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.

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.

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.

Wenxin granule for cardiac arrhythmia: an overview of systematic reviews

目的:对稳心颗粒治疗心律失常的系统评价/meta分析进行再评价,为临床应用提供证据;分析目前研究中存在的问题,为研究者提供可能的优先研究主题。方法:从8 个数据库中检索稳心颗粒治疗心律失常的系统评价。分别用AMSTAR和GRADE评估系统评价的方法学质量和证据质量。结果:共纳入1 9 项系统评价,涉及52, 9 0 5 个参与者。AMSTAR评分3-10分,平均6 .5 分,中位数为6 分, 9 (9/19, 47.37°%)项系统评价的AMSTAR得分大于7 分,对其中的6 项研究采用GRADE评估其证据质量。结果显示,所有研究的证据质量都在极低和低之间,无中、高质量证存在。从结局指标报告来看,没有系统评价评估终点指标,虽然有部分研究报告了不良反应/事件,但很少有研究进行因果关系判断。系统评价结局指标矩阵显示,结局指标报告存在明显的异质性及不完全报告的情况,导致有些研究不能进行m eta分析。同时,一些原始研究由于结局指标报告不合理而被不能纳入系统评价(如未报告相关结局指标,治疗时间不合适/不清楚,数据不完全或无法提取)。结论:稳心颗粒治疗心律失常的疗效和安全性证据有限,未来需要更多的高质量R C T s和系统评价提供证据。在未来的研究中,有必要构建心律失常核心指标集,以提高结局指标报告水平,减少由于结局指标报告不合理而造成的浪费。

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.

抗阻运动改善超重肥胖人群身体成分:一项伞形综述

背景:抗阻运动可以增加肌肉质量、提升肌肉力量,但对体成分的相关影响缺乏确凿证据,随机对照试验与多篇Meta分析结果的争议给临床的运动干预决策带来了困扰。目的:基于伞形综述(umbrella review)的方法学范式,探究抗阻运动改善超重、肥胖人群体成分的干预效果及安全性。方法:检索PubMed、Cochrane Library、Web of Science、中国知网等数据库,中文检索词包括“抗阻、阻力、自重、meta、元分析、meta分析、体成分、体脂率、脂肪质量、瘦体重、体质量”,英文检索词包括“Resistance training、Strength Training、Weight-Lifting Strengthening Program、Body Compositions、Body Fat Distribution、Meta Analysis、Data Pooling、Overviews、Clinical Trial、Clinical Trial Overviews”等。收集抗阻运动干预超重、肥胖人群的系统评价,检索时限均从各数据库建库至2022-08-31。采用PRISMA评价纳入研究的方法学质量,采用GRADE评价系统对证据质量进行分级。结果与结论:①最终纳入14篇Meta分析,GRADE证据质量评价显示,2个结局指标证据质量为中级,12个为低级,14个为极低级。②与对照组相比,32个结局指标中有23个得到显著性改善。抗阻运动对体脂率的干预效果已形成共识,对瘦体质量、体质量指数、内脏脂肪的干预效果仍需进一步证实。③抗阻运动是改善超重、肥胖人群体成分的一种有效安全的方法,纳入系统评价的整体研究质量和结局指标证据质量普遍较低,未来应在明确样本特征、细化方案设计的基础上,充分结合被试的初始状态、运动目标和意愿,通过水阻、气阻及弹性阻力的多元、科学、个性化的运动处方设计提升抗阻运动的安全性和依从性,为抗阻运动干预提供明确的循证支持与决策依据。

艾灸治疗膝骨关节炎的系统评价再评价

目的评价艾灸治疗膝骨关节炎的疗效和安全性,以及已发表的相关系统评价的方法学质量。方法计算机检索中国知识资源总库(CNKI)、维普资讯中文期刊服务平台、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Cochrane Library、Embase、Web of Science建库至2022年2月10日收录的艾灸治疗膝骨关节炎的系统评价,采用AMSTAR2量表进行方法学质量评价。汇总并根据纳排标准筛选收集的系统评价中纳入的随机对照试验(RCT),使用RevMan5.4软件进行Meta分析,采用GRADE工具评价证据质量。结果共纳入系统评价15篇,AMSTAR2量表评分显示低质量1篇,极低质量14篇。共涉及RCT 36项,Meta分析结果显示,艾灸相较于非甾体抗炎药改善西安大略麦马斯特大学骨性关节炎指数评分[MD=-5.95,95%CI(-9.25,-2.65),低质量]、减轻疼痛[MD=-1.26,95%CI(-2.19,-0.32),极低质量]、提高总有效率[RR=1.16,95%CI(1.11,1.22),低质量]效果更佳。纳入试验报告了艾灸组不良事件(水泡),多于3 d内痊愈。结论艾灸相较于常用西医疗法,在改善患者疼痛、提高总有效率方面呈现一定优势,仍需设计严谨的高质量RCT进一步验证。

保肝药物预防及治疗抗结核药物性肝损伤的系统评价再评价

目的:对保肝药物预防及治疗抗结核药物性肝损伤(ATB-DILI)的系统评价的方法学质量和证据质量等级进行评价,为临床用药及今后临床研究方向提供一定的参考。方法:通过检索The Cochrane Library、EMBASE、PubMed、中国知网、中国生物医学文献数据库、维普和万方数据库,筛选出符合纳入标准的系统评价类文献,采取主题词与自由词相结合的方式检索,检索时限均从建库至2023年1月30日。采用AMSTAR 2量表评价纳入研究的系统评价文献的方法学质量,运用GRADE工具对纳入研究的结局指标进行证据质量分级。结果:纳入中英文系统评价共12篇,其中6篇比较了抗结核标准治疗中预防性应用保肝药物组与对照组(有或无安慰剂)肝损伤发生的情况。另6篇系统评价比较了ATB-DILI患者治疗性应用某种保肝药物组与对照组(空白对照或其他保肝药物等)的临床疗效。AMSTAR 2质量评级显示11篇为极低质量、1篇为低质量,其中存在较大缺陷的关键条目为2和7,非关键条目为3、15和16。GRADE证据评价显示12篇系统评价所包含的41项结局指标中,中级质量证据8项,低级质量证据16项,极低级质量证据17项,无高级质量证据。结论:现有证据提示,抗结核治疗中预防性应用保肝药物可降低肝损伤的发生,治疗性应用部分西医保肝药物及中药复方可改善ATB-DILI患者的肝功能,疗效明显,短期安全性可。但纳入文献的方法学质量与结论的证据等级均较低,需加强系统评价的方法学质量和证据质量。

中药注射液治疗肺心病的系统评价再评价

[目的]本研究对中药注射液治疗肺心病的系统评价/Meta分析进行再评价,以期为临床应用中药注射液提供循证支持。[方法]计算机检索中国知网(CNKI)、中国生物医学文献数据库(SinoMed)、Embase、The Cochrane Library等8个中英文数据库,检索年限为建库至2023年3月,搜集中药注射液治疗肺心病的系统评价/Meta分析。分别使用AMSTAR-2、PRISMA 2020、GRADE系统对纳入研究的方法学质量、报告质量及证据质量进行评价。[结果]共纳入26篇系统评价/Meta分析,涉及16种中药注射液,29个结局指标。AMSTAR-2评价结果表明,纳入文献的方法学质量整体较低,无中、高质量文献,条目2(前期方案)、3(研究类型选择原因)、4(文献检索)、8(研究特征描述)、10(资助来源)具有明显缺陷。PRISMA 2020结果显示8个主题条目的报告完整度<50%,分别为检索策略、方法综合、可信度评价、结果综合、证据可信度、注册与计划书、利益冲突和补充材料。GRADE评估结果表明纳入研究中无高质量证据体,方法学质量低、结果不一致、存在发表偏倚是证据质量降级的主要因素。[结论]基于现有证据,提示中药注射液治疗肺心病有效且基本安全,有助于纠正肺心病患者的缺氧状态、改善心室收缩和舒张功能、降低肺动脉压、改善血液流变学指标。但目前已发表系统评价/Meta分析的方法学质量较低,文献报告存在一定缺陷,且证据质量等级不高,影响结果的可靠性。因此,未来需要更多高质量的临床研究和证据为中药注射液治疗肺心病的有效性和安全性提供循证支持。

荆花胃康治疗幽门螺杆菌感染的系统评价再评价

目的 评价荆花胃康治疗幽门螺杆菌感染的系统评价的质量。方法 本研究采用计算机检索Pub Med、The Cochrane Library、EMbase、中国知网、维普网、中国生物医学文献服务系统和万方数据知识服务平台,以获取关于荆花胃康治疗幽门螺杆菌感染的系统评价/meta分析。检索时限为建库至2023年7月。使用AMSTAR 2和PRISMA 2020工具对纳入的研究进行方法学质量和报告质量评估,并采用GRADE系统对证据质量进行评定。结果 最终纳入5篇荆花胃康治疗幽门螺杆菌感染的系统评价/meta分析。AMSTAR 2评价结果显示,所有系统评价为极低质量;PRISMA 2020得分为15.5~23.0分;GRADE证据分级结果显示证据整体质量偏低。结论 荆花胃康治疗幽门螺杆菌感染具有一定优势,然而文献的报告、方法学及证据质量普遍较低,需要更多高质量的研究来提供有力的证据支持。

穴位按摩治疗失眠效果系统评价的再评价

目的 对穴位按摩治疗失眠的系统评价或Meta分析进行再评价,为穴位按摩治疗失眠的临床应用提供参考。方法 系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library、Embase、Medline数据库,检索穴位按摩治疗失眠的系统评价或Meta分析,检索时限为建库至2023年1月19日。采用AMSTAR 2和GRADEⅡ评价纳入研究的方法学质量和证据质量等级。结果 共纳入8篇系统评价或Meta分析。AMSTAR 2评分结果显示,文献质量1篇为中等,5篇为低,2篇为极低。结果显示,穴位按摩可提高失眠患者的睡眠质量,效果指标以主观评估为主;选穴遵循一定的规律,但缺乏统一,大多建议持续4周,于晚上或睡前按摩神门、三阴交、涌泉、内关、百会及太阳等穴位1~5 min,以出现酸胀感且可以耐受为度。结论 穴位按摩可提高不同疾病类型失眠患者的睡眠质量,且常用穴位、按摩时间、频率、时长、周期等相近。由于纳入文献的方法学质量及证据等级偏低,其疗效尚需开展高质量、大样本的随机对照研究以进一步验证。

基于雷达图对针灸治疗脊髓损伤后神经源性膀胱系统评价再评价

目的 运用雷达图多元评价针灸治疗脊髓损伤后神经源性膀胱系统评价/meta分析的质量及结果。方法 检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library建库至2023年9月2日针灸治疗脊髓损伤后神经源性膀胱系统评价/Meta分析相关文献。从发表年份、研究类型、同质性、发表偏倚风险、AMSTAR-2方法学质量、PRISMA报告质量6个维度进行多元评价。结果 共纳入12项系统评价/Meta分析,雷达图多元评价显示,纳入文献质量秩平均分为8.56分。多项研究存在同质性不高、异质性解释与讨论欠充分、检索不全面、项目方案未注册、资金利益冲突欠描述等问题。结论 针灸治疗脊髓损伤后神经源性膀胱的系统评价/Meta分析文献质量不高,今后需严格按照AMSTAR-2和PRISMA清单的标准提高系统评价的方法学质量和报告质量。

中成药治疗消化性溃疡的系统评价再评价

目的:对中成药治疗消化性溃疡(PU)的系统评价进行再评价。方法:检索PubMed、Cochrane Library、Embase、国家知识基础设施数据库(CNKI)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)及中文科技期刊数据库(CCD),2名研究者独立筛选文献、提取资料,纳入中成药治疗PU的系统评价,采用多项系统综述评价2(AMSTAR 2)、系统评述和Meta分析优先报告条目(PRISMA)评价纳入系统评价的方法学质量和报告质量,应用建议评价开发和评估分级(GRADE)量表评价纳入系统评价的方法学质量、报告质量和证据质量。结果:共纳入系统评价10个,AMSTAR 2评价结果,系统评价为高质量1个,中质量5个,低质量3个,极低质量1个。PRISMA评价结果,系统评价报告相对完整6个,存在一定缺陷3个,存在相对严重缺陷1个。纳入系统评价10个报告了结局指标42个,GRADE评价结果,高质量6个,中质量27个,低质量8个,极低质量1个。与常规西药治疗比较,康复新液可提高临床有效率及溃疡愈合率,联合常规西药可提高内镜下总有效率、临床有效率和溃疡愈合率,降低临床症状改善积分和溃疡复发率;复方丹参滴丸联合常规西药可提高临床疗效;胃复春联用常规西药的临床疗效和Hp根除率更高,胃泌素水平更低;健胃愈疡片的总有效率、治愈率更高;荆花胃康胶丸联合常规西药可改善总有效率、溃疡愈合率和Hp根除率。结论:中成药或其联合常规西药治疗PU疗效优于常规西药治疗,但由于纳入系统评价的方法学质量、报告质量及证据质量存在一定缺陷,应慎重对待。

非药物干预对阿尔茨海默病患者照顾者负担影响系统评价的再评价

目的对非药物干预影响阿尔茨海默病患者照顾者负担的相关系统评价/Meta分析进行再评价,旨在为我国改善照顾者负担提供借鉴。方法计算机检索国内外数据库中有关阿尔兹海默症患者照顾者负担的非药物干预的系统评价/Meta分析,进行文献筛选、资料提取,并对纳入文献进行方法学质量和证据质量等级评价。结果共纳入15篇系统评价/Meta分析,其中2篇质量等级为中,5篇为低,8篇为极低。21条证据质量分级为中等质量7条,低质量7条,极低质量7条。结果显示多组分干预、基于互联网的干预措施、心理教育、健康教育、个案管理对照顾者负担具有积极影响。结论非药物干预在一定程度上可降低照顾者负担,但纳入的系统评价/Meta的方法学质量和证据质量均较低,需谨慎采纳相关证据。

Benefits and Safety of Tripterygium Glycosides and Total Glucosides of Paeony for Rheumatoid Arthritis: An Overview of Systematic Reviews

Objective: To summarize the evidence from systematic reviews(SRs) on the benefits and safety of Tripterygium glycosides(TG) and total glucosides of paeony(TGP), commonly used to treat rheumatoid arthritis(RA) in China, for patients with RA. Methods: SRs of randomized controlled trials(RCTs) on TG or TGP in treating RA were included, by searching 8 databases from their inception until December 2017. Two authors extracted data independently. We assessed the quality of SRs using AMSTAR and graded the quality of evidence according to the GRADE approach. Results: Eleven SRs containing an average of 7.6 RCTs, involving a total of 7,012 participants were included in this overview. On the basis of included SRs, TG and TGP could improve the following indexes for RA patients: American College of Rheumatology(ACR) 20 response rate, ACR50 response rate and ACR70 response rate, swollen joint count, tender joint count, erythrocyte sedimentation rate and C-reactive protein. Moreover, TGP could reduce incidence of hepatotoxicity. The most common adverse effects of TG were gastrointestinal discomfort and gonad toxicity, while for TGP was mild to moderate diarrhea. The overall quality of evidence for these findings ranged from "low" to "moderate". Conclusions: TG and TGP might be 2 potentially effective complementary and alternative drugs for patients with RA. Nevertheless, due to gonad toxicity, TG should only be considered in elderly patients or patients without reproductive needs. More evidence from high quality RCTs and SRs is warranted to support the use of TG and TGP for RA patients.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

Application of artificial intelligence in clinical diagnosis and treatment:an overview of systematic reviews

Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematically searched seven English-and Chinese-language literature databases to identify sys-tematic reviews on the application of AI,deep learning,or machine learning in the diagnosis and treatment of any disease published in 2020.We evaluated the methodological quality of the included systematic reviews using“A Measurement tool for the assessment of multiple systematic reviews”(AMSTAR).We also conducted meta-analyses on the diagnostic accuracy of AI on selected disease categories with a large number of included studies and low clinical heterogeneity.Results A total of 40 systematic reviews reporting 1,083 original studies were included,covering 31 diseases from 11 groups of diseases.Eleven systematic reviews were related to neoplasms and nine were systematic reviews related to diseases of the digestive system.We selected digestive system diseases for the meta-analysis.The pooled sensitivities(with 95%confidence interval(CI))of AI to assist the diagnosis of helicobacter pylori,gastrointestinal ulcers,hemorrhage,esophageal tumors,gastric tumors,and intestinal tumors(with 95%CI)were 0.91(0.83-0.95),0.99(0.76-1.00),0.95(0.83-0.99),0.90(0.85-0.93),0.90(0.82-0.95),and 0.93(0.88-0.96),respectively,and the pooled specificities were 0.82(0.77-0.87),0.97(0.86-1.00),1.00(0.99-1.00),0.80(0.71-0.87),0.93(0.87-0.97),and 0.89(0.85-0.92),respectively.The AMSTAR items“the list of included studies”(n=39,97.5%)and“the characteristics of the included studies”(n=39,97.5%)had the highest compliance among the reviews;the compliance was relatively low to the items“the consideration of publication status”(n=1,2.5%),“the consideration of scientific quality”(n=19,47.5%),“data synthesis methods”(n=18,45.0%),and“the evaluation of publication bias”(n=13,32.5%).Conclusions The main subjects of systematic reviews on AI applications in clinical diagnosis and treatment pub-lished in 2020 were diseases of the digestive system and neoplasms.The methodological quality of the systematic reviews on AI needs to be improved,paying particular attention to publication bias and the rigorous evaluation of the quality of the included studies.

Interventions for preventing influenza: An overview of Cochrane systematic reviews and a Bayesian network meta-analysis

Background:Influenza places a heavy public health burden in numerous countries every year.In addition to vaccines,there are some interventions that are effective in preventing influenza.Objective:This overview of systematic reviews(SRs)aimed to evaluate the efficacy and safety of interventions for influenza prevention.Search strategy:We searched the Cochrane Database of Systematic Reviews,2020,Issue 1 for relevant Cochrane SRs using the keywords‘‘common cold,"‘‘influenza,"and‘‘flu."Inclusion criteria:Cochrane SRs that investigated the prevention of influenza were included.Participants included the general population without influenza or influenza-like symptoms,who were treated with preventative interventions and compared to individuals receiving no treatment or placebo.Data extraction and analysis:Two reviewers independently screened citations against pre-defined inclusion criteria and extracted data.The methodological quality of these SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-II(AMSTAR-II)guidelines.The primary outcome of our analysis was the incidence of influenza,and the secondary outcomes were the incidence of influenza-like illness and hospitalization.In addition to the narrative summary of SR findings,we also pooled data from homogeneous trials among these SRs and produced evidence mapping.We conducted a network meta-analysis to compare the effect across interventions and used the Cochrane approach to grading of recommendations,assessment,development,and evaluation(GRADE)to assess the quality of evidence.Results:Eleven Cochrane SRs were included,covering five medications,eleven vaccinations and four complementary therapies.Among these SRs,73%scored"high"quality on AMSTAR-II rating.We found that eight interventions,including amantadine,garlic,and six different vaccines,were beneficial for reducing the incidence of influenza compared to placebo,while oseltamivir,zanamivir,Ganmao capsule,Echinacea,and another three types of vaccine were probably beneficial.Ganmao capsule ranked highest for influenza prevention in the network meta-analysis,followed by amantadine,garlic,and vaccines of all types.Monovalent inactivated parenteral vaccine was found to be beneficial in reducing the incidence of influenza-like illness.None of the interventions reduced the hospitalization rate.Conclusion:High-quality evidence showed that garlic or vaccine had advantages in preventing influenza,and that vitamin C is not effective.The effect of other interventions needs to be further verified with highquality evidence.

独活寄生汤治疗膝骨关节炎临床效果的系统评价再评价

目的对独活寄生汤治疗膝骨关节炎(KOA)的系统评价及meta分析进行再评价。方法检索中国知网、万方数据知识服务平台、维普网、CBM、Pub Med、Web of Science、The Cochrane Library和Prospero,收集独活寄生汤治疗KOA的系统评价及meta分析,检索时限为建库至2022年12月,采用系统综述和meta分析优先报告规范(PRISMA)声明进行报告质量评价,AMSTAR-2量表进行方法学质量评价,GRADE系统进行结局指标证据质量分级。结果共纳入8篇文献,对照组涉及西药、针灸,试验组为单用独活寄生汤和在对照组基础上使用独活寄生汤,8篇文献PRISMA声明得分≥20分,AMSTAR-2量表评价结果显示多个关键条目不达标,文献方法学质量均为极低。GRADE系统的评价结果显示,无高等证据质量,整体证据质量偏低。结论独活寄生汤治疗KOA临床效果的相关meta分析整体方法学和证据质量水平不高,研究结论存在一定局限性,且对安全性方面的评估较少,医师在临床决策的使用中需谨慎,未来相关研究需进一步加强规范性。