Analgesic comparison of dezocine plus propofol versus fentanyl plus propofol for gastrointestinal endoscopy: A meta-analysis

Introduction:As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their efficacy and safety.Methods:PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of dezocine versus fentanyl for the anesthesia of patients undergoing gastrointestinal endoscopy were included.Results:Five RCTs involving 677 patients were included in the meta-analysis. Overall, compared with fentanyl plus propofol for gastrointestinal endoscopy, dezocine plus propofol resulted in the reduction in propofol dose(mean difference [MD] = −11.72; 95% confidence interval [CI] = −22.83 to −0.61; P = .04), awakening time (std. MD = −1.79; 95% CI = −3.31 to −0.27; P = .02) and hypopnea (risk ratio [RR] = 0.16; 95% CI = 0.06–0.41; P = .0002), but had no remarkable effect on induction time (MD = 1.20; 95% CI = −0.98 to 3.39; P = .28), postoperative pain score (MD = −0.38; 95% CI = −1.00 to 0.24; P = .24), nausea or vomiting (RR = 0.45; 95% CI = 0.10–1.98; P = .29).Conclusion:Dezocine plus propofol may be better for the anesthesia of gastrointestinal endoscopy than fentanyl plus propofol.     

The analgesic efficacy of pregabalin for shoulder arthroscopy: A meta-analysis of randomized controlled trials

Introduction:The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy.Methods:We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model.Results:Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = −0.57; 95% CI = −1.04 to −0.09; P = .02) and 12 hours (Std. MD = −0.37; 95% CI = −0.72 to −0.02; P = .04), as well as analgesic consumption (Std. MD = −1.84; 95% CI = −2.24 to −1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = −0.54; 95% CI = −1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53–1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89–1.47; P = .30).Conclusions:Pregabalin may benefit to pain control after shoulder arthroscopy.     

Effectiveness and safety of acupuncture combined with traditional Chinese medicine in the treatment of chronic prostatitis: A systematic review and meta-analysis

Objective:Chronic prostatitis (CP) is a common disease in the outpatient department of males and urology. Clinical studies have found that acupuncture combined with traditional Chinese medicine (TCM) has achieved good results in treating CP, but its efficacy and safety are not completely clear. This study aimed to investigate the efficacy and safety of acupuncture combined with TCM in the treatment of CP.Methods:Randomized controlled trials of acupuncture combined with TCM in treating CP were screened by searching PubMed, Embase, Cochrane Library, CNKI, etc. The retrieval time was from the database establishment date to March 31, 2021. The Cochrane Collaborative Risk Bias Assessment tool was used to evaluate literature''s methodological quality of the literature. The RevMan5.4 software was used for the meta-analysis of outcome indicators. The TSA v0.9 software was used for sequential trial analysis (TSA) of effectiveness.Results:In this study, 19 related randomized controlled trial studies were included, with a total of 1831 cases. The results of the meta-analysis showed that acupuncture combined with TCM could significantly improve the clinical efficacy of CP (OR = 3.76, 95%CI: 2.82 to 5.02, P < .00001), reduce the total score of The National Institutes of Health chronic prostatitis symptom index (MD = −4.00, 95%CI: −4.67 to 3.33, P < .00001), and improve patients’ urination symptoms (MD = −1.10, 95%CI: −1.23 to −0.97, P < .00001), alleviated the pain symptoms of patients (MD = −2.38, 95%CI: −2.41 to −2.35, P < .00001), improved the quality of life of patients (MD = −1.69, 95%CI: −1.97 to −1.41, P < .00001), decreased the scores of TCM symptoms of patients (MD = −2.39, 95%CI: −3.45 to −1.33, P < .00001), and did not increase the adverse reactions of patients (MD = 1.09, 95%CI: 0.57 to 2.06, P = .8). The results of publication bias showed that this study was not affected by publication bias, and the conclusion was reliable. TSA showed that acupuncture combined with TCM was effective in treating CP.Conclusion:Acupuncture combined with TCM is safe and effective for alleviating CP. It can be used as an effective treatment for chronic prostatitis in the clinic.Registration number: DOI 10.17605/OSF.IO/Z8FJM.     

Efficacy and safety of acupuncture for urinary retention after hysterectomy: A systematic review and meta-analysis

Objective:The aim of this study was to evaluate the efficacy and safety of acupuncture in the treatment of urinary retention after hysterectomy in women.Methods:This research searched for 6 database documents, and the deadline is July 23, 2020. This study included a randomized controlled trial of women with urinary retention after hysterectomy. These randomized controlled trials compare acupuncture with bladder function training or other nonacupuncture treatments, and measure urodynamics, effectiveness (BR), and urinary tract infection rates (UIR). Four independent reviewers participated in data extraction and evaluation. Assess the risk of bias in each article, and conduct a meta-analysis according to the type of acupuncture. The result is expressed as a mean difference (MD) or relative risk (RR) with a 95% confidence interval (CI).Results:The meta-analysis contains 12 studies. Most studies indicate low risk or unknown risk, but the GRADE scores of the combined results show low or moderate levels. After the combined analysis, we found that acupuncture versus bladder function exercise and other nonacupuncture therapies can significantly improve the values of post voided residual urine (PVR) (MD = −25.29; 95% CI [−30.45 to −20.73]), maximal cystometric capacity (MD = 39.54; 95% CI [10.30–68.78]), bladder capacity for first voiding desire (MD = −61.98; 95% CI [−90.69 to −33.26]) and maximal flow rate (MFR) (MD = 7.58; 95% CI [5.19–9.97]). And compared with the control group, acupuncture still has advantages in BR (RR = 1.36; 95% CI [1.18–1.56]) and UIR (RR = 0.22; 95% CI [0.08–0.82]). These heterogeneities have been resolved through subgroup analysis, and their main sources are related to different intervention times, the time to start the intervention, and different PVR requirements.Conclusions:There is insufficient evidence that acupuncture can increase the patient''s MFR, BR, and UIR. However, acupuncture can effectively improve the PVR, maximal cystometric capacity, and bladder capacity for first voiding desire values of patients with urinary retention after hysterectomy. Although limited due to the quality and methodological limitations of the included studies, acupuncture can still be used as an effective and safe treatment for women with urinary retention after hysterectomy.Registration:The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119238.     

Nebulized versus invasively delivered surfactant therapy for neonatal respiratory distress syndrome: A systematic review and meta-analysis

Background:Pulmonary surfactant (PS) is commonly used for the treatment of neonatal respiratory distress syndrome (NRDS), several randomized controlled trials (RCTs) have evaluated the role of nebulized versus invasively delivered PS, yet the results remained inconsistent. Therefore, we aimed to conduct this meta-analysis to evaluate the effects and safety of nebulized versus invasively delivered PS in the treatment of NRDS.Methods:We searched PubMed et al databases from inception date to May 15, 2020 for RCTs that compared nebulized vs invasively delivered PS. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios (OR) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated for each outcome by means of fixed- or random-effects model.Results:Two RCTs with a total of 95 preterm neonates were identified, with 48 neonates received PS nebulization and 47 neonates undergone invasive PS administration. There was no significant difference in the SpO₂ level (MD = −0.44, 95% CI −6.01 to 5.12) and the A/APaO₂ level (MD = 0.01, 95% CI −0.02 to 0.05) 1 hour after treatment among 2 groups. But the duration of mechanical ventilation in the nebulization groups was significantly less than that of invasive group (MD = −30.70, 95% CI −41.45 to 19.95).Conclusions:Given the limited evidences, the effects and safety of nebulized versus invasively delivered PS still need further verification.     

The comparison of ketamine with tramadol for postoperative pain relief on children following adenotonsillectomy or tonsillectomy: A meta-analysis of randomized controlled trials

Introduction:The comparison of ketamine with tramadol for pain control remains controversial in pediatric adenotonsillectomy or tonsillectomy. We conduct a systematic review and meta-analysis to explore the efficacy of ketamine vs tramadol for pain relief in children following adenotonsillectomy or tonsillectomy.Methods:We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2019 for randomized controlled trials (RCTs) assessing the effect of ketamine vs tramadol for pediatric adenotonsillectomy or tonsillectomy. This meta-analysis is performed using the random-effects model.Results:Six RCTs are included in the meta-analysis. Overall, compared to ketamine group for pediatric adenotonsillectomy or tonsillectomy, tramadol is associated with substantially lower CHEOPS at 1 h (SMD = 1.56; 95% CI = 0.20–2.92; P = .02; low quality) and longer first time of additional pain medication (SMD = −0.47; 95% CI = −0.74 to −0.19; P = .0008; low quality), but demonstrates no obvious effect on CHEOPS at 6 h (SMD = 0.51; 95% CI = −1.17 to 2.19; P = .55; low quality), sedation scale at 1 h (SMD = −0.80; 95% CI = −3.07 to 1.48; P = .49; low quality) or additional pain medication (RR = 1.31; 95% CI = 0.85–2.02; P = .23; moderate quality).Conclusions:Tramadol may be better to alleviate the postoperative pain after pediatric adenotonsillectomy or tonsillectomy.     

Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation

Background:We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder.Methods:A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses.Results:A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = −0.65, 95% confidence interval [CI]: −1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: −0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: −0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = −0.14, 95% CI: −0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group.Conclusion:Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.     

The efficiency and safety of manual therapy for cervicogenic cephalic syndrome (CCS): A systematic review and meta-analysis

Background:Manual therapy is a common technique for the treatment of (CCS) cervicogenic cephalic syndrome, but the efficiency is various. The aim of the study is to evaluate the evidence pertaining to the efficiency and safety of using manual therapy to treat patients with CCS.Methods:We searched the electronic databases including PubMed, ScienceDirect, and the Cochrane Library. Only randomized controlled trials (RCTs) were enrolled in this systematic review and cumulative meta-analysis.Results:A total of 8 RCTs with 395 patients were included for meta-analysis. Patients who underwent manual therapy showed lower scores of visual analog scale (VAS) (weighted mean difference) WMD = 1.7, 95% confidence interval CI = 0.74–2.65, P = .0005); dizziness handicap inventory (DHI) (WMD = 0.66, 95%CI = 0.31–1, P = .0002); and neck disability index (NDI) (WMD = 0.59, 95%CI = 0.23–0.96, P = .002) and better rotation range of motion (ROM) of the cervical spine (WMD = −6.54, 95%CI = −7.60 to −5.48, P < .0001). However, these patients did not show much benefit from manual therapy with respect to the frequency of CCS episodes and head repositioning accuracy (HRA). No serious adverse effects were reported in our included studies lasting longer than 24 hours.Conclusions:Manual therapy offers an effective and safe approach to treat CCS with lower VAS, DHI, and NDI scores and better cervical spinal movement. Further high-quality RCTs are required to provide more conclusive evidence.Systematic review registration number:PROSPERO172740.     

Pooled-analysis of efficacy and safety of minimally invasive versus standard percutaneous nephrolithotomy

Background:This study aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) versus standard percutaneous nephrolithotomy in patients with renal and upper ureteric stones.Methods:We conducted a pooled analysis on randomized controlled trials (RCTs). The eligible RCTs were selected from the following databases: MEDLINE, Embase, Web of Science, and the Cochrane Library. The reference lists of retrieved studies were also investigated.Results:Our analysis included 10 RCTs with 1612 patients. Pooled data from 10 RCTs revealed the following: stone-free rate (odds ratio = 1.46, 95% confidence interval (CI) [1.12,1.88], P = .004), operative time (mean difference [MD]  = 4.10, 95% CI [–1.37,9.56], P = .14), length of hospital stay (MD = –15.31, 95% CI [–29.43,–1.19], P = .03), hemoglobin decrease (MD = –0.86, 95% CI [–1.19,–0.53], P < .00001), postoperative fever (MD = 0.83, 95% CI [0.49,1.40], P = .49), and urine leakage (MD = 0.59, 95% CI [0.25,1.37], P = .22). Besides, we performed sub-group analysis based on vacuum suction effect and multiple kidney stones. For vacuum suction effect, it revealed the following: stone-free rate in vacuum suction group (P = .007) and in non-vacuum suction group (P = .19). Operative time in vacuum suction group (P = .89), non-vacuum suction group (P = .16). Postoperative fever in vacuum suction group (P = .49), non-vacuum suction group (P = .85).Conclusion:This pooled analysis indicated that MPCNL was a safe and effective method for treating renal stones compared with standard percutaneous nephrolithotomy. Besides, the vacuum suction effect in MPCNL played a more important role. When it comes to multiple or staghorn stones, the longer operative time in MPCNL could not be ignored.     

Clinical efficacy and safety of traditional Chinese medicine Xiao Yao San in insomnia combined with anxiety

Background:Patients with long-term insomnia generally experience anxiety and depression. Traditional sleeping pills and anti-anxiety drugs have certain limitations. Xiao Yao San (XYS), a complementary and alternative therapy, has been widely used to treat insomnia combined with anxiety. This study aims to evaluate the efficacy and safety of XYS in the treatment of insomnia combined with anxiety.Methods:Related literature was retrieved from 8 electronic databases from the establishment time to March 2021. The subjects were diagnosed with insomnia combined with anxiety. We assessed the methodological quality of randomized controlled trials (RCTs) according to the Cochrane Handbook. Data analysis was conducted using RevMan 5.3 software.Results:The analysis includes 9 RCTs involving 681 patients. Meta-analysis supported that as an auxiliary drug for Western medicine (WM), XYS could enhance the clinical efficacy of insomnia calculated according to the traditional Chinese medicine (TCM) syndrome score scale (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.13–1.43; P = .0002) and reduced the scores of Hamilton Anxiety Scale (mean difference [MD]: −5.19; 95% CI: −7.78 to −2.60; P < .001), Pittsburgh Sleep Quality Index (MD: −3.35; 95% CI: −4.86 to −1.84; P < .001), Self-rating Anxiety Scale (MD: −9.38; 95% CI: −10.20 to −8.75; P < .001), TCM syndrome score scale for insomnia (MD: −4.45; 95% CI: −6.65 to −2.24; P < .001), and TCM syndrome score scale for anxiety (MD: −5.54; 95% CI: −9.48 to −1.6; P = .006). The summary analysis also shows that the separate use of XYS was advantageous in reducing the scores of the Hamilton Anxiety Scale (MD: −3.70; 95% CI: −6.31 to −1.09; P = .005), Pittsburgh Sleep Quality Index (MD: −1.82; 95% CI: −2.39 to −1.24; P < .001), and Self-rating Anxiety Scale (MD: −10.79; 95% CI: −14.09 to −7.49; P < .001). The incidence of adverse events with XYS as an ancillary drug or used separately was lower than that in the WM.Conclusion:Our systematic evaluation and meta-analysis showed that XYS combined with WM or XYS alone was beneficial for improving sleep quality and relieving anxiety. Due to the low methodological quality, small sample size, and significant heterogeneity of RCTs, more rigorous and scientific clinical trials are required to further evaluate the efficacy and safety of XYS.PROSPERO registration number:CRD42020190613.     

Efficacy and safety of Lianhuaqingwen for mild or moderate coronavirus disease 2019: A meta-analysis of randomized controlled trials

Background: Coronavirus disease 2019 (COVID-19) is an emerging and rapidly evolving disease, with no recommended effective anti-coronavirus treatments. Traditional Chinese Medicine (TCM) has been widely used to treat COVID-19 in China, and the most used one is Lianhuaqingwen (LH). This study aimed to assess the efficacy and safety of LH combined with usual treatment vs usual treatment alone in treating mild or moderate COVID-19 by a meta-analysis of randomized controlled trials (RCTs).Methods and analysis: We systematically searched the Medline (OVID), Embase, the Cochrane Library, and 4 Chinese databases from inception to July 2020 to include the RCTs that evaluated the efficacy and safety of LH in combination with usual treatment vs usual treatment for mild or moderate COVID-19. A meta-analysis was performed to calculate the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes and mean difference (MD) for continuous outcomes.Results: A total of 5 RCTs with 824 individuals with mild or moderate COVID 19 were included. Compared with the usual treatment alone, LH in combination with usual treatment significantly improved the overall clinical efficacy (RR = 2.39, 95% CI 1.61–3.55), increased the rate of recovery of chest computed tomographic manifestations (RR = 1.80, 95% CI 1.08–3.01), reduced the rate of conversion to severe cases (RR = 0.47, 95% CI 0.29–0.74), shorten the duration of fever (MD = −1.00, 95% CI −1.17 to −0.84). Moreover, LH in combination with usual treatment did not increase the occurrence of the adverse event compared to usual treatment alone.Conclusion: Our meta-analysis of RCTs indicated that LH in combination with usual treatment may improve the clinical efficacy in patients with mild or moderate COVID-19 without increasing adverse events. However, given the limitations and poor quality of included trials in this study, further large-sample RCTs or high-quality real-world studies are needed to confirm our conclusions.     

Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis: A systematic review and meta-analysis

Background:Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.Objective:To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.Methods:We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.Results:A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).Conclusion:Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.PROSPERO registration number:CRD42020195727.     

The analgesic evaluation of gabapentin for arthroscopy: A meta-analysis of randomized controlled trials

Introduction:The efficacy of gabapentin for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of gabapentin versus placebo on the postoperative pain intensity of arthroscopy.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials assessing the effect of gabapentin versus placebo on pain control of arthroscopy. This meta-analysis is performed using the random-effect model.Results:Five randomized controlled trials are included in the meta-analysis. Overall, compared with control group for arthroscopy, gabapentin remarkably decreases pain scores at 24 hour (standard mean difference [SMD]=-0.68; 95% confidence interval [CI]=-1.15 to -0.02; P = .21), analgesic consumption (SMD = -18.24; 95% CI=-24.61 to -11.88; P < .00001), nausea and vomiting (OR = 0.42; 95% CI = 0.21 to 0.84; P = .01), but has no obvious influence on pain scores at 6 h (SMD = −1.30; 95% CI = −2.92 to 0.31; P = .11) or dizziness (OR = 1.12; 95% CI = 0.56 to 2.24; P = .75).Conclusions:Gabapentin is effective for pain control after arthroscopy.     

Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: A systematic review and meta-analysis

Background:To explore the effectiveness of platelet-rich plasma (PRP) injection regarding functional recovery, pain relief, and range of motion (ROM) of shoulder compared with the corticosteroid injection in patients with rotator cuff lesions treated non-operatively.Methods:An electronic literature search was performed by 2 authors in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant randomized controlled trial (RCTs) that were published up to July 20, 2020. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were applied to calculate the pooled effect sizes.Results:Six RCTs were included in this systematic review. Meta-analysis revealed that corticosteroid injection yielded statistically significant superior functional recovery (SMD = −0.80; 95% CI, −1.42 to −0.18; P = .01) and pain relief (MD = 1.59; 95% CI, 0.30–2.89; P = .02) compared with PRP injection for rotator cuff lesions during the short-term follow-up period. However, at the medium-term and long-term follow-up, no statistically significant difference was identified between the 2 groups. Regarding the ROM of shoulder, no statistically significant difference was found between the 2 groups during the whole follow-up period.Conclusions:The current clinical evidence revealed short-term efficacy of corticosteroid injection and no significant medium- to long-term difference between corticosteroid and PRP injection in the treatment of rotator cuff lesions. Additional studies with longer follow-ups, larger sample sizes, and more rigorous designs are needed to draw more reliable and accurate conclusions.     

Perioperative omega-3 fatty acids for liver surgery: A meta-analysis of randomized controlled trials

Introduction:The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery.Methods:We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model.Results:Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34–0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29–1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06–9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63–4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07–2.05; P = .27).Conclusion:Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.     

Effect of liuzijue qigong on patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis

Backgrounds:Chronic obstructive pulmonary disease (COPD) is a common, preventable disease of airflow limitation that accounts for the third leading deaths of any disease process in the worldwide. Health benefits of liuzijue qigong (LQG) on patients with stable COPD has been assessed. This study was designed to perform a systemic review and meta-analysis of the effect of Liuzijue breathing exercise on patients with stable COPD.Methods:Published articles from 1970 to December 2020 were conducted using electronic searches. Two independents reviewers conducted data extraction. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies.Results:A total of 16 eligible trials with 1039 patients with stable COPD were identified. Compared with control group, the pool meta-analysis of LQG showed a significant improvement in forced expiratory volume in one second (FEV1) (MD = −0.16, 95% CI [0.09, 0.23], P < .00001), FEV1% (MD = 9.71, 95% CI [8.44, 10.98], P < .00001), the ratio of forced expiratory volume to forced vital capacity in the first second (FEV1/FVC [%]) (MD = 4.81, 95% CI [2.12, 7.51], P = .0005), 6 minutes walking distance (6MWD) (MD = 21.89, 95% CI [14.67, 29.11], P < .00001), health-related quality of life (SMD = −0.84, 95% CI [−1.12,-0.55], P < .00001) and modified medical research council dyspnea scale (mMRC) (MD = −0.73, 95% CI [−0.96, −0.50], P < .00001). The observed effect was more pronounced for short term and medium-term duration interventions of study. It also showed improvements in the secondary outcome measures by LQG.Conclusions:In this systematic review and meta-analysis, LQG can improve lung ventilation function, exercise endurance and health-related quality of life of patients with stable COPD.Ethic and dissemination:This study is a systematic review and it does not involve harming to the rights of participants. Ethical approval will not be require for this study. The research results may be published in a peer-reviewed journals.     

LigaSure hemorrhoidectomy versus the procedure for prolapse and hemorrhoids: A meta-analysis of randomized controlled trials

Background:LigaSure hemorrhoidectomy and the procedure for prolapse and hemorrhoids (PPH) are both relatively new treatments for managing symptomatic hemorrhoids. This review aimed to evaluate and compare their short-term outcomes.Methods:We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the China National Knowledge Infrastructure database for randomized controlled trials comparing the LigaSure procedure and PPH published in any language from 1998 to October 2013.Results:A total of 5 studies involving 397 participants were included in this review. Pooled analysis showed that the LigaSure procedure was associated with significantly lower recurrence rate [relative risk (RR) = 0.21, 95% confidence interval (CI): 0.06 to 0.72, P = .01] and significantly shorter operating time [mean difference (MD) = −6.39, 95% CI: −7.68 to −5.10, P < .001]. The analysis showed no significant difference in postoperative pain between the two techniques (MD = 0.55, 95% CI: −0.15 to 1.25, P = .12] or in time off work or away from normal activity [standard MD = 0.13, 95% CI: −1.80 to 2.06, P = .9]. The two techniques did not show significant differences in postoperative complications or other patient-related outcomes (P > .05).Conclusions:Our review indicates that both LigaSure hemorrhoidectomy and PPH are safe alternatives for the management of hemorrhoids. Available evidence suggests that the LigaSure technique is associated with shorter operating time and lower hemorrhoid recurrence rate, but these conclusions should be further confirmed in large, multicenter randomized controlled trials with long-term follow-up.     

Is rifaximin better than nonabsorbable disaccharides in hepatic encephalopathy?: A meta-analysis

Background:The purpose of the present meta-analysis was to compare the efficacy of rifaximin and nonabsorbable disaccharides (NADs) in hepatic encephalopathy (HE).Methods:After the registration of the present meta-analysis on INPLASY, all procedures were performed according to PRISMA 2020. Relevant literature was retrieved on PubMed, Embase, and the Cochrane Library up to September 5, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the enrolled studies, and Review Manager software (version 5.3) was used to analyze the clinical efficacy, blood ammonia and adverse effects.Results:Six studies with 559 patients were included in the present meta-analysis. There were no significant differences in the basic characteristics of the included studies. Analysis of the complete resolution of HE showed that rifaximin was better than NADs (risk ratio [RR] = 1.87, 95% confidence interval [CI] = 1.03–3.39, P = .04). However, there were no significant differences in mental status (RR = 1.04, 95% CI = 0.92–1.18, P = .53), blood ammonia level (standard mean difference = −0.02, 95% CI = −0.40–0.02, P = .08), or drug adverse drug effects (OR = 0.43, 95% CI = 0.10–1.77, I² = 56%, P = .24) between the rifaximin and NADs treatment groups.Conclusion:Rifaximin is not superior to NADs in the treatment of HE.     

The efficacy of dexmedetomidine for the prevention of catheter-related bladder discomfort: A systematic review and meta-analysis

Background:The effective therapy to reduce postoperative catheter-related bladder discomfort (CRBD) remained unknown.Objective:We attempted to manage the systematic review and a meta-analysis to clarify the efficacy of dexmedetomidine (DEX) in potential prevention on CRBD.Methods:We performed the meta-analysis on randomized clinical trials (RCTs), and searched the databases from Web of Sciences, Embase and referred Cochrane Library published from October 2016 to September 2020. Data extraction was carefully conducted by 2 authors, respectively. Meta-analysis that was applied synthetically concerns the incidence and severity of CRBD and the treatment effect of DEX on CRBD.Results:We acquired 5 RCTs with interventions of DEX on CRBD. Meta-analysis showed DEX has significantly reduced the incidence and severity of CRBD compared with control at 0 hour (risk ratios [RR] = 0.40, 95% CI = 0.53–0.29, P < .01), 1 hour (RR = 0.44, 95% CI = 0.34–0.57, P < .01), and 2 hours (RR = 0.43, 95% CI = 0.32–0.58, P < .01) and 6 hours (RR = 0.43, 95% CI = 0.29–0.63, P < .01). DEX was also associated with lower incidence of moderate to severe CRBD at 0, 1, and 6 hours after surgery. There were no significant differences in adverse events other than bradycardia, hypotension, and hypertension.Conclusion:The 5 RCTs showed great effectiveness in reducing the incidence and severity of the early and later postoperative CRBD. Meta-analysis showed that DEX interventions were useful in preventing the early and later postoperative CRBD without significant side effects.     

Acupuncture for oligospermia and asthenozoospermia: A systematic review and meta-analysis

Background:Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia.Methods:An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria.Results:Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: −0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27–0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = −0.53, 95% CI: −2.54 to 1.48), the sperm concentration (SMD = −1.10, 95% CI: −1.48 to −0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09–7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739–1.40), but the study heterogeneity was too high to establish robust conclusions.Conclusion:These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future.Trial registration number:PROSPERO CRD42018083885