ObjectiveTo systematically review the efficacy of Chinese medicine injection (CMI) for treating heart failure (HF).MethodsCNKI, WanFang Data, VIP, The Cochrane Library, PubMed, and EMbase databases were electronically searched from inception to January 2021 to identify randomized controlled trials (RCTs) on CMI for treating HF. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Network meta-analysis was then performed by RevMan 5.2 software and Stata 16.0 software.ResultsA total of 47 studies were included involving 4 902 patients and 5 types of CMIs, including Shenmai, Shenfu, Yiqi Fumai (lyophilized), Shengmai, and Danhong injections. The results of network meta-analysis showed that the efficacy of combined CMIs was superior to conventional Western medicine alone. For the main efficacy, Shenmai, Shengmai, and Shenfu injections had significant advantages in improving the total clinical effectiveness. Shengmai, Shenmai, and Yiqi Fumai (lyophilized) injections were significantly more effective for reducing NT pro-BNP levels than other injections. Shenfu and Shengmai injections were significantly more effective for reducing BNP levels than other injections. Shenmai, Danhong and Shengmai injections were significantly more effective for improving the left ventricular ejection fraction than the other injections. These CMIs showed similar advantages for secondary efficacy indicators as for main efficacy indicators.ConclusionsThe combined 5 types of CMIs for treating HF can improve the clinical efficacy when compared with conventional Western medicine treatment. Shenmai injection, Yiqi Fumai injection (lyophilized), and Shengmai injection, which is part of Sheng Mai San, have clear advantages in terms of the overall curative effect or on individual indices.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To systematically review the efficacy of eight time-restricted eating strategies on overweight/obese adults using network meta-analysis. MethodsThe Scopus, MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the intervention effects of eight time-restricted eating strategies on overweight/obese adults from inception to September 18, 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was performed using ADDIS 1.16.8 and Stata 18.0 software. ResultsA total of 23 RCTs involving 1 306 overweight/obese adults were included. The network meta-analysis revealed that compared with standard diets, the 8-hour time-restricted eating combined with a low-carbohydrate diet (MD=−4.01, 95%CI −5.95 to −2.08, P<0.05) showed better weight reduction effects. Compared with standard diets, the 8-hour time-restricted eating combined with a low-carbohydrate diet (MD=−3.54, 95%CI −5.44 to −1.63, P<0.05) and the 8-hour time-restricted eating combined with a low-sugar diet (MD=−4.19, 95%CI −8.33 to −0.05, P<0.05) significantly improved overall fat mass. Compared with standard diets, the 8-hour time-restricted eating combined with a low-sugar diet (MD=−15.42, 95%CI −29.12 to −1.72, P<0.05) had a better effect on fasting blood glucose control. The 8-hour time-restricted eating combined with high-intensity interval training (MD=−3.68, 95%CI −6.57 to −0.79, P<0.05) showed better results in reducing waist circumference. No statistical significance was found in direct comparisons regarding bone mineral content. The efficacy ranking showed that the 8-hour time-restricted eating combined with a low-carbohydrate diet was most effective for weight reduction; the 8-hour time-restricted eating combined with a low-sugar diet was more effective in reducing overall fat mass and controlling fasting blood glucose; the 8-hour time-restricted eating combined with calorie restriction had significant effects on waist circumference improvement; and the 8-hour time-restricted eating combined with high-intensity interval training was more effective for increasing bone mineral content. ConclusionBased on the results of the network meta-analysis and ranking, different time-restricted eating strategies have specific advantages for the intervention of overweight or obese individuals. The choice of the appropriate strategy should consider individual dietary habits and health conditions. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
With the rapidly growing literature across the surgical disciplines, there is a corresponding need to critically appraise and summarize the currently available evidence so they can be applied appropriately to patient care. The interpretation of systematic reviews is particularly challenging in cases where few robust clinical trials have been performed to address a particular question. However, risk of bias can be minimized and potentially useful conclusions can be drawn if strict review methodology is adhered to, including an exhaustive literature search, quality appraisal of primary studies, appropriate statistical methodology, assessment of confidence in estimates and risk of bias. Therefore, the following article aims to: (Ⅰ) summarize to the important features of a thorough and rigorous systematic review or meta-analysis for the surgical literature; (Ⅱ) highlight several underused statistical approaches which may yield further interesting insights compared to conventional pair-wise data synthesis techniques; and (Ⅲ) propose a guide for thorough analysis and presentation of results.
Objective To systematically review the efficacy of six cognitive interventions on cognitive function of patients with mild cognitive impairment after stroke. Methods The PubMed, EMbase, Cochrane Library, SinoMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials on the effects of non-drug interventions on the cognitive function of patients with mild cognitive impairment after stroke from inception to March 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Openbugs 3.2.3 and Stata 16.0 software. Results A total of 72 studies involving 4 962 patients were included. The results of network meta-analysis showed that the following five cognitive interventions improved the cognitive function of stroke patients with mild cognitive impairment: cognitive control intervention (SMD=−1.28, 95%CI −1.686 to −0.90, P<0.05) had the most significant effect on the improvement of cognitive function, followed by computer cognitive training (SMD=−1.02, 95%CI −1.51 to −0.53, P<0.05), virtual reality cognitive training (SMD=−1.20, 95%CI −1.78 to −0.62, P<0.05), non-invasive neural regulation (SMD=−1.09, 95%CI −1.58 to −0.60, P<0.05), and cognitive stimulation (SMD=−0.94, 95%CI −1.82 to −0.07, P<0.05). Conclusion Five cognitive interventions are effective in improving cognitive function for stroke patients with mild cognitive impairment, among which cognitive control intervention is the most effective. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically evaluate the effects of nine different dressings in the treatment of diabetic foot (DF). MethodsDatabases including PubMed, The Cochrane Library (Issue 2, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data were searched to collect randomized control trials (RCTs) about the effects of dressings for the DF from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then network meta-analysis was performed using WinBugs 1.4.3 and Stata 13.0 softwares. ResultsA total of 29 RCTs involving 2 393 patients were included. The network meta-analysis showed that silver ion was superior to alginate, hydrogel, honey, sterile gauze and povidone-iodine gauze; Alginate was superior to sterile gauze and povidone-iodine gauze; Hydrogel was superior to povidone-iodine gauze; Honey was superior to sterile gauze and povidone-iodine gauze; Foam was superior to silver ion, alginate, hydrogel, honey, sterile gauze, povidone-iodine gauze and antibacterials gauze; Chitosan was superior to hydrogel, sterile gauze and povidone-iodine gauze; Antibacterials gauze was superior to sterile gauze and povidone-iodine gauze. All of the differences were statistically significant. Probability ranking according to SUCRA showed that there was a great possibility for foam and chitosan in the treatment of DF. ConclusionBased on the results of network meta-analysis and rank, foam dressing and chitosan dressing are superior to other dressings in the treatment of DF. More attentions should be made regarding comparisons directly of different dressing and reporting of cost-effective analysis.
Network meta-analyses (NMA) of survival data often rely on the proportional hazards (PH) assumption, however, this assumption fails when survival curves intersect. With the emergence of innovative therapies such as immunotherapy, the importance of NMA based on non-proportional hazards (non-PH) in the current evidence-based medicine evaluation of oncology drugs has become increasingly prominent. Fractional polynomial (FP) models do not rely on the assumption of PH, which can flexibly capture the characteristics of survival curves, and the corresponding fitting effects are better than those of the PH models. This study introduced a complete workflow in R for NMA using FP models with non-PH.
Due to the lack of head to head direct comparison evidence, applying indirect comparison (ITC) as well as network meta-analysis to compare multiple interventions becomes a new popular and powerful statistical technique. However, its theoretical system still needs improvement. In this article, we briefly introduce and summarize its progress concerning basic concepts, method assumptions, influencing factors of effectiveness, and software for analysis, so as to help researchers better understand the method and promote its application in evidence production.
The primary advantage of network meta-analysis is the capability to quantify and compare different interventions for the same diseases and rank their benefits or harms according to a certain health outcome. The inclusion of a variety of interventions has increased the complexity of the conclusions drawing from a network meta-analysis, and based on the ranking results alone may lead to misleading conclusions. At present, there are no accepted standards for the conclusion drawing from a network meta-analysis. In November 2020, based on the evidence certainty results of network meta-analysis, the GRADE (Grades of Recommendations Assessment, Development and Evaluation) working group proposed two approaches to draw conclusions from a network meta-analysis: the partially contextualised framework and the minimally contextualised framework. This paper aimed to introduce principles and procedures of the minimal contextualised framework through a specific example to provide guidance for the network meta-analysis authors in China to present and interpret the results using minimally contextualised framework.
ObjectiveTo systematically review the efficacy of different drugs for patients with methamphetamine-induced psychotic disorders by network meta-analysis.MethodsAn electronical search was conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, CBM, WanFang Data and VIP databases from inception to October 2016 to collect randomized controlled trials (RCTs) about different drugs for methamphetamine-induced psychotic disorders. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then RevMan 5.3, R 3.3.2 and JAGS 4.2.0 softwares were used to perform network meta-analysis.ResultsA total of 16 RCTs involving 1 676 patients and 9 kinds of drugs were included. The results of network meta-analysis showed that: compared with the placebo group, olanzapine (OR=28.00, 95%CI 8.10 to 110.00), risperidone (OR=20.00, 95%CI 7.70 to 58.00), quetiapine (OR=30.00, 95%CI 6.60 to 160.00), ziprasidone (OR=28.00, 95%CI 3.70 to 230.00), chlorpromazine (OR=29.00, 95%CI 5.00 to 200.00), aripiprazole (OR=13.00, 95%CI 1.70 to 93.00), haloperidol (OR=19.00, 95%CI 2.10 to 190.00) could significantly improve the psychotic disorders of patients with methamphetamine, respectively, in which quetiapine was the best choice. There were no significant differences between any other pairwise comparisons of these different drugs.ConclusionFor the treatment of psychotic disorders caused by methamphetamine, quetiapine should be of a priority choice, follows by ziprasidone, chlorpromazine, olanzapine, risperidone, aripiprazole or haloperidol in a descending priority. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.