Using AGREE II reporting checklist to evaluate the quality of Tuina clinical practice guidelines.

Objective: The objective of this study is to evaluate the methodological quality of Tuina clinical practice guidelines (CPGs). Methods: Computer searches of China National Knowledge Infrastructure (CNKI), Chinese Technical Periodicals (VIP), Wanfang Data Knowledge Service Platform, PubMed, Cochrane Library, Embase, and other databases were conducted to search for published guidelines on Tuina, with a search time frame from database creation to March 2021. Four evaluators independently used the Appraisal of Guidelines for Research and Evaluation II instrument to evaluate the quality of the included guidelines. Results: A total of eight guidelines related to Tuina were included in this study. The quality of reporting was low in all included guidelines. The highest quality report had a total score of 404 and was rated as "highly recommended." The worst guideline had a final score of 241 and was rated as "not recommended." Overall, 25% of the included guidelines were recommended for clinical use, 37.5% were recommended after revision, and 37.5% were not recommended. Conclusion: The number of existing Tuina clinical practice guidelines is limited. The methodological quality is low, far from the internationally accepted clinical practice guideline development and reporting norms. In the future, reporting specifications of guidelines and the methodology of guideline development, including the rigor of the guideline development process, the clarity, application, and independence of reporting, should be emphasized in the development of the Tuina guidelines. These initiatives could improve the quality and applicability of clinical practice guidelines to guide and standardize the clinical practice of Tuina.

Controlling Welding Residual Stress and Distortion of High-Strength Aluminum Alloy Thin Plates by a Trailing Hybrid High-Speed Gas Fluid Field.

This paper presents an investigation of the welding residual stress and distortion of LY12 high-strength aluminum alloy (6061) by improving the local welding thermal and mechanical fields. A trailing hybrid high-speed gas fluid method was proposed and applied to decrease the welding residual stress and distortion of 6061 aluminum alloy efficiently. Firstly, the temperature and stress fields were calculated using the finite element simulation method, considering a trailing hybrid high-speed gas fluid field. The distance between the aerodynamic load and the heat source action was a key factor determined by the simulation method. In addition, the reasonable effective range of gas pressure was obtained. Subsequently, welding and distortion tests were conducted on the self-developed device under conventional welding and high-speed gas fluid field conditions. The results showed that an aerodynamic load under 30 MPa of gas pressure was available near the area at a distance of 20-28 mm from the heat source for thin plate welding distortion. The peak longitudinal residual tensile stresses in the weld's mid-length section decreased by 77.73%, the peak residual compressive stresses decreased by 69.23% compared with conventional welding, and the deflection distortion disappeared almost entirely. The maximum deflection of the distortion was only 1.79 mm, which was 83.76% lower than the 11.02 mm of the conventional welding distortion. This validates that the method can simultaneously and greatly eliminate the welding residual stress and distortion.

Acupuncture for diabetic peripheral neuropathy: An overview of systematic reviews.

BACKGROUND: Acupuncture has been widely used to treat diabetic peripheral neuropathy (DPN) in China as a complementary and alternative therapy. This study aims to summarize the characteristics and evaluate the methodology quality of the systematic reviews (SRs) regarding acupuncture for DPN. METHODS: A comprehensive literature search was performed from inception to February 2020. We assessed the methodological quality of the included SRs with the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to evaluate the reporting characteristics of included SRs, and utilized the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of evidence for outcomes including total effective rate, sensory nerve conduction velocity, motor nerve conduction velocity and adverse events. One-way analysis of variance and multiple linear regression were conducted to evaluate the associations between characteristics and two index scores (PRISMA and AMSTAR 2). RESULTS: Eighteen SRs were included in this overview. The methodology quality of the included SRs ranged from very low to high. Only protocol registration and funding source reported were associated with the AMSTAR 2 index scores, while no variable showed significant difference in the PRISMA scores. The overall quality of evidence in included SRs ranged from "very low" to "moderate". CONCLUSION: This overview suggested beneficial effects of acupuncture on DPN, whereas the results should be interpreted with cautious owing to methodology flaws, providing reference for further improvement of the study design.

The effectiveness and safety of Tuina for tension-type headache: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Tension-type headache (TTH) is one of the most common primary headache diseases in the world and has a serious negative impact on the physical and mental health of patients. Tuina is now widely used to treat tension-type headaches. This article aims to systematically review the evidence about the effectiveness of Tuina on the effectiveness rate, pain intensity, and impact of headache in individuals with TTH. METHODS: Eight databases for randomized controlled trials (RCTs) of Tuina were included in treatments for TTH. Cochrane Collaboration's tool was applied to evaluate the quality of the studies. Confidence in the effect estimates was determined with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We use the software STATA 12.0 for meta-analysis and TSA software for test sequence analysis. RESULTS: Seven studies were included with a total sample of 1228 individuals. Meta-analysis results showed that Tuina was superior to drugs for improving the effectiveness rate (RR = 1.49, 95%CI: 1.25 to 1.77, p < 0.01, low evidence). A visual analog scale (VAS) score of Tuina was significantly lower than that of drugs (WMD = -0.738, 95% CI: -1.128 to -0.349, p < 0.01, moderate evidence). The trial sequential analysis showed that the effectiveness of Tuina for TTH was accurate. Adverse events were tolerable. CONCLUSION: Tuina has a certain effect in treating tension headache. However, due to the low level of methodological quality included in the article, this conclusion should be considered cautiously. More studies are necessary to strengthen the evidence regarding the effectiveness and safety of Tuina for subjects with TTH.

Evaluating the Characteristics, Reporting and Methodological Quality of Systematic Reviews of Acupuncture for Low Back Pain by Using the Veritas Plot.

OBJECTIVE: To evaluate systematic reviews (SRs) of acupuncture for low back pain (LBP) in terms of characteristics, reporting and methodological quality using a Veritas plot and to explore factors that may be associated with methodological quality and reporting quality. STUDY DESIGN AND SETTING: We searched 8 electronic bibliographic databases to find all SRs, and we evaluated the SRs' quality in 6 dimensions, including publication year, design type, homogeneity, risk of publication bias, methodological quality by Assessment of Multiple Systematic Reviews (AMSTAR) 2 and reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Excel 2010 and Adobe Illustrator CC were used to draw and optimize Veritas plots. Exploratory analysis was done using SPSS software version 23.0 to explore factors related to AMSTAR-2 and PRISMA scores. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence quality evaluation tool was used to grade all the outcome indicators in the included literature. RESULTS: We included 19 SRs in the analysis. Literature quality rank scores ranged from 9.67 to 17.00, with an average score of 13.18 ± 2.35. The average score of AMSTAR-2 was 7.47, and the average score of PRISMA was 18.47. Overall, the main issues were research strategies, inclusion and exclusion criteria, publication bias, and registration in PROSPERO. The results of exploratory analysis showed that duplication of literature selected and appropriate tools to assess the risk of bias were related to the AMSTAR-2 score, and the summary of evidence was related to the PRISMA score. The GRADE quality evaluation results showed mainly low quality. CONCLUSION: The quality of SRs on acupuncture for low back pain should be improved, mainly by strengthening the methodological quality and reporting quality. The Veritas plot is an effective graphical evaluation method that is worth popularizing.

Acupuncture for primary osteoporosis: A network meta-analysis of randomized controlled trials protocol.

BACKGROUND: A large number of randomized controlled trials (RCTs) have shown that acupuncture (ACU) has certain advantages over pharmacotherapies in the treatment of primary osteoporosis (POP). However, due to the diversity of ACU treatments, its relative effectiveness have not yet been studied and explained. Therefore, based on the network meta-analysis (NMA), this study will compare the differences in the efficacy of multiacupuncture in the treatment of POP, to provide a reference for clinical treatment. METHODS: We will search PubMed, MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CHKD-CNKI), WANFANG database (Chinese Medicine Premier), Chinese Biomedical Literature database (CBM), and VIP for relevant RCTs of ACU treatments for POP, from their inceptions to January 2019. STATA 15.0 and GEMTC software will be used to perform a NMA. The evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the type 1 error rate will be assessed by trial sequential analysis (TSA). RESULTS: The results of this review will be submitted to a recognized journal for publication. CONCLUSION: This proposed systematic review will evaluate the different advantages of various types of ACU in the treatment of POP. REGISTRATION: PROSPERO (registration number CRD42019122724).