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Background. Due to the limited treatment options in antibiotic-associated diarrhea (AAD) in children, more effective treatments should be explored. Traditional Chinese medicine (TCM) has a long history in China, which has produced a pretty effect in clinical practice. Many randomized clinical trials (RCTs) have explored the effect of traditional Chinese medicine on treating AAD in children. However, there has been no systematic review or meta-analysis on the impact of TCM on AAD in children. The aim of this study was to systematically review RCTs on the effect of TCM in children with AAD. Methods. RCTs in the past ten years on TCM for AAD in children were included. We searched Electronic databases as much as possible. This paper was registered in PROSPERO (CRD42022301034). Results. 26 studies were included in this systematic review. 25 studies reported the effects of TCM interventions on the total effective rate (RR = 1.20, CI 1.16 to 1.24; p < 0.001). 7 studies reported the effects of TCM interventions on the time to change the shape of feces (MD = −1.37, CI −1.67 to −1.07; p < 0.001). 17 studies reported the effects of TCM interventions (MD = −1.43, CI −1.71 to −1.15; p < 0.001). The pooled results showed that there were no significant differences between the two groups in CD3+, CD4+, CD8+, CD4 : CD8, time for bowel sounds to return to normal, hs-CRP, and IgM. There was a significant difference between the two groups in frequency of diarrhea on the third day after TCM intervention, vomiting improvement time, diamine oxidase, IL-8, TNF, IgA, IgG, and average hospital stay. Conclusions. TCM interventions combined with conventional therapy can improve the therapeutic effect of AAD in children. However, future studies are still needed for the low methodological quality. [ABSTRACT FROM AUTHOR]

Backgrounds. Chuanxiong Chatiao san (CXCT) is a famous Chinese classical prescription. It has a favorable effect in treating migraine. It is reported that CXCT combined with Western conventional medicine (WCM) could increase the therapeutic efficacy on migraine. The purpose of this paper is to systematically assess the clinical efficacy, safety, and some indexes of CXCT for migraine. Methods. PubMed, Embase Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, the Cochrane Library, and the CBM were searched from January 2000 to February 2019. We made a detailed record of outcome measurements. Meta-analysis was performed using RevMan 5.3 software. Results. A total of 3307 patients were included in the 37 articles. Meta-analysis showed that CXCT significantly increased the total efficiency rate (TER), compared with Western medicine treatment (WMC) (P < 0.00001). When CXCT is combined with WMC, the result showed that P < 0.00001. CXCT was significantly reduced the adverse events (AEs) compared with WMC (P < 0.00001). The levels of VAS, number of migraine episodes (NE), and time of headache duration (TD) were significantly reduced (P < 0.00001). Platelet function and blood rheology level were improved via a significantly decrease in 5-HT and β-EP (P < 0.00001). Other indicators such as substance P, CGRP high-cut viscosity, low-cut viscosity, plasma viscosity, and fibrinogen were significantly reduced (P < 0.00001). Conclusion. Our findings provide evidence that CXCT and CXCT combined with WMC have higher efficacy in the treatment of migraine compared with WCM alone. Methodological quality was generally low, so the conclusion of this paper has some limitations and it has to be carefully evaluated. [ABSTRACT FROM AUTHOR]

Background. Diabetic nephropathy (DN) is a major cause of end-stage renal disease. In order to palliate renal function impairment and reduce kidney related mortality, it is crucial to treating DN patients at the early stage. This study aims to assess the efficacy and safety of conventional therapy combined with safflower yellow versus conventional therapy alone in early DN patients. Methods. A meta-analysis of randomized controlled trials that compared safflower yellow plus conventional therapy with conventional therapy alone in early DN patients was conducted. Papers were searched using the electronic databases and reference lists. Two reviewers working independently extracted relevant data and carried out risk-of-bias assessments. Statistical analysis was undertaken in Review Manager 5.3. Results. Fourteen trials (1,072 patients) were included in the meta-analysis. Conventional therapy combined with safflower yellow was associated with a higher effective rate (RD, 0.24; 95% CI, 0.17 to 0.30) and a greater decline in urinary albumin excretion rates (SMD, -1.34; 95% CI, -1.77 to -0.92), fasting blood glucose (MD, -0.57; 95% CI, -0.98 to -0.16), serum creatinine (MD, -12.36; 95% CI, -14.66 to -10.06), and blood urea nitrogen (SMD, -0.93; 95% CI, -1.13 to -0.73) in the subgroup with a follow-up time > 15 days. The incidence of adverse events did not differ significantly between these two regimens (RD, -0.01; 95% CI, -0.03 to 0.01). Findings were similar in the subgroup with a follow-up time < 15 days. Conclusions. Conventional therapy combined with safflower yellow had a more beneficial effect than conventional therapy alone in early DN patients. There were significant differences in effective rate, urinary albumin excretion rates, fasting blood glucose, serum creatinine, and blood urea nitrogen between the two regimens and no significant difference in adverse events. More randomized controlled research using standardized protocols would be needed in the future to compare these two regimens. [ABSTRACT FROM AUTHOR]

Objective. To investigate the effectiveness of moxibustion combined with Chinese medicine in the treatment of spleen and stomach deficiency cold-type gastroparesis by meta-analysis and to provide the clinical basis for its treatment. Methods. A computer search of eight databases was performed for published and unpublished randomized controlled trials on moxibustion for spleen and stomach deficiency cold-type stomach pain from domestic and international clinical trial centers. The study was divided into a combination of a moxibustion and Chinese medicine group and a regular Western medicine group, and the outcome indicators were "effective" and "ineffective." The relative risk (RR) was used as the effect indicator for the dichotomous data, and the meta-analysis was performed using Reviewer Manager 5.4 and Stata17.0 software. Results. A total of 8 randomized controlled studies with 729 patients were included, and all studies were analyzed for comparability of patients' baseline information, with no statistically significant differences found (P > 0.05). The meta-analysis results showed that the pooled effect size RR for the eight studies was 1.24 (95% confidence interval 1.16–1.32), and the statistical significance test was Z = 6.69 (P < 0.05), indicating that the difference was statistically significant. Conclusion. The meta-analysis concluded that the efficacy of moxibustion combined with Chinese medicine for the treatment of spleen and stomach deficiency cold-type gastroparesis was superior to that of regular Western medicine, but more high-quality studies are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Objective. To systematically evaluate the efficacy and safety of Dan’e-fukang soft extract in endometriosis treatment. Method. PubMed, CNKI, Wanfang Database, VIP, SinoMed, and Cochrane Library were searched. Randomized controlled trials (RCTs) comparing the efficacy of Dan’e-fukang soft extract and conventional western medicines for endometriosis treatment were included. The data were extracted independently by two people and analyzed using RevMan 5.2.0 software. The relative risk (RR) and mean difference (MD) with 95% confidence intervals were considered as effective outcome indicators. Results. Thirty-nine papers including 5442 patients with endometriosis were included in this study. A meta-analysis revealed that Dan’e-fukang soft extract was more efficient than gestrinone in the treatment of endometriosis (RR = 1.08, 95% CI = 1.03 to 1.15, I2 = 71%, REM, 18 trials) and its efficacy was comparable to that of danazol and mifepristone. Dan’e-fukang soft extract was also as effective as gestrinone and mifepristone in terms of relapse rate and relieving dysmenorrhea. The incidence of adverse reactions was lower than that of conventional western medicines. Conclusions. The results of this study showed that Dan’e-fukang soft extract offers certain advantages in endometriosis treatment, but rigorously designed, strictly implemented RCTs are needed to further validate its efficacy. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study is to assess the efficacy and safety of the integration of Western medicine with traditional Chinese medicine (TCM) in patients with coronary heart disease (CHD) which is comorbid with anxiety and depression. Methods. Randomized controlled trials (RCTs) were searched in databases such as VIP, WanFang, CNKI, Embase, PubMed, and Cochrane Library from the inception of databases to November 2021. RCTs on treating CHD comorbid with anxiety and depression with the integration of TCM and Western medicine were retrieved, and publications were screened according to the screening criteria. Software RevMan 5.4 was utilized to analyze related indicators. Results. Thirteen eligible studies were included in this meta-analysis. They involved a total of 1460 cases, including 747 cases in the TCM and Western medicine group, and 713 cases in the control group. Meta-analysis results illustrated that the difference in the relief of angina pectoris in treating CHD comorbid with anxiety and depression with the integration of TCM and Western medicine was statistically significant (OR = 3.97, 95% CI [2.47, 6.39], P < 0.05), and HAMD score, HAMA score, and clinical effective rate were statistically significant (MD = −4.11, 95% CI [−5.10, 3.12]), (SMD = 1.88, 95% CI [2.53, 1.24]), (OR = 9.71, 95% CI [4.65, 20.28]). Conclusion. By combining TCM and Western medicine, the treatment of angina pectoris and CHD comorbid with anxiety and depression can alleviate anxiety and depression and can enhance patients' quality of life. [ABSTRACT FROM AUTHOR]

Background. Chronic urticaria (CU) can severely impair the quality of life. Acupuncture and related therapies have been widely used in the treatment of CU in China. This study aimed to summarize and critically evaluate the methodological and reporting quality of relevant systematic reviews (SRs) and present objective and comprehensive evidence on the effectiveness and safety of acupuncture and related therapies for CU. Methods. Eight electronic databases were searched from inception to October 2021 for SRs examining acupuncture and related therapies for CU, and gray literature was manually searched. Two authors independently identified SRs and extracted data. The methodological and reporting quality of these SRs were assessed by the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and preferred reporting items for SRs and meta-analyses (PRISMA, 2020), respectively. In addition, the risk of bias in systematic reviews (ROBIS) was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to evaluate the quality of evidence for outcome measures. Results. In total, 23 SRs, including a total of 11 outcome indicators, were published before October 2021. The AMSTAR-2 results showed that the methodological quality of all SRs was critically low; items 2, 3, 7, 9, 10, and 16 were found to have particularly low quality. For PRISMA, the reporting quality of the included SRs was unsatisfactory, and major reporting flaws were observed in the search strategy, synthesis method, certainly assessment, reporting biases, registrations, and financial support of the included SRs. For ROBIS, 22 SRs (95.65%) had a high risk of bias. Among the 55 outcomes assessed using the GRADE framework, there were 3 (5.45%) outcomes with moderate-quality evidence, 6 (10.91%) outcomes with low-quality evidence, and 46 (83.64%) outcomes with very low-quality evidence. We found the moderate quality of evidence indicating that the total effective rate and curing rate of the acupuncture group were higher than those of the western medicine group, and the recurrence rate was lower than that of the western medicine group. Conclusions. Acupuncture and related therapies for the treatment of CU are supported by low-quality evidence-based medicine. However, considering the poor quality of these SRs, we suggest that studies with more rigorous designs, larger sample sizes, and higher methodological and reporting quality are necessary to provide stronger evidence. Registration. The protocol for this study has been registered (PROSPERO registration number: CRD42021259131). [ABSTRACT FROM AUTHOR]

Qili Qiangxin capsule (QQC) is a formulation of traditional Chinese medicine commonly used for the treatment of heart failure in China. This meta-analysis aimed to assess the clinical efficacy of QQC combined with western medicine in the treatment of chronic heart failure (CHF). We conducted a systematic review and meta-analysis abided by the PRISMA guidelines. Literature search was conducted in the China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Database, PubMed, and Web of Science from inception to August 2020. A total of 52 eligible studies were obtained, and 42 of these studies were included in the meta-analysis. The results showed that, compared with western medicine alone, the combination of Qili Qingxin capsule and Western medicine treatment has better efficacy (metoprolol: RR: 1.24, 95%CI 1.14–1.34; carvedilol: RR: 1.24, 95%CI 1.14–1.34; trimetazidine: RR: 1.20, 95%CI: 1.12–1.27; sacubitril valsartan sodium: RR: 1.23, 95%CI: 1.11–1.36; sodium nitroprusside: RR: 1.33, 95%CI: 1.23–1.45; and bisoprolol: RR: 1.31, 95%CI: 1.15–1.49) and increased the level of LVEF, LVEDD, and 6MWT of patients with CHF and reduced the adverse effects and the level of HR, LVESD, BNP, and Hs-cTnT as well. However, there is high heterogeneity in the meta-analysis of LVEDV, BNP, NT-proBNP, Hs-cTnT, 6MWT, and adverse effects, and the methodological quality of the included studies was poor. Therefore, further studies with good methodological quality and large sample size are required to validate our findings. In our study, evidence suggests that Qili Qiangxin capsule combined with Western medicine may improve therapeutic effect and the quality of life of patients with CHF. [ABSTRACT FROM AUTHOR]

Objective. The systematic review was designed to evaluate the safety and efficacy of Qishen Yiqi dropping pill combined with conventional Western medicine in the treatment of chronic heart failure (CHF). Methods. Relevant randomized controlled trials (RCTs) investigating the clinical efficacy of Qishen Yiqi dropping pill combined with conventional Western medicine in treating CHF were widely searched in electronic databases, including PubMed, Cochrane Library, EMBASE, CBM, CNKI, Read-show database, VIP database, and WanFang up to December 26, 2020. The methodological quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0. Meta-analysis was performed by using Review Manager 5.3. Results. Twenty-one RCTs (N = 2162) that met the criteria were included in the review for the assessment of methodological quality. Meta-analysis showed that compared with the conventional Western medicine (control group), Qishen Yiqi dropping pill combined with conventional Western medicine (experience group) significantly improved clinical efficiency, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), brain natriuretic peptide level (BNP), 6 min-walk distance (6-MWD), and adverse reactions. Conclusion. Qishen Yiqi dropping pill combined with conventional Western medicine are better than conventional Western medicine alone to improve the indicators of patients with CHF, which provides a certain basis for the treatment of CHF. [ABSTRACT FROM AUTHOR]

In this study, we aim to evaluate the efficacy and safety of acupoint catgut embedding for the treatment of diarrhea-predominant irritable bowel syndrome and constipation-predominant irritable bowel syndrome. We searched seven online databases to collect studies published up to Feb 29th, 2020. Study quality of each included article was evaluated by the Cochrane Collaboration Risk of Bias Tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using RevMan 5.3 software. Among the included trials, acupoint catgut embedding alone or plus oral western medicine or plus other acupoint-based therapies, or plus oral traditional Chinese medicine were the main therapies in the experimental groups. Interventions in control groups mainly include oral western medicine alone, other acupoint-based therapies alone, or other acupoint-based therapies alone. Primary outcomes in this study include recovery rate, accumulative marked effective rate, accumulative effective rate, and recurrence rate. Finally, 30 trials involving 1889 participants were included. The results of systematic reviews and meta-analyses show that acupoint catgut embedding alone or plus oral western medicine or plus other acupoint-based therapy or plus oral traditional Chinese medicine was significantly better compared with using oral western medicine alone in terms of efficacy for IBS-C and IBS-D. In addition, acupoint catgut embedding alone or plus oral western medicine or plus other acupoint-based therapy or plus oral traditional Chinese medicine could improve the effective rate and decrease the recurrence rate for IBS-D compared with using oral western medicine, other acupoint-based therapies, or oral traditional Chinese medicine alone. Adverse events of acupoint catgut embedding include local induration, redness, swelling, and itchiness, but they were all mild and disappeared swiftly with ordinary local interventions. There is an urgent need for RCTs of high quality and large sample size and with longer treatment duration and follow-up periods of acupoint catgut embedding for IBS. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to evaluate the effects and safety of moxibustion in the management of constipation. Background. Constipation is extremely common in clinical practice and causes physical and mental pain to patients. This study aimed to evaluate the effects and safety of moxibustion in the management of constipation. Methods. Studies on moxibustion for constipation published up to November 2019 were searched in PubMed; EBSCO; EMBASE; Cochrane Library; and three Chinese databases, namely, China National Knowledge Internet, Wanfang, and China Biomedical Network. The methodological quality of the included studies was assessed on the basis of the CLEAR NPT system evaluation methods of Boutron. Further meta-analysis was performed using the RevMan 5.3 and Stata 15.0 software. Results. Ten randomized controlled trials involving 760 patients were included in this study. The meta-analysis revealed that, in comparison to western medicine treatment or other Chinese medicine methods (control group), moxibustion (experimental group) had a higher total effective rate (RR = 1.30, 95% CI [1.21, 1.40], P < 0.00001), and the clinical effectiveness of the experimental group was higher than that of the control group in any subgroup analysis. The first defecation time of the experimental group was shorter than that of the control group (SMD = −1.36, 95% CI [−2.03, −0.68], P < 0.0001). The clinical symptom score of the patients in the experimental group was lower than that in the control group (SMD = −0.65, 95% CI [−1.00, −0.30], P = 0.0003). The patients in the experimental group had higher scores on Bristol stool form scale than those in the control group (MD = 0.99, 95% CI [0.48, 1.50], P = 0.0001). However, there was no obvious difference in safety between the two groups (RR = 0.38, 95% CI [0.01, 11.8], P = 0.58). Conclusions. Moxibustion may have better effect than other treatments on constipation. However, it is not yet possible to assess the safety level of moxibustion therapy, and the quality of the included literature is low, so rigorous studies are warranted. Implications for Nursing and Health Policy. The focus of this study was to evaluate the effectiveness and safety of moxibustion therapy in constipation. This evaluation showed that moxibustion therapy has a good effect on constipation and provides an effective treatment for constipation patients. Whether moxibustion therapy can be used for different syndrome types deserves further discussion. [ABSTRACT FROM AUTHOR]

Objective. Lumbar disc herniation (LDH) is based on the degenerative changes of the intervertebral disc. Many drugs are used to treat and prevent LDH, including Western medicine and Chinese medicine. Duhuo Jisheng Decoction (DHJSD) is one of the most classic Chinese medicine prescriptions. The purpose of our meta-analysis is to evaluate the efficacy and safety of modified DHJSD in the treatment of LDH. Methods. We searched multiple databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) databases, Wanfang Database, and Chinese Scientific Journal Database (VIP) to identify studies that met the inclusion criteria. This meta-analysis was registered at INPLASY with reference number ID: INPLASY202060053. Results. Fourteen randomized controlled trials (RCTs) were identified, including 1560 patients. This meta-analysis showed that the total effective rate and cure rate of modified DHJSD are higher than those of diclofenac sodium enteric-coated tablets (total effective rate: RR = 1.18, 95% CI: 1.12 to 1.25, P < 0.0001 , I2 = 0%; cure rate: RR = 1.60, 95% CI: 1.30 to 1.97, P < 0.00001 , I2 = 2%), diclofenac sodium enteric-coated tablets plus ibuprofen and indomethacin (total effective rate: RR = 1.23, 95% CI: 1.11 to 1.37, P = 0.0001 , I2 = 0%; cure rate: RR = 1.58, 95% CI: 1.22 to 2.04, P = 0.0005 , I2 = 0%), and diclofenac sodium sustained-release capsule (total effective rate: RR = 1.49, 95% CI: 1.27 to 1.74, P < 0.00001 , I2 = 0%; cure rate: RR = 10.07, 95% CI: 3.29 to 30.88, P < 0.00001 , I2 = 5%). Modified DHJSD was also better than Western medicine (MD = −1.56, 95% CI: −2.42 to −0.70, P = 0.0004 , I2 = 74%) in terms of visual analogue scale (VAS) scores. Three RCTs showed no adverse events in the modified DHJSD group, but adverse events existed in the Western medicine group. Conclusion. This meta-analysis showed that modified DHJSD had a more favorable effect on the treatment of LDH than Western medicine, and there were no obvious adverse events. More high-quality RCTs are needed to complement existing conclusions. [ABSTRACT FROM AUTHOR]

Background. Shengmai injection (SMI) is made from purified ginseng, Radix Ophiopogonis, and Schisandra chinensis. It has cardiotonic effects and is clinically used for the adjuvant treatment of chronic heart failure (CHF). However, its efficacy and safety are uncertain. The purpose of this study was to systematically evaluate the existing efficacy and safety evidence in randomized controlled trials (RCTs) that studied SMI for the treatment of CHF. Methods. PubMed, Embase, Cochrane Library, clinicaltrials.gov, CNKI, Wanfang, VIP, and CBM databases were searched up to September 10, 2019. RCTs that compared basic Western medicine treatment with SMI + basic Western medicine were included. The Cochrane Collaboration Risk of Bias Tool was used to assess the risk of bias in the RCTs. The meta-analysis used the random effects model; the mean difference (MD) and 95% confidence intervals (CIs) were combined using the inverse variance method, and the Mantel–Haenszel method was used to combine the relative risk (RR) and 95% CIs. Heterogeneity was assessed using I2 and Q tests, and the source of heterogeneity was explored by analyzing three preset subgroup hypotheses. Results. A total of 20 RCTs were included (n = 1562), with a moderate-to-high risk of bias. The meta-analysis showed that, compared with Western medicine alone, SMI adjuvant therapy significantly improved cardiac function indicators, including left ventricular ejection fraction (MD 6.8%, 95% CI 4.68 to 8.91), stroke volume (MD 9.81 ml, 95% CI 5.67 to 13.96), cardiac output (MD 0.96 L/min, 95% CI 0.66 to 1.25), and cardiac index (MD 0.53 L/min, 95% CI 0.36 to 0.70); heterogeneity was generally high among these outcomes. Compared with the controls, patients receiving SMI adjuvant therapy also had a higher response to treatment (RR 2.89, 95% CI 2.10 to 3.99; I2 = 0%), a greater decrease in brain natriuretic peptide levels (MD −284.66 ng/l, 95% CI −353.73 to −215.59, I2 = 0%), and a greater increase in six‐minute walk test performance (MD 70.67 m, 95% CI 22.92 to 118.42; I2 = 84%). Nine studies reported mild adverse events, such as gastrointestinal reactions, and no serious adverse events were reported. Conclusion. Currently, available evidence indicates that SMI, as an adjuvant for basic Western medicine treatment, can improve the cardiac function of patients with CHF with good safety outcomes. Because of the high risk of bias among the included RCTs and the large heterogeneity of partial outcomes, the findings of this study must be verified by high-quality studies with large sample sizes. [ABSTRACT FROM AUTHOR]

Introduction. Pediatric bronchopneumonia is one of the common respiratory diseases in pediatrics. Chinese herbal injections (CHIs) are widely used to treat pediatric bronchopneumonia. In this study, we examined the efficacy of CHIs in the treatment of pediatric bronchopneumonia using a network meta-analysis (NMA). Methods. Randomized controlled trials (RCTs) of CHIs combined western medicine (WM) versus WM were searched from electronic databases. WinBUGS 1.4.3 and Stata 13.0 were adopted to compute calculations and prepare graphs, respectively. Results. 168 RCTs with 21917 patients were included. The results revealed that Xixinnao injection (XXN) + WM had the most probability to be the best intervention in the four aspects of rate of clinical efficacy, antipyretic time, cough disappearance time, and lung shadow disappearance time. While as to lung shadow disappearance time, asthma disappearance time, and hospitalization time, Yanhuning injection (YHN) + WM could be the best intervention. The safety of CHIs needs to be further assessed. Conclusions. Based on this NMA, XXN + WM and YHN + WM were potential optimal therapies in pediatric bronchopneumonia, and their safety should be strictly monitored. [ABSTRACT FROM AUTHOR]

Objective. The aim of this review and meta-analysis was to assess the effects and safety of modified Si-Miao pill (mSMP) in treatment of rheumatoid arthritis. Design. A systematic literature search was carried out in eight databases from their available dates of inception to April 2020. After screening, fifteen randomized, controlled trials (RCTs) comparing the effects and safety of mSMP in combination with western medicine (including disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs)) in treating rheumatoid arthritis patients were included after screening. Results. In comparison with DMARDs, or coadministration of DMARDs and NSAIDs, mSMP in combination with western medicine significantly lowered erythrocyte sedimentation rate (mean difference (MD) = -10.61, 95% confidence interval (CI) [−12.19, −9.03]), C-reactive protein (MD = −6.50, 95% CI [−8.43, −4.56]), rheumatoid factors (MD = −17.31, 95% CI [−24.34, −10.27]), swollen joint count (MD = −1.63, 95% CI [−2.29, −0.97]), tender joint count (MD = −1.98, 95% CI [−2.34, −1.62]), and morning stiffness time (MD = −24.37, 95% CI [−29.41, 19.33]) and ameliorated the condition of patients (odds ratio (OR) = 3.69, 95% CI [2.64, 5.14]). Additionally, mSMP in combination with western medicine seemed safer (OR = 0.49, 95% CI [0.30, 0.81]). Conclusion. The results of the meta-analysis study have shown that mSMP in combination with western medicine therapies appears to be more effective and safer than western medicine alone in the treatment of rheumatoid arthritis including reducing inflammatory markers and adverse events and improving symptoms. Howbeit, more high-grade, large-scale RCTs of mSMP in various countries and regions are still needed. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to evaluate the efficacy and safety of Qidong Yixin (QY) oral liquid in the treatment of viral myocarditis (VMC). Methods. We searched seven databases for randomized clinical trials on QY for treating VMC. The retrieval period was from database establishment to December 31, 2019. Cochrane risk of bias tool in the Cochrane Handbook was used to assess the methodological quality. Review Manager (RevMan) 5.3 was used to analyze the results. Results. We included 19 studies comprising 2,608 patients, albeit with low methodological quality. Our meta-analysis revealed that combination therapy with QY and western medicine was more effective than western medicine alone (QY vs other Chinese patent medicines: RR = 1.37, 95% Cl: 1.23∼1.52, P < 0.00001 ; QY + coenzyme Q10 + routine treatment vs coenzyme Q10 + routine treatment: RR = 1.20, 95% Cl: 1.14∼1.27, P < 0.00001 ; QY + trimetazidine + acyclovir vs trimetazidine + acyclovir: RR = 1.59, 95% Cl: 1.38∼1.83, P < 0.00001 ; QY + routine treatment vs routine treatment: RR = 1.09, 95% Cl: 1.03∼1.15, P < 0.003). A study on posttreatment myocardial enzyme levels revealed that QY with western medicine downregulated creatine kinase isoenzyme (CK-MB) (QY + antiviral treatment + routine treatment vs antiviral treatment + routine treatment group: MD = −11.28, 95% CI: −13.33∼−9.22, P < 0.00001 ; QY + routine treatment vs routine treatment: MD = −4.96, 95% CI: −5.56∼−4.32, P < 0.00001), creatine kinase (CK) (MD = −32.10, 95% CI: −35.63∼−28.57, P < 0.00001), and lactate dehydrogenase (LDH) (QY + antiviral treatment + routine treatment vs antiviral treatment + routine treatment: MD = −48.76 95% CI: −58.18∼−39.33, P < 0.00001 ; QY + routine treatment vs routine treatment: MD = −23.52, 95% CI: −30.10–16.94, P < 0.00001) rather than western medicine alone, with no evidence of aspartate aminotransferase (AST) downregulation on treatment with QY with western medicine (MD = 2.88, 95% CI: −0.95∼6.71, P < 0.00001) in patients. Two studies reported adverse events, indicating that QY is relatively safe. Conclusion. Although QY may have potential advantages in treating VMC, they remain unclear owing to the poor methodological quality of most studies. Larger, multicenter, high-quality randomized controlled trials are required to verify the effectiveness of QY. [ABSTRACT FROM AUTHOR]

Introduction. TCMI with the effect of Liqihuoxue and Yiqihuoxue has been applied as complementary therapies during the perioperative period of PCI for patients with ACS, while the recommended time points and plans of TCMI are still short of the support of evidence-based medicine. Methods. A systematic review and meta-analysis was conducted to evaluate the clinical efficacy and safety of TCMI on patients with ACS during the perioperative period of PCI. RCTs were searched based on standardized searching rules in seven medical databases from the inception up to August 2019. Two reviewers conducted the study selection, data extraction, and quality analysis independently. Data were analysed with the support of software RevMan and Stata. Results. A total of 68 articles with 6,043 patients were enrolled. The result of meta-analysis showed that the TCMI combined with western medicine was superior to the western medicine alone on clinical efficiency (before the PCI, before and after the PCI, or overall, P < 0.05), the occurrence of MACE (myocardial infarction and stenocardia: before the PCI, before and after the PCI, or overall, P < 0.05 ; arrhythmia: before and after the PCI, P < 0.05), and the level of inflammatory factors (hs-CRP: before the PCI, before and after the PCI, or overall, P < 0.05 ; IL-6: after the PCI, P < 0.05). The TCMI with the effect of Liqihuoxue obtained more support compared with Yiqihuoxue based on the result of meta-analysis. Conclusions. TCMI with the effect of Liqihuoxue or Yiqihuoxue combined with western medicine generally showed the potential advantage on the treatment of ACS during the perioperative period of PCI. However, the optimal time point of intervention and recommended plan based on the effect still needs more clinical evidence. We consider that the research of precise and standardized application of TCMI will be a promising direction for TCM in the future. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the effectiveness and safety of acupuncture moxibustion therapy (AMT) for the breast cancer-related lymphedema (BCRL). Methods. Four English databases (MEDLINE, PubMed, Embase, and Cochrane CENTRAL) and four Chinese databases were searched from their inception to Feb 1, 2020. Eligible randomized controlled trials (RCTs) investigating AMT against any type of controlled intervention in patients for BCRL and assessing clinically relevant outcomes (total effective rate, circumference difference, and Karnofsky performance score) were included. The methodological quality of all selected trials was estimated in accordance with the guidelines published by the Cochrane Collaboration. Review Manager 5.3 was used to conduct analyses. Results. Twelve eligible RCTs are confirmed. Most of the trials selected are regarded as low methodological quality. Compared with Western medicine, physiotherapy, and functional training, traditional AMT has significantly higher treatment effect (RR 1.03 (95% CI: 1.22, 1.45); p < 0.00001). In comparison with physiotherapy, AMT is better in reducing edema symptoms (MD = −0.77; 95% CI (−1.13–0.41); p < 0.00001). Moreover, pooled results demonstrate that AMT results in better outcomes than functional training and Western medicine in improving Karnofsky performance score of BCRL patients (SMD = 0.69; 95% CI (0.38–1.00); p < 0.00001). Conclusion. This systematic review and meta-analysis provides evidence that AMT is serviceable and safe in treating BCRL. With the limited number of available studies and methodology drawbacks, further high-quality RCTs with reasonable designs are still warranted. [ABSTRACT FROM AUTHOR]

Background. Combination therapy with Chinese herbal medicines (CHMs) and conventional medical treatment (CMT) was proposed as a therapeutic strategy for chronic heart failure (CHF) patients complicated with depression. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess effects of this combination therapy on CHF complicated with depression. Methods. RCTs comparing the combination of CHMs and CMT to CMT were retrieved in seven electrical databases till March 30, 2019. The effective rate of cardiac function and Hamilton depression scale (HAMD) were marked as the primary outcomes. Left ventricular ejection fraction (LVEF) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were marked as the secondary outcomes. The methodological quality of eligible RCTs used the Cochrane bias risk assessment tool. Stata 13.0 and Review Manager 5.3 were preferred for synthesizing the results if the results were appropriate. Results. Thirteen RCTs enrolling 1022 subjects met the inclusion criteria. The majority of the retrieved RCTs were evaluated to be of low methodological quality. The pooled results of the meta-analysis showed that CHMs plus CMT group created better outcomes compared to CMT alone therapy, as evidenced by the fact that the overall effects of combination therapy strategy were significantly greater than the control group in increasing effective rate of cardiac function (risk ratio (RR) = 1.28; 95% CI: 1.16 to 1.42), in improving depressive symptoms (HAMD) (standard mean difference (SMD) = −1.31; 95% CI: −1.68 to −0.95) and quality of life (MLHFQ) (weighted mean difference (WMD) = −8.42; 95% CI: −10.08 to −6.76), in increasing LVEF scores (WMD = 5.33; 95% CI: 4.30 to 6.35). Conclusion. The combination of CHMs and CMT increased the effective rate of cardiac function and LVEF scores and reduced HAMD and MLHFQ scale scores, which was a potential therapeutic strategy that improved the management of CHF patients complicated with depression. Future trials were needed to verify the above results since abnormal heterogeneity and poor quality of literature have existed in the included studies. [ABSTRACT FROM AUTHOR]

Primary nephrotic syndrome (PNS) is a common renal disease that presents with heavy proteinuria and hypoalbuminemia. Despite notable advances in its treatment, some patients show poor responses and clinical outcomes when treated with conventional Western medicine (WM). Chinese herbal injections (CHIs) have been reported to have beneficial effects for PNS. The aim of the present study was to comprehensively determine the efficacy and safety of CHIs for PNS in adults using a network meta-analysis approach. PubMed, Embase, the Cochrane library, and four Chinese databases were systematically searched to identify randomized controlled trials (RCTs) using CHIs for treatment of PNS published before June 1, 2019. Quality assessment of the identified RCTs was performed according to the Cochrane Handbook. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated for discrete or continuous variables, respectively. The primary outcome was complete/total remission and secondary outcomes were serum albumin and urinary protein excretion. The surface under the cumulative ranking curve (SUCRA) value and cluster analyses were used to rank treatment by probability. Eighty-five studies involving 11 CHIs and 5801 subjects were included. Compared with WM alone, CHI plus WM showed an improved complete/total remission rate as well as higher serum albumin and lower 24-hour urinary protein excretion, except in the following: Yinxingye injection plus WM did not improve the total remission rate, and Dengzhanhua or Xueshuantong injection plus WM did not lower the 24-hour urinary protein excretion. Either Danhong (DH) or Dengzhanhua (DZH) injection plus WM was the preferable treatment for PNS based on SUCRA and cluster analyses of clinical remission and adverse events. However, considering that literature in this area is limited, these results need further validation. CHIs administered as adjuvants to WM showed favourable outcomes for PNS. DH + WM and DZH + WM might be the potential optimal therapies for PNS. [ABSTRACT FROM AUTHOR]

Objective. Yimucao injection combined with several contraction uterus drugs is in use for preventing postpartum hemorrhage after cesarean section. The present study is a meta-analysis comparing the efficacy and safety of these drugs. Methods. PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Database (CBM), VIP, and Wanfang database were searched until June 2018. We selected RCTs of Yimucao injection combined with western medicine for preventing postpartum hemorrhage and study quality was assessed using the revised Cochrane risk of bias tool. Forty-eight RCTs are comprised of 7,330 participants. Results. The overall response rate of Yimucao injection combined with western medicine as a class (OR=4.19, 95%CI=2.83, 6.20, P<0.00001) was found to be significantly improved than western medicine alone. Yimucao injection combined with western medicine group could significantly reduce blood loss in intraoperative (SMD= -1.15, 95%CI= -1.43, -0.87, P<0.00001), compared with control group. The treatment group could significantly reduce postpartum blood loss within 2 hours (SMD= -1.73, 95%CI= -2.01, -1.46, P<0.00001) and had a significantly lower blood loss within 24 hours (SMD= -1.92, 95%CI= -2.21, -1.63, P<0.00001) than control group. Additionally, in terms of the safety, Yimucao injection group reduced the risk of adverse events in the course of prevention than the western medicine group. Conclusions. This study demonstrated that Yimucao injection combined with western medicine may be more effective for preventing postpartum hemorrhage after cesarean section. However, high-quality and large multicenter randomized clinical trials will be needed to prove the consequence in the further. [ABSTRACT FROM AUTHOR]

Aim(s). To evaluate the efficiency of acupuncturing at the sphenopalatine ganglion acupoint alone for treatment of allergic rhinitis. Design. A total of ten online databases were searched to find studies published up to Jan. 2018. Primary outcome measures include the TNSS, the RQLQ score, the VAS score, total effective rate, score for signs and symptoms, and the improvement of disease classification. Study quality of each included article was evaluated by the Cochrane Collaboration risk of bias tool. A meta-analysis was conducted based on the Cochrane systematic review method by using RevMan 5.3 software. Interventions. Acupuncturing SGA alone was the only therapy in experimental group. Interventions in control groups includes sham acupuncture, acupuncturing other regular acupoints, and western medicine. Specific techniques included manual acupuncture and electroacupuncture only. Primary Outcomes. They include TNSS, RQLQ, VAS score, total effective rate, the improvement of disease classification. Results. Ten studies of eight articles involving 1004 participants were included. Result of meta-analysis showed that acupuncturing sphenopalatine ganglion acupoints alone was more effective than control groups. However, several adverse effects were reported. Conclusion. These findings show that acupuncturing the sphenopalatine ganglion acupoint alone has a potential role in alleviating nasal symptoms, improving quality of life for patients, and the effectiveness of acupuncture in the treatment of allergic rhinitis, suggesting it as a considerable therapy for allergic rhinitis. However, more studies are needed to execute a subgroup analysis of various variables and to evaluate the publication bias of the study. [ABSTRACT FROM AUTHOR]

Object. Halitosis has great adverse impact on personal and social life. There is no strong evidence for the effect of Chinese medicine (CM) and combined Chinese and western medicine (CWM) on halitosis. The aim of the present study is to evaluate the effective rate of CM and CWM on halitosis. Materials and Methods. Literature search in English and Chinese was conducted in PubMed, Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by the Cochrane tool. Synthesis of results was done by RevMan 5.3. p<0.05 was considered significant difference. Subgroup analysis by classification of halitosis and sensitivity analysis were also conducted. Results. Seventeen studies were included. The follow-up length ranged from five days to eight weeks. CM had significantly better effect than WM on intraoral halitosis (I2 =24%; RR=1.21 (95% CI, 1.04, 1.40), P=0.01) and extraoral halitosis (I2 =0; RR=1.39 (95% CI, 1.19, 1.63), P<0.0001). CWM had significantly better effect than WM on intraoral halitosis (I2 =0; RR=1.25 (95% CI, 1.16, 1.35), P<0.00001) and extraoral halitosis (I2 =0; RR=1.19 (95% CI, 1.08, 1.31), P=0.0004). Subgroup analysis and sensitivity analysis showed insignificant results. Conclusion. With the limitation of our study, both CM and CWM have significantly better effect on halitosis than WM. More effort should be made to explore long-term effect of CM and CWM on halitosis. This study was registered with the PROSPERO (ID: CRD42018107229). [ABSTRACT FROM AUTHOR]

Objective. In China, the method of clearing heat and removing dampness medicine of Chinese traditional medicine has been widely used on gout. However, the clinical effects are various and not summarized systematically. Methods. In this study, a large number of randomized controlled clinical trials were reviewed and analyzed and the clinical efficacy and adverse reactions of traditional Chinese medicine with clearing heat and removing dampness effects for the treatment of gout were systematically evaluated. A comprehensive search of databases including pubMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, Wanfang Data, and SinoMed was performed. Results. There are 69 randomized controlled trials with 5915 sample sizes meeting the criteria in the study. The results of the meta-analysis indicate that the effects of clearing heat and removing dampness medicine were slightly better than western medicine in the treatment of gout based on the following parameters: serum uric acid (standardized mean difference (SMD):-62.14, 95% confidence interval (CI): -78.12 to-46.15), C reactive protein (SMD: -4.21, 95% CI: -6.19 to -2.23), erythrocyte sedimentation rate (SMD: -6.23, 95% CI: -8.39 to-4.06), and overall clinical response (relative risk (RR): 1.11, 95% CI: 1.08 to 1.15) and, in the profile of adverse drug reactions, the clearing heat and removing dampness medicine showed less adverse reactions than traditional Western medicine (RR: 0.18, 95% CI: 0.10 to 0.32). Conclusions. Through a systemic evaluation of the clinical efficacy of the clearing heat and removing dampness medicine of traditional Chinese medicine and western medicine on gout, the clearing heat and removing dampness medicine and western medicine possessed similar clinical efficacy, but traditional Chinese medicine treatments are superior to western medicine in controlling adverse reactions. [ABSTRACT FROM AUTHOR]

Introduction. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) imposes a huge economic burden on healthcare systems worldwide. Chinese herbal injections (CHIs) are widely used to treat AECOPD. In this study, we examined the efficacy of CHIs in the treatment of AECOPD using a network meta-analysis (NMA). Methods. Literature search was conducted from electronic databases of randomized controlled trials (RCTs) on CHIs plus Western medicine (WM) versus WM. WinBUGS 1.4.3 and STATA 12.0 were adopted to compute calculations and prepare graphs, respectively. Results. We included 155 RCTs with 13,218 patients. The results revealed that Danhong injection (DH) + WM had the greatest therapeutic potential in terms of rate of clinical efficacy (RCE). In addition, in comprehensively improving RCE and FEV1%, and RCE and C-reactive protein, Huangqi injection (HQ) +WM was associated with preferable effects. Similarly, Xixinnao injection + WM, Reduning injection (RDN) +WM, and HQ+WM had a favorable effect on RCE and PaO2. The effect of RDN+WM was favorable in all outcomes except RCE. The safety of CHIs needs to be further assessed. Conclusions. Based on this NMA, DH+WM, HQ+WM, and RDN+WM were potential optimal therapies in AECOPD and their safety should be strictly monitored. [ABSTRACT FROM AUTHOR]

Objectives. Traditional Chinese medicine (TCM) therapy for nonerosive reflux disease (NERD) remains controversial. The aim of this study was to evaluate the efficacy and safety of TCM regimens in NERD treatment. Methods. Randomized controlled trials (RCTs) of TCM treatment for NERD through September 31, 2017, were systematically identified in PubMed, Wanfang Data, CNKI, VIP, CBM, Ovid, Web of Science, and Cochrane Library databases. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool. Results. A total of 725 and 719 patients in 14 RCTs were randomly divided into TCM alone and conventional Western medicine groups, respectively. The clinical total effective rate of the TCM group was markedly higher than that of the single proton pump inhibitors (PPIs) or Prokinetics therapy group (RR = 1.19, 95% CI = 1.07–1.31, and P = 0.0008), while it was comparable to that of the combination of PPIs and Prokinetics therapy group (RR = 1.14, 95% CI = 1.00–1.29, and P = 0.05). Compared with Western medicine group, the TCM group showed improved symptom relief through a reduced RDQ score (SMD = −0.91; 95% CI = −1.68–−0.15; and P = 0.02). Additionally, TCM clearly decreased the recurrence rate (RR = 0.38, 95% CI = 0.28–0.52, and P < 0.00001). Adverse events, such as constipation, sickness, fever, abdominal distension, and stomach noise, were slight for both the TCM and Western medicine groups and disappeared after the easement of pharmacological intervention; in particular, TCM possessed fewer side effects. Conclusion. Compared with PPIs or Prokinetics therapy alone, TCM single therapy can better improve the clinical total effective rate and symptom relief and decrease the recurrence rate and adverse events in the treatment of NERD. Our results suggest that TCM will be a promising alternative therapy for NERD patients in the future. [ABSTRACT FROM AUTHOR]

We evaluated the effectiveness of “the therapy of elimination first” in early acute mastitis, using four databases (CNKI, Wanfang, Embase, and PubMed). The study incorporated 2508 patients from 16 randomized controlled trials (RCTs). Included trials used Chinese oral medicine and applied the principle of “Eliminating Therapy” for the early treatment of acute mastitis, with simple antibiotic treatment as a control group. Meta-analysis showed significant differences between the overall effectiveness of oral Chinese medicine using Eliminating Therapy (OCM-ET) and western medicine using antibiotics (WM-A) (odds ratio [OR] = 4.43, 95% confidence interval [CI] = 3.21–6.12, Z = 9.04, and P<0.00001). Analysis of subgroups based on the use of classic or self-made preparations of the medicines showed smaller statistical heterogeneity among the different subgroups (P>0.05, I2≤50%). The OCM-ET group showed significantly shorter pain relief times [mean difference (MD) = −3.08, 95% CI = (−5.90, −0.26), and P=0.03] and cure times [MD = −6.27, 95% CI = (−9.68, −2.85), and P=0.0003] than did the WM-A group. Our findings suggest that OCM-ET can shorten the duration of pain and improve cure time in early acute mastitis patients, with fewer adverse reactions. However, RCTs of higher quality with larger sample sizes are required to confirm these findings. [ABSTRACT FROM AUTHOR]