Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint.

PURPOSE: The management of a proximal interphalangeal (PIP) joint fracture dislocation becomes more challenging when the joint surface is damaged because of severe comminution or inadequate treatment in the acute phase. The purpose of this study was to evaluate the clinical outcomes of an osteochondral autograft for the reconstruction of the joint surface in patients with a partial PIP joint defect. METHODS: Twelve patients underwent osteochondral autograft surgery from May 2007 to July 2018. The average age at the time of surgery was 38 years (range, 21-67 years), and there were 10 men and 2 women. Plain radiographs and computed tomography scans showed a partial middle phalangeal base defect in all the cases. The surgeries were performed 2 weeks to 20 months after the fracture or a previous surgery. Partial hamate grafts were harvested to reconstruct volar lip (n = 7), middle portion (n = 2), and dorsal lip (n = 3) defects of the middle phalangeal base. Bone healing, postoperative range of motion, instability, and pain were evaluated. The average follow-up duration was 27.8 months (range, 12-53 months). RESULTS: Radiographic graft union was observed in all the patients 6-8 weeks after the surgery. The deformity was corrected in 11 patients. The active range of motion of the involved PIP joint was improved from 28.3° (range, 0°-60°) to 75.0° (range, 25°-95°). Complications were observed during follow-up, including degenerative arthritis (n = 2), instability (n = 3), and stiffness (n = 5). CONCLUSIONS: Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. The functional recovery is generally acceptable, with a well-restored joint architecture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Investigating the intentions and reasons of senior high school students in registering for nursing education in China.

BACKGROUND: A shortage of qualified nurses and their low level of educational qualifications hinders the development of global health services. Studies have proven the role of nursing education in addressing these problems. However, no related studies have focused on senior high school students in China. This study aimed to explore senior high school students' intentions to learn nursing and identify the factors influencing their decision-making processes. METHODS: An anonymous questionnaire was distributed to 8050 senior high school students, which included questions regarding their demographic characteristics, obtaining nursing specialty information, cognition of the nursing occupation and the impact of the COVID-19 on the nursing profession. Descriptive calculation, the chi-square test and logistic regression were used for the analysis. RESULTS: Only 0.73% of the participants had a clear intention to study nursing. Academic performance and family support were significant predictors of students' intentions to pursue nursing education. Students' interest in nursing specialties was associated with their choice. There was a positive correlation between cognition of nursing occupation and students' choice of nursing. Students' experience of the COVID-19 pandemic also had a positive impact on their nursing career choice. CONCLUSION: This survey to some extent reflects the problem of nurses shortage in China. In addition, these findings may also provide a new perspective for predictors of nursing shortage and potential interventions.

Probiotics therapy for adults with diarrhea-predominant irritable bowel syndrome: a systematic review and meta-analysis of 10 RCTs.

PURPOSE: Accumulating evidence showed that probiotics therapy might be effective in treating diarrhea-predominant irritable bowel syndrome (IBS-D). This study aimed to evaluate the effectiveness and safety of probiotics therapy for the treatment of IBS-D. METHODS: We performed a comprehensive literature search in eight electronic databases, and gray literature from inception to August 4, 2021. Randomized controlled trials (RCTs) of probiotics therapy for the treatment of IBS-D were included and the quality was assessed using the risk of bias tool recommended by the Cochrane Handbook version 5.1.0. RevMan 5.4 software was used to perform the meta-analysis on the outcomes of IBS-D symptoms, abdominal pain, quality of life, and abdominal distension. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. RESULTS: Ten RCTs evaluating 943 patients were identified. Only one study had unclear risk of bias, while nine studies had a high risk of bias. The meta-analysis results showed that, compared to the placebo, probiotics therapy significantly decreased the score of IBS-D symptoms (SMD = - 0.55, 95% CI: [- 0.83, - 0.27], P < 0.05), abdominal pain (SMD = - 0.43, 95% CI: [- 0.57, - 0.29], P < 0.05), and abdominal distension (SMD = - 0.45, 95%CI: [- 0.81, - 0.09], P < 0.05). There was no statistical difference in the quality of life. However, all the certainty of evidence was very low. CONCLUSION: Very low certainty evidence showed that probiotics might be an effective treatment for improving the IBS-D symptoms, abdominal pain, and abdominal distension, in adult IBS-D patients. However, these conclusions should be supported by high-quality evidence.

The recurrence rate of Helicobacter pylori in recent 10 years: A systematic review and meta-analysis.

OBJECTIVE: To update and evaluate the recurrence rate of Helicobacter pylori (H. pylori) eradication therapy in recent 10 years. METHODS: A systematic search of PubMed, Embase, Cochrane library, and Web of science was performed to identify the studies of recurrence rate of H. pylori published from 2010 to 2019. Stata 15.0 was used for analysis. RESULTS: A total of 31 studies (16,797 participants) were analyzed. The recurrence rate of H. pylori was 9% (95% CI, 8-11%), and it showed an upward trend with the time elapsed after eradication. The annual recurrence rate was 4%, and there was a stable trend with the time elapsed after eradication. Subgroup analyses showed that the recurrence rate of H. pylori eradication by triple therapy was higher than that of quadruple therapy (14% [95% CI, 9-19] vs 12% [95% CI, 7-17]); urban was higher than that of rural (8% [95% CI, 1-14] vs 5% [95% CI, 1-9]); males were higher than that of females (11% [95% CI, 8-14] vs 10% [95% CI, 7-14]); Europe had the highest recurrence rate (16% [95% CI, -1 to 42]), and Africa had the lowest (1% [95% CI, 0-2]). The recurrence rate ofH. pylori was inversely related to the human development index. CONCLUSIONS: The recurrence rate of H. pylori showed an increasing trend in recent 10 years, and it is still a knotty public health problem worldwide. The recurrence rate of H. pylori showed an upward trend with the time elapsed after eradication, and the recurrence rate of H. pylori varies by area, gender, and eradication methods.

An investigation of the intention and reasons of senior high school students in China to choose medical school.

BACKGROUND: Shortages of qualified health workers have been a global concern, especially in developing countries. China also faces this dilemma, which hinders the development of public health services. Senior high school students are a group who are considering their college majors and careers after graduation. They are also a potential and basic talent reserve for the health sector. This survey focused on senior high school students' intention to learn clinical medicine and explored potential influencing factors. METHODS: An anonymous questionnaire containing 20 items was distributed to 5344 senior high school students. The questions covered the following topics: students' intention to learn clinical medicine, personal and family information, understanding of medical education, cognition of doctors' working conditions, and doctor-patient relationships. Logistic regression and the chi-square test were used to compare students with and without a clear intention to learn clinical medicine to explore influencing factors. RESULTS: Only 5.6% of senior high school students had a clear intention to learn medicine (CILCM). Personal and family information had distinct impacts. Interest and anatomy course were also associated with students' choice. There was a positive correlation between understanding of medical education and students' intention Meanwhile, students' cognition of doctors, career prospects, and social status had significant impacts. The more optimistic students were about doctors' working conditions and doctor-patient relationships, the more likely they were to have a CILCM. CONCLUSION: To some extent, this survey reflects the shortage of medical talent in China and provides possible clues for solving this problem. In addition, these findings may provide a perspective for understanding the development of health services in developing countries.

Intra-articular Osteotomy for Malunited Proximal Interphalangeal Joint Fracture.

BACKGROUND: Intra-articular malunion of the proximal interphalangeal joint is challenging. Multiple treatment options vary from arthrodesis to different types of osteotomy procedures. The aim of this study was to evaluate the effectiveness of intra-articular osteotomy in treating malunited proximal interphalangeal (PIP) joint fractures. MATERIALS AND METHODS: Fifty-nine consecutive patients with chronic PIP joint fractures were presented to us from May 2007 to December 2017. Sixteen joints of 15 patients were malunited PIP fracture without severe cartilage damage and underwent intra-articular osteotomy. The average interval from injury to operation was 4 (1-48) months. The mean duration of follow-up was 9 (2-43) months. Radiographic evidence of bone healing, joint alignment, range of motion of PIP, and distal interphalangeal joints were documented and assessed. RESULT: Fifteen patients underwent intra-articular osteotomy. The average age was 32 (15-54) years. Fourteen of them were males. Fractures affect 9 middle phalangeal bases and 7 proximal phalangeal heads. Bony union was obtained in all patients by 6 to 10 weeks after surgery. Pain was relieved in 14 patients and the deformity was corrected in 12 joints of 11 patients. The average arc of motion for involved PIP joints was improved from 30.3 (10.0-39.1) degrees to 68.4 (7.2-75.6) degrees. One patient arose painful degenerative arthritis after surgery. Ten patients were satisfied or very satisfied. CONCLUSIONS: For malunited PIP joint fracture without severe cartilage damage, intra-articular osteotomy provides predictable functional recovery and minimal donor site sacrifice.

Spine surgeon specialty differences in single-level percutaneous kyphoplasty.

BACKGROUND: Percutaneous kyphoplasty (PKP) is a procedure performed by a spine surgeon who undergoes either orthopedic or neurosurgical training. The relationship between short-term adverse outcomes and spine specialty is presently unknown. To compare short-term adverse outcomes of single-level PKP when performed by neurosurgeons and orthopedic surgeons in order to develop more concretely preventive strategies for patients under consideration for single-level PKP. METHODS: We evaluated patients who underwent single-level PKP from 2012 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We used univariate analysis and multivariate logistic regression to assess the association between spine surgeon specialty and short-term adverse events, including postoperative complication and unplanned readmission, and to identify different independent risk predictors between two specialties. RESULTS: Of 2248 patients who underwent single-level PKP procedure, 1229 patients (54.7%) had their operations completed by a neurosurgeon. There were no significant differences in the development of the majority of postoperative complications and the occurrence of unplanned readmission between the neurosurgical cohort (NC) and the orthopedic cohort (OC). A difference in the postoperative blood transfusion rate (0.7% NS vs. 1.7% OC, P = 0.039) was noted and may due to the differences in comorbidities between patients. Multivariate regression analysis revealed different independent predictors of postoperative adverse events for the two spine specialties. CONCLUSIONS: By comparing a large range of demographic feature, preoperative comorbidities, and intraoperative factors, we find that short-term adverse events in single-level PKP patients does not affect by spine surgeon specialty, except that the OC had higher postoperative blood transfusion rate. In addition, the different perioperative predictors of postoperative complications and unplanned readmissions were identified between the two specialties. These findings can lead to better evidence-based patient counseling and provide valuable information for medical evaluation and potentially devise methods to reduce patients' risk.

NF-κB and enhancer-binding CREB protein scaffolded by CREB-binding protein (CBP)/p300 proteins regulate CD59 protein expression to protect cells from complement attack.

The complement system can be activated spontaneously for immune surveillance or induced to clear invading pathogens, in which the membrane attack complex (MAC, C5b-9) plays a critical role. CD59 is the sole membrane complement regulatory protein (mCRP) that restricts MAC assembly. CD59, therefore, protects innocent host cells from attacks by the complement system, and host cells require the constitutive and inducible expression of CD59 to protect themselves from deleterious destruction by complement. However, the mechanisms that underlie CD59 regulation remain largely unknown. In this study we demonstrate that the widely expressed transcription factor Sp1 may regulate the constitutive expression of CD59, whereas CREB-binding protein (CBP)/p300 bridge NF-κB and CREB, which surprisingly functions as an enhancer-binding protein to induce the up-regulation of CD59 during in lipopolysaccharide (LPS)-triggered complement activation, thus conferring host defense against further MAC-mediated destruction. Moreover, individual treatment with LPS, TNF-α, and the complement activation products (sublytic MAC (SC5b-9) and C5a) could increase the expression of CD59 mainly by activating NF-κB and CREB signaling pathways. Together, our findings identify a novel gene regulation mechanism involving CBP/p300, NF-κB, and CREB; this mechanism suggests potential drug targets for controlling various complement-related human diseases.

MALAT1 promotes the proliferation and metastasis of osteosarcoma cells by activating the PI3K/Akt pathway.

Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), one of the first found cancer-associated long noncoding RNAs (lncRNAs), involves in the development and progression of many types of tumors. An aberrant expression of MALAT1 was observed in hepatocellular carcinoma, cervical cancer, breast cancer, ovarian cancer, and colorectal cancer. However, the exact effects and molecular mechanisms of MALAT1 in osteosarcoma progression are still unknown up to now. Here, we investigated the role of MALAT1 in human osteosarcoma cell lines and clinical tumor samples in order to determine the function of this molecule. In our research, the MALAT1 messenger RNA (mRNA) was highly expressed in human osteosarcoma tissues, and its expression level was closely correlated with pulmonary metastasis. Then, we employed lentivirus-mediated knockdown of MALAT1 in U-2 OS and SaO2 to determine the role of MALAT1 in osteosarcoma cell lines. Lentivirus-mediated MALAT1 small interfering RNA (siRNA) could efficiently downregulated the expression level of MALAT1 in osteosarcoma cell lines. Knockdown of MALAT1 inhibited the proliferation and invasion of human osteosarcoma cell and suppressed its metastasis in vitro and vivo. At the same time, the proliferating cell nuclear antigen (PCNA), matrix metallopeptidase 9 (MMP-9), phosphorylated PI3Kp85α, and Akt expressions were significantly inhibited in MALAT1-deleted cells. These findings indicated that MALAT1 might suppress the tumor growth and metastasis via PI3K/AKT signaling pathway. Taken together, our data indicated that MALAT1 might be an oncogenic lncRNA that promoted proliferation and metastasis of osteosarcoma and could be regarded as a therapeutic target in human osteosarcoma.

High-mobility group nucleosome-binding domain 5 increases drug resistance in osteosarcoma through upregulating autophagy.

Although tumor therapy has been improved in the past decades, the survival outcomes for osteosarcoma remain unsatisfactory, and one of the primary reasons for the failure of current treatment is that patients with late-stage cancer often develop resistance to anticancer drugs. High-mobility group nucleosome-binding domain 5 (HMGN5) is a newly identified gene associated with cancer and autophagy, which could inhibit apoptosis induced by anticancer agents. However, it is still unclear whether HMGN5 regulated autophagy in osteosarcoma, and the mechanism and significance of HMGN5-mediated autophagy in tumor therapy is never investigated. In this study, we first detected HMGN5 in vivo and in vitro. HMGN5 was highly expressed in osteosarcoma tumor, especially in posttreatment tumor. Next, we employed adenovirus-mediated overexpression of HMGN5 in U-2OS and MG63 to investigate the role of HMGN5 in osteosarcoma cell lines. Adenovirus-mediated overexpression of HMGN5 could efficiently upregulate the expression level of HMGN5 in osteosarcoma cell lines at both messenger RNA (mRNA) and protein levels. Anticancer agents namely doxorubicin, cisplatin, and methotrexate each induced HMGN5 upregulation in human U-2OS and MG63 osteosarcoma cell lines. In addition, overexpression of HMGN5 reduced the chemosensitivity of osteosarcoma cells in vitro, and the mechanistic investigation revealed that HMGN5 increased drug resistance by upregulating autophagy. Therefore, HMGN5 is a critical factor in the development of chemoresistance through regulating autophagy, and it offers a novel target for improving osteosarcoma therapy.

All-Thermally Evaporated Blue Perovskite Light-Emitting Diodes for Active Matrix Displays.

With the rapid progress of perovskite light-emitting diodes (PeLEDs), the large-scale fabrication of active matrix PeLED displays (AM-PeLEDs) is gaining increasing attention. However, the integration of high-resolution PeLED arrays with thin-film transistor backplanes remains a significant challenge for conventional spin-coating techniques. Here, the demonstration of large-area, blue-emitting AM-PeLEDs are demonstrated using a vacuum deposition technique, which is regarded as the most effective route for organic light-emitting diode displays. By the introduction of an in situ passivation strategy, the defects-related nonradiative recombination is largely suppressed, which leads to an improved photoluminescence quantum yield of vapor-deposited blue-emitting perovskites. The as-prepared blue PeLEDs exhibit a peak external quantum efficiency of 2.47% with pure-blue emission at 475 nm, which represents state-of-the-art performance for vapor-deposited pure-blue PeLEDs. Benefiting from the excellent uniformity and compatibility of thermal evaporation, the 6.67-inch blue-emitting AM-PeLED display with a high resolution of 394 pixels per inch is successfully demonstrated. The demonstration of blue-emitting AM-PeLED display represents a crucial step toward full-color perovskite display technology.

ORFV can carry TRAP gene expression via intracellular CRISPR/Cas9 gene editing technology.

Orf is an acute and highly contracted human and animal infection caused by orf virus (ORFV), which mainly affects sheep, goats, and other species. Clinically, opportunistic or conditional pathogens such as Staphylococcus aureus (S. aureus) are often detected in cases of orf, which greatly increases the risk of disease progression and clinical death. It has been reported that TRAP gene products of S. aureus can broadly influence bacterial life and pathogenicity in vivo, and introduction of exogenous TRAP genes may help to inhibit the proliferation of bacteria. In order to achieve the combined control of ORFV and S. aureus, a novel approach to design a S. aureus TRAP gene vaccine using a live attenuated ORFV vector is proposed. In this study, CRISPR/Cas9 gene editing technology was used to disable vascular endothelial growth factor E of ORFV (VEGF-v) and introduced TRAP gene into this position. TRAP gene expression was detected in keratinocytes infected with recombinant virus. The construction and experimental verification of recombinant ORFV (ORFV-v/TRAP) will provide a reference for in-depth studies on the prevention and control of mixed infectious disease.

Effectiveness and Safety of Varenicline for Smoking Cessation: An Overview and Meta-analysis.

OBJECTIVE: An overview, meta-analysis, and trial sequential analysis were conducted to evaluate the efficacy and safety of varenicline for smoking cessation. METHODS: Systematic reviews (SRs) and randomized controlled trials evaluating varenicline versus placebo for smoking cessation were included. A forest plot was used to summarize the effect size of the included SRs. Traditional meta-analysis and trial sequential analysis (TSA) were performed using Stata software and TSA 0.9 software, respectively. Finally, the Grades of Recommendation, Assessment, Development, and Evaluation approach was used to assess the quality of evidence for the abstinence effect. RESULTS: A total of 13 SRs and 46 randomized controlled trials were included. Twelve review studies showed that varenicline was superior to placebo for smoking cessation. The meta-analysis results showed that, compared with the placebo, varenicline significantly increased the odds of smoking cessation (odds ratio = 2.54, 95% confidence interval = 2.20-2.94, P < 0.05, moderate quality). Subgroup analysis showed that there were significant differences in smokers with disease and general smokers ( P < 0.05). Differences were also found in the follow-up time at 12, 24, and 52 weeks ( P < 0.05). The common adverse events were nausea, vomit, abnormal dreams, sleep disturbances, headache, depression, irritability, indigestion, and nasopharyngitis ( P < 0.05). The TSA results confirmed the evidence for the effect of varenicline on smoking cessation. CONCLUSIONS: Existing evidence supports the superiority of varenicline over a placebo for smoking cessation. Varenicline had mild to moderate adverse events but was well tolerated. Future trials should investigate varenicline in combination with other smoking cessation approaches and compare it with other interventions.

Physical state of water controls friction of gabbro-built faults.

Earthquakes often occur along faults in the presence of hot, pressurized water. Here we exploit a new experimental device to study friction in gabbro faults with water in vapor, liquid and supercritical states (water temperature and pressure up to 400 °C and 30 MPa, respectively). The experimental faults are sheared over slip velocities from 1 µm/s to 100 mm/s and slip distances up to 3 m (seismic deformation conditions). Here, we show with water in the vapor state, fault friction decreases with increasing slip distance and velocity. However, when water is in the liquid or supercritical state, friction decreases with slip distance, regardless of slip velocity. We propose that the formation of weak minerals, the chemical bonding properties of water and (elasto)hydrodynamic lubrication may explain the weakening behavior of the experimental faults. In nature, the transition of water from liquid or supercritical to vapor state can cause an abrupt increase in fault friction that can stop or delay the nucleation phase of an earthquake.

Reporting and methodological quality of acupuncture network meta-analyses could be improved: an evidence mapping.

BACKGROUND AND OBJECTIVES: To evaluate and map the reporting and methodological quality of network meta-analysis (NMA) on acupuncture. METHODS: Published acupuncture NMAs were searched through eight databases from inception to February 2022. The reporting and methodological quality of included studies was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analysis (PRISMA-NMA) statement and the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist. RESULTS: A total of 113 NMAs were identified. Most (99, 87.61%) studies were performed in China. Most studies focused on multiple acupuncture techniques (82.30%), and the main studied ailments were pain and poststroke sequelae (20.24%). The median (interquartile range (IQR)) score of the reporting quality was 26.5 (25-28.5). However, poor reporting rates in the protocol and registration (33.63%) and geometry of the network (35.40%), especially for China-based studies, were identified. The methodological quality of only 2 (1.77%) English studies was high. The reporting rate of Chinese studies was below 15% on each of items 4, 7, 10, and 12. CONCLUSION: The reporting quality of the NMAs was moderate, but the methodological quality was very low. The reporting and methodological quality of future NMAs, especially for Chinese studies, need further improvement.

Lnc-TRTMFS promotes milk fat synthesis via the miR-132x/RAI14/mTOR pathway in BMECs.

As an important index to evaluate the quality of milk, milk fat content directly determines the nutrition and flavor of milk. Recently, growing evidence has suggested that long noncoding RNAs (lncRNAs) play important roles in bovine lactation, but little is known about the roles of lncRNAs in milk fat synthesis, particularly the underlying molecular processes. Therefore, the purpose of this study was to explore the regulatory mechanism of lncRNAs in milk fat synthesis. Based on our previous lncRNA-seq data and bioinformatics analysis, we found that Lnc-TRTMFS (transcripts related to milk fat synthesis) was upregulated in the lactation period compared to the dry period. In this study, we found that knockdown of Lnc-TRTMFS significantly inhibited milk fat synthesis, resulting in a smaller amount of lipid droplets and lower cellular triacylglycerol levels, and significantly decreased the expression of genes related to adipogenesis. In contrast, overexpression of Lnc-TRTMFS significantly promoted milk fat synthesis in bovine mammary epithelial cells (BMECs). In addition, Bibiserv2 analysis showed that Lnc-TRTMFS could act as a molecular sponge for miR-132x, and retinoic acid induced protein 14 (RAI14) was a potential target of miR-132x, which was further confirmed by dual-luciferase reporter assays, quantitative reverse transcription PCR, and western blots. We also found that miR-132x significantly inhibited milk fat synthesis. Finally, rescue experiments showed that Lnc-TRTMFS could weaken the inhibitory effect of miR-132x on milk fat synthesis and rescue the expression of RAI14. Taken together, these results revealed that Lnc-TRTMFS regulated milk fat synthesis in BMECs via the miR-132x/RAI14/mTOR pathway.

Milk fat is an important index to evaluate the quality of milk. The content of milk fat directly determines the quality and flavor of milk. Studies have shown that milk components can change with the expression of specific genes and noncoding RNA that regulate it in different lactation periods. In this study, after the interference and overexpression of Lnc-TRTMFS on milk fat metabolism in bovine mammany epithelial cells, we found that Lnc-TRTMFS could positively regulate milk fat synthesis in bovine mammary epithelial cells. The ceRNA network of Lnc-TRTMFS-miR-132x-RAI14 was constructed by software prediction and double fluorescein report test, and the salvage effect of Lnc-TRTMFS on milk fat synthesis was confirmed by salvage test. Most importantly, we found that Lnc-TRTMFS and miR-132x can regulate milk fat by regulating the mTOR pathway by regulating RAI14.

Adverse effects associated with acupuncture therapies: An evidence mapping from 535 systematic reviews.

BACKGROUND AND OBJECTIVE: Considering that physicians and patients widely use acupuncture, it is necessary to explore its adverse effects during treatment. Herein, an evidence map was generated based on published studies to identify acupuncture-induced adverse effects and assess their severity, with the overarching goal of providing references for safe and effective implementation. METHODS: A comprehensive literature search was performed in four public databases (PubMed, Embase, Web of science, and the Cochrane Library) to identify relevant studies published up to 15th June 2022. In addition, relevant studies were explored in the Epistemonikos database and reference lists were retrieved as a supplement. A MeaSurement Tool to Assess systematic Reviews, Version 2 (AMSTAR-2) quality assessment tool was applied to determine the methodological quality of included systematic reviews (SRs) and/or meta-analysis (MAs), whereas Microsoft Excel 2019 tool was used for data extraction and coding. Heatmaps were generated to display disease type, countries of origin for the first authors, and the sample sizes of original studies. Moreover, bubble charts comprehensively presented intervention categories, adverse reaction types, and evidence levels. RESULTS: A total of 535 SRs involving 33 adverse reactions were included. Among them, 22 studies were rated as high quality, 28 as moderate, 106 as low, and the rest were of critically-low quality. Numerous adverse effects were described in the studies, including syncope (86 SRs), organ or tissue injury (233 SRs), systemic reactions (113 SRs), infection (19 SRs), and other adverse events (373 SRs). Importantly, these adverse reactions were mainly associated with 19 acupuncture techniques, including electroacupuncture (n = 67), manual acupuncture (n = 47) and acupoint catgut embedding (n = 41). Furthermore, the 535 SRs described 23 diseases, among which symptoms, signs or clinical findings (83 SRs), mental, behavioral or neurodevelopmental disorders (67 SRs), and diseases of the nervous system (66 SRs) had the highest incidence. CONCLUSION: This evidence mapping explores the adverse effects of acupuncture, showing that there are multiple types of adverse reactions to acupuncture, with milder symptoms. The methodological assessment revealed that most of the included studies were of low- or critically low-quality. Therefore, there is a need for future randomized controlled trials and SRs to comprehensively analyze acupuncture-related adverse events in order to provide reliable and credible evidence.

Network Meta-Analysis of Behavioral Programs for Smoking Cessation in Healthy People.

INTRODUCTION: Smoking is a risk factor for most chronic diseases and premature death, with a global prevalence of more than 1 billion people who smoke. This network meta-analysis aimed to investigate the impact of different behavioral interventions on smoking cessation. METHODS: Four electronic databases were searched for RCTs from inception to August 29, 2022. The risk of bias for the included RCTs was evaluated using the revised version of Cochrane tool for assessing risk of bias and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The network meta-analysis was performed using Stata 16SE and R 4.1.3 software. RESULTS: A total of 119 included RCTs enrolled 118,935 participants. For the 7-day-point prevalence abstinence rate, video counseling had a best intervention effect than brief advice, followed by financial incentives, self-help materials plus telephone counseling, motivational interview, health education, telephone counseling, and text messages. For the 30-day-point prevalence abstinence rate, face-to-face cognitive education and financial incentives were superior to brief advice. For the continuous abstinence rate, motivational interview and financial incentives were more effective than brief advice. The certainty of evidence was very low to moderate for these studies. DISCUSSION: From the results of the network meta-analysis, different behavioral interventions resulted in positive impacts on smoking cessation compared with that of brief advice, especially video counseling, face-to-face cognitive education, and motivational interviews. Owing to the poor quality of evidence, high-quality trials should be conducted in the future to provide more robust evidence.

Efficacy of internet-based cognitive-behavioral therapy for depression in adolescents: A systematic review and meta-analysis.

Objective: Internet-based cognitive behavior therapy (ICBT) may provide an accessible alternative to face-to-face treatment, but the evidence base in adolescents is limited. This systematic review and meta-analysis aims to comprehensively assess the efficacy of ICBT in addressing depression among adolescents. Methods: Four electronic databases were searched on June 8, 2023. Randomized controlled trials (RCTs) evaluating the efficacy of ICBT for depression in adolescents were included. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook. Furthermore, the GRADE approach was employed to gauge the certainty of the obtained evidence. Meta-analysis was conducted using RevMan 5.4, and Egger's test was implemented through Stata for assessment of potential publication bias. Results: A total of 18 RCTs involving 1683 patients were included. In comparison to control groups like attention control, waiting list, and treatment as usual, our meta-analysis findings elucidate a significant reduction in depression scores (SMD = -0.42, 95 % CI: [-0.74, -0.11], p < .05) as well as anxiety scores (SMD = -0.34, 95 % CI: [-0.60, -0.08], p < .05) in adolescents following ICBT interventions. Furthermore, the analysis indicated no notable distinctions in patient's quality of life (QoL) scores. (SMD = 0.12, 95 % CI: [-0.10, 0.34], p > .05). Conclusion: Results provide evidence of the efficacy of ICBT to reduce depressive and anxiety symptoms in adolescents. These research findings are of vital significance for the establishment of evidence-based treatment guidelines in the digital era. Trial registration: PROSPERO registration: CRD42021277562.

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta-analysis.

OBJECTIVE: To investigate the most effective and best-tolerated drugs for treating diseased smokers. METHODS: Eight databases were searched for randomized controlled trials (RCTs) involving different pharmacological interventions for smoking cessation in disease patients (January 2023). Network meta-analysis was performed using STATA 15.1 software. The Cochrane Risk of Bias Tool assessed the risk of bias, and confidence in evidence was assessed using CINeMA. RESULTS: A total of 60 RCTs involving 13,009 patients of 12 disease categories were included. All trials reported 13 interventions, resulting in 78 comparisons. Network meta-analysis showed that varenicline (OR = 2.30, 95% CI (1.77, 3.00)) and bupropion (OR = 1.65, 95% CI (1.29, 2.11)) showed favorable abstinence effects compared to placebo in the cardiovascular disease population. Nicotine replacement therapy (NRT) had better withdrawal advantages than placebo (OR = 11.18, 95% CI (2.25, 55.54)) in the chronic obstructive pulmonary disease (COPD) population. Some combination treatments showed better results than monotherapy, such as bupropion + NRT was superior to bupropion (OR = 8.45, 95% CI (1.84, 38.89)) and NRT (OR = 4.98, 95% CI (1.25, 19.78)) in mental illness population. The final surface under the cumulative ranking curve indicated that bupropion + NRT achieved the best smoking cessation effect. Overall confidence in the evidence was low. In a comparison of drugs, the results showed that bupropion + NRT had the best safety. CONCLUSIONS: Most interventions show the benefit of quitting smoking compared with placebo, including monotherapy and combination therapy. Moreover, varenicline or bupropion combined with NRT is superior to some monotherapies.