针灸治疗坐骨神经痛系统评价/Meta-分析的方法学质量及报告质量评价

目的:评价目前国内外针灸治疗坐骨神经痛的系统评价/Meta-分析的方法学质量和报告质量。方法:检索国内外大型医学数据库,依照纳入/排除标准进行严格筛选,分别采用AMSTAR量表和PRISMA清单对最终纳入的文献进行方法学质量评价和报告质量评价。结果:(1)纳入的8篇系统评价/Meta-分析,均存在不同程度的方法学质量问题,主要包括:所有研究均未提供纳入文献和排除文献清单报告;87.5%的研究缺少相关利益冲突报告;75%的研究未进行发表偏倚分析等。(2)报告质量方面,存在的主要问题包括:所有研究均未对结构式摘要、目的、方案和注册进行完整报告;75%的研究未对研究特征、其他分析进行完整报告;62.5%的研究未对研究理论基础、研究间偏倚、证据强度总结、资金支持进行完整报告等。结论:目前国内外针灸治疗坐骨神经痛的系统评价/Meta-分析质量参差不齐,需进一步提高方法学水平并规范报告,以期为循证决策提供高质量的证据。     

Antipsychotic switching in schizoaffective disorder: A systematic review

Objectives. To systematically review the evidence about the switching of antipsychotics in SZA in acute and maintenance treatment. Methods. A systematic review following the PRISMA statement identifying studies specifically conducted on, or including, SZA patients. Results. One analysis considered uniquely a SZA population, 13 more studies including an adequate SZA subsample were considered. Most of the studies were aimed at switching antipsychotic treatments to improve tolerability issues. Despite the absolute lack of trials specifically conducted on SZA populations, we found limited evidence on the use of aripiprazole, lurasidone, and, to a lesser extent, risperidone and ziprasidone as possible agents to substitute previous treatments whereas efficacy or, more frequently, tolerability issues arise. Evidence supports also the switch to risperidone long-acting injectable when the adherence to oral treatment may be a concern. Conclusions. Antipsychotic switching in SZA is a neglected topic that would need better profiling. Clinicians should keep in mind the receptor binding characteristics of drugs in order to optimize transitions. Evidence supports the switch to aripiprazole and lurasidone, less strongly to risperidone and ziprasidone. The switch to risperidone long-acting injectable is supported, especially in patients with limited treatment adherence to oral therapy.     

Systematic review of progressive familial intrahepatic cholestasis

Background and aims

Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous group of rare genetic disorders associated with bile acid secretion or transport defects. This is the first systematic review of the epidemiology, natural history and burden of PFIC.

Periodontal disease in patients with Down syndrome: A systematic review

Background

The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS).

Immunogenicity,safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints.In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment.PROSPERO registration code CRD42018103605.