Burnout among doctors in China through 2020: A systematic review and meta-analysis.

Objective: To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout. Methods: A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger's and Begg's tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I2 statistic. The study protocol was registered on PROSPERO (CRD42018104249). Results: In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I2 = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I2 = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I2 = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I2 = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I2 = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout. Conclusions: The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.

Efficacy and safety of Morinda officinalis oligosaccharide capsules for depressive disorder: a systematic review and meta-analysis

Objective: To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. Methods: Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. Results: Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. Conclusion: This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.

Efficacy and safety of Morinda officinalis oligosaccharide capsules for depressive disorder: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. METHODS: Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. RESULTS: Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. CONCLUSION: This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.

[Detection and functional analysis of CD-4+ CD-25+ regulatory T cells in the peripheral blood of patients with generalized aggressive periodontitis].

OBJECTIVE: To investigate the changes of proportion and suppression function of CD-4+ CD-25+ regulatory T cells in the peripheral blood of patients with aggressive periodontitis. METHODS: Flow cytometric analysis was used to detect the frequency of CD-4+ CD-25+ regulatory T cells in the peripheral blood of 16 patients with generalized aggressive periodontitis and 17 patients with chronic periodontitis, as well as 17 periodontal healthy controls. Furthermore, CD-4+ CD-25+ regulatory T cells and CD-4+ CD-25- T cells were separated from peripheral blood of each enrolling subject using magnetic cell sorting technology. The direct suppression effect of CD-4+ CD-25+ regulatory T cells on CD-4+ CD-25- T lymphocytes proliferation was performed by the mixed lymphocytes reaction and measured by 3H-thymidine radioactive assay. RESULTS: The patients with generalized aggressive periodontitis had a lower frequency of CD4+ CD-25+ regulatory T cells (9.71 +/- 4.01)% in the peripheral blood than periodontal healthy controls [(14.72 +/- 3.51)%] and chronic periodontitis patients [(17.01 +/- 5.16 )%], P < 0.05. A significant decrease was found in the suppression function of CD-4+ CD-25+ regulatory T cells from peripheral blood of patients with generalized aggressive periodontitis when co-cultured with CD-4+ CD-25- T lymphocytes in the proportion of 2 : 1, 1 : 1 and 1 : 2 as compared with chronic periodontitis patients and periodontal healthy controls (P < 0.05). CONCLUSIONS: Diminished numbers and decreased suppression function of CD-4+ CD-25+ regulatory T cells were found in patients with generalized aggressive periodontitis.

[Biologic effects of advanced oxidative protein products on the human gingival fibroblasts].

OBJECTIVE: To investigate the effects of advanced oxidative protein products (AOPP) on the proliferation, apoptosis and matrix metalloproteinase-1 (MMP-1) synthesis of the human gingival fibroblast (HGF). To explore the possible mechanism of the periodontal destruction acceleration in diabetes through AOPP-mediated oxidative stress. METHODS: HGF were isolated by both tissue explant cultivation technique and enzyme digestion method. The culture media with 5, 50, 100 mg/L AOPP-HAS were added into each experimental group, but the culture media in the control group didn't contain AOPP-HAS. MTT colorimetric assay and ELISA were used to measure the changes of HGF proliferation and the levels of MMP-1 protein from HGF at different time periods, respectively. Seventy-two hours after co-culture with 50 mg/L AOPP-HSA, cell apoptosis was detected by flow cytometry with Annexin V/PI staining. RESULTS: Compared to the control group, the growth inhibition rate of HGF in 5, 50, 100 mg/L AOPP-HSA group was significantly different (P < 0.05). The peak value appeared at 48 hours of co-culture [(19.01 +/- 6.28)%, (30.48 +/- 5.75)%, (39.75 +/- 4.60)%, respectively]. There was a dose-dependent relationship between the growth inhibition rate and AOPP-HSA. No significant difference was detected on the apoptotic level between experimental group and the control (P > 0.05). The MMP-1 synthesis in 0.5, 5, 50, 100 mg/L AOPP-HAS group [(55.61 +/- 1.06), (65.78 +/- 4.04), (79.24 +/- 3.09), (89.76 +/- 28.88) mg/L, respectively] was significantly higher than that in the control [(34.90 +/- 3.15) mg/L] after 72 hours co-culture (P < 0.05). There was a dose-dependent relationship between MMP-1 and AOPP-HSA. CONCLUSIONS: AOPP may inhibit the proliferation of HGF and such effect was not achieved through apoptosis. AOPP may increase collagen degradation by promoting MMP-1 synthesis and thus may accelerate periodontal destruction process in diabetes.