African natural medicine:Toward a health preservation theory and systematization model for clinical applicationAfrican natural medicine and health preservation theory

All knowledge fields are founded on universal epistemologies and philosophies.This is evident in ancient Traditional Chinese and Ayurvedic(Siddha)medical systems,which are integrated into national health systems of China and India respectively.African natural medicines(ANMs)are not part of national health systems on the African continent because of a lack of systematization frameworks.This article explores classical medical systems drawn from ancient African and Chinese cosmologies.A qualitative research methodology was used to conduct in-depth interviews with 20 respondents selected using a purposeful sampling technique.The data were summarized into systematization frameworks for disease theories,etiology and pathogenesis,diagnosis and prognosis,and treatment including medicines and disease classification.The study findings revealed that in antiquity,Africa had systematic medical cosmologies,remnants of which are evident in current cultural health practices.Therefore,parallels can be drawn in relation to Chinese Taoist and Indian Tantric healing arts.Ancient Africans recognized Ra or iSithunzi(uMbhilini),which correspond to qi or prana and refer to energetic life force in Asian cultures.Shu and Tefnut(Nkomo weLwandle and Dungha Manzi)correspond to yin and yang or purusha and prakriti,the natural principles of polarised duality.The jing or oojas(physiological essences)and wu xing or pancha tattvas(five ele-ments and modes of nature)and their relationships with the zang and fu(five vital organs and visceral organs,respectively)also found their application in African medical cosmologies.The data revealed that ancient and contemporary ANM systems are based on the concept of con-sciousness(saa or ntu)and life force energy,ra.These cosmological concepts are predicated upon the Paut Neteru or Amathogo(archetypal forces)that prescribe properties to everything.On this basis,an African-Kemetic Health Preservation Theory was developed,which gives rise to African theories for disease etiology,pathogenesis,differential diagnoses,comprehensive prognosis,and holistic treatment regimens.In addition,we developed an uBu-Ntu bio-innovation model for integral research,inclusive innova-tion,local technology transfer,holistic enterprising,and conscious commercialization of African natural medicines.It is the intention of the authors to influence policy in the implementation of these theories,models,and frameworks for clinical application and socio-economic development.

Study and Proposal to Build the Maintenance Systematization for Preservation of Buildings Aiming at Long-Lived Buildings

Systematization for the maintenance of buildings enables their supporting system to be more practical than before. This study aims to make the maintenance and the long-term repairs for the buildings to be easier. In Japan, 30-40-year-old buildings seem to have been planned and built with little thought about their future maintenances, which have made them very difficult to be repaired on a large scale. This is why effective management systems about dealing with the data should be strongly suggested. Since the Building Standard Law was amended on April 1, 2008, in Japan, the regular investigation and report for particular buildings are legally obligated every three years, thus a variety of useful data can be obtained through Kitakyushu City cases as well as former data personally obtained. With those data used usefully, systematization for the maintenance of the buildings will produce satisfactory results by building up a connection between those data and the long-term repair planning.

The Evaluation System Research based on the Working Process Systematization of the Practice Teaching Quality

The design philosophy based on the working process systematization, the feature of practice teaching is analyzed the principles of practice teaching quality evaluation system are summed up. The evaluation system based on working process systematization of the practice teaching quality is established, the management of quality evaluation system and the project of the monitoring are put forward.

Wang Tao, a distinguished scholar in medical classic systematization

Wang Tao (circa 690-756) was from today's Mei County,Shaanxi Province in the Tang Dynasty,and born into an official family.His father,grandfather and brothers served the imperial government for many years and he himself was put in charge of the imperial library for about 20 years.He compiled the Arcane Essentials from the Imperial Library (Wài Tái Mì Yào),a well-known miscellaneous medical masterpiece,which has been honored with a 'treasure handed down from ancient times'.

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.

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.

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

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.

Morphogenesis and Molecular Phylogeny of a Marine Urostylid Ciliate Apokeronopsis wrighti(Protista, Ciliophora, Hypotrichia)

Hypotrichs are one of the highly differentiated ciliated lineages which play important roles in ecological, environmental,evolutionary and basic biological studies. In the present study, we investigated the living characteristics, infraciliature, nuclear apparatus, ontogenesis and phylogenetic position of a marine hypotrichous ciliate, Apokeronopsis wrighti Long et al., 2008, which was isolated from coastal waters in Shenzhen, China. The new isolate resembles the type population in terms of morphological characteristics, morphometrics, and SSU rRNA gene sequence that is with a 99.7% similarity. Ontogenesis of A. wrighti is characterized by oral primordium for the proter as well as marginal and dorsal kineties anlagen in both filial products formed de novo, and the cirral row arranged along the paroral and endoral arises from several anterior frontoventral-transverse cirral streaks. Phylogenetic analyses based on SSU and concatenated gene data suggest that five species of Apokeronopsis form a monophyletic clade, and the genus Apokeronopsis is closely related to Thigmokeronopsis and Metaurostylopsis.

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.

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.

Early Neoproterozoic Granite-Gneisses of the Junggar Alataw(Southeastern Kazakhstan):Age,Petrogenesis and Tectonic Implications

The combined petrographic,petrological,geochemical and geochronological study of the Neoproterozoic gneisses of the Sarychabyn and Baskan complexes of the Junggar Alataw of South Kazakhstan elucidate the Precambrian tectonic evolution of the Aktau–Yili terrane.It is one of the largest Precambrian crustal blocks in the western Central Asian orogenic belt.The U-Pb single-grain zircon ages indicate that granite-gneisses formed from the same source and crystallised in the early Neoproterozoic ca.930–920 Ma.The chemical composition of gneisses corresponds to A2-type granites.The whole-rock Nd isotopic characteristics(εNd(t)=−4.9 to−1.0 and TNd(DM-2st)=1.9 to 1.7 Ga)indicate the involvement of Paleoproterozoic crustal rocks in magma generation.Early Neoproterozoic ca.930–920 Ma A-type granitoids in the Aktau–Yili terrane of South and Central Kazakhstan might reflect within-plate magmatism adjacent to the collisional belt or a local extension setting in back-arc areas of the continental arc.

Phylogenetic, phylogeographic and divergence time analysis of Anopheles subpictus species complex using ITS2 and COI sequences

Objective:To address the phylogenetic and phylogeographic relationship between different lineages of Anopheles(An.)subpictus species complex in most parts of the Asian continent by maximum utilization of Internal Transcriber Spacer 2(ITS2)and cytochrome C oxidase I(COI)sequences deposited at the GenBank.Methods:Seventy-five ITS2,210 COI and 26 concatenated sequences available in the NCBI database were used.Phylogenetic analysis was performed using Bayesian likelihood trees,whereas median-joining haplotype networks and time-scale divergence trees were generated for phylogeographic analysis.Genetic diversity indices and genetic differentiation were also calculated.Results:Two genetically divergent molecular forms of An.subpictus species complex corresponding to sibling species A and B are established.Species A evolved around 37-82 million years ago in Sri Lanka,India,and the Netherlands,and species B evolved around 22-79 million years ago in Sri Lanka,India,and Myanmar.Vietnam,Thailand,and Cambodia have two molecular forms:one is phylogenetically similar to species B.Other forms differ from species A and B and evolved recently in the above mentioned countries,Indonesia and the Philippines.Genetic subdivision among Sri Lanka,India,and the Netherlands is almost absent.A substantial genetic differentiation was obtained for some populations due to isolation by large geographical distances.Genetic diversity indices reveal the presence of a long-established stable mosquito population,at mutation-drift equilibrium,regardless of population fluctuations.Conclusions:An.subpictus species complex consists of more than two genetically divergent molecular forms.Species A is highly divergent from the rest.Sri Lanka and India contain only species A and B.

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.

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.

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.

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.

Mapping the intellectual structure and emerging trends for the application of nanomaterials in gastric cancer:A bibliometric study

BACKGROUND Recent reviews have outlined the main nanomaterials used in relation to gastrointestinal tumors and described the basic properties of these materials.However,the research hotspots and trends in the application of nanomaterials in gastric cancer(GC)remain obscure.AIM To demonstrate the knowledge structure and evolutionary trends of research into the application of nanomaterials in GC.METHODS Publications related to the application of nanomaterials in GC were retrieved from the Web of Science Core Collection for this systematic review and bibliometric study.VOSviewer and CiteSpace were used for bibliometric and visualization analyses.RESULTS From 2000 to 2022,the application of nanomaterials in GC developed rapidly.The keyword co-occurrence analysis showed that the related research topics were divided into three clusters:(1)The application of nanomaterials in GC treatment;(2)The application and toxicity of nanomaterials in GC diagnosis;and(3)The effects of nanomaterials on the biological behavior of GC cells.Complexes,silver nanoparticles,and green synthesis are the latest high-frequency keywords that represent promising future research directions.CONCLUSION The application of nanomaterials in GC diagnosis and treatment and the mechanisms of their effects on GC cells have been major themes in this field over the past 23 years.

Current status of magnetic resonance imaging radiomics in hepatocellular carcinoma:A quantitative review with Radiomics Quality Score

BACKGROUND Radiomics is a promising tool that may increase the value of magnetic resonance imaging(MRI)for different tasks related to the management of patients with hepatocellular carcinoma(HCC).However,its implementation in clinical practice is still far,with many issues related to the methodological quality of radiomic studies.AIM To systematically review the current status of MRI radiomic studies concerning HCC using the Radiomics Quality Score(RQS).METHODS A systematic literature search of PubMed,Google Scholar,and Web of Science databases was performed to identify original articles focusing on the use of MRI radiomics for HCC management published between 2017 and 2023.The methodological quality of radiomic studies was assessed using the RQS tool.Spearman’s correlation(ρ)analysis was performed to explore if RQS was correlated with journal metrics and characteristics of the studies.The level of statistical significance was set at P<0.05.RESULTS One hundred and twenty-seven articles were included,of which 43 focused on HCC prognosis,39 on prediction of pathological findings,16 on prediction of the expression of molecular markers outcomes,18 had a diagnostic purpose,and 11 had multiple purposes.The mean RQS was 8±6.22,and the corresponding percentage was 24.15%±15.25%(ranging from 0.0% to 58.33%).RQS was positively correlated with journal impact factor(IF;ρ=0.36,P=2.98×10^(-5)),5-years IF(ρ=0.33,P=1.56×10^(-4)),number of patients included in the study(ρ=0.51,P<9.37×10^(-10))and number of radiomics features extracted in the study(ρ=0.59,P<4.59×10^(-13)),and time of publication(ρ=-0.23,P<0.0072).CONCLUSION Although MRI radiomics in HCC represents a promising tool to develop adequate personalized treatment as a noninvasive approach in HCC patients,our study revealed that studies in this field still lack the quality required to allow its introduction into clinical practice.

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.