Systematic Review and Meta‑analysis of Shenfu Injection on Treating Acute Exacerbation of Chronic Obstructive Pulmonary Disease

The objective of the study was to systematically evaluate the efficacy and safety of Shenfu injection in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A total of 15 randomized controlled trials involving 1198 patients were included. The results of meta?analysis showed that compared with the control group, the experimental group can improve the total clinical effective rate in AECOPD patients (relative risk = 1.15, 95% confidence interval [CI] [1.09, 1.21], P < 0.000 01), improve the pulmonary function levels: forced expiratory volume in one second (FEV1) (standardized mean difference = 1.88, 95% CI [0.89, 2.88], P = 0.000 2) and the FEV1 /forced vital capacity (FVC) ratio (FEV1 /FVC) (mean difference [MD] = 3.96, 95% CI [2.74, 5.19], P < 0.000 01); improve the arterial blood oxygen partial pressure (MD = 6.03, 95% CI [4.58, 7.48], P < 0.000 01), and reduce the arterial blood partial pressure of carbon dioxide (MD = ?4.59, 95% CI [?6.91, ?2.26], P = 0.000 01), and the white blood cell count in pulmonary infection may be improved (MD = ?1.16, 95% CI [?1.63, ?0.68], P < 0.000 01). The study showed that the efficacy of experimental group in the treatment of AECOPD is better than control group. Due to the limitation of the number and quality of included studies, this conclusion needs more high quality studies to confirm.     

Medium- and long-term efficacy of ligustrazine plus conventional medication on ischemic stroke： a systematic review and meta-analy- sis

OBJECTIVE： To evaluate the medium- to long-term efficacy of ligustrazine plus conventional medicine treating ischemic stroke. METHODS： Randomized controlled trials （RCTs） testing ligustrazine in the treatment of acute isch- emic stroke were retrieved from Cochrane Library, PubMed, Excerpta Medica Database, Chinese Medi- cal Journal Database, Chinese Biomedical Data- base, China National Knowledge Infrastructure Da- tabase, and Chinese Clinical Trial Register, and then identified by the inclusive and exclusive criteria. The quality of trials was assessed with the Co- chrane Handbook 5.1, a risk of bias assessment toot. RevMan 5.1 was used for meta-analysis.RESULTS： Three RCTs involving 643 patients were included. Compared to conventional medicine treatment alone, ligustrazine plus conventional medicine treatment showed significant difference in reduction of stroke recurrence either at the end of 1-year follow-up [RR=0.42, 95% CI （0.18, 0.94）, P〈 0.05] or 3-years observation [RR=0.48, 95% C/（0.27, 0.83）, P〈0.05]. The ligustrazine group also showed higher survival rate [RR=1.67, 95% CI （1.02, 0.2.71）, P〈0.05] and significantly better effective rate [RR= 1.28, 95% CI（1.10, 1.50）, P〈0.05] than that of the control group at the end of 1 year visit. Only one tri- al conducted safety assessment and no adverse events were reported. The methodological quality of all the trials included was generally poor. CONCLUSION： The findings provided evidence that the combination of ligustrazine and conven- tional medication was medium- and long-term ben- eficial to the patients suffering ischemic stroke. But more RCTs of high quality are needed to further prove the efficacy and safety of using ligustrazine for ischemic stroke.     

Clinical Effect of Tripterygium Glycosides Combined with Glucocorticoids in the Treatment of Refractory Nephrotic Syndrome Patients: A Systematic Review and Meta‑Analysis

The objective of this study is to evaluate the effectiveness and safety of Tripterygium glycosides combined with glucocorticoids for the treatment of refractory nephrotic syndrome (NS). Computer search of Chinese and English databases, including CNKI, VIP, Wan Fang Database, PubMed, Cochrane Library, Embase, and Sinomed, for randomized controlled trials (RCTs) of Tripterygium glycosides combined with glucocorticoids for refractory NS (RNS) was conducted. Meta?analysis was performed using RevMan5.3. Thirteen RCTs comprising 994 patients were included in the study. Tripterygium glycosides combined with glucocorticoids had a statistical significance on the effective rate (odds ratio [OR] =4.69, 95% confidence interval [CI] 3.29, 6.67, P < 0.00001), 24?h urine protein ( Weighted mean difference (MD) = ?0.57, 95% CI [?0.62, ?0.51], P < 0.00001), serum albumin (MD = 4.77,95% CI [4.30, 5.24], P < 0.00001), total serum protein (MD = 9.45, 95% CI [8.73, 10.17], P < 0.00001), urea nitrogen (MD = ?0.53, 95% CI [?0.90, ?0.17], P = 0.005), and serum creatinine (MD = ?8.45, 95% CI [?15.32, ?1.57], P = 0.02). There was no statisticalsignificance on adverse reactions(OR = 0.68, 95% CI [0.41, 1.12], P = 0.13). Tripterygium glycosides combined with glucocorticoids could improve clinical effective rate, reduce 24?h urine protein, improve serum albumin and total serum protein, and reduce urea nitrogen and serum creatinine levels in patients with RNS. However, the quality of the included literature is poor, and conclusion still needs further verification using larger samples and high?quality randomized, double?blind controlled trials.     

Safety and efficacy of Danqipiantan capsule for treatment of stroke： a systematic review

OBJECTIVE： To evaluate the efficacy and safety of Danqipiantan capsule （DPC） for the treatment of stroke. METHODS： PubMed, China Science And Technolo- gy Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infra- structure, and the General Hospital of Tianjin Medi- cal University＇s Library were searched until July 2012. Randomized controlled trials （RCTs） and ob- servational studies that reported the use of DPC for treatment of stroke were selected. RESULTS： Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participat- ed in the studies. We found that there was a signifi-cant statistical difference between DPC treatment groups and the control groups in terms of the effec- tive rate [risk ratio （RR）, 1.14; 95% confidence inter- vals （CI）, 1.04, 1.25; P=0.01], FugI-Meyer Assessment Scale [weighted mean difference （WMD）, 9.77; 95% CI （4.84, 14.70）; P=0.00], Barthel Index [WMD=6.40; 95% CI （3.15, 9.65）], and mean flow velocity [WMD= 5.79; 95% CI （1.64, 9.94）]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI （ - 1.09, 2.29）], vi- sual field defects [left visual field： WMD= - 203.10; 95% CI （ - 424.41, 18.21）; right visual field： WMD= - 172.60; 95% CI （ - 409.29, 64.09）] or the functional independence measure [WMD= - 7.90; 95% CI （ - 16.64, 0.84）]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two ar- ticles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quali- ty, and most of the sample sizes were small, our analysis was likely affected by bias. CONCLUSION： DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.     

火针对比西药治疗痛风性关节炎血尿酸及关节功能影响Meta分析及试验序贯分析

Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.     

雷公藤多苷联合缬沙坦治疗糖尿病肾病的系统回顾和荟萃分析

Objective: To assess the efficacy and safety of the combination therapy of Chinese herbal medicines,tripterygium glycosides, plus valsartan for the treatment of diabetic nephropathy(DN).Methods: A comprehensive research of 12 electronic databases was performed. Data of the included studies were extracted and analyzed independently by two authors, and were synthesized using Review Manager(version 5.2) and Stata(version 12.0).Results: A total of 12 randomized controlled trials(RCTs) involving 829 patients were included. Pooled results showed that the combination therapy significantly increased total efficacy of DN patients [RR = 1.35,95% CI(1.22, 1.50), P 0.001], the level of serum albumin [Mean difference(MD) = 3.87, 95% CI(3.12,4.62), P 0.001], and significantly decreased 24 h urinary protein level [MD =-0.97, 95% CI(-1.19,-0.76), P 0.001], urinary albumin-excretion rate [MD =-145.53, 95% CI(-227.95,-63.11), P 0.001],and urinary β2-microglobuli level [MD =-11.86, 95% CI(-13.02,-10.69), P 0.001]. No significant differences were found in levels of serum creatinine [MD =-0.26, 95% CI(-7.52, 7.00), P 0.05), blood urea nitrogen [MD = 0.25, 95% CI(-0.23, 0.74), P 0.05], and endogenous creatinine clearance rate[MD =-0.43, 95% CI(-3.48, 2.62), P 0.05]. However, tripterygium glycosides plus valsartan seemed to exert higher adverse reaction rate than valsartan monotherapy [MD = 3.41, 95% CI(1.34, 8.66), P 0.05].There were no publication bias for all of the pooled effect sizes.Conclusion: Combination therapy of tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy need to be further confirmed.     

Combination therapy of tripterygium glycosides plus valsartan in diabetic nephropathy treatment: A systematic review and meta-analysis

Objective: To assess the efficacy and safety of the combination therapy of Chinese herbal medicines,tripterygium glycosides, plus valsartan for the treatment of diabetic nephropathy(DN).Methods: A comprehensive research of 12 electronic databases was performed. Data of the included studies were extracted and analyzed independently by two authors, and were synthesized using Review Manager(version 5.2) and Stata(version 12.0).Results: A total of 12 randomized controlled trials(RCTs) involving 829 patients were included. Pooled results showed that the combination therapy significantly increased total efficacy of DN patients [RR = 1.35,95% CI(1.22, 1.50), P 0.001], the level of serum albumin [Mean difference(MD) = 3.87, 95% CI(3.12,4.62), P 0.001], and significantly decreased 24 h urinary protein level [MD =-0.97, 95% CI(-1.19,-0.76), P 0.001], urinary albumin-excretion rate [MD =-145.53, 95% CI(-227.95,-63.11), P 0.001],and urinary β2-microglobuli level [MD =-11.86, 95% CI(-13.02,-10.69), P 0.001]. No significant differences were found in levels of serum creatinine [MD =-0.26, 95% CI(-7.52, 7.00), P 0.05), blood urea nitrogen [MD = 0.25, 95% CI(-0.23, 0.74), P 0.05], and endogenous creatinine clearance rate[MD =-0.43, 95% CI(-3.48, 2.62), P 0.05]. However, tripterygium glycosides plus valsartan seemed to exert higher adverse reaction rate than valsartan monotherapy [MD = 3.41, 95% CI(1.34, 8.66), P 0.05].There were no publication bias for all of the pooled effect sizes.Conclusion: Combination therapy of tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy need to be further confirmed.     

Effectiveness and safety of moxibustion in treatment of lumbar disc herniation: a systematic review and Meta-analysis

OBJECTIVE: To evaluate the effectiveness and safety of moxibustion therapy in the treatment of lumbar disc herniation(LDH).METHODS: Four Chinese databases and three English databases were searched from their inception to April 2018.Randomized controlled trials(RCTs)were included if moxibustion was used as the sole treatment or as a part of combination therapy with other treatments in patients with LDH.Two reviewers independently extracted the data and assessed the methodological quality using the Cochrane criteria for the risk of bias.The Meta-analysis was performed using Review Manager 5.3 software.RESULTS: In total, 16 RCTs including 1186 patients with LDH were analyzed.The Meta-analysis showed favorable effects of moxibustion in combination with massage therapy on the visual analog scale score compared with massage therapy alone[mean difference(MD) =-1.32, 95% confidence interval(CI)(-2.12,-0.51), P = 0.001].The subgroup Meta-analysis failed to show favorable effects of electro-acupuncture plus moxibustion on the efficacy rate compared with electro-acupuncture alone [relative risk(RR) = 1.06, 95% CI(0.98,1.14), P = 0.15].However, acupuncture or massage therapy plus moxibustion improved the efficacy rates compared with acupuncture or massage therapy alone [RR = 1.33, 95% CI(1.18, 1.49),P 0.000 01] [χ~2= 2.76, P = 0.25, I~2= 27%], [RR =1.15, 95% CI(1.06, 1.25), P = 0.001] [χ~2= 0.00, P =0.95, I~2= 0%].With respect to the Japanese Orthopaedic Association(JOA) scores, acupuncture or massage therapy in addition to moxibustion produced results different from those of acupuncture or massage therapy alone [MD = 5.58, 95% CI(4.15, 7.00), P 0.000 01] [χ~2= 0.58, P = 0.45, I~2=0%], [MD = 3.61, 95% CI(3.01, 4.21), P 0.000 01].There were no significant differences in the JOA score for subjective symptoms, objective symptoms, daily living ability, and other parameters.In six RCTs, no adverse reactions occurred during moxibustion.CONCLUSION: Whether moxibustion is an effective intervention for LDH is unclear because of the small sample size of qualified RCTs and the high risk of bias.More high-quality RCTs that overcome the methodological shortcomings of the existing evidence are needed.     

Traditional Chinese Herbal Medicine for Perimenopausal Depression of Chinese Women: A Meta‑analysis

Objective: The objective of this study is to evaluate the effectiveness and safety of traditional Chinese herbal medicine (TCHM) in treatment of perimenopausal depression (PD) in China. Methods: To identify randomized controlled trials, an electronic search has been conducted through databases as follows: PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese Biological Medicine Database, China National Knowledge Infrastructure Database, Chinese Scientific Journal Database, and WanFang Digital Periodicals Database. Methodological quality was evaluated by Cochrane Collaboration’s tool which is able to assess the risk of bias in Review Manager Software. What’s more, meta?analysis was performed by using Cochrane Collaboration’s RevMan 5.2 software, (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, and Denmark). Dichotomous data were analyzed by using relative risk (RR) and 95% confidence interval (CI). Continuous variables were analyzed using weighted mean differences (WMDs) and 95% CI. Subgroup analysis was performed by the type of medicine which was used in the experimental group. Results: This meta?analysis includes 11 randomized control trials with 818 patients. Compared to the control group (RR: 1.14, 95% CI: [1.03, 1.26], P = 0.009 and WMD: ?2.09, 95% CI: [ ?3.58, ?0.18]), the experimental group had a significant higher clinical efficacy rate and relatively lower Hamilton Depression Rating Scale (HAM?D) score. For clinical efficacy rate, the results varied depending on the detail treatment measures of the experimental group. In the experimental group with TCHM, no significant difference was observed (RR: 1.14, 95% CI: [0.97, 1.33]), while in the experimental group combined with western medicine, a significant difference in the clinical efficacy rate between the experimental group and control group showed up (RR: 1.15, 95% CI: [1.01, 1.32], P = 0.04). For the HAM?D score, subgroup analyses revealed that the pure TCHM therapy was not associated with significant HAM?D score reduction compared to the control group (WMD: ?2.48, 95% CI: [?6.00, 1.03], P = 0.17). However, in the experimental group where western medicine was added to, the HAM?D score decreased statistically compared to the control group (WMD: ?1.88, 95% CI: [?3.58, ?0.18], P = 0.03). There is no serious adverse event in both groups. Conclusions: Combination therapy of TCHM and western medicine is more effective in treating PD in terms of clinical efficacy rate. However, the results should be interpreted with caution due to the mediocre methodological quality of the included trials.     

Efficacy of Chinese herbal medicine for lumbar disc herniation： a systematic review of randomized controlled trials

OBJECTIVE： This is a review of the effects of Chi- nese herbal medicine （CHM） used alone to treat lumbar disc herniation （LDH）. METHORDS： A literature search of the following electronic databases from their inception to Febru- ary 2013 was conducted： Chinese Biomedical data- bases, Chinese National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Cochrane Library, Web of Sci- ence, MEDLINE, and EMBASE. Randomized con- trolled trials where CHM had been used to treat LDH were selected. Data extraction, quality assess- ment, and data analysis were carried out by two in- dependent reviewers. RESULTS： Of the 2415 studies identified, eight with complete data on 1146 patients were selected. The methodological quality was poor in all trials. Five studies reported that CHM was better than WesternMedicine [OR=2.81, 95% CI （1.27, 6.18）; OR=3.34, 95% CI （1.92, 5.79）; 0R=2.22, 95% CI （1.08, 4.57）; OR= 6.67, 95% CI （1.34, 33.28）; and OR=1.94, 95% CI （1.23, 3.06）]. Two studies reported that the clinical outcome was better in CHM groups than in physio- therapy and placebo groups, [OR=3.02, 9.5% CI （1.08, 8.46）; and OR=2.67, 95% CI （1.26, 5.64）, re- spectively], whereas one study reported no differ- ence between CHM and physiotherapy groups. One study reported that CHM resulted in higher Japanese Orthopedic Association scores [MD=7.78, 95% CI （6.67, 8.89）] than in a control group and an- other that participants treated with CHM had lower Visual Analogue Scale scores [MD=- 0.72, 95% CI （ - 0.86, 0.58）] than those in a control group. Three studies reported that the adverse effects of CHM and Western Medicine did not differ signifi- cantly [OR=0.10, 95% CI （0.01, 1.85）; OR=0.19, 95% CI （0.01,4.07）; and OR=O.07, 95% CI （0.00, 1.32）]. CONCLUSION： CHM may be more effective than other interventions for LDH; however, methodologi- cal weaknesses in the studies assessed in this re- view prevent a definitive conclusion. More high-quality large-scale studies are required to clar- ify this matter.     

Xuefuzhuyu decoction for hyperlipidemia： a systematic review and Meta-analysis of randomized clinical trails

OBJECTIVE：To evaluate the efficacy and safety of Xuefuzhuyu decoction for hyperlipidemia.METHODS：Randomized clinical trials on hyperlipidemia treated by Xuefuzhuyu decoction,either alone or with Western Medicine,were searched in electronic databases.Databases searched were：MEDLINE,Allied and Complementary Medicine Database,EMBASE,The Cochrane Library 2013（Issue4）,China National Knowledge Infrastructure Database,Chinese Biomedical Literature Database,and Wanfang Database up to 2 May,2013.Study selection,data extraction,quality assessment,and data analysis were conducted according to the Cochranestandards.RESULTS：Six randomized clinical trials involving748 patients（373 patients in the treatment group,375 patients in the control group）were included in the analysis.The studies were of low methodological quality.Meta-analysis indicated that the effect of Xuefuzhuyu decoction on hyperlipidemia was better than that in the control group[n=748,OR=5.07,95%CI（3.40,7.58）,P〈0.01].Weighted mean differencesin total cholesterol,low-densitylipoprotein cholesterol,triglycerides,and high-density lipoprotein cholesterol were﹣0.79,﹣0.74,﹣0.44,0.16,respectively,and Meta-analysis revealed that the treatment group was better than the control group with 95%CI（﹣1.21,﹣0.36）,（﹣0.94,﹣0.55）,（﹣0.77,﹣0.11）,（0.04,0.27）,respectively（all P〈0.05）.Some adverse events in evaluated studies wererecorded.CONCLUSION：Xuefuzhuyu decoction may be effective for treating hyperlipidemia.The studies we analyzed were of low methodological quality,which indicates that the above findings should be considered cautiously.Therefore,more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Xuefuzhuyu decoction in hyperlipidemia.     

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction: This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney, lung, and spleen(TKLS) combined with Western medicine for stable chronic obstructive pulmonary disease(COPD). Materials and Methods: Randomized controlled trials(RCTs) of TKLS for stable COPD were searched from four databases including Pub Med, the Cochrane Library, China Biology Medicine, and China National Knowledge Infrastructure from inception to December 2017. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Rev Man5.3 software was used for meta-analysis. Results: Fourteen RCTs involving 1339 patients with stable COPD were included. Five of the included articles described the specific method of randomization, 1 of them was double-blind method research, and 1 of them was single-blind method research. Compared with the conventional Western medicine(CWM) group, the use of TKLS, if combined with CWM demonstrated significantly improved effective rate(relative risk = 1.25, 95% confidence interval [CI]: 1.18–1.33, P 0.00001), decreased traditional Chinese medicine syndrome score(mean difference [MD]-5.72, 95% CI:-8.31 to-3.14, P 0.0001), Decreased St George's Respiratory Questionnaire total score(MD-7.39, 95% CI:-10.46 to-4.31, P 0.00001), increased 6-min walk distance in meters(MD 78.46, 95% CI: 60.18–96.73, P 0.00001), increased forced expiratory volume 1%(MD 6.49, 95% CI: 3.64–9.33, P 0.00001), increased CD4(MD 9.84, 95% CI: 6.73–12.94, P 0.00001), CD8(MD-1.84, 95% CI:-3.62 to-0.06, P = 0.04) and CD4/CD8(MD 0.26, 95% CI: 0.20–0.32, P 0.0001), and increased immunoglobulin M(MD 0.15, 95% CI: 0.10–0.20 P 0.00001).. Conclusions: For stable COPD, TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness, symptoms, and quality of life. The above conclusion needs to be validated by further well-designed, multicentric, large-scale, double-blinded RCTs.     

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Treating Ulcerative Colitis by the Integration Method of Heat-Clearing, Damp-Excreting, Spleen-Strengthening, and Stasis-Removing of Traditional Chinese Medicine with Western Medicine

Objective:The objective ofthisstudywasto systematically evaluate the clinical efficacy ofthe integrationmethod of heat?clearing, dampness?excreting, spleen-strengthening, and stasis-removing from traditional Chinese medicine (TCM) combined with Western medicine for the treatment of ulcerative colitis (UC). Materials and Methods: The databases China National Knowledge Infrastructure, China Biology Medicine disc (CBMdisc), WANFANG, VIP, and PubMed were searched for randomized controlled trials investigating the integration of the TCM methods of clearing heat, draining dampness, invigorating the spleen, and removing stasis, combined with Western medicine to treat UC from January 2009 to March 2019. Two reviewers independently conducted literature searches, screenings, data extractions, and literature bias evaluations. A meta-analysis was conducted using RevMan 5.3 and Stata 13.0 software. Results: In total, 15 studies involving 1289 patients were included. The results of the meta-analysis showed that the total effective rate of treatment in the experimental groups was higher than that of the control groups(relative risk [RR] = 1.27, 95% confidence interval [CI]: 1.21, 1.35, Z = 8.74, P < 0.00001). In the subgroup analysis, the total effective rate of oral TCM combined with Western medicine was higher than that of the control groups (RR = 1.24, 95% CI: 1.15, 1.33, Z = 5.88, P < 0.00001). The total effective rate of oral TCM with enemas combined with Western medicine was higher than that of the control group (RR = 1.30, 95% CI: 1.12, 1.50, Z = 3.52, P = 0.0004). The comparison between Western medicine alone and oral TCM combined with enteroscopy and Western medicine showed that the effective rate of enteroscopy (RR = 1.18, 95% CI: 1.05, 1.33, Z = 2.86, P = 0.004) and the symptom scores before and after treatment all improved more in the combined treatment groupsthan in those of the Western medicine group alone, with statistically significant differences(RR = ?4.23, 95% CI: ?4.93, ?3.53, Z = 11.84, P < 0.00001). Conclusion: The integration of the TCM methods of heat clearing, dampness excreting, spleen strengthening, and stasis removing combined with Western medicine can significantly improve the cure rate of UC, and is an effective method to treat UC.     

Clinical Evaluation on Xiyanping Injection in the Treatment of Bronchopneumonia in Children Based on Meta‑Analysis

Objective: The aim of this study is to evaluate the effectiveness and safety of xiyanping injection (XYPI) in the treatment of children with bronchopneumonia. Methods:Asystematic and comprehensive search was conducted in the domestic and foreign electronic databases CNKI, SinoMed, VIP, WanFang DATA, PubMed, The Cochrane Library, Embase, Web of Science, Clinical?Trials.gov, and the search date ended on May 30, 2019. Inclusion criteria: (1) the types of studies included were randomized controlled trials; (2) the study participants were infants and children with a clear diagnosis of bronchopneumonia, without gender and ethnic restrictions; (3) the intervention test group was XYPI or the control group plus XYPI. The control group was routine treatment (RT) (basic treatment such as fever, cough and asthma, oxygen inhalation, anti?infection, maintaining water, electrolyte balance, etc.) or other Western medicine or RT + other Western medicine treatment. Except for XYPI, the two groups were consistent in intervention measures.According to the Cochrane Handbook, 5.1 evaluation standard and a meta?analysis of the final included studies was performed using RevMan 5.3 software. Results:Atotal of 57 studies were included, with a total sample size of 8454 cases, of which 4255 were in the experimental group and 4199 were in the control group. Meta?analysis results showed that (1) Total effective rate: XYPI group was better than the control group (relative risk [RRRT] = 1.25, 95% confidence interval [CI] [1.15, 1.36], P < 0.00001; RRRT + RBVI = 1.18, 95% CI [1.09, 1.29], P < 0.0001; RR antibiotic = 1.16, 95% CI [1.09, 1.24], P < 0.00001, RRRT + antibiotic = 1.22, 95% CI [1.16, 1.27], P < 0.00001); antipyretic time: XYPI group was better than the control group (mean difference [MDRT] = ?0.97, 95% CI [?1.17, ?0.76], P < 0.00001; MDRT + antibiotic = ?2.28, 95% CI [?2.88, ?1.67], P < 0.00001; MDRT + RBVI = ?1.51, 95% CI [?1.81, ?1.21], P < 0.00001; cough disappearing time: XYPI group was better than the control group (MDRT = ?1.37, 95% CI [?1.74, ?1.00], P < 0.00001; MDRT + antibiotic = ?1.71, 95% CI [?2.04, ?1.37], P < 0.00001; MDRT + RBVI = ?1.51, 95% CI [?2.15, ?0.86], P < 0.00001); disappearance time of lung rales: XYPI group was better than the control group (MDRT = ?1.11, 95% CI [?1.35, ?0.88], P < 0.00001; MDRT + RBVI = ?1.63, 95% CI [?2.23, ?1.03], P < 0.00001). The difference was statistically significant; (2) Of the 57 studies (a total of 8454 cases), 29 studies reported adverse reactions, of which 18 studies did not find adverse reactions, and 11 studies reported adverse reactions such as nausea, vomiting, and rash after medication in both groups. (3) The funnel chart indicated potential publication bias. Conclusion: Based on the existing clinical evidence, XYPI can have a certain effect on the treatment of children with bronchopneumonia, and it is not yet possible to conclude its safety evaluation. Moreover, due to the low quality of the included studies, this evidence is still used with cautious clinically.     

Meta‑Analysis of Niaoduqing Granules Combined With RAAS System Blocker in the Treatment of Diabetic Nephropathy

To systematically evaluate the efficacy of urinary granules combined with RAAS system blockers in the treatment of diabetic nephropathy(DN). A meta-analysis of the data required in the literature in accordance with this study was performed using Rev Man 5.3 software. Fifteen randomized controlled trials were analyzed in the present study to evaluate the clinical effect of Niaoduqing-angiotensin converting enzyme inhibitors/angiotensin receptor blocker(ACEI/ARB) in DN patients. A total of 1063 patients were involved, including 538 patients receiving the combination treatment and 525 patients in the control group. The results showed that the clinical efficacy of Niaoduqing granule combined with ACEI/ARB was significantly better than of the control group(odds ratio = 2.92, 95% confidence interval [CI] 1.76–4.86). The treatment combined with Niaoduqing granule decreased the 24-h urinary protein quantitation(mean difference [MD] 0.71, 95% CI 0.28–1.14) and urine albumin excretion rate(UAER)(MD 41.13, 95% CI 26.66–55.59) levels. However, the combination group had no treatment advantage on reducing serumurea nitrogen(MD 0.86, 95% CI 0.05–1.68, P = 0.02) and fasting blood glucose(MD-0.03, 95% CI-0.15–0.09, P = 0.61). And there was no significance in adverse events between two groups(risk ratio = 2.34, 95% CI 0.69–7.95, P = 0.17). Niaoduqing granule-ACEI/ARB combination group maybe as safe as ACEI/ARB alone, and the combination played an advantage in improvement in total effective rate, reduction of 24-h urinary protein quantitation and UAER.     

Meta-analysis on the effect of combining Lianhua Qingwen with Western medicine to treat coronavirus disease 2019

Background: Coronavirus disease 2019(COVID-19) has become a worldwide life-threatening pandemic.Lianhua Qingwen is believed to possess the ability to treat or significantly improve the symptoms of COVID-19. These claims make it important to systematically evaluate the effects of using Lianhua Qingwen with Western medicine to treat COVID-19.Objective: To evaluate the safety and efficacy of combination therapy, employing Lianhua Qingwen with Western medicine, to treat COVID-19, using a meta-analysis approach.Search strategy: China National Knowledge Infrastructure, Wanfang Database, VIP Database, Pub Med,Embase, and Cochrane Library databases were searched for studies evaluating the effect of Lianhua Qingwen-Western medicine combination therapy in the treatment of COVID-19.Inclusion criteria:(1) Research object: hospitalized patients meeting the diagnostic criteria of COVID-19 were included.(2) Intervention measures: patients in the treatment group received Lianhua Qingwen treatment combined with Western medicine, while the control group received either Western medicine or Chinese medicine treatment.(3) Research type: randomized controlled trials and retrospective study were included.Data extraction and analysis: Two researchers extracted the first author, the proportion of males and females, age, body temperature, course of treatment, rate of disappearance of main symptoms, duration of fever, adverse reactions, and total effectiveness from the literature. Odds ratio(OR) and 95% confidence interval(CI) were used as the effect value for count data, and mean difference(MD) and 95% CI were used as the effect value for measurement data.Results: Six articles met the inclusion criteria, including a total of 856 COVID-19 patients. The meta-analysis showed that Lianhua Qingwen combination therapy achieved higher rates of fever reduction(OR = 3.43, 95% CI [1.78, 6.59], P = 0.0002), cough reduction(OR = 3.39, 95% CI [1.85, 6.23],P < 0.0001), recovery from shortness of breath(OR = 10.62, 95% CI [3.71, 30.40], P < 0.0001) and recovery from fatigue(OR = 2.82, 95% CI [1.44, 5.53], P = 0.003), higher total effectiveness rate(OR = 2.51, 95% CI[1.73, 3.64], P < 0.00001), and shorter time to recovery from fever(MD = à1.00, 95% CI [à1.04, 0.96],P < 0.00001), and did not increase the adverse reaction rate(OR = 0.65, 95% CI [0.42, 1.01], P = 0.06), compared to the single medication control.Conclusion: The Lianhua Qingwen and Western medicine combination therapy is highly effective for COVID-19 patients and has good clinical safety. As only a small number of studies and patients were included in this review, more high-quality, multicenter, large-sample-size, randomized, double-blind,controlled trials are still needed for verification.     

Xiaoke Decoction in treatment of type II diabetes: A Meta-analysis

Objective: To systematically evaluate the clinical effect of Xiaoke Decoction in the treatment of type 2 diabetes. Methods: Chinese databases such as CNKI, Wanfang, Weipu Chinese Biomedical Journal Database, and Chinese Medical Biological Literature Database, PubMed, Cochrane Library, Embase, and Web of Science were searched for english language literature from their inception until November 2019. A Meta-analysis was performed using RevMan 5.3 and Stata 12.0. Results: Thirty-eight studies were included in this study, with a total of 3757 patients. It was found that adding Xiaoke Decoction could improve total efficiency. The Xiaoke Decoction groups surpassed the western medicine groups regarding improvement in total efficiency (OR=3.49; 95% CI: 2.78–4.39, P < 0.00001). Adding Xiaoke Decoction could lower the fasting plasma glucose (FPG) level. The Xiaoke Decoction groups surpassed the western medicine groups regarding reduction in FPG levels (MD=-1.14; 95% CI: -1.36－-0.92, P < 0.00001). Adding Xiaoke Decoction could lower the 2h postprandial blood glucose (2hPG) level. The Xiaoke Decoction groups surpassed the western medicine groups regarding reduction in 2hPG (MD=-1.40; 95% CI: -1.61－-1.19, P < 0.00001). Adding Xiaoke Decoction could lower glycated hemoglobin (HbA1c). The Xiaoke Decoction groups surpassed the western medicine groups regarding reduction in HbA1c (MD=-0.77; 95% CI: -0.95－-0.58, P < 0.00001). It was found that adding Xiaoke Decoction could lower the traditional Chinese medicine (TCM) syndrome score. The TCM syndrome scores among patients in the Xiaoke Decoction group were lower than those among patients in the control group after treatment (MD=-4.90; 95% CI: -7.22－-2.57, P < 0.0001). At the same time, we conducted a subgroup and sensitivity analysis of age and intervention duration on the heterogeneity of total efficiency, FPG, 2hPG, HbAlc, and TCM syndrome score outcome indicators. For detecting publication bias, an egger test was conducted. Conclusion: Compared with western medicine alone, Xiaoke Decoction has more advantages for the treatment of type 2 diabetes with respect to total efficiency, FPG, 2hPG, HbAlc, and TCM syndrome score.     

Effectiveness and safety of heat-sensitive moxibustion on bronchial asthma：a Meta-analysis of randomized control trials

OBJECTIVE： To systematically evaluate the effectiveness and safety of heat-sensitive moxibustion（HSM）onasthma.METHODS： Large databases in China and overseas were searched by electronic and manual means to collect information on randomized controlled trials（RCTs）.Two evaluators independently extracted data and evaluated the quality of RCTs according to Cochrane Review Handbook v5.0. RevMan v5.0.20 was used for statisticalanalyses.RESULTS： Fourteen RCTs involving 637 patients were collected.Thirteen RCTs compared the effects of HSM and Western Medicine. After 3-month treatment and after 6-month follow-up, there was no significant difference in effective rate [relative risk（RR）=1.01, 95% CI（0.92, 1.12）, and 1.12,（0.93, 1.36）,respectively], in the asthma control test score of asthma symptoms [weighted mean difference（WMD）=﹣1.54, 95% CI（﹣3.54, 0.47）, and 1.41,（﹣0.48, 3.29）, respectively] and in the forced expiratory volumein 1 second（FEV1）and peak expiratory flow（PEF）. One RCT compared the effect of HSM with warm-suspended moxibustion. After 6-month follow-up, there was a significant difference in FEV1 and PEF [WMD=0.51, 95% CI（0.10, 0.92）, and 1.78,（1.06, 2.50）, respectively]. After 3-month treatment,there was no significant difference between the two groups. One RCT compared the effect of HSM with acupoint application. After 3-month treatment, there was no significant difference in the effectiverate[RR=0.68,95%CI（0.42,1.12）].CONCLUSION： HSM did not show superiority to conventional Western Medicine and acupoint application in terms of curative effects, and may be superior to warm-suspended moxibustion with regard to long-term curative effects. Because of low quality of the included RCTs, this conclusion must be bolstered with higher-quality RCTs.     

Traditional Chinese Medicine Based on Zheng Differentiation versus Angiotensin Receptor Blocker/Angiotensin-converting Enzyme Antagonist in Efficacy of Treating Diabetic Kidney Disease: A Meta-analysis of Randomized Clinical Trials

Objective: To compare the efficacy of traditional Chinese medicine(TCM) based on Zheng differentiation with angiotensin receptor blocker/angiotensin-converting enzyme inhibitor(ARB/ACEI) in treating diabetic kidney disease(DKD) from the aspects of decreasing urinary microalbumin, declining 24-h urinary protein, reducing endpoint events, and renal function protection. Methods: The Chinese Biomedical Literature Database(CBM), the Chinese Academy of Sciences database(CNKI), the VIP Chinese journal database, Wanfang DATA, Medline database, Cochrane library, excerpt medical database(Embase), and Web of science were used for literature searching. The reviewer manager5.3 software was utilized to analyze the data. Results: Twenty-four studies including 1956 participants were involved in this review. Results showed that TCM had a better effect(mean difference [MD],-23.20, 95% confidence interval [CI],-30.60 to-15.79, P 0.00001) than ARB/ACEI on lowering urinary albumin excretion rate(UAER) and urine albumin-to-creatinine ratio(MD-4.56 mg/mmol, 95% CI,-5.76 to-3.36, P 0.00001). Moreover, the advantage of decreasing UAER was greater as the follow-up period become longer(P = 0.04). TCM also had a better effect in 24-h urinal protein, decreasing 0.36 g/24 h(95% CI,-0.45 to-0.27, P 0.00001) more than the control in shorter follow-up period(ranged from 12 to 24 weeks) subgroup but only 0.08 g/24 h(95% CI,-0.13 to-0.03, P = 0.0006) in the longer follow-up period(24 weeks) subgroup. TCM worked as well as ACEI/ARB in reducing endpoint events(relative risk, 0.67, 95% CI, 0.20–2.224, P = 0.51)and decreasing urinary albumin concentration(UAC)(MD,-16.50, 95% CI,-46.28–13.28, P = 0.28). As for protecting renal function, TCM had an equal effect to AECI/ARB in improving creatinine clearance ratio(MD,-3.30, 95% CI,-6.66–0.03, P = 0.05) or estimated glomerular filtration rate(MD, 1.00, 95% CI,-0.59–2.58, P = 0.22). However, TCM had a better effect in releasing the glomerular hyperfiltration state(MD,-9.64, 95% CI,-14.45 to-4.84, P 0.0001). Conclusions: TCM based on Zheng differentiation can work as well as ACEI/ARB in treating DKD and even better in decreasing urinary microalbumin and releasing glomerular hyperfiltration. It is a good alternative treatment of DKD.