China Network Knowledge Infrastructure Research Articles

Transcutaneous electrical acupoint stimulation reduces postoperative patients' length of stay and hospitalization costs: A systematic review and meta-analysis.

To study the effects of transcutaneous electrical acupoint stimulation (TEAS) on length of stay (LOS) and hospitalization costs in postoperative inpatients. Two researchers collectively searched PubMed, Embase, Cochrane Library, China Network Knowledge Infrastructure and Wanfang Database. The search time was set from the beginning to April 25, 2023, to identify randomized controlled trials articles that met the criteria. Statistical analyses were performed using the Stata software (version 16.0). The risk of bias was assessed using the Cochrane risk-of-bias tool, and publication bias was evaluated using a funnel plot and Egger's test. The quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Thirty-four randomized controlled trials were included. The main results showed that TEAS reduced hospitalization costs (standardized mean difference (SMD)=-1.92; 95% confidence interval (CI) -3.40, -0.43), LOS (SMD=-1.00; 95% CI -1.30, -0.70) and postoperative LOS (SMD=-0.70; 95% CI -0.91, -0.49) in postoperative patients. Subgroup analyses further revealed that TEAS was effective in reducing both the overall and postoperative LOS in patients undergoing multiple surgical procedures. It is worth noting that the observed heterogeneity in the results may be attributed to variations in surgical procedures, stimulation frequencies, and stimulation points utilized in different trials. TEAS can help postoperative patients reduce their LOS and hospitalization cost. However, considering the bias identified and heterogeneity, the results of this review should be interpreted with caution.

Acupoint catgut embedding for simple obesity in animal studies: a systematic review and Meta-analysis.

To assess the efficacy of acupoint catgut embedding (ACE) for simple obesity in preclinical animal experiments. We searched the following 14 electronic databases: PubMed, Cochrane Library, EMBASE, Oriental Medicine Advanced Searching Integrated System, KoreaMed, Korean Studies Information Service System, Science-on, Research Information Sharing Service, Korea Citation Index, Korea Traditional Knowledge Portal, China Network Knowledge Infrastructure Database, Wanfang Database, Chinese Science and Technology Journal Database, and Chinese Biology Medicine Database, from inception to November 2021 without language limitation. The assessment was performed according to the guidelines of Animal Research: Reporting of experiments; and Meta-analysis was performed using Reviewer Manager 5.4.1 software. Twenty-four studies involving 813 animals were selected. Meta-analysis showed that ACE was beneficial for weight control [ 40, = -50.63, 95% (－57.59, －43.67), 0.000 01, = 0%] and reduced the Lee index [ 40, = －18.79, 95% (－20.01, －17.57), 0.000 01, = 0%]. However, when efficacy of ACE was compared with that of manual acupuncture, electroacupuncture, or oilistat therapy, statistical difference was not observed between the two groups. This systematic review suggests that ACE may be efficacious in treating obesity. Moreover, the analyses highlighted the necessity to perform well-designed, higher-quality experiments.

The effect of horticultural therapy on older adults in pension institutions: a systematic review

AimsTo systematically evaluate the effect of horticultural therapy (HT) on older adults in pension institutions. DesignSystematic review was conducted based on the checklist for PRISMA. MethodsThe searches were conducted in the Cochrane library, Embase, Web of Science, PubMed, Chinese Biomedical Database (CBM), and the China Network Knowledge Infrastructure (CNKI), from their inception until May 2022. In addition, manual screening of references of relevant studies was performed to identify potential studies. We conducted a review of quantitative studies published in Chinese or English. Experimental studies were evaluated using the Physiotherapy Evidence Database (PEDro) Scale. ResultsA total of 21 studies involving 1214 participants were included in this review, and the quality of the literature was good. Sixteen studies were Structured HT. The effects of HT were significant in terms of physical, physiological, and psychological aspects. In addition, HT improved satisfaction, quality of life, cognition, and social relationships, and no negative events were found. ConclusionAs an affordable non-pharmacological intervention with a wide range of effects, horticultural therapy is suitable for older adults in pension institutions and is worth promoting in pension institutions, communities, homes, hospitals, and other institutions that require long-term care.

Pharmaceutical preparations of Periplaneta americana (KangFuXin liquid) in the treatment of pressure ulcer: A meta-analysis.

Pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. In China, convincing data from randomised trials have demonstrated that the pharmaceutical preparations of Periplaneta americana (KangFuXin Liquid, KFX) have a significant efficacy for pressure ulcers. To provide more reference to the clinicians and experts, we conducted a meta-analysis based on the existing randomised controlled trials (RCTs). We searched the RCTs about KFX for the treatment of pressure ulcers published up to July 2022 in major English and Chinese databases with no language restriction, including PubMed, EMBASE, Web of Science (WOS), Cochrane Central Register of Controlled Trials (CENTRAL), China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang database. Cochrane Handbook guidelines were used to assess the risk of bias and to evaluate the methodological quality of included RCTs. Estimates of the intervention's effects are expressed as the risk ratio (RR) (95% CI) for binary outcomes and mean difference or standardised mean difference (95% CI) for continuous outcomes. We applied fixed or random effects models, and all analyses were performed using Review Manager version 5.4 and Stata/SE version 12.0. We included 22 studies with a total of 1575 participants. Compared with controls, KFX combined with basic wound care or KFX combined with basic wound care and another topical drug or physical treatment significantly increase clinical efficacy (RR: 1.17; 95% CI, 1.06-1.28; P=0.001; I2 = 81%) and shorten the complete healing time (MD=-5.11; 95% CI [-8.19, -2.02]; P=0.001) for pressure ulcers. Subgroup analysis showed a significant difference in the total clinical effect rate between KFX combined with basic wound care and controls. (n=1018, RR 1.21, 95% CI [1.07, 1.36], I2 = 82%, P=0.003). No difference was found in the total clinical effective rate between patients using KFX combined with basic wound care and another topical drug or physical treatment with controls (KFX combined with basic wound care and topical physical treatment: n=267, RR 1.15, 95% CI [0.86, 1.52], I2 = 87%, P=0.34; KFX combined with basic wound care and topical drug: n=290, RR 1.05, 95% CI [0.80, 1.37], I2 = 86%, P=0.71). Based on treatment duration, subgroup analysis indicated that increasing treatment duration increased the total clinical effective rate when treatment duration was not long. (treatment duration: 14 days: n=158, OR 5.48, 95% CI [1.47, 20.43], I2 = 0%, P=0.01; 21 days: n=132, OR 5.93, 95% CI [1.86, 18.91], I2 = 65%, P=0.003). When treatment duration was 28 days or 30 days, the results showed that there was no significant difference in total clinical effective rate between interventions and controls (treatment duration: 28 days: n=107, OR 3.04, 95% CI [0.25, 37.32], I2 = 50%, P=0.38; 30 days: n=256, OR 0.58, 95% CI [0.11, 3.15], I2 = 65%, P=0.53). No data on side effects were reported in any of the 22 studies. Theconclusionisthatthe combination of KFX and basic wound care is effective in increasing the total clinical effectiveness and shortening the complete healing time of pressure ulcers.

The Effect of Traditional Chinese Medicine on Postviral Olfactory Dysfunction: A Systematic Review and Meta-Analysis.

The aim of this study is to evaluate the efficacy and safety of traditional Chinese medicine (TCM) for postviral olfactory dysfunction (PVOD). PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical (CBM) Database, and Wanfang Database were electronically searched from their inception to July 25, 2022. Two authors independently performed study selection, data extraction, and quality assessment to ensure systematic quality evaluation. Randomized controlled trials (RCTs) comparing TCM with olfactory training and/or drug therapy (OTDT) were included. The outcomes were the effective rate, QOD-P, TDI score, UPSIT score, and adverse effects. Cochrane RoB was the guideline used to evaluate the methodological quality of the included trials. RevMan 5.3 software was used for statistical analysis. A total of 6 RCTs involving 467 patients with PVOD were selected. Compared with OTDT, TCM plus OTDT decreased QOD-P (MD = -1.73, 95% CI (-2.40, -1.06), P < 0.0001) but did not increase the effective rate (T&T) (RR = 1.28, 95% CI (0.86, 1.90), P=0.22, I 2 = 61%). Compared with no treatment, TCM seemed to increase the treatment success rate (UPSIT) (RR = 3.17, 95% CI (1.78, 5.65), P < 0.0001, I 2 = 0%), but there was no statistically significant difference in improving the UPSIT score (MD = 3.44, 95% CI (-1.36, 8.24), P=0.16). Compared with drug therapy, TCM plus drug therapy appeared to increase the effective rate (ΔVAS) (RR = 2.36, 95% CI (1.41, 3.94), I 2 = 0%), but there was no statistically significant difference in improving the TDI score (MD = 2.10, 95% CI (-1.99, 6.19), P=0.31). No significant differences in adverse reactions were reported between TCM and OTDT. TCM may be an effective treatment for PVOD. With a lack of high-quality RCTs, further large-scale and high-quality RCTs are still warranted.

Efficacy and safety of Shouhui Tongbian Capsules in the treatment of constipation: A systematic review and meta-analysis

BackgroundConstipation is a common gastrointestinal disorder, which has seriously affected the quality of people's daily life. Traditional Chinese Medicine (TCM) therapy takes syndrome differentiation and treatment as the theoretical guidance with certain advantages in treating constipation with the holistic approach. However, there are few studies on the treatment of constipation with Shouhui Tongbian Capsules (SHTB). PurposeThis study was aimed to evaluate the clinical effect and safety of SHTB in the treatment of constipation and provide evidence-based references for clinical application. Study designA systematic review and meta-analysis of existing literature on SHTB for treating constipation. MethodsChinese databases (China Network Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database) and English databases (PubMed, EmBase and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on SHTB for constipation from the establishment of all databases to September 26, 2022. Data extraction and quality evaluation were performed on the literature that met the inclusion criteria and a meta-analysis was performed for selected data using Review Manager 5.4, ROB 2.0 and Stata 17.0. ResultsA total of 14 RCTs (randomized controlled trial) including 1310 participants were included in the analysis. The results showed that the test group was superior to the control group in improving the total effective rate and curative effect, clinical symptom score, gastrointestinal peptide index and reducing adverse reactions and recurrence rate. The specific results were as follows: ① The total effective rate increased significantly (RR = 1.24, 95% CI [1.18, 1.30], Z = 8.25, p< 0.00001); ② The clinical symptom indexs, including the difficulty of defecation [SMD = –1.28, 95% CI (–1.44, –1.12), Z = 15.65, p< 0.00001], the frequency of spontaneous defecation [SMD = 1.28, 95% CI (1.01, 1.54), Z = 9.52, p< 0.00001], defecation interval [SMD = –1.47, 95% CI (–1.68, –1.26), Z = 13.79, p < 0.00001], incomplete defecation [SMD = –1.34, 95% CI (–1.57, –1.11), Z = 11.42, p < 0.00001], duration of defecation [SMD = –2.02, 95% CI (–2.39, –1.65), Z = 10.73, p < 0.00001], stool characteristics [SMD = –2.30, 95% CI (–2.60, −1.99), Z = 14.72, p< 0.00001] and TCM main syndrome scores [SMD = −1.25, 95% CI (−1.46, −1.05), Z = 11.79, p< 0.00001] increased observably; ③ The gastrointestinal peptide hormone indexs, including MTL Level [SMD = 0.43, 95% CI (0.24, 0.62), Z = 4.44, p < 0.00001] and SP Level [RR =0.57, 95% CI (0.37, 0.87), Z = 2.61, p = 0.009] were improved obviously; ④ The incidence of adverse reactions (RR = 0.57, 95% CI [0.37, 0.87], Z = 2.61, p = 0.009) and recurrence rate (RR = 0.31, 95% CI [0.18, 0.54], Z = 4.28, P <0.001) reduced significantly. Sensitivity analysis showed that there was no significant change in all outcome indicators, which suggested that the results of meta-analysis were relatively stable. Funnel plot and Egger test results showed that the literature included in the study might have publication bias. ConclusionSHTB can be used to treat functional constipation, especially elderly functional constipation, constipation caused by tumor chemotherapy and disease concomitant constipation. The optimal dosage of SHTB was 0.70 g (2 capsules) each time, 3 times a day, for 28 days. Combined with basic treatment, lactose oral solution, mosaic or castor oil could improve the total effective rate, clinical symptom indicators, gastrointestinal peptide hormone indicators and reduce adverse reaction rate of patients. However, due to the limitations of the included clinical trials, high-quality clinical trials with long follow ups are needed to evaluate the effectiveness and safety of SHTB in treating different types of constipation.

Effectiveness of Chinese herbal medicine Zhi Shi Xiao Pi Wan on adult diabetic gastroparesis: a systematic review and meta-analysis

Chinese herbal medicine formula Zhi Shi Xiao Pi Wan (ZSXPW) is commonly used for gastrointestinal diseases. Previous research showed ZSXPW also suggested for diabetic gastroparesis (DGP) treatment. The aim of this study is to evaluate the effectiveness and safety of ZSXPW in treating adult DGP. Six databases, including Pubmed, Cochrane Library, EMBASE, China Network Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journals were searched from their inceptions to November 2021. Only randomized control trials (RCTs) evaluating ZSXPW for adult DGP were included in this review. Two investigators independently evaluated and extracted the data. Total 11 RCTs and 802 participants were included in the review. In these studies, ZSXPW was compared with oral cisapride, domperidone, and mosapride citrate tablets. The outcomes of effective rate, stomach emptying time, stomach emptying rate, motilin, gastrin, somatostatin, vasoactive intestinal peptide, and adverse events were analyzed. The effective rate of ZSXPW is higher than other pharmacotherapies (RR:1.24, 95% CI [1.16,1.32]). The results showed intervention group has better effect on gastric emptying time used (MD: -0.51, 95% CI [-0.81, -0.21]) and gastric emptying rate (MD: 19.32, 95% CI [12.82, 25.83]) than the comparison group. The meta-analysis results showed ZSXPW is effective on adult DGP.

Effects and Safety of the Tripterygium Glycoside Adjuvant Methotrexate Therapy in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Objective This study aimed to systematically review the efficacy and clinical safety of different courses and doses of tripterygium glycoside (TG) adjuvant methotrexate (MTX) therapy in the treatment of rheumatoid arthritis (RA). Methods Randomized controlled trials (RCTs) of TG adjuvant MTX therapy in patients with RA were retrieved from SinoMed, China Network Knowledge Infrastructure, WanFang Data, PubMed, Cochrane Library, and Embase from inception to September 30, 2021. The effects and clinical safety evaluations were conducted using RevMan 5.3 software. Results A total of 9 RCTs and 892 patients with RA were included in this study. In the meta-analysis, a total of 463 and 429 patients were enrolled into the TG adjuvant MTX therapy group and MTX monotherapy group, respectively. In comparison with MTX monotherapy, the results of the analyzed effects showed that the TG adjuvant MTX therapy can achieve 20%, 50%, and 70% improvements in American College of Rheumatology (ACR) criteria ACR20, ACR50, and ACR70 at P = 0.005, P = 0.0001, and P = 0.004, respectively. Simultaneously, the efficacy of the TG adjuvant MTX therapy was improved at either 30 or 60 mg/day over a six-month course compared to MTX monotherapy (P < 0.0001). There was no statistical difference in the effects between the doses of 30 and 60 mg/day after three months (P = 0.82). TG adjuvant MTX also reduced the expression rate of the swollen joint count, tender joint count, erythrocyte sedimentation rate, rheumatoid factor, and C-reactive protein in subgroup analyses with different courses and doses. In terms of hepatic adverse effects (P = 0.28), leukopenia (P = 0.78), gastrointestinal adverse effects (P = 0.17), cutaneous adverse effects (P = 0.94), and irregular menstruation adverse effects (P = 0.29), there was no statistically significant difference with TG adjuvant MTX therapy and MTX monotherapy with different courses and doses. Conclusions TG adjuvant MTX therapy is more effective than MTX monotherapy and is a safe strategy for RA treatment in doses of 30 or 60 mg/day over a treatment course of six months. However, high-quality multicenter RCT studies with large sample sizes are still needed to confirm the effects and clinical safety of different courses and doses of TG adjuvant MTX therapy.

Therapeutic efficacy and safety of Yinzhihuang granules with phototherapy in neonatal pathologic jaundice: An updated systematic review and meta-analysis

BackgroundYinzhihuang granule, consisting of extracts of Artemisia capillaris Thunb., Gardenia jasminoides Ellis, Lonicera japonica Thunb., and Scutellaria baicalensis Georgi is a well-known traditional Chinese patent medicine for patients with liver injury in China. However, the effects and safety of its use for pathologic jaundice in newborns require further systematic evaluation. PurposeTo systematically evaluate the efficacy and safety of Yinzhihuang granules for the treatment of neonatal pathologic jaundice and to provide clinical evidence. MethodsChinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and VIP Database) and English databases (PubMed, EmBase, and the Cochrane Library) were thoroughly investigated through screening randomized controlled trials on Yinzhihuang granules for neonatal pathologic jaundice from the establishment of all databases to November 18, 2021. A meta-analysis was performed for selected data using STATA software. TSA software was used for trial sequential analyses of the total effective rate and adverse reactions. ResultsA total of 19 trials and 2,221 newborns with pathologic jaundice were included in this study. Outcome measures of clinical efficacy in the experimental group were higher than in controls, including total bilirubin (WMD = -30.34, 95% CI = -35.44 to -25.23, p < 0.001), direct bilirubin (WMD = -15.03, 95% CI = -23.54 to -6.52, p < 0.001), indirect bilirubin (WMD = -11.22, 95% CI = -17.50 to -4.95, p < 0.001), recovery time (WMD = -2.96, 95% CI = -3.92 to -2.00, p < 0.001), hospitalization time (WMD = -3.83, 95% CI = -4.89 to -2.76, p < 0.001), and liver function indices. There were statistically significant differences between the two groups. Likewise, the incidence of adverse reactions, including diarrhea, erythra, and fever decreased remarkably in the trial group (RR = 0.44, 95% CI = 0.33 to 0.59, p < 0.001). Publication bias did not exist. We verified the efficacy and safety of Yinzhihuang granules with phototherapy for pathologic jaundice in newborns according using TSA analysis. ConclusionYinzhihuang granules with phototherapy for neonatal pathologic jaundice are more effective than phototherapy alone. The incidence of ADRs does not increase with the application of Yinzhihuang granules. Due to the heterogeneity across the included studies, additional multicenter clinical trials with follow-ups are needed to confirm our findings

Efficacy and Safety of Yinzhihuang Granule Combined with Phototherapy in Neonatal Pathological Jaundice Treatment: A Meta-Analysis

To assess the efficacy and safety of Yinzhihuang granule combined with phototherapy in neonatal pathological jaundice treatment. By searching China network knowledge infrastructure, Wan Fang database, Virtual IP address database, Virtual IP, PubMed, EmBase together with the Cochrane library until March 31st, 2022. Literatures on Yinzhihuang combined with phototherapy in neonatal pathological jaundice treatment were collected. Literatures were screened by the inclusion and exclusion criteria and data were extracted. A total of 19 literatures were included in this study, a total of 2221 neonates with pathological jaundice. The outcomes of metaanalysis demonstrated the total clinical effective rate of Yinzhihuang combined with phototherapy in neonatal pathological jaundice treatment was significantly higher than that of phototherapy. At the end of one course of treatment, the total bilirubin level was significantly lower than that of the phototherapy group. The recovery time and hospital stay were shorter than those in the phototherapy group. The occurrence rate of adverse reactions was reduced compared to that of phototherapy group and the difference was significant. Yinzhihuang granule combined with phototherapy in neonatal pathological jaundice treatment has better clinical effect and safety.

Effectiveness of horticultural therapy on physical functioning and psychological health outcomes for older adults: A systematic review and meta-analysis.

To systematically determine the effectiveness of horticultural therapy (HT) on the physical functioning and psychological health of older people. With advancing age and increased chronic diseases, older adults are vulnerable to physical deterioration and psychological problems. There is evidence that horticultural therapy (HT) has positive effect among older adults. However, less attention has been devoted to systematically evaluating the physical functioning and psychological health effects of HT in older adults. Systematic review and meta-analysis were conducted based on the checklist for PRISMA. The searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, China Network Knowledge Infrastructure, Wan Fang, and China Science and Technology Journal Database, from their inception until June 2021. Randomised controlled trials published in either English or Chinese were reviewed. The Review Manager 5.4software was used for meta-analyses. The quality of included studies was evaluated using the Cochrane risk of bias tool by two independent researchers. Ten studies involving 884 participants were included. Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer. Besides, HT was found to be more effective for promoting emotional functioning and well-being, subjective social functioning, and quality of life among the elderly. The attendance rate for HT was 66%-100%, and no negative events were found. Horticultural therapy has potentially positive effects on the physical functioning and psychological health of older adults. However, more rigorous randomised controlled trials with larger populations are required to confirm the findings. As a safe and promising nonpharmacological intervention, healthcare professionals may consider the HT intervention when caring for older adults with cancer, dementia and frailty.

Efficacy and Safety of Liquid Nitrogen Cryotherapy for Lichen Simplex Chronicus: A Meta-Analysis

Background: Lichen simplex chronicus (LSC) is characterized by localized lichenification and intense itching. It has been reported that the added use of liquid nitrogen cryotherapy (LNC) for LSC has significant efficacy and notable safety. Therefore, we conducted a meta-analysis based on existing randomized controlled trials (RCTs). Method: We searched RCTs on LNC for LSC published up to August 2020 using various databases, including PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang Database. Other studies were manually identified using the references cited in reviews. We applied fixed- or random-effects models, and all analyses were performed using Review Manager 5.4 software. Results: Twelve RCTs involving 1,066 participants provided eligible data for the meta-analysis. Based on the clinical effective rate, LNC treatment of LSC (risk ratio, RR 1.25, p = 0.005, I² = 82%) was superior to controls. Subgroup analysis showed that the use of LNC alone (RR 1.04, I² = 95%, p > 0.05) is not more effective than other therapies in the treatment of LSC, but the addition of LNC to the existing treatment increases the total clinical efficacy. Furthermore, the combined effect of LNC and topical medication (RR 1.39, I² = 0%, p < 0.0001) was better than that of LNC and oral medication (RR 1.30, I² = 0%, p < 0.00001). Greater frequency of LNC treatment did not improve the efficacy (thrice a week: RR 1.39 [1.21, 1.60]; twice a week: RR 1.27; once every 2 weeks: RR 1.32). Data from 6 RCTs with 508 participants showed no significant difference in AEs (p = 0.31) associated with added LNC treatment. Conclusion: The addition of LNC (applying a cotton swab soaked with liquid nitrogen to wipe the lesion for approximately 10 s each time) to topical ointments, is effective and safe in the treatment of LSC. Increasing the treatment frequency of LNC did not necessarily improve the efficacy.

The effect of traditional Chinese medicine treatment for post-viral olfactory dysfunction

Background:Post-viral olfactory dysfunction (PVOD) have been reported in infections caused by several respiratory viruses, especially in COVID-19 which influence severely the quality of life of affected subjects. Few study has been published on the treatment of PVOD. Traditional Chinese medicine (TCM) is an effective method for PVOD which effects and safety have been confirmed. Therefore, this study is aim to evaluate the effects of TCM on PVOD.Methods:A searching strategy will be carried out mainly in the following databases in English and Chinese, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical Database (CBM), and Wanfang Database. Only randomized controlled trials related to TCM for PVOD will be included to enhance effectiveness. The primary outcome is the effective rate of PVOD. The secondary outcomes are included olfactory domain value examination, visual analogue scale (VAS), questionnaires of olfactory disorders (QOD), T&T olfactometer test, Sniffin ticks test, and any other clinical assessments. Two authors will independently perform study selection, data extraction, and quality assessment to ensure the quality of the systematic evaluation. Every disagreement will be deal with by the third author. Data synthesis and subgroup analysis will be performed in the Review Manager V 5.3.3.Results:This study is aim to evaluate the efficacy and safety of TCM in PVOD.Conclusion: This meta-analysis may provide more reliable evidence-based medical evidence for clinical practice to assist patient in relieving PVOD.Ethics and dissemination:There is no need to acquire ethical approval for individuals come from literatures instead of recruiting directly. The findings of this review will be reported in peer-reviewed publications and/or presented at relevant conferences.Prospero registration number:CRD42021238977.

Clinical safety of total glucosides of paeony adjuvant therapy for rheumatoid arthritis treatment: a systematic review and meta-analysis

BackgroundTotal glucosides of paeony (TGP), an active compound extracted from the roots of Paeonia lactiflora Pallas, has been increasingly used as the adjunctive therapy for rheumatoid arthritis (RA) patients. Though TGP could mitigate the unanticipated adverse effects during the conventional treatment of RA, high-quality evidence-based meta-analysis data on this subject are still insufficient. The objective of this study is to evaluate the clinical safety of TGP adjuvant therapy in the RA treatment.MethodsPubMed, EMBASE, Web of Science, China Network Knowledge Infrastructure (CNKI), SinoMed and WanFang Data were retrieved for randomized controlled trials (RCTs) and cohort study about TGP adjuvant therapy in patients with RA up to 28 January 2021. Literatures with eligibility criteria and information were screened and extracted by two researchers independently. The RevMan5.3 software was used for data analysis with effect estimates as risk ratio (RR) with 95% confidence interval (CI).ResultsA total of 39 studies involving 3680 RA participants were included. There were 8 comparisons: TGP plus methotrexate (MTX) therapy versus MTX therapy, TGP plus leflunomide (LEF) therapy versus LEF therapy, TGP plus MTX and LEF therapy versus MTX plus LEF therapy, TGP plus tripterygium glycosides (TG) therapy versus TG therapy, TGP plus meloxicam (MLX) therapy versus MLX therapy and TGP plus sulfasalazine (SSZ) therapy versus SSZ therapy, TGP plus iguratimod (IGU) therapy versus IGU therapy, TGP plus prednisone acetate tablets (PAT) therapy versus PAT therapy. The meta-analysis results showed that the occurrence of hepatic adverse effect (RR = 0.31, 95% CI = 0.23–0.41, P < 0.00001) and leukopenia (RR = 0.41, 95% CI = 0.26–0.66, P = 0.0002) in TGP adjuvant therapy was significant decreased compared with non-TGP therapy. However, only TGP plus LEF therapy (RR = 0.22, 95% CI = 0.08–0.60, P = 0.003) and TGP plus MTX and LEF therapy (RR = 0.31, 95% CI = 0.22–0.42, P < 0.00001) had statistical difference in the subgroups of hepatic adverse effect. In leukopenia, TGP plus MTX and LEF therapy (RR = 0.47, 95% CI = 0.25–0.87, P = 0.02) had statistical difference.ConclusionsThis meta-analysis indicated that TGP adjuvant therapy might alleviate the incidence of hepatic adverse effect and leukopenia for the RA treatment compared to non-TGP therapy. The clinical safety of TGP adjuvant therapy warrant further investigation in experimental studies.

Efficacy and Safety of Cyclophosphamide for the Treatment of Graves’ Ophthalmopathy: A Meta-Analysis

Background: Graves’ ophthalmopathy (GO) is a complicated autoimmune disease. Cyclophosphamide (CTX) is an alkylant agent with highly potent immunosuppressive effects. Some case reports and recent randomized controlled trials (RCTs), have reported numerous patients with GO have benefited from CTX. However, its practical application value is still unclear. Therefore, we performed a meta-analysis to investigate the efficacy and safety of CTX for patients with GO. Methods: A literature search in the Embase, Cochrane, PubMed, China Network Knowledge Infrastructure (CNKI) and Chinese Scientific Journal Database (VIP) databases was undertaken through October 2020, looking for the open published RCTs related to CTX for the treatment of GO. The Cochrane bias risk assessment tool conducts the evaluation of included studies, and meta-analysis was performed using Revman 5.3 software. Subgroup analyses and sensitivity analyses were also performed. Findings: A total of twelve RCTs with 654 patients were included in the meta-analysis. CTX therapy brought about a higher response rate compared with non-CTX treatments (RR: 1.20; 95% CI: 1.10 to 1.31). Compared with the non-CTX group, considerable proptosis reduction was also observed in the CTX group (SMD: 1.35; 95% CI: 0.60 to 2.10), Subgroup meta-analysis showed that cumulative doses ≥4g of intravenous CTX (SMD: 1.86; 95% CI: 1.41 to 2.30) had a higher efficacy in the treatment of exophthalmos than non-CTX group, but when cumulative doses ≤4g of intravenous CTX (SMD: 0.04; 95% CI: ﹣0.29 to 0.37) there was no significant differences. The CTX group and the non-CTX group had no statistically significant difference in the proportion of adverse events (RR:0.74; 95% CI: 0.54 to 1.01). Furthermore, the above results were robust to sensitivity analysis. Interpretation: This review found that CTX is a relatively safe and viable treatment for patients with GO. Cumulative doses ≥4g of intravenous CTX appeared to show a superior ability in the treatment of exophthalmos. Nevertheless, large sample, multi-center, reasonable design, and high-quality clinical studies are still needed for further verification. Funding Statement: This work was supported by the Government and School Cooperation Program of Nanchong, Sichuan, China. Declaration of Interests: We declare no conflict of interests in this work.

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials.

Pudendal nerve block (PNB) is one of the common anesthesia methods, which has been widely applied in postoperative analgesia of hemorrhoids in recent years. To analyze the effectiveness and safety of PNB on postoperative analgesia of hemorrhoids, we conducted a systematic review of 7 randomized controlled trials (RCT) searched from PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), the China Network Knowledge Infrastructure (CNKI), the Wan Fang Database and Chinese Biomedicine (CBM), which were published before 7th September, 2020, and involved a total of 560 participants. We evaluated the function of PNB in improving outcomes of postoperative analgesia of hemorrhoids. Visual analogue scale (VAS) scores on postoperative 6, 12, 24, 48 h and the first time of defecation were enhanced by the application of PNB. The incidence of urinary retention, the need for analgesics [odds ratio (OR), 0.11; 95% CI, 0.04-0.37; P=0.0003] and the incidence of side effects (OR, 0.12; 95% CI, 0.04-0.39; P=0.004) in patients receiving PNB were lower than those of controls. In addition, there was no significant difference in the incidence of bleeding between groups. PNB could effectively relieve postoperative pain of hemorrhoids and reduce complications without increasing the incidence of side effects. Our results still need to be confirmed by high-quality, multi-center clinical studies.

Chinese Herbal Medicine for Psoriasis: Evidence From 11 High-Quality Randomized Controlled Trials.

Background: Chinese herbal medicine (CHM) provides a theoretical basis for the treatment of psoriasis with considerable benefits and a low toxicity. The purpose of this quantitative study was to show high-quality evidence of the efficacy and safety of CHM for the treatment of psoriasis to promote its clinical application. Methods: Several databases were systematically searched including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure, Chinese Scientific Journals Database, and Wan Fang Database. High-quality randomized controlled trials that compared CHM with non-CHM interventions were included. The RevMan5.3 software was used to calculate risk ratios (RR) at 95% confidence intervals (CI) and conduct the meta-analysis. Results: Altogether, 1,215 patients participated in this study, including 711 in the experimental group and 504 in the control group. The psoriasis area severity index (PASI) score of the CHM group was significantly lower than that of the placebo group (MD, −4.02; 95% CI, −6.71 to −1.34; p = 0.003). To achieve PASI-60 and PASI-75, the arrival rate of the CHM group was higher than that of the placebo group (PASI-60: RR, 3.52; 95% CI, 1.17 to 10.61; p = 0.03; PASI-75: RR, 9.87; 95% CI, 3.11 to 31.31; p = 0.0001). Furthermore, the efficacy rate was higher in patients receiving CHM than in those receiving placebo (RR, 1.72; 95% CI, 1.01 to 2.93; p = 0.04). The results suggested a greater impact of CHM in improving the dermatology life quality index (DLQI) of patients (MD, −2.12; 95% CI, −3.75 to −0.49; p = 0.01). Regarding pruritus severity, there was no significant difference between the two groups (MD, −1.90; 95% CI, −3.79 to −0.01; p = 0.05). The meta-analysis revealed that the recurrence rate (RR, 0.74; 95% CI, 0.32 to 1.71; p = 0.48) and proportion of adverse events (RR, 1.36; 95% CI, 0.95 to 1.93; p = 0.09) associated with using CHM were similar to those associated with using a placebo. Conclusion: CHM appears safe and effective in the treatment of psoriasis and has a great positive impact on the DQLI of patients; however, CHM could not completely eliminate skin lesions, improve pruritus severity, and reduce the recurrence rate.

Effect and safety of Chinese patent medicine capsules for recurrent angina pectoris after percutaneous coronary intervention: A protocol for systematic review and meta-analysis.

Introduction:Recurrent angina pectoris after percutaneous coronary intervention (PCI) is a common clinical syndrome, which seriously reduces the quality of life and health of patients, increases medical costs, and causes the risk of cardiogenic death. The efficacy of various western medicine improving angina symptoms has not been fully confirmed at the moment, whereas Chinese patent medicine capsules (CPMC) have been generally used in clinical practice due to the therapeutic efficacy and safety. This study evaluates the efficacy and safety of CPMC for stable angina after PCI, designed to provide more evidence for clinical treatment.Methods:This protocol was based on the previous reporting items. We will search 3 English databases (PubMed, Excerpta Medica Database, and the Cochrane Library) and 3 Chinese databases (China Network Knowledge Infrastructure, Wan Fang Database, and Chinese Biomedicine) until January 2020. RCTs to evaluate the efficacy and safety of CPMC for recurrent stable angina pectoris after PCI will be included. The primary outcome will be assessed by major adverse cardiovascular events and angina attack frequency. We will use the criteria provided by Cochrane risk of bias tool for quality evaluation and risk assessment, and use the Revman 5.3 for meta-analysis.Ethics and Dissemination:Ethical approval is not required for systematic review and meta-analysis. The results of this review will be disseminated in a peer-review journal.PROSPERO registration number:CRD42020164005.

Moving cupping therapy for plaque psoriasis: A PRISMA-compliant study of 16 randomized controlled trials.

Background:Clinical treatment of plaque psoriasis typically involves a comprehensive therapy, which is expensive and unsatisfactory, and some medications have serious side effects. Moving cupping therapy has shown good clinical efficacy in the treatment of plaque psoriasis; it can significantly relieve skin inflammation and excessive thickening of plaque psoriasis and has fewer side effects. However, a comprehensive evaluation of the current clinical evidence regarding its use is lacking.Methods:Several databases were systematically searched from inception to March 2, 2020, including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure, and Wan Fang. This review included randomized controlled trials on plaque psoriasis treatment with the use of moving cupping and in combination with Chinese herbs or conventional Western medicine therapy. These trial findings were compared with the treatment results using placebo, pharmaceutical medications, or Chinese herbs. Moving cupping treatment frequency was also compared.Results:Sixteen trials with 1164 participants met the inclusion criteria. Meta-analysis showed that the intervention group (moving cupping therapy) had a significant effect compared with the no-moving cupping therapy group (weighted mean difference = –1.22, 95% confidence interval [CI] [–1.58, –0.85], P < .00001 random model; I2 = 85%). Furthermore, moving cupping (weighted mean difference = –1.19, 95% CI [–1.98, –0.39], P = .003 random model; I2 = 85%) or combined with pharmaceutical medications (weighted mean difference = –1.55, 95% CI [–1.89, –1.20], P < .00001 random model; I2 = 0%) were better than pharmaceutical medications alone in treating plaque psoriasis. Cupping therapy significantly improved psoriasis recurrence rate (risk ratio = 0.33, 95% CI [0.16, 0.68], P = .003 fixed model; I2 = 28%). However, for the visual analogue score, moving cupping showed no obvious advantages (weighted mean difference = –0.27, 95% CI [–0.71, 0.17], P = .22 random model; I2 = 64%). Moreover, studies reported that moving cupping reduced serum tumor necrosis factor-α and vascular endothelial growth factor levels more significantly than pharmaceutical medications. Moving cupping was associated with few transient adverse reactions, such as redness, itching, and local skin burning.Conclusion:Moving cupping therapy could be an effective treatment either alone or as a combination therapy for plaque psoriasis. However, further large-scale, rigorously designed trials are needed to confirm these findings.

Xiao'er Xiaoji Zhike Oral Liquid Combined with Azithromycin for Mycoplasma pneumoniae Pneumonia in Children: A Systematic Review and Meta-Analysis.

Background This study was aimed at systematically evaluating the clinical effect and safety of Xiao'er Xiaoji Zhike oral liquid in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children and providing evidence-based references for clinical application. Methods The databases like Chinese Biomedical Literature Database, China Network Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journal Database, PubMed, EmBase, and the Cochrane Library were systematically investigated via searching clinical trials about Xiao'er Xiaoji Zhike oral liquid in treating MPP from the establishment of these databases to Jun 8, 2020, the valid data from which were entered meta-analysis. The quality of evidence was assessed by GRADE criteria. Results Totally, 15 trials and 1500 patients were involved in this review. It showed that clinical efficacy of trial group was more superior than control group at the outcome measures of cough disappearance time, lung rale disappearance time, fever subsidence time, total effective rate, lung X-ray infiltrates disappearing time, reduction of hospital stay, immunological indexes, and some other measures. And the differences between groups were statistically significant. There was no statistical difference in the adverse effects between two groups. Lung X-ray infiltrates disappearing time and cough disappearance time were separately high- and moderate-quality evidences while lung rale disappearance time and fever subsidence time were all low in accordance with GRADE criteria. Conclusions In accordance with trials with low methodological quality, Xiao'er Xiaoji Zhike oral liquid combined with azithromycin seems to be safe and superior to azithromycin alone for the treatment of MPP in children. However, further trials with rigorous methodology need to be implemented for these potential benefits.