High-quality Randomized Controlled Trials Research Articles

Efficacy and safety of salvianolate injection in treating acute myocardial infarction: a meta-analysis and systematic literature review

PurposeSalvianolate for injection (SFI) is a widely used treatment for acute myocardial infarction (AMI). This study aims to assess the efficacy and safety of SFI in treating AMI by synthesizing evidence from published randomized controlled trials (RCTs).MethodsSeven databases were searched for relevant RCTs published up to 1 July 2024. Two investigators independently conducted the literature searches, data extraction, and quality assessment. Subgroup and sensitivity analyses were performed to address potential heterogeneity. Data analyses were conducted using RevMan 5.4 software.ResultThirty RCTs with a total of 3,931 participants were included in the study and analyzed. The results revealed that SFI significantly reduced major adverse cardiac events (MACEs) (RR = 0.34, 95% CI: 0.24 to 0.49, p < 0.05). In addition, SFI lowered creatine kinase-MB (CK-MB) (MD = −5.65, 95% CI: −9.55 to −1.76, p < 0.05) and improved left ventricular ejection fraction (LVEF) (MD = 6.2, 95% CI: 4.82 to 7.57, p < 0.05). Further reductions were observed in C-reactive protein (CRP) (MD = −6.17, 95% CI: −8.11 to −4.23, p < 0.05), malondialdehyde (MDA) (MD = −1.95, 95% CI: −2.08 to −1.83, p < 0.05), and endothelin-1 (ET-1) (MD = −12.27, 95% CI: −17.13 to −7.40, p < 0.05). The incidence of adverse events did not significantly differ between the EG and CG [RR = 0.74, 95% CI: 0.42 to 1.33, p = 0.32].ConclusionThis study suggests that SFI may be a promising alternative therapy for treating AMI without increasing the risk of adverse events. However, our findings may be limited by the quality of the existing studies. High-quality RCTs are needed to provide more robust evidence.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024567279.

Acupuncture for atopic dermatitis: a systematic review and meta-analysis

ObjectivesAtopic dermatitis is a chronic, relapsing, inflammatory skin disease that impacts patients’ quality of life and imposes substantial economic burdens on their families. Acupuncture holds promise as a viable treatment...

Electroacupuncture versus 5-HT4 receptor agonist for functional constipation: A systematic review and meta-analysis of randomized controlled trials.

Functional constipation (FC) has been found as a chronic gastrointestinal disease that is commonly diagnosed in patients. However, patients have a low satisfaction level with the treatment of constipation drugs (e.g., 5-HT4 agonists). A meta-analysis was performed to compare the efficacy and safety between electroacupuncture and 5-HT4 agonists. The included study were randomized controlled trials (RCTs), in which EA was used in the experimental group and 5-HT4 receptor agonist was used in the control group. Four English databases (PubMed, Cochrane Library, Web of Science, Embase) and 4 Chinese databases (China National Knowledge Infrastructure, CBM, WanFang, VIP) were searched. Relevant studies retrieved were published before September 30, 2024. The risk of bias was assessed by tool of Cochrane and GRADEpro. The Review Manager 5.4 was used for analyzing Data analysis, and Endnote X9 for screening studies. In this paper, we included 12 studies, involving 1473 participants. We found that EA significantly improved patient assessment of cab quality of life questionnaire (PAC-QOL) (MD = -0.52, P = .03), self-rating anxiety scale (SAS) (MD = -3.00, P < .00001) and self-rating depression scale (SDS) (MD = -4.13, P < .00001) compared with 5-HT4 receptor agonists. In addition, we failed to identify any significant difference in Stool consistency, the number of weekly complete spontaneous bowel movements and weekly spontaneous bowel movements (SBMs) between the 2 groups. EA has been indicated to be better than 5-HT4 receptor agonists since it can more effectively improve FC patients' life quality and mental state without an increased risk of adverse even. However, the previous evidence is characterized by low quality and small sample size, which should be further confirmed by high-quality and large-sample multicenter RCTs.

Management of Muscle Cramps in Patients With Cirrhosis: A Systematic Review of Randomised Controlled Trials.

Muscle cramps are common in patients with cirrhosis. Despite their prevalence and impact on health-related quality of life, there are no widely used clinical practice guidelines for management of muscle cramps in cirrhosis. The aim of this review was to critically evaluate current evidence regarding treatment of muscle cramps in cirrhosis. A systematic review using PubMed, MEDLINE (Ovid), Embase, and Scopus databases was performed on 30 June by two independent reviewers to identify randomised controlled trials (RCTs) reporting interventions for muscle cramps in cirrhotic patients. Twelve RCTs evaluating 13 distinct interventions were identified. Baclofen, methocarbamol, orphenadrine, and taurine supplementation reduced cramp frequency, severity, and duration when compared to placebo. Human albumin, pregabalin, and quinidine reduced cramp frequency compared to placebo. Pickle juice reduced cramp severity compared to placebo. BCAA supplementation and calcium carbonate were found to reduce cramp frequency compared to baseline. Stretching demonstrated a signal towards reducing cramp severity and frequency, and meditation had a signal towards reducing severity only when compared to baseline. Electro-acupuncture was the only intervention which demonstrated no therapeutic effect. Pregabalin was the only agent associated with significant side effects that limited its use. Methocarbamol, orphenadrine, and taurine supplementation were found in placebo-controlled RCTs to be effective in reducing cramp frequency, severity, and duration in cirrhotic patients. All other interventions reported aside from electro-acupuncture demonstrated a positive impact on cramps. High-quality RCTs are needed to further investigate the use of these treatments in terms of comparative efficacy and safety.

The Effect of Spirulina Supplementation on Blood Pressure in Adults: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Previous studies have yielded controversial results regarding the effect of spirulina on blood pressure (BP), which need updating. So, this updated systematic review and meta-analysis of randomized controlled trials (RCTs) carry out a more accurate estimation of the effect of spirulina on BP in adults. This systematic searches (in PubMed/Medline, Scopus, and ISI Web of Science) until April 1, 2024, to identify related RCTs based on PICOS guidelines (population (individuals > 18 years old), the intervention (spirulina), the comparison (control or placebo group), the outcomes (systolic BP (SBP) and diastolic BP (DBP)), the study design (RCTs)), and PRISMA-checklist (Supporting Information, data S2). We evaluated the impact of spirulina on DBP and SBP. Conventional procedures were employed for analyzing publication bias, heterogeneity, and sensitivity. The GRADE criteria and the Cochrane assessment method were employed to evaluate the risk of bias (ROB) and certainty of evidence across the studies, respectively. The result shows spirulina consumption decreases SBP (WMD: -4.41 mmHg, 95% CI: -6.74 to -2.07, I2 = 66.1%) and DBP (WMD: -2.84 mmHg, 95% CI: -4.65 to -1.03, I2 = 62.3%). Subgroup analysis demonstrated SBP and DBP were still lower in individuals with ≥ 120 and ≥ 80 mmHg, hypertension (HTN) individuals, overweight individuals, age > 50 years, and > 8 weeks of intervention. Indeed, we do not observe publication bias, ROB, or interference studies in the overall results of BPs, and based on GRADE, our outcomes have moderate quality. Because of the low number of studies and participants, the dose-response and meta-regression are not significant. His study demonstrated spirulina intervention decreased SBP and DBP in HTN and overweight individuals, age > 50 years, and > 8 weeks of intervention. So, spirulina intake decreases BP and could be used in clinical practice. Furthermore, more and high-quality RCTs are needed to establish the clinical efficacy of the spirulina and determine cutoff spirulina interventions based on dose and duration. Trial Registration: PROSPERO: CRD42024534608.

Acupuncture as an Adjunct to Lifestyle Interventions for Weight Loss in Simple Obesity: A Systematic Review and Meta-Analysis.

This study aims to evaluate the efficacy of acupuncture as an adjunct to lifestyle interventions on weight loss in simple obesity. Potentially eligible studies that assessed anthropometric outcomes as well as glucose and lipid metabolism following acupuncture combined with lifestyle interventions in simple obesity patients were searched from eight databases from inception to October 2023. All analyses were performed using the Review Manager software v5.4 and Stata software v17.0. Herein, 25 randomized controlled trials (RCTs) involving 2018 patients were included. Generally, acupuncture combined with lifestyle interventions outperformed lifestyle interventions alone in terms of body weight (MD = -4.73, 95% CI [-6.32, -3.13], p < 0.00001), body mass index (BMI) (MD = -2.11, 95% CI [-2.75, -1.48], p < 0.00001), waist circumference (WC) (MD = -4.96, 95% CI [-6.89, -3.03], p < 0.00001), body fat percentage (BF %) (MD = -2.61, 95% CI [-4,51, -0.71], p = 0.007), fasting plasma glucose (FPG) (SMD = -0.66, 95% CI [-1.02, -0.31], p = 0.0002), fasting serum insulin (FINS) (SMD = -1.12, 95% CI [-1.44, -0.81], p < 0.00001), homeostasis model assessment-insulin resistance (HOMA-IR) (MD = -1.22, 95% CI [-1.50, -0.94], p < 0.00001), total cholesterol (TC) (SMD = -1.14, 95% CI [-1.83, -0.45], p = 0.001), triglyceride (TG) (SMD = -1.31, 95% CI [-2.07, -0.56], p = 0.0006), and low-density lipoprotein cholesterol (LDL-C) (SMD = -1.81, 95% CI [-3.11, -0.51], p = 0.006). Subgroup analysis based on three subgroup variables (types of acupuncture and lifestyle interventions as well as treatment durations) could partially explain the heterogeneity of the results. Acupuncture demonstrated an enhancing effect on the benefits of lifestyle interventions for weight loss in patients with simple obesity, including reducing body weight and improving glucose and lipid metabolism. This finding suggests its potential value as a complementary therapy alongside lifestyle interventions in a clinical setting. However, further validation with rigorously designed and high-quality RCTs is still needed in the future.

Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis.

Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial. We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA). A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method. The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency. This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations. CRD42024524657.

The Effectiveness of Neural Mobilization in Patients with Tarsal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Background: Tarsal Tunnel Syndrome (TTS) is a compression neuropathy, occurring when the distal branches of the posterior tibial nerve become entrapped within the tarsal tunnel, with no definitive evidence for its conservative management. Neural mobilization, a therapeutic approach involving joint and peripheral nerve movement, seeks to restore the nervous system’s homeostasis. There is currently insufficient evidence to determine the efficacy of neural mobilization. Objectives: Analysis of data from randomized controlled trials (RCTs) examining the efficacy of neural mobilization techniques (NMT) in TTS patients. Methods: A thorough search was carried out from inception until September 2024 utilizing four scientific databases (PubMed, Scopus, EMBASE, and Physiotherapy Evidence Database-PEDro) and the Google Scholar search engine. Relevant English-language research was retrieved, assessed, and given an independent methodological quality rating (PEDro scale). Meta-analyses were conducted for select outcomes, where possible. Results: 745 studies were eliminated from the total of 748 because they were duplicates or did not fit the inclusion criteria. Three RCTs were finally included, rated on average with 6.67/10 for methodological quality (PEDro scale). NMT led to a highly significant improvement of the nerve’s physiological sensitivity (p0.001), measured with the Tinel’s sign, based on evidence of high methodological quality (7.5/10) and no heterogeneity. NMT did not lead to a significant diminution of pain intensity (p=0.21) based on evidence of moderate methodological quality (6.67/10). Significant improvements in favour of NMT, however measured in one out of three studies, were identified for 2-point discrimination and light touch, the Neuropathic Pain Questionnaire, and the Functional Foot Index (p0.05). No adverse events were reported. All studies measured change immediately post-treatment. Conclusion: NMT significantly improved the tibial nerve’s mechanosensitivity. Moreover, as part of the treatment of patients with TTS, high-quality RCTs are necessary to examine the short and longer-term effects of NMT.

Insulin in aluminum phosphide poisoning: A systematic review of the current literature.

Aluminum phosphide (AlP) is a commonly used fumigant in agriculture and grain preservation because of its high potency and low cost. Due to the absence of a specific antidote and promising treatment modality, poisoning with this substance is deadly. Amid multiple studies in different parts of the world, each exploring options like lavage, inotropes, antioxidants, etc, we conducted a systematic review to find the possible role of exogenous insulin in treating symptomatic cases of AlP poisoning. Experimental studies released before February 15, 2024, that reported the use of exogenous insulin were systematically reviewed following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The search was done on PubMed Central, Cochrane Library, and Google Scholar. After applying the inclusion and exclusion criteria, we finalized a few scientific papers for the review. Studying data from 4 scientific papers (3 quasi-experimental studies and 1 randomized controlled trial), we could postulate the significant improvement in survivability after the inclusion of exogenous insulin in the treatment of poisoned cases of AlP. Studies showed divergent results for the blood pressure, blood gases, and need for mechanical ventilation. Hypoglycemia, hyperglycemia, and hypokalemia were the reported adverse effects of this therapy. Our review found that the use of exogenous insulin in AlP poisoning reduced mortality rates, which was consistent across all studies. With available knowledge, its inclusion as a part of therapy might be beneficial in AlP poisoning, but to put it forward confidently, we still need high-quality randomized control trials. It is indeed a subject of interest for future research.

Interventions for Preventing Tobacco Uptake among Adolescents within School Setting in South-East Asia region: A Systematic Review

Abstract Background Tobacco users disproportionately reside in lower-and-middle income countries, with many people beginning consumption of tobacco in adolescence. Countries employ interventions in schools as a means of providing health education thereby creating mass awareness among them. However, research has mostly restricted to developed nations. Objective To examine the impact of interventions implemented in preventing tobacco uptake among adolescents in school setting in South-East Asia region. Method The protocol was registered prospectively on PROSPERO (CRD42022337341). Systematic search was conducted on 6 databases: PubMed, Embase, Scopus, CINAHL, ProQuest and Web of Science. Randomized Control Trials (RCT) and Cluster RCT conducted in school set-up in South-East Asia among adolescents below 18 years’ age were included. Articles between timeline 2002–2022 were considered. Results From a total of 963 articles, total of 13 studies were included. Four were RCT, while nine were Cluster RCT. Most of the studies were targeted at change in prevalence, followed change in knowledge and attitude towards tobacco and impact on susceptibility to use tobacco. Nine studies had interventions based on Health Promoting School Framework, three were Peer-led Interventions and one was Counsellor-centred Intervention. Risk of Bias assessment revealed eight studies had low risk of bias, two had some concerns while three were high risk studies. Conclusion Interventions that focus on building a holistic environment and go beyond the usual classroom environment have primarily been implemented and found to be effective in this region. There is a need for strong, high-quality RCT studies with standardised evaluation techniques to combat tobacco use among adolescents.

Efficacy of an erector spinae plane block for renal colic: a systematic review and meta-analysis

Background and aimThe passage of kidney stones through the ureter creates renal colic, a severe visceral abdominal pain. Renal colic is typically managed with non-steroidal anti-inflammatory drugs and opioids. Yet,...

Effects of Probiotics, Prebiotics, and Synbiotics on Sarcopenia Parameters in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

There is scarce evidence about which probiotic, prebiotic, or synbiotic supplementation is the most appropriate to improve sarcopenia parameters, and this presents a challenge. The effects of consumption of probiotics, prebiotics, and synbiotics on sarcopenia, muscle strength, muscle mass, and physical performance and function were assessed in this study. In addition, another aim of the study was to determine the best probiotic, prebiotic, and/or synbiotic for the management of sarcopenia in older adults. A systematic search was conducted in the MEDLINE/PubMed, Cochrane Library, SCOPUS databases, and other sources (eg, references obtained from articles identified in databases). The search was limited from 2000 to 2023 and was based on sarcopenia parameters, and probiotics, prebiotics, or synbiotics supplementation. The quality of each included study also was assessed. A meta-analysis was performed with the Review Manager program and publication bias and sensitivity analysis were performed. Eight randomized controlled trials (RCTs) were included in the systematic review and 4 in the meta-analysis. Results showed that probiotics supplementation improved muscle strength and physical performance and function and suggested a beneficial effect on muscle mass. Prebiotics are suggested to be effective on muscle strength. The meta-analysis also determined that probiotic interventions were effective in increasing muscle strength by handgrip strength (mean difference [MD], 2.50 kg [95% CI, 1.33-3.66]; P < .0001) and physical performance and function by gait speed (MD, 0.10 m/s [95% CI, 1.33-3.66]; P < .0001) and physical performance and function by gait speed (MD, 0.10 m/s [95%CI, 0.03-0.16]; P = .003), but when sensitivity analysis was applied, the effectiveness was only maintained for gait speed. Nutritional strategies based on probiotic supplementation seem to improve muscle strength and physical function. More robust research is needed with high-quality RCTs to confirm probiotics' effects. There is still limited evidence about prebiotic and synbiotic strategies, and more evidence is needed to elucidate their effects on sarcopenia parameters. PROSPERO registration no. CRD42022360514.

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning

ObjectiveDefine a best practice guide for managing people with patellofemoral pain (PFP).MethodsA mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement...

Comparative Efficacy of Spinal Cord Stimulation in the Management of Acute Pain and Chronic Pain Related to Failed Back Surgery Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Spinal cord stimulation (SCS) is a well-established treatment for chronic pain. However, its potential in acute pain management requires further investigation. The goal of this review is to assess and compare the effectiveness of SCS for managing acute postoperative pain against chronic pain associated with failed back surgery syndrome (FBSS). A comprehensive search of databases identified randomized controlled trials (RCTs) that examined SCS for both acute and chronic pain associated with FBSS. Pain relief was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). Study quality was evaluated using the Jadad score and Cochrane risk of bias tool. Evidence suggests that SCS significantly reduces acutepain, achieving over a 50% reduction in VAS scores. For chronic pain associated with FBSS, SCS demonstrated substantial efficacy, with a mean reduction of -2.45 on pain scales compared to baseline. When compared to optimal medical management (OMM), SCS was more effective, showing a mean reduction of -1.17 in pain scores for FBSS.Overall, SCS offers significant benefits in managing chronic pain, particularly in FBSS, by reducing pain intensity and opioid use. While the initial findings for acute pain relief are promising, further high-quality RCTs are needed to better understand SCS's role in preventing the transition from acute to chronic pain. Continued research into optimizing patient selection and stimulation parameters will be essential to improve therapeutic outcomes in both acute and chronic pain management.

Effect of Acupuncture on Cognitive Function in Patients With Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis.

To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI). PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear. A meta-analysis and systematic review of randomized controlled trials (RCTs). Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects. There were 29 randomized clinical trials with 2477 participants included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD]=1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2=59%, p<0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment. Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs. Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.

A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review

Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs. We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications. Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups. Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study's limitations. Therapy/Prevention, Etiology/Harm II.

Healing of Humerus Non-union Fracture Using Recombinant Human Bone Morphogenetic Protein With Bone Graft Compared to Bone Graft Alone: A Systematic Review and Meta-Analysis.

Non-union fractures of the humerus present significant challenges in orthopedic surgery, often requiring advanced treatments to achieve successful bone healing. The study aimed to compare the use of recombinant human bone morphogenetic protein (rhBMP) with bone grafts versus bone grafts alone for treating humerus non-union fractures with regard to healing rate and complications. Six databases, PubMed, ScienceDirect, The Cochrane Library, Scopus, Web of Science, and Google Scholar, were searched for relevant literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and studies were selected according to the set eligibility criteria. Quality assessment was performed using the Mixed Methods Appraisal Tool for randomized controlled trials (RCTs) and non-RCTs. Review Manager (RevMan) version 5.4 (2020, The Cochrane Collaboration, London, United Kingdom) was utilized for meta-analysis at a significance level of 0.01. Eighteen research papers were included for qualitative and quantitative analysis. Due to the unavailability of RCTs, data from the two studies were combined. The pooled data from 16 studies for effectiveness regarding union achieved forrhBMP with bone graft versus bone graft alone was 0.65 (95%CI: 0.07-6.38, I2 =67%, p=0.02). For rhBMP-2 and rhBMP-7 with bone graft, the pooled data was 0.09 (95%CI: 0.00-3.63) with high heterogeneity (I2 =88%) and statistically significant differences (p<0.00001). In the sub-group analysis, the pooled data for infection rate was 1.18 (95%CI, 0.37-3.73) with 39% heterogeneity and a non-significant difference (p=0.10). AddingrhBMP to bone grafts may not significantly improve union rates compared to bone graft alone in humerus non-union fractures. However, the trend shows increased infection rates with rhBMP usage. Further high-quality RCTs are warranted to confirm these findings and elucidate the optimal management strategy for humerus non-union fractures.

The differential effects of eicosapentaenoic acid and docosahexaenoic acid on cardiovascular risk factors: an updated systematic review of randomized controlled trials.

Cardiovascular disease remains a major global health concern. The combination of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been shown to beneficially modify a range of cardiovascular risk factors. However, whether EPA and DHA have differential effects or potencies is currently unclear. A systematic review of randomized controlled trials (RCTs) that compared ≥2 g/day of near pure EPA and DHA was conducted. A total of 24 publications from nine unique RCTs were included. EPA and DHA both lower triglyceride levels, with DHA most likely having a slightly greater effect. Furthermore, both EPA and DHA increase high density lipoprotein (HDL) 2 cholesterol, which is cardioprotective, with the increase being greater with DHA. DHA appears to increase low density lipoprotein (LDL) cholesterol; however, DHA also increases LDL particle size, which would render LDL less atherogenic. DHA seems more effective than EPA in decreasing heart rate and blood pressure. Both EPA and DHA alter platelet function decreasing thrombogenicity, although they may have different actions on platelets. Both EPA and DHA decrease F2-isoprostanes, interpreted as a reduction in oxidative stress. They both decrease inflammatory gene expression and promote an anti-inflammatory oxylipin profile. These are all favorable effects with regard to cardiovascular disease risk. Effects of EPA and DHA on blood glucose are inconsistent. This review is constrained by the small number of high quality RCTs that directly compare EPA to DHA and report on outcomes other than blood lipids. There is a need for additional high-quality research to assess the independent effects of EPA and DHA on cardiovascular risk factors (e.g., inflammation, blood pressure, vascular function, platelet function) in larger and more diverse study populations.

Association of beta blockers and mortality in adults with septic shock: systematic review and meta-analysis of randomized clinical trial.

Septic shock still entails significant morbidity and mortality, with the heart being affected due to catecholamine overexpression and direct injury from sepsis. Therefore, the effect of β-blocking the receptors to improve performance is promising when attempting to reverse tachycardia and reduce mortality. We conducted a comprehensive search across five databases for studies published up to 28 January 2024, using a PICO strategy. Ten studies were identified for quantitative analysis and included in our meta-analysis. Our meta-analysis evaluated 28-day in-hospital mortality risk across nine randomized controlled trials (RCTs) involving a total of 1,121 adults with septic shock. We found an association between β-blocker use and reduced overall mortality (OR 0.57; 95% CI 0.34-0.98; I 2: 56%). This effect was significant in the esmolol subgroup (OR 0.47; 95% CI 0.26-0.82; I 2: 32%), but not in the landiolol subgroup (OR 0.98; 95% CI 0.0-1,284.5; I 2: 72%). Additionally, the intervention group shows a significant reduction in HR and lactate levels, as well as an increase in stroke volume index (SVI). In adults with septic shock, β-blockers are associated with a reduction in 28-day in-hospital mortality, a benefit primarily observed with esmolol rather than landiolol. Furthermore, improvements in heart rate (HR) control, lactate levels, and SVI were noted. However, these findings should be interpreted with caution, and further high-quality RCTs comparing different β-blockers are necessary to better elucidate these effects. https://www.crd.york.ac.uk/prospero/, identifier CRD42024513610.

Effects of acupuncture on ischemic stroke: A systematic review with meta-analyses and trial sequential analyses

BackgroundAlthough acupuncture is widely used to treat ischemic stroke, its effects remain uncertain. This systematic review aims to synthesize current evidence on the effects of acupuncture for ischemic stroke and assess whether current randomized controlled trials (RCTs) have sufficient power to detect its effects. MethodsSeven databases and two registry platforms were searched systematically from inception to June 13, 2023, to identify RCTs comparing the effects of acupuncture on ischemic stroke with control groups (placebo/blank). The Cochrane Risk of Bias 2 (RoB 2) tool was used to evaluate the risk of bias in the included trials. Random effects models through restricted maximum likelihood estimation were further used to estimate the pooled mean differences (MDs) and the corresponding 95 % confidence intervals (CIs). The primary outcome was neurological function (National Institutes of Health Stroke Scale, NIHSS), while secondary outcomes included global disability (modified Rankin Scale, mRS) and activities of daily living (ADLs) (Barthel Index, BI or Modified Barthel Index, MBI). The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to evaluate the certainty of the evidence. Trial sequential analysis (TSA) was further applied to control random errors and calculate the required information size (RIS). ResultsForty RCTs involving 4485 patients were included. Acupuncture was found to significantly improve NIHSS (18 trials, 2658 patients; MD = −1.61, 95 % CI [-2.12, −1.09], low certainty evidence), mRS (3 trials, 298 patients; MD = −0.34, 95 % CI [-0.50, −0.19], moderate certainty evidence), and BI/MBI (26 trials, 2562 patients; MD = 8.98, 95 % CI [6.18, 11.77], low certainty evidence). Further, graphs of TSA indicated that the sample size of the trials was sufficient, and the results are robust. ConclusionCurrent evidence suggests that acupuncture can significantly improve neurological function, global disability, and ADLs in patients with ischemic stroke. The results were robust, as confirmed by TSA. However, the certainty of the evidence is moderate to low and should be further verified by more high-quality RCTs.