grading of Recommendations Assessment,Development and Evaluation(GRADE),were used to score the included SRs.Results:A total of 885 studies were retrieved,and 11 eligible SRs were finally included in this review.The methodological quality of 2 SRs(18.18%)was low,while the other 9 SRs(81.82%)were scored as extremely low.Four SRs(36.36%)were considered to be of low risk of bias.As for reporting quality,the reporting completeness of 9 SRs(81.82%)was more than 70%.Concerning the confidence in study results,2study results were considered to have a high quality of evidence(3.13%),14(21.88%)a“moderate”quality,28(43.75%)a“low”quality,and 20(31.24%)considered a“very low”quality.Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate(CPR)and ovulation rate,and reduce luteinizing hormone/follicle-stimulating hormone ratio,homeostasis model assessment of insulin resistance,and body mass index(BMI).When compared with medicine alone,acupuncture alone also can improve CPR.Further,when compared with no intervention,acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI.Acupuncture was reported to cause no adverse events or some adverse events without serious harm.Conclusion:The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence.More high-quality studies are needed to support the use of acupuncture in PCOS.

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.

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.