ABSTRACT
Objective: To review the systematic reviews of acupuncture for diabetic peripheral neuropathy (DPN) and to provide evidence for clinical decisions. Methods: Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1, 2019. Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation, methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses (PRISMA), assessment of multiple systematic review 2 (AMSTAR 2) and grading of recommendations assessment, development and evaluation (GRADE). Results: Ten systematic reviews were included, involving 11 outcome measures. According to PRISMA, 6 items were sufficiently reported while 1 item was not; AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation; according to GRADE, of the 30 clinical evidences, only 5 were graded moderate while the remained were graded low or extremely low. Descriptive analysis showed that acupuncture can significantly improve DPN symptoms, accelerate the conduction velocities of sensory and motor nerves, and up-regulate the content of plasma nitric oxide (NO), while the adverse reaction rate was low. Conclusion: Acupuncture can produce satisfactory clinical efficacy in treating DPN, but the existing problems, such as low-quality evidence, unitary outcome measures, poor methodological quality of systematic reviews and nonstandard reporting, need to be treated cautiously; meanwhile, more high-quality clinical trials are required to elevate the level of evidence.
ABSTRACT
Objective To explore the clinical effect of transrectal ultrasound-guided puncture and cathetering drainage in the treatment of high-position perianal abscess. Methods Eighty patients with high-position perianal abscess, who admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from Jan. of 2015 to 2018, were randomized into interventional therapy group and surgical treatment group, with 40 cases in each group. The patients in the interventional therapy group were treated with cathetering drainage guided by transrectal ultrasound, and the patients in the surgical treatment group were treated with traditional incision drainage. The clinical effect was evaluated in the two groups, and the pain, fever and exudation scores, white blood cell count, C-reactive protein level, maximal section area of abscess cavity, and wound healing time were compared between the two groups before operation and on 3 days and 7 days after operation. Results The total effective rates of the interventional therapy and surgical treatment groups were 87.5% (35/40) and 80% (32/40), respectively, and the difference was significant (χ2=1.385, P=0.709). On 3 days and 7 days after operation, the pain score, exudation score, white blood cell count, C-reactive protein level and maximum section area of the abscess cavity were significantly lower in the interventional therapy group than those in the the surgical treatment group (all P<0.01). The patients with retrorectal abscess or high intersphincteric abscess in the interventional therapy group had shorter wound healing time versus the patients in the surgical treatment group (both P<0.01). Conclusion Compared with traditional incision drainage, cathetering drainage guided by transrectal ultrasound can reduce pain and decrease exudation of the patients with high-position perianal abscess to effectively control infection.