Cochrane Bias Risk Assessment Research Articles

Traditional Chinese exercises on depression: A network meta-analysis.

Exercise is an important factor for the treatment and rehabilitation of depression. Traditional Chinese exercise is considered as an effective treatment for depression. In recent years, many studies have shown that Chinese exercise therapy may be safe in the treatment of depression. To evaluate the therapeutic effect of traditional Chinese exercise on depression using network meta-analysis. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP shop Database, China Biomedical Literature Database, and Wan Fang Data Knowledge Service Platform were included in randomized controlled studies on traditional Chinese exercises for the treatment of depression from the establishment of the library to July 2023. The literature was extracted and assessed for risk of bias using the Cochrane Risk of Bias Assessment and statistically analyzed using Review Manager 5.4 and Stata 14.2. A total of 25 studies involving 3 exercises with a total of 1605 cases were included. The results of the network meta-analysis showed that each exercise significantly reduced the 24-item Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale, Beck Depression Inventory, and Self-rating Depression Scale scores. However, conventional treatments have the advantage of improving the sleep quality of patients with depression. The 3 exercises included in this study were effective for depression. Baduanjin and Tai Chi were better at improving the outcomes related to depression and anxiety. The effect of sleep quality intervention was slightly worse. Larger, high-quality randomized controlled trials are needed to compare interventions across exercises in a more granular manner.

Efficacy of Acupuncture in Acute Exacerbation ofChronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

The effect of acupuncture as adjunctive therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was controversial. Thus, we aimed to evaluate the effects of acupuncture for treating AECOPD. Eight databases were searched from database inception to July 30, 2023. All RCTs compared acupuncture plus conventional western medicine with conventional western medicine alone were included. Outcomes were quality of life, lung function, blood oxygen condition, exercise capacity, daily symptoms, duration of hospitalization, and adverse events. The statistical analyses were conducted using Stata 17.0, and methodological quality was measured by the Cochrane bias risk assessment tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Twelve studies including 915 patients were included. Compared with conventional western medicine alone, acupuncture combined with conventional western therapy significantly improved quality of life (CAT: MD: -3.25; 95% CI: -3.73 to -2.78, P<0.001) and arterial blood gas (PaCO2: MD: -1.85; 95% CI: -2.74 to -0.95, P<0.001; PaO2: MD: 5.15; 95% CI: 1.22 to 9.07, P = 0.01). And for lung function, statistical benefits were found in FEV1/FVC (MD: 4.66; 95% CI: 2.21 to 7.12, P<0.001), but no difference was seen for FEV1% (MD: 1.83; 95% CI: -0.17 to 3.83, P = 0.073). There was no significant improvement in exercise capacity (6MWD: MD: 96.69; 95% CI: -0.60 to 193.98, P = 0.051), hospitalization duration (MD: -5.70; 95% CI: -11.97 to 0.58, P = 0.075), and dyspnea (mMRC: MD: -0.19; 95% CI: -0.61 to 0.63, P = 0.376) between two groups. Overall bias for CAT and mMRC was in "high" risk, FEV1%, FEV1/FVC, PaCO2, and PaO2 was in "some concern" and 1 RCT assessing hospitalization duration was in "low" risk. And the overall assessments were either moderate, low or very low certainty. Seven trials performed safety assessment of acupuncture, and no serious adverse events were reported. Acupuncture might have auxiliary effects on AECOPD. However, the quality of the evidence is limited, and more high-quality RCTs are needed to be performed in the future.

Caries in Primary Molars: Is Silver Diamine Fluoride Effective in Prevention and Treatment? A Systematic Review

In recent years, pediatric dentistry has evolved considerably in terms of both the techniques and materials used. A clear, odorless liquid called silver diamine fluoride (SDF) is recommended for molars affected by hypoplasia and dentinal hypersensitivity. In adults and children who are at a high risk of developing caries, it is also helpful to prevent the progression of carious lesions. Teeth too compromised to be reconstructed that are not accompanied by discomfort or infection can be treated with SDF. The current review aims to provide an overview of the most recent research over the last 10 years on the potential of SDF, focusing on the clinical evidence of professionally applied fluoride therapy to prevent and arrest caries in children’s primary molars. Research was conducted according to the guidelines of the PRISMA statement. “silver diamine fluoride”, “primary molar”, and “primary molars” were the search terms utilized on the databases Scopus, Web of Science, and PubMed, with the Boolean operator “AND” and “OR”. Of these 195 studies, 13 primary studies were included in this review. The quality of the included papers was assessed using the reputable Cochrane risk of bias assessment for randomized trials. The studies reviewed consistently support the effectiveness of SDF in stopping the progression of existing caries in deciduous molars; on the contrary, there is insufficient evidence to draw conclusions about SDF being effective for the prevention of carious lesions in deciduous molars.

The effect of single-component sleep restriction therapy on depressive symptoms: A systematic review and meta-analysis.

Sleep restriction therapy is a behavioural component within cognitive behavioural therapy for insomnia and is an effective standalone treatment for insomnia, but its effect on depressive symptoms remains unclear. This review aimed to synthesise and evaluate the impact of single-component sleep restriction therapy on depressive symptoms relative to a control intervention. We searched electronic databases and sleep-related journals for randomised controlled trials and uncontrolled clinical trials, published from 1 January 1986 until 19 August 2023, that delivered sleep restriction therapy to adults with insomnia. Random-effects meta-analysis of standardised mean differences and Cochrane risk of bias assessment were performed on randomised controlled trials, while uncontrolled clinical trials were discussed narratively. The meta-analysis was pre-registered on PROSPERO (ID: CRD42020191803). We identified seven randomised controlled trials (N = 1102) and two uncontrolled clinical trials (N = 22). Findings suggest that sleep restriction therapy is associated with a medium effect for improvement in depressive symptoms at post-treatment (Nc = 6, g = -0.45 [95% confidence interval = -0.70 to -0.21], p < 0.001) and a small effect at follow-up (Nc = 4, g = -0.31 [95% confidence interval = -0.45 to -0.16], p < 0.001). Five of the seven included randomised controlled trials were judged to have a high risk of bias. Standalone sleep restriction therapy appears to be efficacious for improving depressive symptoms at post-treatment and follow-up. However, conclusions are tentative due to the small number of trials and because none of the trials was performed in a population with clinically defined depression. Large-scale trials are needed to test the effect of sleep restriction therapy in patients experiencing depression and insomnia. Findings also highlight the need to improve the standardisation and reporting of sleep restriction therapy procedures, and to design studies with more rigorous control arms to reduce potential bias.

Clinical efficacy of acupuncture in treating postoperative gastrointestinal dysfunction of colorectal cancer, a systematic review and Meta analysis.

To evaluate the efficacy of acupuncture in the treatment of postoperative gastrointestinal dysfunction(POGD) of colorectal cancer. Randomized controlled trials of acupuncture in the treatment of POGD were retrieved from 7 databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Chinese Journal Service Platform, WanFang Data Knowledge Service Platform, and China Biology Medicine disc. The search period ranged from the inception of the databases to November 10th, 2022. The quality of the included literature was assessed using the Cochrane bias risk assessment tool and the modified Jadad scale. Meta analysis was conducted using RevMan 5.4. Regression analysis and bias risk analysis were performed using Stata 16.0. Trial sequential analysis was conducted using TSA 0.9 software. A total of 27 randomized controlled trials involving 2 629 patients were included. Intervention measures included manual acupuncture, electroacupuncture, transcutaneous acupoint electrical stimulation, warm acupuncture, and thumb-tack needle. The results showed that acupuncture treatment significantly reduced time to tolerance of liquid diet after surgery (MD=-13.70, 95% CI=［-17.94, -9.46］, P<0.000 01), time to first defecation (MD=-18.20, 95% CI=［-22.62, -13.78］, P<0.000 01), time to first flatus (MD=-16.31, 95% CI=［-20.32, -12.31］, P<0.000 01), time to bowel sounds recovery (MD=-11.91, 95% CI=［-14.01, -9.81］, P<0.000 01), and length of hospital stay (MD=-1.49, 95% CI=［-2.27, -0.70］, P=0.000 2). Regression analysis indicated that cancer type, study quality and number of acupuncture were the main sources of heterogeneity. Bias analysis suggested potential publication bias risks. Trial sequential analysis indicated that the required number of cases had been met and the conclusion was reliable. Acupuncture is an effective intervention for promoting gastrointestinal recovery in patients undergoing colorectal cancer surgery. Further large-sample and well-designed clinical trials are still needed to compare different acupuncture techniques.

Postpartum Pelvic Floor Muscle Training for Reducing Urinary Incontinence: A Systematic Review of Randomized Control Trials

Postpartum urinary incontinence is an increasingly prevalent problem for women, as it affects about one-third of women. The clinical significance of urine incontinence in relation to deficiencies in the active and passive pelvic floor structures is well recognized. Hence, pelvic floor muscle training (PMFT) treatment for urine incontinence is recommended. Several research studies suggest that PFMT prevents and treats pregnancy- and delivery-related urine incontinence. This study aimed to determine the effectiveness of postpartum PFMT for the treatment of urinary incontinence. Randomized control trials reporting the efficiency of PFMT among postpartum women from 2003–2023 were included. Studies including pregnant women or women who underwent any surgical intervention, along with studies describing pharmacological interventions and others apart from PFMT or PFMT with electrostimulation or biofeedback, were excluded. Additionally, studies with insufficient or unclear data regarding pregnancy outcomes were excluded. A Cochrane bias risk assessment tool was utilized to assess the quality of the studies. Final inclusion resulted in 7 studies that recruited 1398 patients. Four of the included trials assessed the endurance and strength of PFMT, and various rates of strength and endurance were observed among participants in both the intervention and control groups. The prevalence of urinary incontinence in comparison to the control group was observed to be lower in the intervention group, which demonstrates the beneficial role of PFMT in the management of urinary incontinence postpartum. There is strong evidence to suggest the effectiveness of PFMT in the management of postpartum urinary incontinence. However, this beneficial role of PFMT is often overlooked or under-described in clinical practice, for which awareness among clinicians and patients is vital. Additionally, awareness and planning for PFMT execution during antenatal visits can also help prevent urinary incontinence postpartum.

The Efficacy of Internet-Based Cognitive Behavioral Therapy for Patients With Breast Cancer: A Systematic Review and Meta-Analysis.

To systematically review and analyze the effects of Internet-based cognitive behavioral therapy (ICBT) on physical, psychological, and daily life outcomes in patients with breast cancer. Relevant studies were retrieved from Wanfang, CBM, CNKI, CINAHL, PsycINFO, Web of Science, The Cochrane Central Register of Controlled Trials, Embase and PubMed from inception to December 2023. Two independent authors conducted the literature search and data extraction. The Cochrane bias risk assessment tool was used to evaluate the included studies for methodological quality, and the data analysis was performed using Stata (Version 15.0). Among 700 records, 11 randomized controlled trials were identified in this study. The meta-analysis showed statistically significant effects of ICBT on depression (standardized mean difference (SMD) = -0.38, 95% confidence interval (CI): -0.70 to -0.06, P = .019) and insomnia severity (SMD = -0.71, 95% CI: -1.24 to -0.19, P = .008). However, there were no statistically significant effects on anxiety, fatigue, sleep quality and quality of life. ICBT appears to be effective for improving depression and reducing insomnia severity in patients with breast cancer, but the effects on anxiety, fatigue, sleep quality and quality of life are non-significant. This low-cost treatment needs to be further investigated. More randomized controlled trials with a larger sample size, strict study design and multiple follow-ups are required to determine the effects of ICBT on patients with breast cancer.

The impact of different activation protocols of rapid maxillary expansion on external root resorption: a systematic review and meta-analysis.

This comprehensive meta-analysis investigated the effects of Rapid Maxillary Expansion (RME) on external root resorption, which is a prevalent orthodontic treatment intended to correct transverse maxillary deficiency and constricted dental arches. By conducting a systematic literature search across prominent electronic databases, including the Cochrane Library, EMBASE, LILACS, MEDLINE, PubMed, and Web of Science, the study compiled evidence until April 2023. A spectrum of search terms was utilized to capture diverse aspects of root resorption, RME, palatal expansion methods, and tooth erosion. Registered with INPLASY (202430057), the meta-analysis meticulously screened 11 studies that fulfilled stringent inclusion criteria. The quality of these studies was assessed using the Cochrane Bias Risk Assessment Tool for Randomized Controlled Trials (RCTs) and the Methodological Index for Non-Randomized Studies (MINORS) for other research designs. The collective analyses disclosed a substantial impact of RME on external root resorption, indicating that the treatment may induce pronounced root erosion. Subgroup analyses further elucidated distinct patterns in root resorption among various types of RME, underscoring the variability in treatment outcomes and the need for personalized care. Consequently, the meta-analysis unequivocally confirmed that external root resorption may be a concerning consequence of RME treatment, necessitating thorough monitoring and management strategies to mitigate potential adverse effects on dental health.

Impact of a positive end-expiratory pressure strategy on oxygenation, respiratory compliance, and hemodynamics during laparoscopic surgery in non-obese patients: a systematic review and meta-analysis of randomized controlled trials

BackgroundHigher positive end-expiratory pressure (PEEP) during laparoscopic surgery may increase oxygenation and respiratory compliance. This meta-analysis aimed to compare the impact of different intraoperative PEEP strategies on arterial oxygenation, compliance, and hemodynamics during laparoscopic surgery in non-obese patients.MethodsWe searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from January 2012 to April 2022 comparing the different intraoperative PEEP (Low PEEP (LPEEP): 0–4 mbar; Moderate PEEP (MPEEP): 5–8 mbar; high PEEP (HPEEP): >8 mbar; individualized PEEP - iPEEP) on arterial oxygenation, respiratory compliance (Cdyn), mean arterial pressure (MAP), and heart rate (HR). We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.Results21 RCTs (n = 1554) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2 (+ 29.38 [16.20; 42.56] mmHg, p < 0.0001) or PaO2/FiO2 (+ 36.7 [+ 2.23; +71.70] mmHg, p = 0.04). HPEEP vs. MPEEP increased PaO2 (+ 22.00 [+ 1.11; +42.88] mmHg, p = 0.04) or PaO2/FiO2 (+ 42.7 [+ 2.74; +82.67] mmHg, p = 0.04). iPEEP vs. MPEEP increased PaO2/FiO2 (+ 115.2 [+ 87.21; +143.20] mmHg, p < 0.001). MPEEP vs. LPEP, and HPEEP vs. MPEEP increased PaO2 or PaO2/FiO2 significantly with different heterogeneity. HPEEP vs. LPEEP increased Cdyn (+ 7.87 [+ 1.49; +14.25] ml/mbar, p = 0.02). MPEEP vs. LPEEP, and HPEEP vs. MPEEP did not impact Cdyn (p = 0.14 and 0.38, respectively). iPEEP vs. LPEEP decreased driving pressure (-4.13 [-2.63; -5.63] mbar, p < 0.001). No significant differences in MAP or HR were found between any subgroups.ConclusionHPEEP and iPEEP during PNP in non-obese patients could promote oxygenation and increase Cdyn without clinically significant changes in MAP and HR. MPEEP could be insufficient to increase respiratory compliance and improve oxygenation. LPEEP may lead to decreased respiratory compliance and worsened oxygenation.Prospero registrationCRD42022362379; registered October 09, 2022.

Meta-analysis of the efficacy of ω-3 polyunsaturated fatty acids when treating patients with polycystic ovary syndrome.

To systematically assess the efficacy of ω-3 polyunsaturated fatty acids (PUFAs) when treating polycystic ovary syndrome (PCOS). This meta-analysis follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We searched PubMed, EMBASE, ScienceDirect, Cochrane Library, China journal full-text database, VIP full-text Database, Wanfang Database, and Chinese Biomedical Literature Data for clinical trials on ω-3 PUFAs' efficacy in treating PCOS. Two independent reviewers examined and analyzed studies, resolving inconsistencies through discussion. RevMan5.3 software performed heterogeneity-based fixed and random-effects meta-analysis. We assessed bias using the Cochrane bias risk assessment tool. Our meta-analysis included 7 clinical control studies comprising 574 samples to evaluate the impact of ω-3 PUFAs on various metabolic markers in PCOS patients. We observed a significant reduction in total cholesterol (TC) and triglyceride (TG) levels (P < .05), along with a decrease in insulin resistance as measured by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (P < .05). Testosterone (T) levels were also lowered in the study group post-treatment (P < .05). However, no notable effects were found on body mass index (BMI), fasting blood sugar (FBS), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and Ferriman-Gallwey (mFG) scores (P > .05). Publication bias was not detected, enhancing the robustness of our results. Our study suggests that ω-3 PUFAs could be beneficial in managing specific metabolic markers in PCOS, although the results showed marked heterogeneity. In PCOS patients, PUFAs can enhance reproductive endocrine, glucose, and lipid levels. However, additional research and extended follow-up are required to confirm this.

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials.

Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials. A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology. The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low. Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Local Immunomodulation of Human Periodontal Ligaments Stem Cells (PDLSC) in Periodontitis: A Systematic Review

Background: Human periodontal ligament stem cells (PDLSC) are multipotent cells, derived from periodontal ligament (PDL), that can attain the formation of new bone, cementum, and periodontal ligament. However, the quantity of stem cells found in PDL tissues is deficient. Therefore, in periodontitis, the limited PDLSCs make regeneration of the periodontium challenging and unpredictable. Objectives: To critically appraise the available experimental evidence of the local immunomodulation signaling systems and their surrounding functional molecules for repair and application in periodontal regeneration therapy. Methods: This systematic review was conducted using PRISMA 2020 guidelines and research papers were selected based on strict exclusion and inclusion criteria. PubMed, Cochrane Library, Google Scholar and Web of Science databases were used to collect all the research papers ranging from January 2012 to December 2022. Results: Nine out of 586 research papers that focused on PDLSCs during inflammatory conditions were selected based on the Cochrane Risk of Bias Assessment. Seven articles documented that non-coding microRNAs (ncRNAs) played critical roles in the modification of PDLSC multipotency in periodontitis. An article showed that the post-translational modifications are influenced by histone deacetylases (HDAC) indicating the involvement of novel epigenetic signaling systems. A natural product-derived functional molecule resveratrol is described to have anti-inflammatory properties through the nuclear factor kappa B (NF-kB) pathway. Conclusion: The results of our present systematic review clearly apprise that the ncRNAs signaling system and natural products derived anti-inflammatory functional molecules play a clinically significant therapeutic target in novel periodontitis therapy as preventive, diagnostic, therapeutic, and prognostic markers.

Review articles (Meta-Analyses) effects of walking on cognitive function in individuals with mild cognitive impairment: a systematic review and meta-analysis

BackgroundMild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Previous studies have shown that regular exercise can improve cognition and physical performance in older adults. Walking is a low-technology and low-cost exercise that has been proven to improve cognition and mobility in healthy elderly individuals. However, no systematic review or meta-analysis has explored whether walking can improve cognitive function in older adults with MCI. This study aimed to explore the effects of walking interventions on cognitive functions in individuals with MCI.MethodsIn accordance with the PRISMA guidelines, MEDLINE, PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan were searched from inception to July 2023. Independent reviewers selected randomized clinical trials (RCT) that compared the effects of walking with no intervention or other exercises in individuals with MCI. The primary outcomes were cognitive functions, and the secondary outcome was walking endurance. Three reviewers independently conducted data extraction. The risk of bias was assessed using the Revised Cochrane Risk of Bias assessment tool.ResultsFourteen RCTs were included in this review. The quality of evidence in these studies was rated as good to excellent. The results of the meta-analysis showed that the individuals with MCI had no significant improvement in cognitive function but had significant improvement in the 6-min walk test (Mean Difference=23.70, p=0.008) after walking interventions compared to no intervention or other exercises.ConclusionWalking intervention has no significant improvement on cognitive functions in older adults with MCI. However, walking induces beneficial effects on aerobic capacity.Trial registrationThis systematic review has the registration number CRD42021283753 on PROSPERO.

Comparative Efficacy of Different Drugs for the Treatment of Dilated Cardiomyopathy: A Systematic Review and Network Meta-analysis.

At present, the therapies of dilated cardiomyopathy concentrated on the symptoms of heart failure and related complications. The study is to evaluate the clinical efficacy of a combination of various conventional and adjuvant drugs in treating dilated cardiomyopathy via network meta-analysis. The study was reported according to the PRISMA 2020 statement. From inception through 27 June 2022, the PubMed, Embase, Cochrane library, and Web of Science databases were searched for randomized controlled trials on medicines for treating dilated cardiomyopathy. The quality of the included studies was evaluated according to the Cochrane risk of bias assessment. R4.1.3 and Revman5.3 software were used for analysis. There were 52 randomized controlled trials in this study, with a total of 25 medications and a sample size of 3048 cases. The network meta-analysis found that carvedilol, verapamil, and trimetazidine were the top three medicines for improving left ventricular ejection fraction (LVEF). Ivabradine, bucindolol, and verapamil were the top 3 drugs for improving left ventricular end-diastolic dimension (LVEDD). Ivabradine, L-thyroxine, and atorvastatin were the top 3 drugs for improving left ventricular end-systolic dimension (LVESD). Trimetazidine, pentoxifylline, and bucindolol were the top 3 drugs for improving the New York Heart Association classification (NYHA) cardiac function score. Ivabradine, carvedilol, and bucindolol were the top 3 drugs for reducing heart rate (HR). A combination of different medications and conventional therapy may increase the clinical effectiveness of treating dilated cardiomyopathy. Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with dilated cardiomyopathy (DCM). Hence, they can be used if patients tolerate them. If LVEF and HR do not meet the standard, ivabradine can also be used in combination with other treatments. However, since the quality and number of studies in our research were limited, large sample size, multi-center, and high-quality randomized controlled trials are required to corroborate our findings.

Efficacy of single-pill combination in uncontrolled essential hypertension: A systematic review and network meta-analysis.

This study aimed to evaluate the efficacy of single-pill combination (SPC) antihypertensive drugs in patients with uncontrolled essential hypertension. Through Searching Pubmed, EMBASE, the Cochrane Library, and Web of Science collected only randomized controlled trials on the efficacy of single-pill combination antihypertensive drugs in people with uncontrolled essential hypertension. The search period is from the establishment of the database to July 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Assessment, and statistical analyses were performed using Review Manage 5.3 and Stata 15.1 software. This review ultimately included 32 references involving 16 273 patients with uncontrolled essential hypertension. The results of the network meta-analysis showed that a total of 11 single-pill combination antihypertensive drugs were included, namely: Amlodipine/valsartan, Telmisartan/amlodipine, Losartan/HCTZ, Candesartan/HCTZ, Amlodipine/benazepril, Telmisartan/HCTZ, Valsartan/HCTZ, Irbesartan/amlodipine, Amlodipine/losartan, Irbesartan/HCTZ, and Perindopril/amlodipine. According to SUCRA, Irbesartan/amlodipine may rank first in reducing systolic blood pressure (SUCRA: 92.2%); Amlodipine/losartan may rank first in reducing diastolic blood pressure (SUCRA: 95.1%); Telmisartan/amlodipine may rank first in blood pressure control rates (SUCRA: 83.5%); Amlodipine/losartan probably ranks first in diastolic response rate (SUCRA: 84.5%). Based on Ranking Plot of the Network, we can conclude that single-pill combination antihypertensive drugs are superior to monotherapy, and ARB/CCB combination has better advantages than other SPC in terms of systolic blood pressure, diastolic blood pressure, blood pressure control rate, and diastolic response rate. However, due to the small number of some drug studies, the lack of relevant studies has led to not being included in this study, which may impact the results, and readers should interpret the results with caution.

The effects of pharmaceutical interventions on potentially inappropriate medications in older patients: a systematic review and meta-analysis.

Potentially inappropriate medications (PIMs) is a particular concern in older patients and is associated with negative health outcomes. As various interventions have been developed to manage it, we performed a systematic review and meta-analysis to evaluate the effect of pharmaceutical interventions on outcomes of PIMs in older patients. Meta-analysis of eligible randomized controlled trials (RCTs) was conducted to report the outcomes of pharmaceutical interventions in older patients searching from the databases of Cochrane Library, PubMed, Embase, Web of Science, Clinicaltrials.gov, SinoMed and Chinese Clinical Trial Registry (ChiCTR). The PRISMA guidelines were followed and the protocol was registered in PROSPERO (CRD42019134754). Cochrane bias risk assessment tool and the modified Jadad scale were used to assess the risk bias. RevMan software was used for data processing, analysis and graphical plotting. Sixty-five thousand, nine hundred seventy-one patients in 14 RCTs were included. Of the primary outcomes, pharmaceutical interventions could significantly reduce the incidence of PIMs in older patients (OR = 0.51, 95% CI: 0.42, 0.62; p < 0.001), and the number of PIMs per person (MD = -0.41, 95%CI: -0.51, -0.31; p < 0.001), accompanying by a low heterogeneity. Subgroup analysis showed that the application of computer-based clinical decision support for pharmacological interventions could remarkably decrease the incidence of PIMs and two assessment tools were more effective. Of the secondary outcomes, the meta-analysis showed that pharmacological interventions could reduce the number of drugs used per person (MD = -0.94, 95%CI: -1.51, -0.36; p = 0.001) and 30-day readmission rate (OR = 0.58, 95%CI: 0.36, 0.92; p = 0.02), accompanying by a low heterogeneity. However, the pharmaceutical interventions demonstrated no significant improvement on all-cause mortality and the number of falls. Our findings supported the efficacy of pharmaceutical interventions to optimize the use and management of drugs in older patients. https://clinicaltrials.gov/, CRD42019134754.

Preventive effects of 13 different drugs on colorectal cancer: a network meta-analysis.

The aim of the study was to evaluate the preventive effect of 13 drugs on colorectal cancer (CRC) and guide the clinical application of these drugs. PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure were searched for randomized controlled trials (RCTs) and cohort studies. The Cochrane bias risk assessment tool and the Newcastle-Ottawa Scale quality evaluation tool were used to evaluate the quality of the included RCTs and cohort studies. The funnel plot was used to analyze publication bias. A network meta-analysis of the extracted data was conducted using Stata16.0 software. A total of 57 studies (34 RCTs and 23 cohort studies) involving 82719 participants were included. The network meta-analysis revealed that the quality of the included studies was good; the funnel plot showed no obvious publication bias. The network meta-analysis showed that the preventive effect of 13 drugs on CRC was better than that of the placebo. Allopurinol (SUCRA: 97.2%) was found to have the best effect, followed by berberine (SUCRA: 89.9%), non-aspirin NSAIDs (SUCRA: 84.5%), statins (SUCRA: 66.5%), metformin (SUCRA: 66.3%), calcium (SUCRA: 48.9%), mesalazine (SUCRA: 44.5%), ursodeoxycholic acid (SUCRA: 42.6%), vitamin D (SUCRA: 41.4%), mercaptopurine (SUCRA: 39.4%), aspirin (SUCRA: 30.4%), folic acid (SUCRA: 24.9%), and eicosapentaenoic acid (SUCRA: 16.3%). The preventive effect of allopurinol on CRC was better than that of the other 13 drugs. These results can help doctors and patients understand the preventative effects of these drugs more intuitively and provide an evidence-based basis for the clinical application of these drugs.

Effects of mind-body therapies in knee osteoarthritis: a systematic review and network meta-analysis

IntroductionKnee osteoarthritis (KOA) is a frequent degenerative condition. Patients with KOA have employed mind-body therapies frequently, and their efficacy has been established. The main purpose of our study is to compare the effects of different mind-body therapies on patients with KOA.Material and methodsOnly randomized controlled trials (RCTs) were gathered through searches in the Cochrane Library, PubMed, EBSCO, Web of Science, Medline, and Embase to investigate the effects of various mind-body therapies on effect in KOA patients. The Cochrane bias risk assessment tool was used to assess the methodological quality of the included studies, and the data analysis program was then used to analyze the data in accordance.ResultsThe study used an overall sample size of 859 from a total of 17 RCTs. In addition, a total of 13 different mind-body therapies were included in our study. According to the network meta-findings, analysis's patients' scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) can be significantly improved by Baduanjin (SUCRA:98.3%), the Time Up and Go (TUG) Test can be significantly decreased by balance training (SUCRA:99.4%), the 36-Item Short Form Health Survey questionnaire's mental health component can be significantly improved by MBSR (SUCRA:87.9%), and balance training can significantly improve patients’ physical health component of SF-36 (SUCRA:90.3%).ConclusionsAccording to the Network's Ranking Plot, Bajuanjin or Balance Training and MBSR can offer patients with KOA higher benefits for motor function or quality of life than other mind-body therapies. The medical staff can choose different mind-body therapies according to the patient's actual condition.

Effect of various types of photodynamic therapy on inflammatory and non-inflammatory lesions in patients with acne: A network meta-analysis of randomized controlled trials

BackgroundRecent studies have demonstrated that photodynamic therapy (PDT) is safe and effective in treating acne vulgaris. The present study aimed to evaluate various PDTs on inflammatory and non-inflammatory lesions in patients with acne by a network meta-analysis (NMA) of randomized controlled trials (RCTs). MethodsThe researchers of this paper searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to March 2022 to identify suitable RCTs. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool. Twenty-one RCTs were included, with a total sample size of 898 participants. ResultsNetwork meta-analysis (NMA) revealed that indocyanine green (ICG) + near-infrared (NIR) diode laser, ICG+830 nm light-emitting diode (LED), indole-3-acetic acid (IAA) + 520 nm LED, and 5-aminolevulinic acid (ALA) + sunlight demonstrated obvious curative effects in patients with acne vulgaris. Importantly, ICG+NIR diode laser provided the greatest improvement in both inflammatory and non-inflammatory acne lesions (surface under the cumulative ranking curve [SUCRA]: 84.4% and 93.5%, respectively). ConclusionsBased on the NWM and SUCRA ranking, ICG + NIR diode laser can be considered more effective in treating acne than the other PDTs of the RCTs. However, this conclusion should be interpreted with caution due to the limitations of the present study.

A Systematic Review of Cognitive Functioning and its Relationship to Outcomes Following Amputation Secondary to Vascular Etiology.

Amputation is a major life event, impacting on all aspects of daily living, and has the goal of achieving maximal patient mobility and independence. The level of cognitive function of those patients who are assigned a prosthesis is an important consideration in the rehabilitation process. Therefore we set out to understand the relationship between cognitive functioning and functional and/or health outcomes following amputation secondary to a vascular condition. This systematic review searched five databases: PsycINFO, Cumulative index to nursing and allied health literature (CINAHL), Scopus, MEDLINE, and Web of Science for peer-reviewed English language articles that met the inclusion criteria. Two authors independently assessed suitability for inclusion, determined biases (Cochrane risk of bias assessment) and extracted data. Results are presented as associations determined on the balance of probabilities. A total of 14 studies were included, with a total of 6891 participants across six domains. Evidence of an association between cognitive function and prosthetic use, mobility and activities of daily living (ADLs) were found. Evidence revealed 83.3% association for cognition and mobility, 66.7% for cognition and ADL, and 62.5% for cognition and prosthetic use. The evidence was indeterminate for an association between cognitive function and living/discharge destination. There was insufficient weight of evidence to determine an association between cognitive function and general health or social participation. The associations found between cognitive function and prosthetic use, mobility and ADL highlight the need for cognitive assessment to form part of the postoperative pathway for vascular amputees.