Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis.

BACKGROUND: Deep vein thrombosis (DVT) is a condition in which a clot forms in the deep veins, most commonly of the leg. It occurs in approximately one in 1000 people. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Previously, a DVT was treated with the anticoagulants heparin and vitamin K antagonists. However, two forms of direct oral anticoagulants (DOACs) have been developed: oral direct thrombin inhibitors (DTIs) and oral factor Xa inhibitors, which have characteristics that may be favourable compared to conventional treatment, including oral administration, a predictable effect, lack of frequent monitoring or dose adjustment and few known drug interactions. DOACs are now commonly being used for treating DVT: recent guidelines recommended DOACs over conventional anticoagulants for both DVT and PE treatment. This Cochrane Review was first published in 2015. It was the first systematic review to measure the effectiveness and safety of these drugs in the treatment of DVT. This is an update of the 2015 review.  OBJECTIVES: To assess the effectiveness and safety of oral DTIs and oral factor Xa inhibitors versus conventional anticoagulants for the long-term treatment of DVT. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 1 March 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in which people with a DVT, confirmed by standard imaging techniques, were allocated to receive an oral DTI or an oral factor Xa inhibitor compared with conventional anticoagulation or compared with each other for the treatment of DVT.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were recurrent venous thromboembolism (VTE), recurrent DVT and PE. Secondary outcomes included all-cause mortality, major bleeding, post-thrombotic syndrome (PTS) and quality of life (QoL). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We identified 10 new studies with 2950 participants for this update. In total, we included 21 RCTs involving 30,895 participants. Three studies investigated oral DTIs (two dabigatran and one ximelagatran), 17 investigated oral factor Xa inhibitors (eight rivaroxaban, five apixaban and four edoxaban) and one three-arm trial investigated both a DTI (dabigatran) and factor Xa inhibitor (rivaroxaban). Overall, the studies were of good methodological quality. Meta-analysis comparing DTIs to conventional anticoagulation showed no clear difference in the rate of recurrent VTE (odds ratio (OR) 1.17, 95% confidence interval (CI) 0.83 to 1.65; 3 studies, 5994 participants; moderate-certainty evidence), recurrent DVT (OR 1.11, 95% CI 0.74 to 1.66; 3 studies, 5994 participants; moderate-certainty evidence), fatal PE (OR 1.32, 95% CI 0.29 to 6.02; 3 studies, 5994 participants; moderate-certainty evidence), non-fatal PE (OR 1.29, 95% CI 0.64 to 2.59; 3 studies, 5994 participants; moderate-certainty evidence) or all-cause mortality (OR 0.66, 95% CI 0.41 to 1.08; 1 study, 2489 participants; moderate-certainty evidence). DTIs reduced the rate of major bleeding (OR 0.58, 95% CI 0.38 to 0.89; 3 studies, 5994 participants; high-certainty evidence).   For oral factor Xa inhibitors compared with conventional anticoagulation, meta-analysis demonstrated no clear difference in recurrent VTE (OR 0.85, 95% CI 0.71 to 1.01; 13 studies, 17,505 participants; moderate-certainty evidence), recurrent DVT (OR 0.70, 95% CI 0.49 to 1.01; 9 studies, 16,439 participants; moderate-certainty evidence), fatal PE (OR 1.18, 95% CI 0.69 to 2.02; 6 studies, 15,082 participants; moderate-certainty evidence), non-fatal PE (OR 0.93, 95% CI 0.68 to 1.27; 7 studies, 15,166 participants; moderate-certainty evidence) or all-cause mortality (OR 0.87, 95% CI 0.67 to 1.14; 9 studies, 10,770 participants; moderate-certainty evidence). Meta-analysis showed a reduced rate of major bleeding with oral factor Xa inhibitors compared with conventional anticoagulation (OR 0.63, 95% CI 0.45 to 0.89; 17 studies, 18,066 participants; high-certainty evidence).  AUTHORS' CONCLUSIONS: The current review suggests that DOACs may be superior to conventional therapy in terms of safety (major bleeding), and are probably equivalent in terms of efficacy. There is probably little or no difference between DOACs and conventional anticoagulation in the prevention of recurrent VTE, recurrent DVT, pulmonary embolism and all-cause mortality. DOACs reduced the rate of major bleeding compared to conventional anticoagulation. The certainty of evidence was moderate or high.

Use of traditional Chinese medicine for the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients: An evidence mapping study.

Background: The potential effectiveness of traditional Chinese medicine (TCM) against "epidemic diseases" has highlighted the knowledge gaps associated with TCM in COVID-19 management. This study aimed to map the matrix for rigorously assessing, organizing, and presenting evidence relevant to TCM in COVID-19 management. Methods: In this study, we used the methodology of evidence mapping (EM). Nine electronic databases, the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal, ClinicalTrials.gov, gray literature, reference lists of articles, and relevant Chinese conference proceedings, were searched for articles published until 23 March 2022. The EndNote X9, Rayyan, EPPI, and R software were used for data entry and management. Results: In all, 126 studies, including 76 randomized controlled trials (RCTs) and 50 systematic reviews (SRs), met our inclusion criteria. Of these, only nine studies (7.14%) were designated as high quality: four RCTs were assessed as "low risk of bias" and five SRs as "high quality." Based on the research objectives of these studies, the included studies were classified into treatment (53 RCTs and 50 SRs, 81.75%), rehabilitation (20 RCTs, 15.87%), and prevention (3 RCTs, 2.38%) groups. A total of 76 RCTs included 59 intervention categories and 57 efficacy outcomes. All relevant trials consistently demonstrated that TCM significantly improved 22 outcomes (i.e., consistent positive outcomes) without significantly affecting four (i.e., consistent negative outcomes). Further, 50 SRs included nine intervention categories and 27 efficacy outcomes, two of which reported consistent positive outcomes and two reported consistent negative outcomes. Moreover, 45 RCTs and 38 SRs investigated adverse events; 39 RCTs and 30 SRs showed no serious adverse events or significant differences between groups. Conclusion: This study provides evidence matrix mapping of TCM against COVID-19, demonstrating the potential efficacy and safety of TCM in the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients, and also addresses evidence gaps. Given the limited number and poor quality of available studies and potential concerns regarding the applicability of the current clinical evaluation standards to TCM, the effect of specific interventions on individual outcomes needs further evaluation.

Reporting and methodological quality of meta-analyses of acupuncture for patients with migraine: A methodological investigation with evidence map.

BACKGROUND: Acupuncture has been widely used to relieve migraine-related symptoms. However, the findings of previous systematic reviews (SRs) and meta-analyses (MAs) are still not completely consistent. Their quality is also unknown, so a comprehensive study is needed. OBJECTIVE: To evaluate the reporting and methodological quality of these MAs concerning acupuncture for migraine, and summarize evidence about the efficacy and safety of acupuncture for migraine. SEARCH STRATEGY: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Databases, Wanfang Data, and VIP databases were searched from inception to September 2020, with a comprehensive search strategy. INCLUSION CRITERIA: The pairwise MAs of randomized controlled trials (RCTs) concerning migraine treated by acupuncture or acupuncture-based therapies, with a control group that received sham acupuncture, medication, no treatment, or acupuncture at different acupoints were included. DATA EXTRACTION AND ANALYSIS: Two independent investigators screened studies, extracted relevant data, and assessed reporting and methodological quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), then all results were cross-checked. Spearman correlation test was used to evaluate the correlation between reporting and methodological quality scores. RESULTS: A total of 20 MAs were included in this study. The included MAs indicated that acupuncture was efficacious and safe in preventing and treating migraine when compared with control intervention. There was a high correlation between reporting and methodological quality scores (rs = 0.87, P < 0.001). The quality of the included SRs needs to be improved mainly with regard to protocol and prospective registration, using a comprehensive search strategy, summarizing the strength of evidence body for key outcomes, a full list of excluded studies with reasons for exclusion, reporting of RCTs' funding sources, and assessing the potential impact of risk of bias in RCTs on MA results. CONCLUSION: Acupuncture is an effective and safe intervention for preventing and treating migraine, and could be considered as a good option for patients with migraine. However, the reporting and methodological quality of MAs included in this overview is suboptimal. In the future, AMSTAR 2 and PRISMA tools should be followed when making and reporting an SR with MA.

Acupuncture for Mild Cognitive Impairment and Dementia: An Overview of Systematic Reviews.

Background: Dementia is a gradual decline in cognitive ability and is becoming more common in our elderly population. Mild cognitive impairment (MCI) is defined as a slight clinical deterioration of memory capacity, below the level of normal aging, but does not constitute a clinical diagnosis of dementia. To date, no interventions have been proven to cure MCI and dementia fully. Purpose: To evaluate the potential effectiveness and safety of acupuncture for mild cognitive impairment (MCI) and dementia and evaluate the methodological quality of systematic reviews (SRs). Methods: We conducted a literature search for SRs with meta-analyses in seven Chinese and international databases through October 1, 2020. The basic characteristics of the included SRs/meta-analyses and the basic information of the original included randomized controlled trials were extracted by three reviewers independently. A meta-analysis of the original randomized controlled trials from the included SRs/meta-analyses was performed using Stata 12.0 software. The Assessing the Methodological Quality of Systematic Reviews 2 was used to assess the methodological quality of the included SRs/meta-analyses, and the Grading of Recommendations, Assessment, Development, and Evaluation was used to rate the quality of evidence. Results: A total of 35 SRs/meta-analyses were included, and the majority showed that acupuncture was more effective than western medicine or conventional therapy for MCI and dementia [odds ratio =1.39; 95% confidence interval (CI): 1.24, 1.56]. There was a statistically significant difference in the Mini-Mental State Examination score (weighted mean difference = 1.23; 95% CI: 0.78, 1.68; p < 0.00001), and there was no significant improvement in the activities of daily living score (weighted mean difference = 1.58; 95% CI: -0.02, 3.18; p = 0.053). The assessment results of Assessing the Methodological Quality of Systematic Reviews 2 showed that the methodological quality of most included SRs/meta-analyses was critically low; the lowest scores were items 2, 7, and 10. For Grading of Recommendations, Assessment, Development, and Evaluation, of the 73 outcomes, 50 (68.5%) outcomes were low or very low quality, and 23 (31.5%) outcomes were moderate quality. Conclusions: Acupuncture can be considered as an alternative for the treatment of MCI and dementia when western medicine or other therapies are contraindicated. More high-quality evidence is needed to determine further the effectiveness of acupuncture.

The effectiveness and safety of acupuncture for depression: An overview of meta-analyses.

PURPOSE: To provide an overview of existing meta-analysis (MAs) on the efficacy and safety of acupuncture for depression, and assess the methodological quality and the strength of evidence of the included MAs. METHODS: We searched MAs of randomized trials that have evaluated the effects of acupuncture on depression in three international and three Chinese databases from their inception until August 2019. The methodological quality of included MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the strength of evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We used the intra-class correlation coefficient (ICC) to assess reviewer agreement in the pre-experiment. RESULTS: We included 31 MAs and 59 RCTs. The results of included MAs were conflicting, our meta-analyses found that acupuncture may confer small benefit in reducing the severity of depression by end of treatment than no treatment/wait list/treatment as usual(SMD -0.74, 95% CI -1.06 to -0.41, eight trials, 624 participants), control acupuncture (invasive, non-invasive sham controls) (SMD 0.27, 95% CI -0.51 to -0.04, 20 trials, 1055 participants), antidepressants(Selective serotonin reuptake inhibitors (SSRI)/ Tetracyclic antidepressants(TCAs)) (SMD -0.28, 95% CI -0.46 to -0.10, 30 trials, 3068 participants), acupuncture plus antidepressants versus antidepressants(SSRI/TCAs) (SMD -0.99, 95% CI -1.37 to -0.61, 17 trials, 1110 participants). Subgroup analyses showed that there was no difference between electro-acupuncture and invasive control (P = 0.37), electro-acupuncture and non-invasive control (P = 0.90), manual acupuncture and Tetracyclic antidepressants (P = 0.57), electro-acupuncture and Tetracyclic antidepressants (P = 0.07). Six MAs concluded that acupuncture reduced the incidence of adverse events compared with antidepressants. The evaluation with AMSTAR-2 showed that the quality of included MAs was low or critically low. The results of the GRADE evaluation showed that the strength of evidence was low to very low for most outcomes. CONCLUSIONS: Although acupuncture appears to be more effective and safer than no treatment, control acupuncture and antidepressants, the quality of the available evidence was very low. Further methodologically rigorous and adequately powered primary studies are needed to confirm the effectiveness of acupuncture for depression.

The effectiveness of acupuncture for Parkinson's disease: An overview of systematic reviews.

OBJECTIVES: Acupuncture is an alternative therapy for Parkinson's disease (PD), but its efficacy and safety are controversial. This overview aimed to summarize the existing evidence from systematic reviews (SRs) and meta-analyses (MAs) in order to assess the effectiveness of acupuncture as a treatment for PD. METHODS: Seven electronic databases were searched from their inception until July 2019. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists were used to assess evidence quality and methodological quality, respectively. The outcomes of study were calculated using mean differences (MDs) and risk ratios (RRs) with 95 % confidence intervals (CIs). A meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 12 SRs/MAs were included. All 12 SRs/MAs had more than one critical weakness in AMSTAR 2 and were considered of critically low methodological quality. The quality of evidence was unsatisfactory according to the GRADE checklist. Meta-analyses showed that acupuncture combined with drug for the treatment of PD can significantly improve the total effectiveness rate compared with drug alone (RR = 1.25, 95 % CI 1.16-1.34, P < 0.001). It was also found that acupuncture combined with drug significantly improved the UPDRS I-IV total summed scores (WMD=-6.18, 95 % CI -10.32 to -2.04, P < 0.001) and Webster scores (WMD=-4.20, 95 % CI -7.59 to -0.81, P < 0.001). CONCLUSION: Acupuncture might improve the UPDRS score, Webster score, and total effective rate in treatment of PD. It might be a safe and useful adjunctive treatment for patients with PD. However, we should interpret the findings of these reviews with caution, considering the overall limited methodological and reporting quality.

Knowledge Mapping of Angelica sinensis (Oliv.) Diels (Danggui) Research: A Scientometric Study.

BACKGROUND: Traditional Chinese medicine (TCM) has been widely accepted and applied worldwide, and many publications related to Angelica sinensis (Oliv.) Diels (AS, Chinese name is "Danggui") have been published. However, to date, there has not been a scientometric study to systematically analyze the intellectual landscape and emerging research trends regarding AS. Therefore, we performed a scientometric study to address this gap. METHODS: Publications related to AS published from 2009 to 2018 were identified and selected from the Web of Science (WoS) Core Collection on May 30, 2019 using relevant keywords. HistCite, CiteSpace, and Excel 2016 software tools were used to conduct this scientometric study. RESULTS: Seven hundred and sixty-seven articles (including 717 primary articles and 60 review articles) and their cited references were included and analyzed. The majority of publications (N = 565, 73.7%) were published in mainland China, with Nanjing University of Chinese Medicine contributing the most publications (N = 42, 5.5%). The first core journal was Journal of Ethnopharmacology (N = 58, 7.6%; impact factor = 3.414). The identification and assessment of active components (like ferulic acid) of AS and their pharmacological actions (such as immunomodulatory effects) are the current research foci for AS research. CONCLUSION: The present scientometric study provides an overview of the development of AS research over the previous decade using quantitative and qualitative methods, and this overview can provide references for researchers focusing on AS.

The effectiveness of music therapy for patients with cancer: A systematic review and meta-analysis.

AIMS: To assess the effectiveness of music therapy on the quality of life, anxiety, depression and pain of patients with cancer. DESIGN: Systematic review. DATA SOURCES: Five electronic databases were searched in September 2018 for randomized controlled trials evaluating music therapy for patients with cancer. REVIEW METHODS: The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Revman version 5.3 software was used to perform the meta-analysis. The outcomes were overall quality of life, anxiety, depression and pain. RESULTS: A total of 19 trials evaluating 1,548 patients were included in this study, of which 765 were in the control group and 783 in the experimental group. Compared with standard care, music therapy can significantly increase the score of the overall quality of life in patients with cancer. In addition, music therapy was found to be more effective for decreasing the score of anxiety, depression and pain. CONCLUSION: Music therapy can improve the overall quality of life of patients with cancer, with an observed optimal intervention duration of 1-2 months. Meanwhile, anxiety, depression and pain are improved as well. Nevertheless, high-quality trials are still needed to further determine the effects of music intervention in supportive cancer care.

Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews.

PURPOSE: Conducting an overview of systematic reviews (SRs)/Meta analyses (MAs) to assess the effectiveness of cognitive interventions on participants with mild cognitive impairment (MCI) or dementia and evaluate the methodological quality of SRs/MAs. METHODS: PubMed, EMBASE, Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Databases (CBM) were systematically searched from inception to January 1, 2019 to identify SRs/MAs. Three reviewers independently screened the articles, extracted data and assessed the quality of the included studies according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of evidence. RESULTS: A total of 22 reviews were included. New meta-analyses (36 RCTs) showed that cognitive interventions were more effective than routine therapies for the alleviation of MCI and dementia symptoms (SMD: 0.62; 95%CI: 0.47, 0.78; I2 = 53.9%). The results of AMSTAR-2 showed that the methodological quality of most included studies was critically low, and two reviews were low quality. The lowest score was item 10, none of reviews reported on the sources of funding for the included studies. Followed by the "provide a list of excluded studies and justify the exclusions" item with only one (4.5%) reviews conforming to this item. Results of GRADE manifested that moderate quality evidence was provided in 11 reviews (39.3%), 12 (42.9%) were low quality and 5 (17.8%) were very low. CONCLUSION: The present SRs/MAs indicated that persons with MCI or dementia could benefit from cognitive interventions. Future trial designs should focus on measuring changes in individual specific cognitive functions. More high-quality evidence is needed to further determine the effectiveness of cognitive interventions.

Ginger for health care: An overview of systematic reviews.

OBJECTIVES: To summarize the evidence from systematic reviews (SRs) and meta-analyses that evaluated the efficacy of ginger in treating any conditions and critically assess the quality of these evidence. METHODS: A systematic search of the literature was conducted from inception until February 28, 2019 using the PubMed, EMBASE, Web of science, Cochrane library, and four Chinese databases. Literature selection and data extraction were conducted by two independent reviewers. The quality of SRs was evaluated using the AMSTAR-2 tool. The GRADE system was used to assess the quality of evidence. RESULTS: Twenty-seven SRs were included. The number of included studies were various, range from 3 to 27. The condition with the most included SRs was nausea and vomiting (n = 12, 44.4%). Many SRs showed a promising efficacy of ginger, including nausea and vomiting, metabolic syndrome and pain, while the effect of ginger for platelet aggregation failed to draw a certain conclusion. The quality of SRs was heterogeneous. All of included SRs well complied with the Item 1 ("research questions included the components of PICO") and Item 3 ("explained selection of the study designs for inclusion"). Twenty review failed to provide registration information. Only one SR reported the sources of funding for studies included. CONCLUSIONS: In our overview, most of SRs suggest ginger is a promising herbal medicine for health care, which is beneficial for nausea and vomiting, metabolic syndrome and pain. However, considering the limited quality of included evidence and heterogeneity of different clinical trials, more well-design studies are required to confirm the conclusion further.

A porous collagen-carboxymethyl cellulose/hydroxyapatite composite for bone tissue engineering by bi-molecular template method.

Inspired by the mechanism of bone formation, a porous collagen-carboxymethyl cellulose/hydroxyapatite (Col-CMC/HA) composite was designed and fabricated using a biomimetic template of Col and CMC protein-polysaccharide bi-molecules. The morphology, composition and physical properties of Col-CMC/HA composites were characterized systematically. It was found that the nano-HA homogenously distributed on the surface of Col-CMC bi-templates while the composite presented 3D porous structure with pore size from 100 µm to 300 µm. The porosities of composites were located at the range of 71%-85%. Besides, the compressive strength of composites was highly depended on the ratio of Col to CMC in the organic template. The optimized composite in respect to physical properties showed a compressive strength as high as 7.06 MPa, quite close to that of natural bone. The high relative growth rate of wild-type mouse embryonic fibroblasts cells was found for the composite, indicating a good biocompatibility. The organic-inorganic composite also behaved good in collagenase resistance and could be biodegraded in 8 weeks, with about 50% of initial weight left at the ratio of Col to CMC of 1:9. The results demonstrated that the Col-CMC/HA composite by bi-molecular template method was a rational and safe method to prepare biomaterials with tunable properties.

The association between calcium supplement and preeclampsia and gestational hypertension: a systematic review and meta-analysis of randomized trials.

OBJECTIVES: The purpose of this study is to investigate whether calcium supplement with or without other drugs could reduce the risk of preeclampsia and gestational hypertension based on existed evidence, and to clarify whether there is discrepant effect among different population and using different dose. METHODS: PubMed, Cochrane library, and EMBASE database were searched. Two authors independently screened all records and extracted data. The meta-analysis was performed to calculate risk ratios and 95% CIs using random-effects models. RESULTS: 27 studies, with 28 492 pregnant women were included. The results showed calcium supplement was associated with lower incidence of preeclampsia (RR 0.51, 95% CI: 0.40 to 0.64) and gestational hypertension (RR 0.70, 95% CI: 0.60 to 0.82). Sub-analyses revealed high-dose (1.2-2 g/day), moderate-dose (0.6-1.2 g/day), and low-dose (<0.6 g/day) of calcium supplement could reduce the risk of preeclampsia. For gestational hypertension, only high dose and moderate dose groups were associated with reducing the risk of gestational hypertension. However, we could draw a conclusion which does group was the most protective, as we were unable to directly compare the effects of different doses. CONCLUSIONS: This study indicated calcium supplementation might decrease the risk of preeclampsia and gestational hypertension. And results of subgroups analyses enhanced our confidence to the protective effect of calcium supplementation. However, further studies with direct comparison of different dose of calcium supplementation are needed to explore the ideal dose of calcium supplementation to prevent preeclampsia and gestational hypertension.

Acupuncture for treatment of anxiety, an overview of systematic reviews.

PURPOSE: To evaluate the methodological quality and summarize evidence of important outcomes of systematic reviews (SRs)/Meta analyses (MAs) of acupuncture for anxiety. METHODS: We conducted a comprehensive literature search for SRs/MAs in PubMed, EMBASE, Cochrane library, Chinese Biomedical Databases (CBM), Wanfang database and China National Knowledge Infrastructure (CNKI) until November 30, 2018. Three reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence. In the pre-experiment, we used the intra-class correlation coefficient (ICC) to assess reviewer agreement, the ICC value for overall score was 0.978. RESULTS: Ten reviews were included. The assessment results of AMSTAR-2 showed that the methodological quality of all included studies was critically low. The lowest score were item "provide a list of excluded studies and justify the exclusions" and item "report sources of funding for the included studies", none of studies provided information about the above two items, followed by the "providing a priori design" item with only two (20%) studies conforming to this item. For GRADE, of the 7 outcomes, high quality evidence was provided in only 1 (14.3%), moderate in 2 (28.6.7%), and low in 4 (57.1%). CONCLUSION: Although most of the included reviews indicated that acupuncture group was more effective than control group in the treatment of anxiety, more importantly, the methodological quality of the included reviews and the quality of evidence were low. More high-quality evidence is needed to determine whether acupuncture is more effective than other treatments.

Acupuncture for treatment of insomnia: An overview of systematic reviews.

PURPOSE: To evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia. METHODS: We conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence. RESULTS: Thirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review). CONCLUSION: Most of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.