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

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

Impact of citrus fruit and hesperidin intake on multiple health outcomes:An umbrella review

Citrus fruits are rich sources of several biologically active flavonoids such as hesperidin,naringin,and polymethoxylated flavones.We evaluated the evidence of associations between citrus fruit or hesperidin intake and multiple health outcomes.An umbrella review was conducted for studies performed in humans.Overall,246 articles were initially identified by searching in 4 databases.Twenty-two meta-analyses and systematic reviews with 28 health outcomes met the inclusion criteria.Citrus fruit intake had beneficial effects on all-cause mortality(relative risk[RR].0.90;95%confidence interval[95%CI],0.86 to 0.94),cardiovascular diseases(RR,0.78;95%CI,0.66 to 0.92),coronary heart disease(RR,0.91;95%CI,0.86 to 0.96),stroke(RR,0.74;95%CI,0.65 to 0.84),type 2 diabetes mellitus(RR,0.85;95%CI,0.78 to 0.92),and several cancers.Dose-response analyses indicated that each 100-g/d increase in citrus fruit intake could reduce the risks of all-cause mortality by 6%(RR,0.94;95%CI,0.88 to 1.00),stroke by 22%(RR,0.78;95%CI,0.69 to 0.90),and cardia gastric cancer by 40%(RR,0.60;95%CI,0.44 to 0.83).Citrus fruit intake also had beneficial effects on the lipid profile and body weight control(weighted mean difference,−1.28;95%CI,−1.82 to−0.74).Grapefruits could reduce the systolic blood pressure(weighted mean difference,−2.43,95%CI,−4.77 to−0.09).Hesperidin supplementation significantly improved inflammation.Citrus fruit intake was generally safe and beneficial for multiple health outcomes in humans.However,grapefruit and pomelo juice may affect the bioavailability of various medications,so care should be exercised before increasing the intake of these fruits or their juices.

Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies

Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.

An umbrella review of Lianhua Qingwen combined with Western medicine for the treatment of coronavirus disease 2019

Objective:Lianhua Qingwen combined with Western medicine(LHQW+WM)has been proposed as a viable treatment for coronavirus disease 2019(COVID-19).Interestingly,umbrella reviews of systematic reviews(SRs),which provide the most comprehensive evidence,are the best evidence in evidence-based medicine.Therefore,an umbrella review of SRs that summarizes and evaluates the efficacy of LHQW+WM for COVID-19 is urgently required.Methods:Overall,6 databases were used to conduct a comprehensive literature search from inception to January 22,2022.The corrected covered area(CCA)was used to analyze the overlapping between SRs.Meta-analysis was conducted when that of the included SRs was inappropriate.A MeaSurement Tool to Assess Systematic Reviews(AMSTAR-2)was also employed to assess the quality of the included SRs.Results:In total,12 SRs were identified,which included 12 unique primary studies.The included SRs ranged in quality from moderate to critically low and had an extremely high CCA(36.4%).Compared to conventional treatment,LHQW+WM showed efficacy concerning fatigue recovery[risk ratio(RR)=1.69,95%confidence interval(CI):1.04-2.73,n=2,I2=0%],cough recovery(RR=1.65,95%CI:1.09-2.51,n=3,I2=39.1%),and overall effective rates(RR=1.17,95%CI:1.07-1.28,n=3,I2=17.5%).Conclusion:LHQW+WM may improve the clinical symptoms of patients with COVID-19;however,the results should be interpreted cautiously because of the rigorous processes in the included SRs.

Pollutant exposure and health outcomes:protocol for a comprehensive umbrella review of meta-analyses and evidence mapping

Background:Many systematic reviews and meta-analyses(MAs)regarding the association between pollutant(e.g.,air pollution,noise pollution,and heavy metal pollution)exposure and health outcomes have been published recently,but there is still a lack of comprehensive research based on these MAs,and the evidence quality of these MAs are unknown.Therefore,we designed an umbrella review to address these gaps in knowledge.Methods:MAs that evaluated the association between pollutant exposure and health outcomes will be systematically searched through the PubMed and Embase databases in May 2021.Pairs of reviewers will conduct the study screening and data extraction independently,and cross-check the results.PRISMA and AMSTAR 2 will be used to evaluate the reporting and methodological quality of MAs included,respectively,and an evidence mapping method will be used to present the results.The corrected cover area(CCA)method will be used to assess the degree of overlap for included primary studies among MAs.The outcomes will be reanalyzed based on the random-effects model using the appropriate effect size,and the corresponding 95%confidence intervals will be reported.Meanwhile,sensitivity analysis and subgroup analysis will be used to explore heterogeneity.The GRADE method will be used to evaluate the evidence quality of outcome indicators.Stata 16.0 and Excel 2019 will be used for data analysis,and P<0.05 will be considered to indicate statistical significance.Results:The results of this umbrella review will be submitted to a peer-reviewed English journal for publication.Conclusion:We designed the first umbrella review to summarize evidence from MAs on the association between common pollutant exposure and health conditions.The results of this study will provide evidence for health policy makers to formulate appropriate health policies and researchers to conduct new studies.

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.

Associations between the use of red yeast rice preparations and adverse health outcomes:An umbrella review of meta-analyses of randomized controlled trials

Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.

Risk factors for running-related injuries:An umbrella systematic review

Purpose:This umbrella systematic review(SR) of SRs and meta-analysis seeks to comprehensively synthesize existing literature to identify and consolidate the diverse range of risk factors contributing to running-related injuries(RRIs).Methods:Systematic searches were conducted on June 28,2023,across Web of Science,SPORTDiscus,Scopus,PubMed,and Cochrane Library.We included SRs,whether accompanied by meta-analyses or not,that focused on investigating risk factors for RRIs within observational studies.The methodological quality of the SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews Ⅱ.To assess the extent of overlap across reviews,the corrected covered area metric was calculated.Results:From 1509 records retrieved,13 SRs were included.The degree of overlap between SRs was low(4%),and quality varied from critically low(n=8) to low(n=5).Two hundred seven outcomes assessed in 148 primary studies were identified as being associated with the occurrence of RRIs.The effect sizes of the associations for which risk measures were reported(n=131) were classified as large(n=30,23%),medium(n=38,29%),small(n=48,37%) or no effect(n=15,11%).Running/training characteristics,health and lifestyle factors,along with morphological and biomechanical aspects,exhibit large effect sizes in increasing the risk for RRIs.Conclusion:Drawing from the outcomes of the low-quality SRs and associations with large effect sizes,our findings indicate that running/training characteristics and health and lifestyle factors,as well as morphological and biomechanical aspects,are all implicated in elevating the risk of RRIs,emphasizing the multifactorial basis of injury incidence in running.Given the low quality and heterogeneity of SR,individual findings warrant cautious interpretation.

Prenatal and postnatal factors associated with sudden infant death syndrome:an umbrella review of meta-analyses

Background Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome(SIDS)effects is lacking.We investigated the risk and protective factors related to SIDS.Methods We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors.PubMed/MEDLINE,Embase,EBSCO,and Google Scholar were searched from inception until January 18,2023.Data extraction,quality assessment,and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines.According to observational evidence,credibility was graded and classified by class and quality of evidence(CE;convincing,highly suggestive,suggestive,weak,or not significant).Our study protocol was registered with PROSPERO(CRD42023458696).The risk and protective factors related to SIDS are presented as equivalent odds ratios(eORs).Results We identified eight original meta-analyses,including 152 original articles,covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents.Several risk factors,including prenatal drug exposure[eOR=7.84(95%CI=4.81–12.79),CE=highly suggestive],prenatal opioid exposure[9.55(95%CI=4.87–18.72),CE=suggestive],prenatal methadone exposure[9.52(95%CI=3.34–27.10),CE=weak],prenatal cocaine exposure[4.38(95%CI=1.95–9.86),CE=weak],prenatal maternal smoking[2.25(95%CI=1.95–2.60),CE=highly suggestive],postnatal maternal smoking[1.97(95%CI=1.75–2.22),CE=weak],bed sharing[2.89(95%CI=1.81–4.60),CE=weak],and infants found with heads covered by bedclothes after last sleep[11.01(95%CI=5.40–22.45),CE=suggestive],were identified.On the other hand,three protective factors,namely,breastfeeding[0.57(95%CI=0.39–0.83),CE=non-significant],supine sleeping position[0.48(95%CI=0.37–0.63),CE=suggestive],and pacifier use[0.44(95%CI=0.30–0.65),CE=weak],were also identified.Conclusions Based on the evidence,we propose several risk and protective factors for SIDS.This study suggests the need for further studies on SIDS-related factors supported by weak credibility,no association,or a lack of adequate research.

Association between antibiotic exposure and adverse outcomes of children and pregnant women: evidence from an umbrella review

Background Antibiotics are widely prescribed among children and pregnant women,but their safety profile is controversial.This study aimed to summarize and appraise current evidence for the potential impact of antibiotic exposure on pregnancy outcomes and children’s health.Methods PubMed,Embase,Web of Science and the Cochrane Database of Systematic Reviews were searched from inception to June 2022.Meta-analyses of any study design comparing the impact of antibiotic exposure with nonexposure among children,pregnant women and prepregnant women on adverse health outcomes of children and pregnancy were retrieved.The quality of evidence was assessed by a Measurement Tool to Assess Systematic Reviews 2(AMSTAR2)and the Grading of Recommendations,Assessment,Development and Evaluation(GRADE).Data were reanalyzed,and the credibility of the evidence was determined.Results Out of 2956 studies identified,19 articles with 39 associations were included.Totally 19 of the associations(48.72%)were statistically significant with a P value≤0.05,while only six were supported by highly suggestive evidence.Children with postnatal antibiotic exposure had a higher risk of developing asthma odds ratio(OR):1.95,95%confidence interval(CI):1.76–2.17,wheezing(OR:1.81,95%CI 1.65–1.97)and allergic rhinoconjunctivitis(OR:1.66,95%CI 1.51–1.83),with prediction intervals excluding the nulls.Quality assessed by both AMSTAR2 and GRADE of included meta-analyses were very low in general.Conclusions Antibiotic exposure in early life was associated with children’s long-term health,especially in cases of allergic diseases.Prenatal exposure might also influence children’s health in some aspects but requires more high-quality evidence.Potential adverse effects of antibiotics on pregnancy outcomes were not observed in our study.Studies with higher quality and better quantification of antibiotic exposure are needed in the future.

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。

甲状腺相关眼病治疗中不同单克隆抗体有效性与安全性的系统评价再评价

目的:全面评估甲状腺相关眼病(thyroidassociated ophthalmopathy,TAO)治疗中利妥昔单克隆抗体(rituximab,RTX)、托珠单克隆抗体(tocilizumab,TCZ)、替妥木单克隆抗体(teprotumumab,TMB)的有效性和安全性。方法:采用系统评价再评价方法,系统检索PubMed、Embase、Cochrane Library数据库中关于TAO治疗的系统评价/Meta分析,检索时间均为建库至2024年1月。分别采用PRISMA 2020声明、AMSTAR 2量表和GRADE工具评估纳入研究的报告质量、方法学质量及证据质量。结果:当前关于TAO治疗中3种单克隆抗体的系统评价在报告规范性、方法学质量和证据质量方面仍存在不足。目前仍缺少3种单克隆抗体直接比较的证据,基于间接比较证据,TCZ可能是最好的治疗方法,其次为TMB和RTX。有效性方面,TCZ、TMB可显著降低临床活动性评分、眼球突出度及生活质量,TCZ显著降低复视发生,RTX显著降低疾病应答,RTX及TCZ显著改善疾病失活率,RTX在复视、眼睑裂变化、NOSPECS评分与生活质量方面无显著差异。安全性方面的结论尚不一致,TCZ和TMB可能增加不良事件的发生率,而RTX在安全性方面与糖皮质激素或安慰剂相比无显著差异。结论:本研究为TAO治疗中3种单克隆抗体的选择提供循证依据。尽管TCZ在有效性方面可能具有优势,但考虑到现有证据的限制性,未来仍需更多高质量研究进一步验证和比较不同单克隆抗体在TAO治疗中的有效性和安全性。

Acupuncture and moxibustion for irritable bowel syndrome:An umbrella systematic review

BackgroundIrritable bowel syndrome(IBS)is a functional bowel disease characterized by abdominal pain or discomfort associated with altered bowel habits.Several clinical studies have demonstrated the effectiveness of acupuncture and moxibustion for IBS.Many systematic reviews of acupuncture and moxibustion for IBS have been published in recent years,but their results are not entirely consistent.ObjectiveTo evaluate the methodological,reporting,and evidence quality of systematic reviews of acupuncture and moxibustion for IBS.Search strategySystematic reviews of acupuncture and moxibustion for IBS published before February 20,2023 were searched in eight databases:PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang Data,VIP Database for Chinese Technical Periodicals,and China Biology Medicine.The keywords used for literature search were acupuncture,moxibustion,systematic review,meta-analysis,and irritable bowel syndrome.Inclusion criteriaSystematic reviews and meta-analyses of randomized controlled trials of acupuncture and moxibustion for IBS were included.Data extraction and analysisRelevant information was independently extracted by two investigators.The A MeaSurement Tool to Assess systematic Reviews 2(AMSTAR 2),Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA 2020),and Grading of Recommendations Assessment,Development and Evaluation(GRADE)were used to evaluate the methodological quality,reporting quality and evidence quality,respectively.ResultsA total of 342 studies were retrieved and 15 systematic reviews were included.The results of AMSTAR 2 showed low methodological quality in 2 studies and very low methodological quality in the remaining 13 studies,with main issues being failure to register a protocol,incomplete search strategy,not providing a list of excluded studies,incomplete consideration of the risk of bias in the included studies,and a failure to assess the publication bias.The results of PRISMA 2020 showed seriously deficient reporting quality of 2 studies,somewhat deficient reporting quality of 12 studies,and relatively complete reporting quality of 1 study,with the main problems being lack of a complete search strategy,non-availability of a list of excluded studies with justification for their exclusion,not conducting heterogeneity and sensitivity analyses,not evaluating the credibility of the evidence,and not registering the protocol.The results of GRADE showed that the quality of the evidence is low or very low.ConclusionMost included systematic reviews interpreted findings to suggest that acupuncture and moxibustion have benefits for IBS.However,there is a need to improve the methodological,reporting and evidence quality of the systematic reviews.Larger,multicenter,rigorously designed randomized controlled trials and high-quality systematic reviews are required to obtain more robust evidence.

神经氨酸酶抑制剂治疗流行性感冒有效性及安全性的系统评价再评价

目的:对神经氨酸酶抑制剂(neuraminidase inhibitor,NAI)治疗流行性感冒(简称流感)有效性及安全性的系统评价/Meta分析(Systematic reviews/Meta analysis,SRs/MRs)进行再评价,以期为该药的临床应用提供循证依据。方法:系统检索中国知网(CNKI)、万方数据知识服务平台(Wanfang)、维普网(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Cochrane Library、Web of Science数据库,收集NAI治疗流感的SRs/MRs,评价其原始研究质量,并分别采用AMSTAR-2量表及GRADE证据分级系统评价文献质量和证据质量。结果:共纳入11篇SRs/MRs,涉及78个结局指标。原始研究为高质量随机对照试验(randomized controlled trial,RCT),AMSTAR-2方法学质量评价为低级和极低级;GRADE证据质量评价显示,78个结局指标中级占10.3%,低级占53.8%,极低级占35.9%。结论:现有研究显示NAI治疗儿童、成人及老年人流感具有一定的疗效、安全性,但鉴于系统评价/Meta分析方法学质量及证据质量等级偏低,尚需开展更多高质量研究以获取高质量的研究结果去验证。

复合绝缘子用伞裙材料研究进展

介绍了绝缘子的应用现状及复合绝缘子的特点,总结了复合绝缘子伞裙材料中的高温硫化硅橡胶及其增强填料、阻燃剂、着色剂等添加剂,以及伞裙加工技术和缺陷检测技术的研究进展,对伞裙材料的研究提出了建议。

基础胰岛素联合口服降糖药治疗效果不佳的2型糖尿病患者的治疗策略选择:伞形评价

目的对基础胰岛素联合一线口服降糖药(二甲双胍/磺脲类药物)治疗效果不佳的2型糖尿病(T2DM)患者的不同治疗策略进行伞形评价,为患者推荐最佳治疗策略提供科学依据。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed、CNKI、WanFang Data和VIP数据库,搜集基础胰岛素联合一线口服降糖药治疗T2DM效果不佳的系统评价(SR)/Meta分析(MA),其原始研究为随机对照试验(RCT),检索时限均从建库至2023年9月13日,由2名研究者独立进行文献筛选、数据提取和文献质量评估,采用R 4.2.2软件中的metaumbrella包进行伞形评价。结果共纳入1篇SR和8篇MA,包括72个RCT,24095例患者,涉及的后续治疗措施有胰高糖素样肽1受体激动剂(GLP-1RA)、二肽基肽酶Ⅳ抑制剂(DPP-4i)、钠葡萄糖共转运蛋白2抑制剂(SGLT-2i)、噻唑烷二酮类药(TZD)等。结果显示,与安慰剂相比,GLP-1RA[WMD=-3.67,95%CI(-5.81,-1.53),P=0.001]、DPP-4i[WMD=-5.56,95%CI(-7.40,-3.73),P<0.001]和SGLT-2i[WMD=-5.34,95%CI(-9.56,-1.13),P=0.013]均可显著降低糖化血红蛋白(%)水平;阳性药物比较中,GLP-1RA vs.甘精胰岛素利司那肽固定比例复方制剂(IGlarLixi)[WMD=7.49,95%CI(7.01,7.92),P<0.001],GLP-1RA vs.德谷胰岛素利拉鲁肽注射液(IDegLira)[WMD=0.83,95%CI(0.11,1.54),P=0.023],显示GLP-1RA的降血糖效果不及IGlarLixi和IDegLira。与安慰剂相比,GLP-1RA可显著减轻体重(kg)[WMD=-3.46,95%CI(-5.30,-1.63),P<0.001];阳性药物比较中,GLP-1RA vs.IGlarLixi[WMD=-8.40,95%CI(-8.86,-7.93),P<0.001],GLP-1RA vs.IDegLira[WMD=-0.53,95%CI(-0.99,-0.07),P=0.025],显示GLP-1RA的降体重效果优于IGlarLixi和IDegLira。与安慰剂相比,TZD[OR=1.51,95%CI(1.11,2.05),P=0.009]和GLP-1RA[OR=1.24,95%CI(1.03,1.49),P=0.023]均会增加低血糖发生风险;阳性药物比较中,GLP-1RA vs.IDegLira[OR=1.22,95%CI(1.04,1.43),P=0.014],显示GLP-1RA导致的低血糖发生风险高于IDegLira。结论后续治疗使用GLP-1RA、DPP-4i、SGLT-2i能更好地控制血糖,且GLP-1RA有降低体重优势,但使用GLP-1RA的患者低血糖风险较高。

术前胆道引流对梗阻性黄疸预后的影响:一项伞状评价

目的评估术前胆道引流对梗阻性黄疸预后的影响。方法计算机检索PubMed、Web of Science、EMBase、The Cochrane Library数据库,检索有关术前胆道引流对梗阻性黄疸预后影响的系统回顾性研究或荟萃分析,由两名研究者独立根据纳入和排除标准进行评估,使用AMSTAR和GRADE进行治疗评价。结果共纳入17篇荟萃分析,其纳入研究的文献数量为5~44篇,中位数为14篇;样本量为312~23076例,中位数为1860例。共提取36项结局指标进行分析。分析表明术前胆道引流与17项指标显著相关,在术后胆红素水平、术后肝功能不全发生率、术后肝衰竭发生率3个指标具有显著优势。其余指标未能呈现改善趋势。直接手术在并发症发病率、死亡率、生存率等指标上优于术前胆道引流。结论对于大多数梗阻性黄疸患者来说,并不能从术前胆道引流中获益。因此并不能将术前胆道引流作为常规术前准备。如何判断使用术前胆道引流的适应症,最大程度上使患者获益,由于大多数结果的证据较低,未来需要更多的前瞻性队列研究。

雷公藤多苷治疗糖尿病肾病的系统评价再评价

目的 针对雷公藤多苷(TG)治疗糖尿病肾病(DKD)的系统评价/Meta分析进行系统评价再评价(伞形综述),以期为TG治疗DKD提供更高质量的循证依据。方法 检索中国知网、万方、维普、中国生物医学文献数据库和PubMed、Cochrane Library、Embase数据库中TG治疗DKD的系统评价/Meta分析,通过PRISMA 2020声明、AMSTAR 2量表、GRADE工具分别进行报告质量、方法学质量及证据质量评价,同时对纳入系统评价/Meta分析的定量结果进行综合分析。结果 共纳入18篇系统评价/Meta分析,PRISMA 2020声明评价结果显示,3篇文献报告较完整,13篇报告存在部分信息缺陷,2篇报告存在严重信息缺陷;AMSTAR 2量表评价结果显示,4篇文献方法学质量等级为低级,14篇文献方法学质量等级为极低级;GRADE工具评价结果显示,共106个结局指标,中级证据34个(占比为32.1%)、低级证据51个(占比为48.1%),极低级证据21个(占比为19.8%),无高级证据;各结局指标定量结果综合分析显示,TG对DKD总有效率、24 h尿蛋白定量、血清白蛋白均有确切改善作用,各研究不良反应结果不统一。结论 TG治疗DKD疗效较为确切,安全性仍需关注,未来有待更大样本量的研究进行验证。

精准医学背景下母方案设计临床应用的范围综述

目的全面检索国内外母方案设计的相关研究,了解其临床应用所覆盖的研究领域,为国内护理人员开展母方案设计相关研究的实施和推广提供参考。方法采用Arksey和O’Malley提出的范围综述方法,系统检索中国知网、万方数据库、中国生物医学文献数据库、维普、PubMed、Cochrane Library、Embase、Web of Science,检索时限为从建库至2023年4月。根据纳入、排除标准筛选文献,2名研究者独立提取母方案设计核心要素及其应用领域相关资料,采用描述性分析及主题分析法对提取结果进行整理。结果共纳入104篇文献,研究领域涉及肿瘤、临床心理学、新型冠状病毒肺炎等的药物开发评估及个性化健康计划的制定。母方案在国内外应用存在着明显差异,主要体现在3个方面:(1)应用范围不同,国外主要用于评估新药、疗法或医学器材的有效性和安全性,而在我国广泛应用于中医药领域;(2)研究类型有别,国外主要应用多中心随机对照试验、队列研究,而我国此类型研究相对较少;(3)经验和技术支持方面,由于历史和文化背景等原因,国外研究者在母方案的设计和实施方面拥有更丰富的经验和技术支持。因此,在推广和应用母方案时,需充分考虑国内外的差异,并结合本土实际情况探索出适合自身条件下的研究模式和方法,以推进其更广泛和深入的应用。结论母方案的实施是临床研究模式的一次突破性创新,当前母方案设计的应用多集中在肿瘤学、新型冠状病毒肺炎领域,但伞式试验和篮式试验可用于健康领域,平台试验的范围可应用于临床心理学和数字心理健康干预,国内护理研究者应重视对母方案设计的应用,在其指导下开展相关研究,提升护士创新行为,积极寻找新方法和技术,循证优化试验设计,解决临床护理问题,快速适应精准医学的发展。

减重手术与多种健康相关结局:一项伞状评价

背景减重手术的数量在世界范围内迅速增加。减重手术对于促进肥胖患者的体质量减少具有显著效果,且有助于改善糖尿病、高血压等疾病情况。但是减重手术也可能增加自杀等不良事件风险。因此需要全面、系统的研究来评估减重手术对多种健康相关结局的影响。目的确定减重手术除减轻体质量外,对各种健康相关结局的影响。方法计算机检索PubMed、Web of Science、EMBase、The Cochrane Library数据库,筛选有关减重手术和健康相关结局之间关联的系统回顾性研究或荟萃分析,检索时间为建库到2020-09-20,每项研究均由两名研究者独立根据纳入和排除标准进行评估,通过AMSTAR对纳入研究的方法学质量进行评估。结果共纳入25篇荟萃分析,通过AMSTAR对纳入研究的方法学质量进行评估,包括11个评分项目,AMSTAR评分中位数为10(7,11)分。从25项荟萃分析中提取54项结局指标进行分析,发现减重手术与多种癌症的风险、癌症死亡率、全因死亡率和心血管死亡率的降低相关。此外,减重手术对健康质量和多种慢性疾病有改善作用,特别是2型糖尿病、心血管疾病、尿失禁、非酒精性脂肪性肝病。一些功能性指标,包括性功能、肺功能、肾功能和体能活动在减重手术后均得到改善。然而,减重手术也增加了自杀、自残、情绪化进食和围生期不良事件的风险。结论大多数与健康相关的结局指标在减重手术后得到改善,同时,也应注意减重手术可能会增加不良精神问题和围生期不良事件的风险。由于本研究纳入的某些系统评价与荟萃分析的方法学质量以及部分健康相关结局指标的证据质量较低,未来仍需更多高质量的临床研究与系统评价进行验证。