Pediatric Tui Na for cough in children: A systematic review and meta-analysis of randomized controlled trials

ObjectivesTo evaluate the effectiveness and safety of pediatric Tui Na for the treatment of cough in children under seven years of age.Design: Systematic review and meta-analysis of randomized controlled trials.MethodsWe searched seven major databases and two ongoing trial registers before November 2021 for randomized controlled trials (RCTs) on pediatric Tui Na for cough in children. Main outcome measures were cough related status (such as cough frequency, severity, and duration), use of western medicines, quality of life, medical costs, recurrence rate, adverse events and acceptance. Two reviewers independentlyselected studies and extracted data. Results were presented by RevMan 5.4 as risk ratios (RRs) and mean differences (MDs), both with 95 % confidence intervals (CIs). Risk of bias were assessed using ROB tools and quality of evidence by GRADE.ResultsSixteen RCTs involving 1502 participants were included in this review. Most trials were poor in quality for not reporting allocation concealment, blinding of outcomeassessment or outcome data completeness. The pooled results demonstrated that pediatric Tui Na alone (2 RCTs, 205 participants; MD −2.22, 95 %CI −3.71 to −0.73; P = 0.004; I ² = 90 %; low certainty) or combined with conventional treatment (7 RCTs, 668 participants; MD −1.66, 95 %CI −2.89 to −0.44; P = 0.008; I ² = 98 %; low certainty) shortened cough duration. The combined treatment also decreased the recurrence rate of cough (3 RCTs, 135 participants; RR 0.35, 95 %CI 0.21–0.58; P < 0.0001; I ² = 0 %; moderate certainty). There were insufficient data on adverse events.ConclusionsThis review indicates that pediatric Tui Na may shorten the course and decrease the recurrence rate of cough in children, and appears to be relatively safe. However, large-sample, multi-center and high-quality RCTs are warranted to confirm these findings.     

Comparison of Therapies for Secondary Prophylaxis of Esophageal Variceal Bleeding in Cirrhosis: A Network Meta-analysis of Randomized Controlled Trials

PurposeThe decision regarding the optimal secondary prophylactic treatment for esophageal variceal bleeding (EVB) in hepatic cirrhosis is controversial. A network meta-analysis was conducted to assess the benefits of various treatments for the secondary prophylaxis of EVB in patients with cirrhosis.MethodsA thorough examination of databases, including EMBASE, PubMed, and Cochrane Database of Controlled Trials, was conducted to identify relevant randomized controlled trials up to December 2019. Key primary outcomes included mortality and rebleeding. Within the identified databases, a network meta-analysis was performed. Results were expressed by using a 95% credible interval (CrI) and odds ratios (ORs). The quality of results was assessed by using the Grading of Recommendations, Assessment, Development and Evaluation approach.FindingsForty-eight trials with 4415 participants with cirrhosis and portal hypertension who had a history of recent variceal bleeding were included. Carvedilol ranked first (surface under the cumulative ranking curve [SUCRA], 87.4%) in overall survival, and some advantage was suggested; however, the findings were not statistically significant, compared with endoscopic variceal ligation + nonselective beta-blockers (NSBB) (OR, 0.59; CrI, 0.28, 1.3), NSBB + isosorbide mononitrate (OR, 0.67; CrI, 0.33, 1.4), and transjugular intrahepatic portosystemic shunt (TIPS) (OR, 0.52; CrI, 0.24, 1.1). NSBB + isosorbide mononitrate (SUCRA, 63.9%) ranked higher than NSBB + endoscopic variceal ligation (SUCRA, 49.6%) in reducing mortality. TIPS (SUCRA, 98.8%) ranked higher than other treatments in reducing rebleeding but did not confer any survival benefit.ImplicationsTIPS ranks first in preventing rebleeding of secondary prophylaxis of EVB and carvedilol shows outstanding efficacy in improving survival. International Prospective Register of Systematic Reviews: identifier CRD42019131814.     

Acupuncture and moxibustion for endometriosis: A systematic review and analysis

ObjectivesThis study aimed to examine the effect of acupuncture on symptoms and health-related quality of life in patients with endometriosis.MethodsNine biomedical databases were searched to April 2022 to identify randomized controlled trials of acupuncture and/or moxibustion used alone or as adjunct to guideline-recommended pharmacotherapy for the treatment of endometriosis. One reviewer extracted data and another verified the data. A random effects model was used to calculate mean differences.ResultsFifteen trials involving 1018 patients met the inclusion criteria, but diversity in comparisons and outcome measures prevented meta-analysis. Compared to sham acupuncture, manual acupuncture was more effective at reducing dysmenorrhea VAS pain score (mean difference [MD] − 2.40, 95 % CI [− 2.80, − 2.00]; moderate certainty evidence), pelvic pain VAS score (MD − 2.65, 95 % CI [− 3.40, − 1.90]; high certainty evidence) and dyspareunia VAS scores (MD − 2.88, [− 3.83, − 1.93]), lessened the size of ovarian cyst (MD − 3.88, 95 % CI [− 7.06, − 0.70]), and improved quality of life. Compared to conventional therapy, manual acupuncture plus conventional therapy and warm needle alone resulted in greater improvements in quality of life than conventional therapy. Among the six studies that reported safety, fewer adverse events were reported in participants who received acupuncture or moxibustion.ConclusionsLow to moderate certainty evidence from single studies showed that manual acupuncture may improve pain-related symptoms and quality of life; however, there is insufficient evidence on the overall effectiveness of acupuncture and moxibustion for endometriosis.     

Efficacy and Safety of Commonly Used Insulin Analogues in the Treatment of Diabetic Ketoacidosis: A Bayesian Indirect Treatment Comparison

PurposeInsulin analogues (IAs) are the mainstay for the management of diabetic ketoacidosis (DKA). However, the relative efficacy of newer IAs is uncertain. The aim of this study was to compare the relative efficacy and safety of IAs for the management of DKA using an indirect treatment comparison (ITC).MethodsPubMed, EMBASE, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing short-, rapid-, and long-acting IAs in patients with DKA. The primary outcomes of interest were time taken to normalize DKA and time taken to normalize blood glucose levels. The secondary outcomes of interest were the amount of insulin needed to normalize DKA, the length of hospital stay, and the number of hypoglycemic events in the intervention and comparator groups. Bayesian ITC was performed by using the gemtc package in the R program. Continuous outcomes are reported as mean difference (MD), and binary outcomes are reported as odds ratios (ORs), with 95% credible intervals (CrIs). The Cochrane risk of bias tool was used to assess the risk of bias in the included RCTs.FindingsTen RCTs randomizing 435 participants to treatment were included in this ITC. A total of 5 interventions (lispro, glargine with regular insulin [RI], glulisine, aspart, and regular insulin) were compared for both safety and efficacy outcomes in DKA. Glargine co-administered with regular insulin showed superiority for clinical outcomes compared with regular insulin: consuming less time (MD, −3.1 h; 95% CrI, −7.9 to 1.8), amount of insulin required (MD, −32 U; 95% CrI, 83.0 to 18.0), and the length of hospitalization (MD, −0.82 day; 95% CrI, −2.7 to 1.0) to normalize DKA. However, these results were not statistically significant. Insulin aspart had fewer reports of hypoglycemic events (OR, 1.7; 95% CrI, 0.34 to 9.3) than regular insulin.ImplicationsNewer IAs were found to be equally effective and safe as regular insulin in the treatment of DKA. Thus, administering these IAs can be considered a safe and cost-effective alternative for DKA management in non-ICU settings. Cost-effective analysis of the newer IAs is needed because these agents are expensive compared with regular insulin.     

Blood Pressure–lowering Effect of Fimasartan Versus Comparators: A Cross-inference With a Systematic Review and Meta-analysis Through a Quality-management System

PurposeFimasartan, one of the newest angiotensin receptor blockers (ARBs) available worldwide, has been investigated extensively since its initial development. Our study group conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating fimasartan and comparators for their blood pressure (BP)-lowering effect. Moreover, we employed a cross-inference (frequentist and Bayesian inference) system, which has never been used in the medical field, to confirm the results of our study. In addition, a quality management system was integrated throughout the study for data quality.MethodsPubMed, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalKey, and ClinicalTrial.gov were searched for RCT studies from March 1998 to March 2022. In each study, the mean differences (MD^s) and 95% CIs were identified for reductions in clinic sitting systolic and diastolic BP (SiSBP/SiDBP) or 24-hour mean systolic BP and diastolic BP by ambulatory BP monitoring (ASBP/ADBP) from baseline between the fimasartan and comparator groups, followed by meta-analysis. A subsequent meta-analysis was performed with frequentist and Bayesian inference as a tool in the cross-checking system.FindingsEleven RCTs with a total of 2459 subjects were included in the study. The clinic SiSBP/SiDBP–lowering effect of fimasartan was significantly greater relative to those of comparators (MD for clinic SiSBP, −2.58 mm Hg [95% CI, −4.35 to −0.81; P = 0.004]; MD for clinic SiDBP, −2.13 mm Hg [95% CI, −2.96 to −1.30; P = 0.00001]). The ASBP/ADBP–lowering effect of fimasartan was also significantly greater relative to those of comparators (MD for ASBP, −3.58 mm Hg [95% CI, −5.74 to −1.43; P = 0.001]; MD for ADBP, −1.99 mm Hg [95% CI, −3.34 to −0.63; P = 0.004]).ImplicationsFimasartan seems to be more effective in lowering BP than its comparators, including other ARBs. Although there is a limited amount of data and a minuscule number of study subjects available, the results of cross-inference (frequentist + Bayesian) were fairly consistent with the meta-analysis results through our quality management system.     

Curcumin as adjuvant treatment in patients with non-alcoholic fatty liver (NAFLD) disease: A systematic review and meta-analysis

ObjectiveThe aim of this review is to determine the effect of curcumin on the liver ultrasonographic morphology, and the effectiveness of curcumin as adjuvant treatment for NAFLD.MethodsThe Cochrane library and PubMed were searched systematically to identify randomized controlled trials from 2000 to January 2021. The primary outcomes were NAFLD severity, liver steatosis resolution, liver scarring, liver enzymes, also lipid profiles. 16 RCTs with a total of 1028 participants were included in the meta-analysis.ResultsCurcumin improved NAFLD severity (RR: 3.52, 95 % CI 1.27–9.72; P = 0.02) and increased the liver steatosis resolution (RR 3.96, 95 % CI 1.54–10.17; P = 0.004) based on the liver ultrasonographic finding. Curcumin supplementation reduced aspartate aminotransferase (MD − 4.00, 95 % CI − 5.72 to − 2.28; P < 0.001), alanine aminotransferase (MD − 7.02, 95 % CI − 9.83 to − 4.20; P < 0.001), total cholesterol (MD − 11.86, 95 % CI − 19.25 to − 4.46; P = 0.002) and BMI (MD: − 0.41, 95 % CI − 0.75 to − 0.07; P = 0.02).ConclusionCurcumin supplementation has a favorable effect on liver ultrasonographic findings, reduced serum liver enzymes, total cholesterol, and BMI in participants with NAFLD. Therefore, promoting curcumin as adjuvant treatment on NAFLD patients might be justified.     

Comparative Efficacy of Acalabrutinib in Frontline Treatment of Chronic Lymphocytic Leukemia: A Systematic Review and Network Meta-analysis

PurposeThe goal of this study was to estimate the relative efficacy of acalabrutinib (monotherapy and in combination with obinutuzumab) compared with standard frontline treatments for chronic lymphocytic leukemia (CLL) in fludarabine-ineligible patients, through a network meta-analysis (NMA).MethodsThe efficacy of acalabrutinib from ELEVATE-TN (study of Obinutuzumab + Chlorambucil, Acalabrutinib [ACP-196] + Obinutuzumab, and Acalabrutinib in Subjects With Previously Untreated CLL) was compared to bendamustine + rituximab, chlorambucil-based therapy, alemtuzumab, ibrutinib mono/combination therapy and venetoclax + obinutuzumab using data from eight randomized controlled trials (RCTs). Relevant RCTs were identified using a systematic literature review. Two evidence networks were constructed: Network A, composed solely of RCTs that met the inclusion criteria; and Network B, composed of 7 RCTs and a published cross-trial comparison of ibrutinib from RESONATE-2 and chlorambucil + obinutuzumab from iLLUMINATE. Bayesian NMAs were conducted on progression-free survival (PFS) and overall survival (OS) endpoints; results were reported by using hazard ratios (HRs) and 95% credible intervals (CrIs). HRs were considered significant if their CrIs did not cross 1. Treatments were ranked by using the surface under the cumulative ranking area (SUCRA) values. Expert opinion from 2 hematologists was sought to validate results.FindingsBoth networks showed a significant improvement in PFS for acalabrutinib + obinutuzumab over all comparators. Both networks also showed a significant improvement in PFS for acalabrutinib monotherapy versus most comparators, with a significant difference to ibrutinib monotherapy found in Network A but not Network B. Conversely, a significant difference in PFS was observed for acalabrutinib monotherapy versus venetoclax + obinutuzumab in Network B but not Network A. Although OS HRs all favored acalabrutinib, most were not significant and were characterized by wide CrIs, indicating a high level of uncertainty. Acalabrutinib + obinutuzumab ranked highest in terms of PFS improvement (SUCRA values, 98% and 100%) and OS improvement (SUCRA values, 92% and 94%), followed by acalabrutinib monotherapy (SUCRA values for PFS, 88% and 90%; OS, 83% and 87%) in Networks A and B, respectively.ImplicationsAcalabrutinib was associated with favorable PFS and OS compared with frontline CLL therapies and ranked highest in treatment efficacy over the other comparators. The NMA was limited by heterogeneity in patient baseline characteristics across trials, variable treatment regimens, and short study follow-up times. Despite these limitations, the NMA provides insights into the relative efficacy of acalabrutinib compared with frontline CLL therapies in the absence of head-to-head clinical trials.     

Effect of supplementation with Chlorella vulgaris on lipid profile in adults: A systematic review and dose-response meta-analysis of randomized controlled trials

ObjectiveTo summarize available findings on the effect of Chlorella vulgaris supplementation on lipid profile in adults.DesignSystematic review and meta-analysis of randomized controlled trials (RCTs).SettingThis study followed 2020 PRISMA guideline. We performed a systematic search in the online databases to identify relevant articles and then, extracted required data from each paper for the meta-analysis. Random-effects models were used to obtain overall mean difference (MD) comparing Chlorella vulgaris supplementation with a control group.Main outcome measuresBlood lipids including triglyceride (TG), total cholesterol (TC), LDL-C, and HDL-C.ResultsIn total, 10 RCTs with a total sample size of 539 adults (264 in the Chlorella vulgaris group and 275 in the control group) were included. Of the 10 RCTs, four had a low risk of bias for all aspects of the Cochrane risk of bias tool. Also, only two studies determined the chlorella content, purity, potency, and contamination of the supplements used in the intervention. Combining results from these studies showed a summary MD of −2.11 mg/dL (95% CI: −7.28 to 3.06) for TG, −7.47 mg/dL (95% CI: −12.98 to −1.96) for TC, −7.71 mg/dL (95% CI: −14.05 to −1.37) for LDL-C, and −0.45 mg/dL (95% CI: −0.67 to 1.57) for HDL-C, indicating a beneficial effect of Chlorella vulgaris supplementation on TC and LDL-C levels. Based on the dose-response analysis, the reducing effect of Chlorella vulgaris supplementation on LDL-C levels was seen at the dosages between zero and 1500 mg/d (P for non-linearity= 0.01), whereas in higher amounts, this effect was not significant.ConclusionWe found that Chlorella vulgaris supplementation had a beneficial effect on TC and LDL-C levels with no significant effect on TG and HDL-C levels.     

Systematic review with network meta-analysis on the treatments for latent tuberculosis infection in children and adolescents

BackgroundWe aimed to synthesize the evidence on the efficacy and safety of different treatment regimens for latent tuberculosis infection (LTBI) in children and adolescents.MethodsA systematic review with network meta-analysis was performed (CRD142933). Searches were conducted in Pubmed and Scopus (Nov-2021). Randomized controlled trials comparing treatments for LTBI (patients up to 15 years), and reporting data on the incidence of the disease, death or adverse events were included. Networks using the Bayesian framework were built for each outcome of interest. Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Rank probabilities were calculated via the surface under the cumulative ranking analysis (SUCRA) (Addis-v.1.16.8). GRADE approach was used to rate evidence's certainty.ResultsSeven trials (n = 8696 patients) were included. Placebo was significantly associated with a higher incidence of tuberculosis compared to all active therapies. Combinations of isoniazid (15–25 mg/kg/week) plus rifapentine (300–900 mg/week), followed by isoniazid plus rifampicin (10 mg/kg/day) were ranked as best approaches with lower probabilities of disease incidence (10% and 19.5%, respectively in SUCRA) and death (20%). Higher doses of isoniazid monotherapy were significantly associated to more deaths (OR 18.28, 95% ICr [1.02, 48.60] of 4–6 mg/kg/day vs. 10 mg/kg/3x per week).ConclusionsCombined therapies of isoniazid plus rifapentine or rifampicin for short-term periods should be used as the first-line approach for treating LTBI in children and adolescents. The use of long-term isoniazid as monotherapy and at higher doses should be avoided for this population.     

Clinical evidence for acupuncture for adult asthma: Systematic review and meta-analysis of randomised sham/placebo-controlled trials

ObjectiveAcupuncture is a widely used asthma therapy, but the benefits remain uncertain. This study aimed to access the effectiveness of acupuncture for treatment of asthma in adults.MethodsFive English databases and four Chinese databases were searched from inception to November 2021. Randomised sham/placebo-controlled trials meeting inclusion criteria were included. Risk of bias was evaluated according to the Cochrane Review Handbook, and data analysis was performed in RevMan 5.4.1. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) profiler.ResultsSixteen randomised controlled trials (RCTs) were included in the meta-analysis. Results indicated that acupuncture was well-tolerated and could improve FEV1% compared with sham/placebo acupuncture [MD 6.11, 95% CI 0.54–11.68, I² = 93%, number of participants (n) = 603]. Acupuncture also improved Cai’s Asthma Quality of Life Questionnaire (AQLQ) (MD 7.26, 95% CI 5.02–9.50, I² = 0, n = 358), and reduced the asthma symptom score (SMD −2.73, 95% CI −3.59 to −1.87, I² = 65%, n = 120). One study showed acupuncture increased the Asthma Control Test (ACT) score (MD 2.00, 95% CI 0.90–3.10, n = 111), and decreased exacerbation frequency (MD −1.00, 95% CI −1.55 to −1.45, n = 111). Other lung function and medication use parameters were not statistically significant.ConclusionsAcupuncture versus sham/placebo control appeared to improve quality of life, FEV1%, symptoms, and asthma control, and reduced exacerbation frequency per year. Further studies with appropriate controls, more participants, and high-quality evidence are needed.     

Dose-dependent effect of vinegar on blood pressure: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials

BackgroundThere are controversial findings regarding the effect of vinegar on blood pressure based on the evidence accumulated so far.MethodsA systematic search was conducted through PubMed, Scopus, and ISI Web of Science up to April 2022. We estimated the change in blood pressure for each 30 ml/d increments in vinegar consumption in each trial and then, calculated the mean difference (MD) and 95 %CI using a fixed-effects model. A dose-response meta-analysis of differences in means provided us with the estimation of the dose-dependent effect. The certainty of evidence was rated by the GRADE tool.ResultsEach 30 ml/d increment in vinegar consumption reduced SBP by − 3.25 mmHg (95 %CI: − 5.54, − 0.96; I² = 67.5 %, GRADE = low). Levels of SBP decreased linearly and slightly (P_nonlinearity = 0.69, P_{dose-response} = 0.02) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 3.36, 95 %CI: − 5.77, − 0.94). Each 30 ml/d increment in vinegar consumption reduced DBP by − 3.33 mmHg (95 %CI: − 4.16, − 2.49; I² = 57.1 %, GRADE = low). Levels of DBP decreased linearly and slightly (P_nonlinearity = 0.47, P_{dose-response} = 0.004) up to vinegar consumption of 30 ml/d (MD30 ml/d: − 2.61, 95 %CI: − 4.15, − 1.06)ConclusionsAccording to the findings, vinegar significantly reduces systolic and diastolic blood pressure and may be considered an adjunct to hypertension treatment. Thus, clinicians could incorporate vinegar consumption as part of their dietary advice for patients.     

Pilates for neck pain: A systematic review and meta-analysis of randomised controlled trials

BackgroundAlthough widely used in clinical practice, evidence on the effectiveness of the Pilates method in people with neck pain has not been adequately summarised yet.ObjectiveTo systematically review the literature on the effectiveness of the Pilates method on improving pain and disability in patients with neck pain.MethodsWe performed searches in multiple databases from their inception to October 2021. We included randomised controlled trials comparing the effects of the Pilates method with other treatments on pain and disability in patients with neck pain. Two authors independently selected studies, rated risk of bias, extracted data, and judged the overall certainty of evidence using GRADE.ResultsWe included five RCTs (n = 224 participants). There is low certainty evidence that Pilates method did not significantly improve pain compared to other treatments at short-term (mean difference (MD): MD: 9.29 points, 95% CI -25.84 to 7.26; I2 = 93%). Low certainty evidence suggested that the Pilates method did not significantly improve disability compared to other treatments at short-term (MD: 3.20 points, 95% CI -7.70 to 1.30; I² = 75%).ConclusionBased on low certainty evidence, the Pilates method is not better than other treatments at 3 months to reduce pain and disability. High quality trials are required.     

Amiodarone and/or lidocaine for cardiac arrest: A Bayesian network meta-analysis

IntroductionAlthough available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine.MethodsWe searched studies from inception until Jan 21, 2020. The primary endpoint was survival to hospital discharge in cardiac arrest, and the secondary endpoints were survival to hospital admission/24 h and favorable neurological outcome.ResultsA total of 9 studies were included. In head-to-head studies, amiodarone (odds ratio [OR] 2.96, 95% credible interval [CrI] 1.02–8.53) and lidocaine (OR 3.12, 95% CrI 1.08–9.98) had superior effects on survival to hospital admission/24 h compared to the combination of the two drugs. In terms of survival to hospital discharge, amiodarone (OR 1.18, 95% CrI 1.03–1.35) and lidocaine (OR 1.22, 95% CrI 1.06–1.41) were more effective than placebo. Amiodarone (OR 1.20, 95% CrI 1.02–1.41) was significantly better than placebo in favorable neurological outcome. However, there was no significant difference in other pairwise comparisons. The surface under cumulative ranking curve (SUCRA) revealed that lidocaine was the most effective therapy for survival to hospital admission (84.1%) and discharge (88.4%), while amiodarone was associated with a more favorable neurological outcome (88.2%).ConclusionsLidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome.Trial registration: This study is registered with PROSPERO, number CRD42020171049.     

Impact of renin–angiotensin system inhibitors use on mortality in severe COVID-19 patients with hypertension: a retrospective observational study

ObjectiveAssociation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) use with coronavirus disease 2019 (COVID-19) remains controversial. We aimed to investigate the impact of ACEI/ARB use on all-cause mortality in severe COVID-19 patients with hypertension.MethodsWe enrolled 650 COVID-19 patients from Changsha and Wuhan city between 17 January 2020 and 8 March 2020. Demographic, clinical characteristics, and outcomes were collected. Multivariable analysis and propensity-score matching were performed to assess the impact of ACEI/ARB therapy on mortality.ResultsAmong the 650 patients, 126 who had severe COVID-19 concomitant with hypertension were analyzed. The average age was 66 years and 56 (44.4%) were men. There were 37 ACEI/ARB users and 21 in-hospital deaths (mortality rate, 16.7%). Male sex (odds ratio [OR], 5.13; 95% confidence interval [CI], 1.75 to 17.8), but not ACEI/ARB use (OR, 1.09; 95%CI, 0.31 to 3.43), was an independent risk factor for mortality in severe COVID-19 patients with hypertension. After propensity-score matching, 60 severe COVID-19 patients were included and no significant correlation between use of ACEI/ARB and mortality was observed.ConclusionsThere was no significant association of ACEI/ARB use with mortality in severe COVID-19 patients with hypertension. These findings support the continuation of ACEI/ARB therapy for such patients.     

Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis

ContextPatients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or patients with early stage cancer. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear.ObjectivesThis meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes.MethodsWe conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook, Version 5.1.0.ResultsAbout 15 RCTs enrolling 1208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (standardized mean difference [SMD] 0.22; 95% CI 0.06–0.38; P = 0.009), fatigue (SMD −0.25; 95% CI −0.45 to −0.04; P = 0.02), insomnia (SMD −0.36; 95% CI −0.56 to −0.17; P = 0.0002), physical function (SMD 0.22; 95% CI 0.05–0.38; P = 0.009), social function (SMD 0.18; 95% CI 0.02–0.34; P = 0.03), and dyspnea reduction (SMD −0.18; 95% CI −0.34 to −0.01; P = 0.03).ConclusionExercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social functions for patients with advanced-stage cancer.     

Shengmai injection as an adjunctive therapy for the treatment of chronic obstructive pulmonary disease: A systematic review and meta-analysis

ObjectiveTo evaluate the clinical efficacy of Shengmai injection for the treatment of chronic obstructive pulmonary disease (COPD) through an evidence-based approach.MethodsRandomized controlled trials (RCTs) investigating the effect of Shengmai injection on COPD were included in this study. Seven electronic databases were searched to obtain eligible studies. The quality of the included RCTs was evaluated according to the Cochrane Risk of Bias Assessment Tool. When appropriate, meta-analysis of the data was conducted by RevMan 5.3 software and Stata 13.0 software. The relative risk (RR) or mean difference (MD) and 95% confidence interval (CIs) were reported for dichotomous or continuous outcomes, respectively. Sensitivity analysis was performed to verify the independence of the results. Funnel plots and the Begg and Egger tests were implemented to determine the potential publication bias.ResultsUltimately, 23 RCTs were included, involving 1804 participants. Meta-analysis showed that the combination of Shengmai injection and western medicine (WM) could achieve a better effect than WM alone in terms of improving the clinical total effective rate (RR = 1.20, 95% CIs: 1.15–1.24), pulmonary function (FEV₁(L): MD = 0.41, 95% CIs 0.32 to 0.49; FEV₁(%): MD = 6.21, 95% CIs: 2.72–9.71), blood gas index (PaO₂: MD = 6.13, 95% CIs: 2.93–9.32; PaCO₂: MD=-6.2, 95% CIs: -11.63 to -0.77), immunoglobulin levels (IgG: MD = 3.55, 95% CIs: 3.10–3.99; IgA: MD = 0.34, 95% CIs: 0.31to 0.38; IgM: MD = 0.35, 95% CIs: 0.27 to 0.42), C-reactive protein levels (MD = −8.05, 95% CIs: −10.11 to −6.00) and the lung rale disappearance time (MD = −2.57, 95% CIs: -3.19 to -1.95). Additionally, the CAT score, mMRC and average hospitalization time were also reduced significantly by Shengmai injection plus WM. Among 11 RCTs that mentioned safety issues, 6 RCTs found no adverse events, and the other 5 RCTs reported the details of adverse events.ConclusionShengmai injection may positively influence COPD in combination with WM. However, firm conclusions could not be draw due to the low quality of the evidence. Further high-quality studies are still required to test the efficacy of Shengmai injection for this condition.     

What is the influence of grape products on liver enzymes? A systematic review and meta‐analysis of randomized controlled trials

ObjectiveThis systematic review and meta-analysis were aimed to determine the effects of grape products on liver enzymes in adults.MethodsDatabases including PubMed/Medline, Cochrane Library, ISI Web of Science, and Scopus were searched up to February 2021. Randomized clinical trials (RCTs) investigating the effect of grape products on serum concentrations of liver enzymes were included. Data were pooled using the random-effects model and weighted mean difference (WMD) was considered as the summary effect size.ResultsEight RCTs enrolling 291 participants met the inclusion criteria for this meta-analysis. The overall effect illustrated no significant change in serum levels of alanine aminotransferase (ALT) (WMD: − 2.04; 95 % CI: − 5.50 to 1.42; P = 0.24; I² = 72.5 %), and aspartate aminotransferase (AST) (WMD: − 1.40; 95 % CI: − 3.80 to 0.99; P = 0.25; I² = 76.0 %) in intervention group compared with the control group. Subgroup analyses revealed that the effect of grape products on ALT (WMD: − 4.97; 95 % CI: − 8.73 to − 1.21; P = 0.01) and AST (WMD: − 2.89; 95 % CI: − 5.69 to − 0.08; P = 0.04) levels was significant when the intervention period was equal or more than 12 weeks.ConclusionOverall, grape products had no significant effect on liver enzymes in adults. However, due to the low number of included studies, these findings must be interpreted with great caution. Larger, well-designed RCTs are still needed to further evaluate the capacity of the grape products as a complementary treatment to improve liver enzymes.     

The efficacy of Da Chaihu decoction combined with metformin tablets for type 2 diabetes mellitus: A systematic review and meta-analysis

ObjectiveTo assess the efficacy of Da Chaihu decoction combined with metformin tablets on patients with type 2 diabetes compared with metformin alone.MethodsThis systematic review and meta‐analysis is written based on 2020 PRISMA Extension for Chinese Herbal Medicines 2020 (PRISMA-CHM 2020) reporting guidelines. We reviewed all the relevant studies from a search of the following databases from inception to February 2022 without any language restriction: Excerpta Medica Database (EMBASE), Google Scholar, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Information, Wanfang Data, and the Chinese Biomedical Literature Database(CBM). Data were extracted and the quality was independently evaluated by two reviewers, based on the inclusion and exclusion criteria. Data were analyzed using the Cochrane software RevMan 5.3.ResultsSix randomized controlled trials comprising 516 participants were included.The meta‐analysis revealed the Da Chaihu decoction combined with metformin tablets group was significantly superior to the metformin tablets group in terms of fasting blood glucose(FPG) (−0.66 mmol/L; 95 % CI (confidence intervals) [− 1.28, − 0.04]), plasma glucose 2 h after meal (2-h PG) (−1.18 mmol/L; 95 % CI [−1.94, −0.42]) in six RCTs, body mass index (BMI) (−3.07 mmol/L; 95 % CI [−6.89, 0.75]) in three RCTs, glycosylated hemoglobin (HbAlc) (−0.36 mmol/L; 95 % CI [−1.04, 0.31]) in three RCTs, and triglycerides (TG) (−0.76 mmol/L; 95 % CI [−1.37, −0.15]) in two RCTs. In two RCTs, there were significant differences in terms of total cholesterol (TC) (−0.97 mmol/L; 95 % CI [−1.18, −0.76]).ConclusionsVery low-quality research shows that Da Chaihu decoction combined with metformin tablets exert a certain level of efficacy on patients with type 2 diabetes compared with metformin alone. However, random sequence generation methodology was reported in five studies leading to the low quality of the included studies. None of the six studies depicted the blinding method, allocation concealment, selective reporting, and assessed the purity and potency of the product. This observation requires verification through high-quality, multi-center, double-blinded randomized controlled trials, and assesses the purity and potency of the product.     

Chinese herbal medicine Dengzhan Xixin injection for acute ischemic stroke: A systematic review and meta-analysis of randomised controlled trials

ObjectiveTo evaluate the effectiveness and safety of Chinese herbal medicine Dengzhan Xixin (Erigeron breviscapus) injection for acute ischemic stroke.DesignSystematic review and meta-analysis (CRD42016038413, http://www.crd.york.ac.uk/PROSPERO).MethodsSix electronic databases were searched from inception to March 2016 for randomised controlled trials (RCTs) of Dengzhan Xixin (DZXX) injection for acute ischemic stroke. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool.Data synthesiswas performed using RevMan 5.3 and was presented with mean difference (MD) or relative risk (RR) and their 95% confidence interval (CI). A summary of finding table was generated by GRADEpro (version 3.6).ResultsTwenty-five RCTs with 2498 participants were included and all trials adopted conventional therapy (CT) in both arms. Most of the studies had high risk of bias. The addition of DZXX to CT showed no significant benefit on death (RR 0.27, 95% CI 0.05–1.63) within the treatment period (14–35 d), but showed higher Barthel index score (MD 10.20, 95% CI 8.16–12.25), lower neurological function deficit score (MD −3.99, 95% CI −5.68 to −2.30, by NFDS; MD −1.67, 95% CI −2.59 to −0.76, by NIHSS), and lower treatment failure (RR 0.40, 95% CI 0.31–0.52). Thirteen trials (52%) reported the outcome of adverse events, but no serious adverse events were reported.ConclusionLow quality evidence implied that DZXX injection appeared to improve neurological function in patients with acute ischemic stroke. However, this potential benefit should be further studied in large, rigorous trials.