The efficacy and safety of traditional Chinese medicine Guilu Erxian Jiao in the treatment of knee osteoarthritis: A systematic review and meta-analysis

ObjectiveA systematic review was conducted to investigate the efficacy of Guilu Erxian Jiao (GEJ) in the treatment of knee osteoarthritis (OA).MethodsWe searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Electronic Periodical Services, and ClinicalTrials.gov to identify relevant randomized controlled trials or controlled clinical trials, from the inception of each source to April 20, 2021. Primary outcome included overall efficacy, pain score, and Lequesne index score; secondary outcome included adverse events. Methodological quality was assessed using the Cochrane risk of bias tool (RoB 1.0). The meta-analysis was performed based on a random-effects model due to anticipated clinical heterogeneity. The grading of overall evidence was assessed using the GRADE system. The study protocol was registered on PROSPERO (CRD42021233573).ResultsEight studies were included. Compared to controls, GEJ exhibited superior overall efficacy for treating OA (risk ratio (RR) = 1.20; 95% confidence interval (CI) = 1.06–1.35). Regarding pain score, there was no statistical difference between GEJ and controls (standardized mean difference (SMD) = 0.27; 95% CI = −0.91 – 1.46). No significant difference was found in Lequesne score between GEJ and controls (MD = −0.25; 95% CI = −0.52 – 0.01). No statistical difference in adverse reactions was observed between GEJ and controls (risk difference (RD) = −0.01; 95% CI = −0.05–0.03).ConclusionOur findings suggest that GEJ may have positive effects on overall efficacy in treating OA. However, there is insufficient evidence regarding pain score, Lequesne score, and knee joint function score.     

Complete mesocolic excision with central venous ligation/D3 lymphadenectomy for colon cancer – A comprehensive review of the evidence

Complete mesocolic excision (CME), central vascular ligation (CVL) and D3 lymphadenectomy refers to mesocolic excision within an intact mesenteric fascia, ligation of the vascular origin, and removal of all lymph nodes along the arterial root. While denoting different techniques, the terms CME, CVL and D3 are often used interchangeably. This review aims to provide the most up-to-date summary on CME.A total of nine meta-analyses were published from 2020 to 2021, as well as preliminary results from three randomised trials. CME invariably resulted in a greater lymph node yield compared to non-CME surgery. Other quality indicators were poorly reported, including completeness of the mesocolic plane. CME improved short to long term survival outcomes. Three meta-analyses showed a reduction in local recurrence rates with CME, and one demonstrated improved incidence of distant recurrence. Analysis of the evidence suggests a benefit for routine CME surgery in all but the earliest colon cancers.CME was associated with a longer surgical duration but reduced operative blood loss. All but two meta-analyses showed no difference in overall complication rates with CME. While vascular, lymphatic and autonomic injury are potential concerns during CME, there was consistently no significant difference between the rates of anastomotic leakage and postoperative mortality as well as the duration of post-operative hospital stay between CME and conventional colectomy. Long-term bowel function and quality of life was similar between both techniques.A substantial learning curve exists for CME. Standardised training regimes are necessary for mastery of the technique to achieve the best outcomes.     

Phototherapy and risk of childhood cancer: A systematic review and meta-analysis

ObjectiveThis study aims to conduct a systematic review and meta-analysis of the scientific studies on the associations between phototherapy and risk of childhood cancer.MethodsElectronic databases including PubMed, Scopus, and Web of Science were searched until March 28, 2020. In general, 11 studies were included in the meta-analyses. Subgroup analyses were performed on the types of cancers and children's age, and the sensitivity analysis was done to search for heterogeneity sources.ResultsThe findings of the meta-analysis show that phototherapy was significantly associated with an increased risk of all types of cancers (RR = 1.28; 95% CI (1.08, 1.51)).ConclusionThis systematic review and meta-analyses indicated that neonatal phototherapy might be a possible risk factor for childhood cancer in general, and leukemia in particular. However, as the role of confounding factors were not controlled in many studies, future large cohorts are necessary in this regard. The findings of this study underscore the importance of greater adherence to scientific guidelines for thresholds of bilirubin for minimizing unnecessary exposure to phototherapy.     

Total Calcium (Dietary and Supplementary) Intake and Prostate Cancer: a Systematic Review and Meta-analysis

Background: Controversial results have been reported concerning the influence of calcium intake on prostate cancerrisk. The aim of this study was to determine any association between total calcium (in the diet and in supplements) intakeand prostate cancer. Materials and Methods: The present systematic review and meta-analysis study was carried outfollowing a PRISMA guidelines. Two reviewers independently using MeSH keywords searched international databasesincluding PubMed, Science Direct, Cochrane, EMBASE, Web of Science, CINAHL, EBSCO and search engines suchas Google Scholar. The searches were performed without any time limit until May 2016. The results were pooledusing a random effects model and homogeneity was confirmed using the Q test and I2 index. Subgroup analyses wasperformed according to continents and study designs. The data were analyzed using STATA software version 3.2, withpfinal meta-analysis. The main age range of the participants was 50 to 70 years. The relative risks (RR) for total calciumwith total prostate cancer, localized prostate cancer, and advance prostate cancer were estimated to be 1.15 (95% CI:1.04-3.46), 1.05 (95% CI: 0.96-1.14), and 1.15 (95% CI: 0.89-1.50), respectively. Only the relationship between totalcalcium and total prostate cancer was significant (P<0.05). Conclusions: High calcium intake can be considered as arisk factor for total prostate cancer. Therefore, calcium intake might be a target for prevention.     

Complication incidence of EUS-guided pancreas biopsy: A systematic review and meta-analysis of 11 thousand population from 78 cohort studies

A systematic review and meta-analysis were performed to estimate the incidence of possible complications following EUS-guided pancreas biopsy. Pancreatic cancer has a very poor prognosis with a high fatality rate. Early diagnosis is important to improve the prognosis of pancreatic cancer. We searched Pubmed, Embase, Web of Science, and Scopus databases for studies published from inception to Augest, 2018. Meta-analysis were conducted with random-effect models and heterogeneity was calculated with the Q, I² and τ² statistics. We enrolled 78 studies from 71 articles in the meta-analysis, comprising 11,652 patients. Pooled data showed that the whole complication incidences were low 0.210 × 10⁻⁴(95%CI -0.648 × 10⁻⁴, 1.068 × 10⁻⁴). And they were in bleeding 0.002 × 10⁻⁴ (95%CI -0.092 × 10⁻⁴, 0.097 × 10⁻⁴), pancreatitis 0.002 (95%CI -0.082 × 10⁻⁴, 0.086 × 10⁻⁴), abdominal pain 0 (95%CI -0.037 × 10⁻⁴, 0.038 × 10⁻⁴), fever 0 (95%CI -0.032 × 10⁻⁴, 0. 032 × 10⁻⁴), infection 0 (95%CI -0.030 × 10⁻⁴, 0.031 × 10⁻⁴), duodenal perforation 0 (95%CI -0.033 × 10⁻⁴, 0.034 × 10⁻⁴), pancreatic fistula 0 (95%CI -0.029 × 10⁻⁴, 0.029 × 10⁻⁴), abscess 0 (95%CI -0.029 × 10⁻⁴, 0.029 × 10⁻⁴) and sepsis 0 (95%CI -0.029 × 10⁻⁴, 0.030 × 10⁻⁴). Subgroup analysis based on the tumor size, site, needle type and tumor style also showed robust results. The pooled data showed EUS-guided pancreas biopsy could be a safe approach for the diagnosis of pancreatic lesions. More large-scale studies will be necessary to confirm the findings across different population.     

Role of acupuncture in the treatment of insulin resistance: A systematic review and meta-analysis

Backgroundand purpose Acupuncture has gained increasing attention in the treatment of insulin resistance (IR). This study systematically reviews the efficacy of acupuncture on clinical IR outcomes.MethodsCochrane Central Register of Controlled Trials, Embase, Medline (via OVID), China National Knowledge Infrastructure (CNKI), Wan Fang and China Science and Technology Journal Database (VIP) were searched to collect randomized controlled trials (RCTs) of patients with IR treated by acupuncture. Meta-analysis was performed by RevMan 5.3.ResultsWith acupuncture, the homeostasis model assessment of insulin resistance (homa-IR) significantly decreased (mean difference (MD) = -1.04, 95% confidence interval (CI) −1.37 to −0.71; P < 0.00001), as did fasting blood glucose (FBG) (MD = −0.56, 95% CI -0.88 to −0.25; P = 0.0005), 2 h postprandial blood glucose (2hPG) (MD = −0.91, 95% CI -1.62 to −0.20; P = 0.01), and fasting insulin (FINS) (MD = −3.23, 95% CI -4.14 to −2; P < 0.00001). Meanwhile, the insulin sensitivity index (ISI) (MD = 0.36, 95% CI 0.18 to 0.53; P < 0.0001) increased, and fewer adverse events occurred.ConclusionAcupuncture may improve homa-IR, ISI, FBG, 2hPG and FINS with fewer adverse events than other treatments, making it a viable treatment for IR.