Meta-analysis and trial sequential analysis of Compound Qinlan Oral Liquid in treatment of acute upper respiratory tract infection / 中国中药杂志

This study aims to evaluate the efficacy and safety of Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. Computer-based online searching of CNKI, VIP, SinoMed, Wanfang, ChiCTR, ClinicalTrials.gov, Cochrane Library, PubMed, EMbase, and Web of Science was performed to retrieve the randomized controlled trial(RCT) regarding Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. In addition, manual searching of gray literature was conducted. After two evaluators independently selected articles, extracted data, and evaluated the quality of methodology included in the studies, Meta-analysis was carried out in RevMan 5.4 and trial sequential analysis(TSA) in TSA 0.9.5.10 Beta. GRADE profiler 3.6.1 was employed to evaluate the evidence quality. A total of 21 RCTs were included in this study, involving 2 651 patients(1 330 patients in the observation group and 1 321 patients in the control group). Meta-analysis showed that compared with conventional western medicine alone, Compound Qinlan Oral liquid improved the total response rate(RR=1.15, 95%CI[1.12, 1.19], P<0.000 01) without increasing the incidence of adverse reactions(RR=0.77, 95%CI[0.47, 1.25], P=0.16). The results of subgroup analysis are described as follows:(1) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid improved the total response rate(RR=1.10, 95%CI[1.05, 1.14], P<0.000 01) and shortened the time to symptom relief(SMD=-0.76, 95%CI[-1.02,-0.51], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=1.16, 95%CI[0.54, 2.47], P=0.71).(2) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid + conventional western medicine improved the total response rate(RR=1.20, 95%CI[1.15, 1.25], P<0.000 01), decreased traditional Chinese medicine(TCM) syndrome scores(MD=-0.58, 95%CI[-0.75,-0.41], P<0.000 01), shortened the time to symptom relief(SMD=-2.44, 95%CI[-3.09,-1.80], P<0.000 01) and physical sign improvement(MD=-2.57, 95%CI[-4.11,-1.04], P=0.001), lowered the serum levels of inflammatory cytokines(SMD=-2.16, 95%CI[-2.61,-1.70], P<0.000 01), improved respiratory function indicators(SMD=1.48, 95%CI[1.00, 1.96], P<0.000 01), and enhanced the humoral immunity(MD=0.94, 95%CI[0.69, 1.18], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=0.57, 95%CI[0.29, 1.09], P=0.09). TSA showed that the cumulative Z curve of total response rate crossed the traditional threshold and TSA threshold, further confirming the clinical efficacy of Compound Qinlan Oral Liquid. The GRADE graded the evidence of the above outcome indicators as low or extremely low, and yielded weak recommendation. Compared with conventional western medicine alone, Compound Qinlan Oral Liquid can improve the total effective rate and reduce the time to symptom relief. The combination of Compound Qinlan Oral Liquid and conventional western medicine can improve the total response rate, mitigate the symptoms and improve the physical signs, reduce inflammation, and improve respiratory function and immunity of the patients with acute upper respiratory tract infection. In view of the limited number and quality of the included studies, the above conclusions still require high-quality RCT to provide evidence support.

Meta-analysis and trial sequential analysis of Chaihuang Granules in treatment of upper respiratory tract infection in children / 中国中药杂志

This study aimed to evaluate the efficacy and safety of Chaihuang Granules in the treatment of upper respiratory tract infection in children. The databases such as CNKI, Wanfang, VIP, SinoMed, Cochrane Library, PubMed, EMbase, Web of Science, Chinese Clinical Trial Registry, and ClinicalTrials.gov were searched for randomized controlled trial(RCT) of Chaihuang Granules for the treatment of upper respiratory tract infection in children, and supplemented by manual searching of gray literature. Two investigators independently screened the literature, extracted data, and assessed the methodological quality. Meta-analysis was performed using RevMan 5.4 software, trial sequential analysis was conducted using TSA 0.9.5.10 Beta software, and evidence quality evaluation was carried out using GRADE profiler 3.6.1 software. Eighteen RCTs involving 2 459 patients(1 262 in the treatment group and 1 197 in the control group) were included. Meta-analysis showed that compared with conventional therapy alone, Chaihuang Granules significantly improved the total effective rate(RR=1.18, 95%CI[1.15, 1.22], P<0.000 01), reduced the disappearance time of symptoms/signs(MD=-1.39, 95%CI[-1.66,-1.12], P<0.000 01), improved cytokine levels(MD=-2.40, 95%CI[-3.80,-1.00], P=0.000 8), improved humoral immune levels(MD=0.75, 95%CI[0.60, 0.90], P<0.000 01), and reduced the recurrence rate(MD=-2.11, 95%CI[-2.98,-1.25], P<0.000 01). However, the incidence of adverse reactions was not increased(RR=0.94, 95%CI[0.59, 1.49], P=0.78). Subgroup analysis showed that:(1) both Chaihuang Granules used alone(RR=1.19, 95%CI[1.11, 1.27], P<0.000 01) and in combination with other therapies(RR=1.18, 95%CI[1.14, 1.22], P<0.000 01) effectively improved the total effective rate.(2) In terms of symptoms/signs disappearance time, Chaihuang Granules effectively reduced the duration of fever(MD=-1.18, 95%CI[-1.78,-0.58], P=0.000 1), cough with sputum(MD=-1.82, 95%CI[-2.38,-1.25], P<0.000 01), cough(MD=-1.31, 95%CI[-1.89,-0.74], P<0.000 01), sore throat(MD=-1.57, 95%CI[-2.25,-0.89], P<0.000 01), and lung rales(MD=-1.49, 95%CI[-2.06,-0.92], P<0.000 01).(3) Regarding cytokine levels, Chaihuang Gra-nules effectively improved the levels of interleukin(IL)-2(MD=-0.94, 95%CI[-1.16,-0.72], P<0.000 01), IL-6(MD=-4.71, 95%CI[-6.39,-3.03], P<0.000 01), and tumor necrosis factor-α(TNF-α)(MD=-2.07, 95%CI[-2.43,-1.71], P<0.000 01).(4) In terms of cellular immune levels, Chaihuang Granules effectively improved the levels of CD3~+(MD=4.11, 95%CI[1.53, 6.69], P=0.002), CD4~+(MD=4.21, 95%CI[1.69, 6.73], P=0.001), CD8~+(MD=-2.65, 95%CI[-3.93,-1.37], P<0.000 1), and CD4~+/CD8~+(MD=0.25, 95%CI[0.14, 0.37], P<0.000 1).(5) In terms of humoral immune levels, Chaihuang Granules effectively improved the levels of IgA(MD=0.44, 95%CI[0.23, 0.64], P<0.000 1), IgM(MD=0.31, 95%CI[0.15, 0.46], P=0.000 1), and IgG(MD=2.02, 95%CI[1.60, 2.43], P<0.000 01). Trial sequential analysis showed that the cumulative Z-curve of the total effective rate crossed the boundary value, further confirming its clinical efficacy. The GRADE evidence quality evaluation showed that the evidence quality of the above outcome indicators was low or very low, and the recommendation strength was weak. Compared to conventional therapy alone, Chaihuang Granules can effectively improve the total effective rate of treatment, alle-viate symptoms and signs of upper respiratory tract infection in children, improve inflammatory conditions, enhance immune function, and reduce the recurrence rate. Due to the limited quality of the included studies, high-quality RCT is still needed to provide evidence support for the above conclusions.

Systematic review and Meta-analysis of efficacy and safety of Xiangju Capsules in treatment of sinusitis / 中国中药杂志

The present study evaluated the efficacy and safety of Xiangju Capsules in the treatment of sinusitis. CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMbase, Web of Science and ClinicalTrials.gov were systematically searched for randomized controlled trials(RCTs) of Xiangju Capsules in the treatment of sinusitis, and Meta-analysis was performed on the included articles using RevMan 5.3. Twenty-nine articles were included, involving 4 331 cases, including 2 196 cases in the experimental group and 2 135 cases in the control group. Meta-analysis results showed that the conventional therapy combined with Xiangju Capsules showed better significant efficiency(RR=1.30, 95%CI[1.15, 1.47], P<0.000 01), total response rate(RR=1.19, 95%CI[1.16, 1.23], P<0.000 01), and Lund-Mackay scores(MD=-1.23, 95%CI[-1.39,-1.07], P<0.000 01) than conventional therapy alone. The conventional therapy combined with Eucalyptol-limonene-pinene Enteric Soft Capsules and Xiangju Capsules showed better total response rate(RR=1.14, 95%CI[1.07, 1.21], P<0.000 1) and VAS scores than conventional therapy combined with Eucalyptol-limonene-pinene Enteric Soft Capsules(MD_(headache)=-1.29, 95%CI[-1.48,-1.10], P<0.000 01; MD_(congestion)=-1.08, 95%CI[-1.21,-0.95], P<0.000 01; MD_(olfactory dysfunction)=-1.05, 95%CI[-1.23,-0.87], P<0.000 01; MD_(facial disorder)=-1.38, 95%CI[-1.49,-1.27], P<0.000 01). The conventional therapy combined with clarithromycin and Xiangju Capsules displayed a better total response rate(RR=1.15, 95%CI[1.08, 1.21], P<0.000 01) than conventional therapy combined with clarithromycin, while no significant difference was observed in the significant efficiency(RR=1.27, 95%CI[0.98, 1.65], P=0.07). The significant efficiency(RR=2.16, 95%CI[1.47, 3.18], P<0.000 1) and total effective rate(RR=1.48, 95%CI[1.28, 1.72], P<0.000 01) of clarithromycin combined with Xiangju Capsules in patients with sinusitis and CT scores(MD=-1.87, 95%CI[-2.01,-1.74], P<0.000 01) was significantly better than clarithromycin alone. Trial sequential analysis(TSA) showed that the cumulative sample size of the main outcome indicators had met expectations. The main adverse reactions included drowsiness, diarrhea, and abdominal pain, which had no direct relationship with Xiangju Capsules. Based on the available data and methods, the combination of Xiangju Capsules with multiple treatments showed significant efficiency and total response rate in the treatment of sinusitis, and improved CT scores, VAS scores, and Lund-Mackay scores, without serious adverse reactions. The efficacy and safety of Xiangju Capsules in the treatment of sinusitis still need to be verified by a large-sample, well-designed, and internationally standardized clinical trial scheme.

Systematic Review and Sequential Analysis on Efficacy of Modified Buyang Huanwu Tang in Treatment of Chronic Heart Failure / 中国实验方剂学杂志

Objective:To systematically evaluate the efficacy and safety of modified Buyang Huanwu Tang in the treatment of chronic heart failure. Method:CNKI database，Wanfang database，VIP database，Pubmed，MEDLINE，EMBASE and Cochrane database were retrieved systematically. The literature retrieval period is from no limit to December 2019，with "Buyang Huanwu Tang" and "chronic heart failure" "heart failure" as the key words for full-text retrieval of Chinese and English databases. Literatures of randomized controlled trials（RCTs） for chronic heart failure were included， and the data were extracted. Cochrane system evaluation method was used to score the quality of literature. Stata 14.0 was applied in Meta-analysis on the retrieval results. TSA0.9 was applied in test sequential analysis. Sensitivity analysis was made to explain heterogeneity，and funnel chart was used to evaluate publication bias. Result:A total of 2 037 patients were included in 21 RCT studies. The article quality risk assessment was generally unclear risk of bias. The results of meta-analysis showed that the left ventricular ejection fraction （LVEF） in the experimental group was significantly higher than that in the control group，with statistically significant differences ［MD=0.901，95% CI （0.772，1.029），P<0.01］，the left ventricular end diastolic diameter （LVEDd） in the experimental group was significantly lower than that in the control group，with statistically significant differences ［OR=-0.650，95% CI=（-0.854，-0.446），P<0.01］，BNP in the experimental group was significantly lower than that in the control group，with statistically significant differences ［MD=-1.212，95% CI=（-1.359，-1.066），P<0.01］，6-minute walk test （6MWT） in the experimental group was significantly higher than that in the control group，with statistically significant differences ［MD=0.797， 95% CI=（0.447，1.146），P<0.01］，and the effective rate in the experimental group was significantly improved，with statistically significant differences ［OR=1.840，95% CI=（1.680，2.016），P<0.01］. Conclusion:Modified Buyang Huanwu Tang combined with conventional western medicine treatment of chronic heart failure is more effective than single administration of western medicine treatment，and can improve clinical efficacy， effectively improve the LVEF of patients with chronic heart failure，reduce the LVEDd reduces plasma BNP levels，prolong the 6-minute walking distance，and reduce the incidence of adverse reactions.

Analysis of the goals scored in the 2016 and 2017 CONMEBOL Libertadores Cups / Análise de gols marcados nas Copas Conmebol Libertadores 2016 e 2017 / Análisis de los goles marcados en las Copas Conmebol Libertadores 2016 y 2017

ABSTRACT This study aimed to describe regularities in soccer goal-ending sequences in the 2016 and 2017 CONMEBOL Libertadores Cups. Observational methodology was used. The sample comprised 699 attack sequences that ended in goal from 250 games played in 2016 and 2017. An ad hoc observational instrument was designed. Data analysis was performed in three complementary ways: sequential, graph theory, and polar coordinates. Two sequences were highlighted: Pass with the head-Shot-Goal and Rebound-Rebound-Shot-Goal. The foot pass action is the most common prior to a shot. In addition, dribbling and conducting were excitatory and inhibitory actions, respectively, to score a goal. In conclusion, the use of open game was relevant to score goals and different patterns were observed.

RESUMO O objetivo foi descrever regularidades nas sequências terminadas em gol nas Copas CONMEBOL Libertadores 2016 e 2017. Foi escolhida a metodologia observacional. A amostra compreendeu 699 sequências de ataques terminadas em gol de 250 jogos disputados em 2016 e 2017. Elaborou-se um instrumento de observação ad hoc. A análise dos dados foi realizada de três maneiras complementares: análise sequencial; teoria dos grafos; e coordenadas polares. Duas sequências foram destacadas: Passe com a cabeça-Chute-Gol e Rebote-Rebote-Chute-Gol. A ação passe com o pé foi a mais comum antes de um tiro. Além disso, dribbling foi uma ação excitatória de marcar um gol e a condução o inibiu. Conclui-se que o uso do jogo aberto foi relevante para marcar gols e diferentes padrões foram observados.

RESUMEN El objetivo fue describir regularidades en las secuencias terminadas en gol en las Copas Libertadores de fútbol 2016 y 2017. Se utilizó la metodología observacional. La muestra comprendió 699 secuencias de ataque que terminaron en gol de 250 partidos jugados en 2016 y 2017. Se diseñó un instrumento de observación ad hoc. El análisis de datos se realizó a través de tres maneras complementarias: análisis secuencial; teoría de grafos y coordenadas polares. Se destacaron dos secuencias: Pase con la cabeza-Remate-Gol y Rebote-Rebote-Remate-Gol. La acción Pase con el pie fue la más común antes de un tiro. Además, el regate fue una acción excitatoria de marcar un gol y la conducción lo inhibió. En conclusión, la utilización del juego abierto fue relevante para marcar goles y se observaron diferentes patrones.

Systematic review and sequential analysis of Xuebijing Injection in treatment of systemic inflammatory response syndrome / 中国中药杂志

To systematically review the efficacy of Xuebijing Injection combined with western medicine in the treatment of systemic inflammatory response syndrome(SIRS). In this study, CBM, CNKI, Wanfang, VIP, PubMed and EMbase databases were retrieved for clinical randomized controlled trials on the effect of Xuebijing Injection combined with western medicine in the treatment of SIRS from the establishment of the database to July 31, 2020. After screening, Meta-analysis was conducted by RevMan 5.3 software, trial sequential analysis was conducted by TSA 0.9.5.10 beta software, and the evidence quality level was evaluated by GRADEprofiler 3.6.1 software. Meta-analysis showed that Xuebijing Injection combined with western medicine could reduce white blood cell count(MD=-2.32, 95%CI[-2.44,-2.21], P<0.000 01), C-reactive protein count(MD=-22.70, 95%CI[-29.61,-15.79], P<0.000 01), APACHE Ⅱ score(MD=-2.15, 95%CI[-2.43,-1.87], P<0.000 01), tumor necrosis factor alpha count(SMD=-1.23, 95%CI[-1.48,-0.99], P<0.000 01) and interleukin-6 count(SMD=-0.92, 95%CI[-1.15,-0.69], P<0.000 01), improve treatment efficiency(RR=1.39, 95%CI[1.23, 1.56], P<0.000 01), reduce incidence of multiple organ dysfunction(RR=0.47, 95%CI[0.35, 0.64], P<0.000 01) and mortality(RR=0.22, 95%CI[0.13, 0.37], P<0.000 01), which were better than western medicine treatment alone. Trial sequential analysis showed that in terms of reducing the incidence of multiple organ dysfunction and C-reactive protein count, the cumulative Z value passed through the traditional threshold, TSA threshold and expected information value, and reached the required number of cases. GRADE evaluation showed that the level of evidence was low or very low. According to the findings, Xuebijing Injection combined with western medicine is effective in treating SIRS. However, as the low quality of the included studies may affect the reliability of the conclusion, more high-quality studies shall be included for further verification in the future, so as to provide better suggestions for clinical medication.

Exploration on rationality evaluation approach of drug combination medication based on sequential analysis and machine learning / 中国中药杂志

Drug combination is a common clinical phenomenon. However, the scientific implementation of drug combination is li-mited by the weak rational evaluation that reflects its clinical characteristics. In order to break through the limitations of existing evaluation tools, examining drug-to-drug and drug-to-target action characteristics is proposed from the physical, chemical and biological perspectives, combining clinical multicenter case resources, domestic and international drug interaction public facilities with the aim of discovering the common rules of drug combination. Machine learning technology is employed to build a system for evaluating and predicting the rationality of clinical drug combinations based on "drug characteristics-repository information-artificial intelligence" strategy, which will be debugged and validated in multi-center clinical practice, with a view to providing new ideas and technical references for the safety and efficacy of clinical drug use.

Systematic evaluation and trail sequential analysis of efficacy and safety of Yangxue Qingnao Granules in treatment of essential hypertension and its accompanying symptoms / 中国中药杂志

To systematically evaluate the efficacy and safety of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and its accompanying symptoms. PubMed, EMbase, Cochrane Library, VIP, CNKI, Wanfang, and China biomedical database(CBD) were searched to screen out from the establishment of the database to April 2020 about the clinical randomized controlled trials of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and accompanying symptoms. The articles were selected according to the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. TSA 0.9.5.10 Beta software was used for sequential analysis, and GRADE 3.6 was used for evidence quality evaluation. A total of 4 532 patients were included in 34 randomized controlled trials. Meta-analysis results showed that: Yangxue Qingnao Granules combined with conventional anti-hypertensive agents reduced systolic blood pressure(MD=-10.56, 95%CI[-13.63,-7.50], P<0.000 01) and diastolic blood pressure(MD=-8.21, 95%CI[-10.84,-5.59], P<0.000 01), improved total effective rate(RR=1.21, 95%CI[1.14, 1.29], P<0.000 01), improved patients dizziness(RR=1.29, 95%CI[1.21, 1.37], P<0.000 01), insomnia(RR=1.66, 95%CI[1.44, 1.91], P<0.000 01), headache(RR=1.32, 95%CI[1.21, 1.43], P<0.000 01), chest distress(RR=1.26, 95%CI[1.12, 1.42], P=0.000 1), memory loss(RR=1.24, 95%CI[1.10, 1.40], P=0.000 4), palpitation(RR=1.28, 95%CI[1.17, 1.41], P<0.000 01), and improved traditional Chinese medicine symptom scores(MD=-4.24, 95%CI[-5.25,-3.23], P<0.000 01) and headache symptom improvement scores(MD=-2.02, 95%CI[-2.51,-1.53], P<0.000 01) as compared with Western medicine group alone. Subgroup analysis results showed that Yang-xue Qingnao Granules combined with ACEI drug had more obvious effects in lowering systolic blood pressure and diastolic blood pressure. There was no statistically significant difference in the incidence of adverse reactions, and no abnormal liver and kidney function was observed in each study. Trial sequential analysis showed that the total effective rate was cumulative across the traditional and TSA thresholds, further confirming its clinical efficacy. The evidence level was mostly low or extremely low in GRADE evaluation. The clinical application of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and its accompanying symptoms is clear and safe, so it is recommended for clinical application.

Systematic evaluation and trial sequential analysis of Tianma Gouteng Granules combined with anti-hypertensive drugs in treatment of essential hypertension / 中国中药杂志

To systematically evaluate the efficacy and safety of Tianma Gouteng Granules combined with conventional anti-hypertensive drugs in the treatment of essential hypertension. The clinical randomized controlled trials(RCTs) on the treatment of essential hypertension with Tianma Gouteng Granules combined with conventional anti-hypertensive drugs were searched in PubMed, EMbase, Cochrane Library, VIP, CNKI, Wanfang, SinoMed since the establishment of the databases to April 2020 based on inclusion and exclusion criteria, and Meta-analysis was conducted by using RevMan 5.3 software. A total of 15 RCTs were included, involving a total of 1 508 patients. Meta-analysis results showed that Tianma Gouteng Granules combined with conventional Western medicine were supe-rior to the control group in reducing systolic blood pressure(MD=-10.24, 95%CI[-13.54,-6.95], P<0.000 01), diastolic blood pressure(MD=-5.33, 95%CI[-7.21,-3.45], P<0.000 01), improving the clinical efficacy of patients(RR=1.22, 95%CI[1.15, 1.28], P<0.000 01) and curative effect of traditional Chinese medicine syndrome(RR=1.26, 95%CI[1.02, 1.57], P=0.04), increasing nitric oxide content(MD=9.59, 95%CI[7.23, 11.96], P<0.000 01), reducing endothelin-1(MD=-10.74, 95%CI[-15.74,-5.75], P<0.000 1), tumor necrosis factor(MD=-0.28, 95%CI[-0.36,-0.19], P<0.000 01), and interleukin-6(MD=-39.71, 95%CI[-43.40,-36.03], P<0.000 01). There was no statistically significant difference between the test group and the control group in the incidence of adverse reactions. No liver and kidney dysfunction occurred. The results of the subgroup analysis showed that the effect of Tianma Gouteng Granules combined with ARB drugs was more obvious in reducing the systolic and diastolic pressure. Trial sequential analysis showed that the studies accumulatively included for clinical efficacy crossed the traditional threshold and the TSA threshold, further affirming its clinical efficacy. The clinical application of Tianma Gouteng Granules combined with conventional Western medicine in the treatment of primary hypertension and accompanying symptoms has clear efficacy and certain safety, so it is recommended for clinical application.

Systematic evaluation and sequential Meta-analysis of modified Xuefu Zhuyu Decoction combined with Western medicine in treatment of leiomyoma / 中国中药杂志

CNKI, PubMed and other databases were retrieved to extract eligible randomized controlled trial(RCT) about modified Xuefu Zhuyu Decoction(MXZD) combined with Western medicine(trial group) versus Western medicine alone(control group) in the treatment of leiomyoma. Therefore, a total of 25 RCTs were included, involving 2 328 patients. Bias risk evaluation tool in Cochrane Handbook 5.1.0 was used for evaluating the quality of these RCTs. Meta-analysis was performed for the reported indicators, including total efficiency, serum hormone level [progesterone(P), luteinizing hormone(LH), estradiol(E_2), follicle stimulating hormone(FSH)], uterine size, fibroids size and adverse reactions by using Stata 14.0 software. Meta-analysis showed that the total efficiency(RR=1.21,95%CI[1.17,1.25],P<0.05) of trial group was better than that of control group. Serum hormone level(WMD_P=-3.86,95%CI[-4.31,-3.41],P<0.05; WMD_(LH)=-3.64,95%CI[-4.47,-2.82],P<0.05; WMD_(E_2)=-39.99,95%CI[-53.45,-26.52],P<0.05; WMD_(FSH)=-3.79,95%CI[-4.86,-2.72],P<0.05), uterine size(WMD=-50.02,95%CI[-55.98,-44.06],P<0.05), fibroids size(WMD=-15.79,95%CI[-18.11,-13.46],P<0.05) and adverse reactions(RR=0.65,95%CI[0.48,0.88],P<0.05) of trial group were all lower than those of control group, with statistical significances. Trial sequential analysis(TSA) was performed by using TSA 0.9 software, and showed a reliable therapeutic effect of the experimental group. In short, our study indicated that modified Xuefu Zhuyu Decoction combined with Western medicine had a better therapeutic effect on leiomyoma than Western medicine alone, but more high-quality studies are needed to verify this conclusion in the future.

Estudio secuencial de la interacción sociocognitiva durante la resolución de problemas lógicos / Sequential study of the socio-cognitive interaction in logical problem solving

Resumen El objetivo del presente estudio fue analizar, desde una perspectiva secuencial, la interacción sociocognitiva durante la resolución colaborativa de problemas lógicos, en díadas de estudiantes de quinto y sexto grado de educación primaria, con composiciones sociocognitivas asimétricas y simétricas. Se trató de un estudio cuasi-experimental de casos, de dos fases: la primera consistió en la resolución individual de ítems lógicos, para evaluar el nivel de competencia específica inicial de cada sujeto. Con base en dicho criterio, se conformaron díadas asimétricas (un compañero de alta competencia con un par de baja competencia) y simétricas (ambos compañeros de baja competencia), que resolvieron la tarea de manera colaborativa. La interacción sociocognitiva fue codificada por un sistema de categorías adaptado. Se realizó un análisis secuencial de la interacción, es decir, de probabilidades de transición entre códigos (eventos); esto se dio al interior de cada condición (asimétrica y simétrica), para detectar patrones secuenciales diferenciales. Los resultados indican patrones de interacción diferentes según la composición de la díada: en las díadas asimétricas, la posibilidad de establecer secuencias de co-construcción de conocimiento depende principalmente de la intervención inicial emitida por el sujeto más competente; en cambio, en las díadas simétricas se constataron niveles altos de alternancia de la participación por ambos compañeros durante la secuencia de interacción. Se ratifica la hipótesis de la influencia de la composición sociocognitiva de la díada sobre la interacción, pero con aporte de considerar a ésta desde una perspectiva secuencial y diacrónica.

Abstract This study aims at analyzing the socio-cognitive interaction during the collaborative resolution of logical problems, from a sequential perspective. It is focused on dyads of fifth and sixth graders, with asymmetric and symmetric socio-cognitive compositions. The design was a quasi-experimental case study with two phases: the first was an individual resolution of logical items to evaluate the initial specific competence level of each subject. Then, it was made up asymmetrical dyads (a high-competence partner with a pair of low competence) and symmetrical (both low-competence partners), which solved the task collaboratively. The socio-cognitive interaction was codified by a system of adapted categories. A sequential analysis of the interaction was performed (analysis of probabilities of transition between codes or events). This was done in relation to each condition (asymmetric and symmetric), to detect differential sequential patterns. The results indicate different interaction patterns depending on the composition of the dyad: asymmetric dyads showed that the possibility of establishing co-construction knowledge sequences depends mainly on the initial intervention issued by the most competent subject; symmetric dyads showed high levels of alternation referred to participation issued by both partners during the interaction sequence. The hypothesis that the influence of the socio-cognitive composition of the dyad on the interaction is ratified, but it is considered from a sequential diachronic perspective.

Systematic review of triangle versus inverted triangle-configurated cannulated screws in the treatment of femoral neck fractures / 中国组织工程研究

BACKGROUND: The use of three cannuiated screws is the preferred method for the treatment of femoral neck fractures for many years. However, some clinical studies have explored the clinical efficacy of triangular and Inverted triangular hollow screw Internal fixation In the treatment of femoral neck fracture, but the conclusions are not consistent. OBJECTIVE: To systematically review the efficacy of triangle and inverted triangle-configurated cannuiated screws in the treatment of femoral neck fractures. METHODS: The PubMed, Cochrane Library, EMbase, CNKI and WanFang Database were searched up to May 2018, for studies concerning the efficacy of three cannuiated screws fixation for femoral neck fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. The meta-analysis and trial sequential analysis were performed by using RevMan 5.3 software and TSA 0.9 respectively. RESULTS AND CONCLUSION: (1) A total of 8 cohort studies involving 1 150 patients were included. (2) The results of meta-analysis showed that compared with the inverted triangle group, the triangle group was inferior in operation time [MD=12.30, 95%C/(4.83,19.77), P < 0.01] and blood loss during the operation [MD=12.44, 95%C/(6.56, 18.32), P < 0.01]. However, there were no statistical differences between the two groups in femoral head osteonecrosis rate [0/?=0.66, 95%C/(0.34,1.29), P=0.22], nonunion rate [OR=1.37, 95%C/(0.86, 2.18), P=0.18] and the Harris scores in the final follow-up [OR=1.29, 95%C/(0.58, 2.26), P=0.53]. (3) Current evidence shows that inverted triangle group is superior to triangle group in shorting operation time and reducing blood loss. Nevertheless, there was no significant difference in femoral head osteonecrosis rate, nonunion rate, and the Harris scores < 70 in the final follow up. Because the inclusion of the study is mainly cohort study, and there is a large bias, so the above conclusions need to be verified by more multi-center randomized controlled trials.

Meta analysis and trial sequential analysis of Shegan Mahuang Decoction in treating acute attack of bronchial asthma / 中草药

Objective: To evaluate the efficacy and safety of Shegan Mahuang Decoction in the treatment of acute attack of bronchial asthma, and provide the support of evidence-based medicine for clinical treatment of bronchial asthma. Methods: The databases such as CNKI and PubMed were searched by computer, and RCT meeting the inclusion criteria was extracted. Cochrane 5.1.0 bias risk assessment tool was used to evaluate the quality of included literatures, and Stata14.0 was used for Meta analysis. The outcome indicators included effective rate, pulmonary function (FEV1 / FVC and / or FEV1%), TCM symptoms score and adverse reactions. Finally, TSA 0.9 was used for trial sequential analysis. Results: A total of 20 articles were included in the study. The effective rate [RR = 1.18, 95% CI (1.14, 1.23), P = 0.00] in the trial group was significantly better than that in the control group. Subgroup analysis showed that the effective rate in the trial group with a course of treatment≤7 d[RR = 1.17, 95% CI (1.11, 1.24), P = 0.00] and 7-15 d[RR = 1.17, 95% CI (1.10, 1.24), P = 0.00] was significantly better than that in the control group. According to funnel chart and Begg's test, there was no published bias. The trial sequential analysis showed that the evidence of the effect was reliable. FEV1/FVC, the indexes of pulmonary function test, in the trial group were [SMD=1.17, 95%CI (0.44,1.90), P = 0.00] was significantly better than the control group, and FEV1% [SMD = 1.38, 95% CI (0.24, 2.52), P = 0.018] was also significantly better than the control group. The TCM syndrome score [WMD = -2.79, 95% CI (-3.39, -2.18), P = 0.00] in the trial group was significantly lower than the control group. The indicators of pulmonary function and TCM syndrome score were not reversed after sensitivity analysis, and the results were relatively stable. Serious adverse reactions were not reported in all studies. Conclusion Shegan Mahuang Decoction combined with conventional western medicine has more advantages in the treatment of acute attack of bronchial asthma than conventional western medicine alone. However, due to the limitations of this study, depth evaluation of its efficacy and safety needs more high quality RCTs in the future.

Meta-analysis and trial sequential analysis of Qingjin Huatan Decoction for treating community-acquired pneumonia in elderly / 中国中药杂志

To systematically evaluate the clinical efficacy and safety of modified Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly, and provide evidence-based reference for the clinical application of this prescription. Randomized controlled trials of Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly were collected by searching PubMed, EMbase, Cochrane Library, CNKI, China Biomedical Literature database, VIP database and WanFang database. Outcome indicators included clinical effective rate, inflammation index, symptom improvement time, chest radiograph improvement time, hospitalization time and adverse reactions. RevMan 5.3 and Stata/IC 15.1 software were used for Meta-analysis; TSA 0.9.5.10 Beta software was used for trial sequential analysis, and GRADE profiler 3.6 was used for grade evidence quality evaluation. Thirteen studies were included finally, including 1 058 patients, 536 patients in the experimental group and 522 patients in the control group.Meta-analysis showed that, the clinical effective rate of the experimental group was significantly higher than that of the control group(RR=1.16, 95%CI[1.10, 1.21], P<0.000 01); fever time(MD=-1.32, 95%CI[-1.93,-0.71], P<0.000 1), cough time(MD=-1.95, 95%CI[-2.69,-1.21), P<0.000 01), time to rale disappearance(MD=-1.55, 95%CI[-2.37,-0.73], P=0.000 2), time to chest radiograph improvement(MD=-1.72, 95%CI[-2.98,-0.46], P=0.007), and hospitalization time(MD=-3.16, 95%CI[-4.58,-1.74], P<0.000 01) in the experimental group were significantly shorter than those in the control group. The improvement in CRP(WMD=-3.44,95%CI[-4.50,-2.38],P<0.001), WBC(WMD=-2.04,95%CI[-3.31,-0.78],P<0.01), IL-6(WMD=-4.27,95%CI[-4.62,-3.92],P<0.001), and TNF-α(WMD=-0.47,95%CI[-0.55,-0.39], P<0.001) of the experimental group was significantly better than that of the control group. There was no significant difference in PCT improvement between the two groups(WMD=-0.63, 95%CI[-1.65, 0.40], P=0.23). No serious adverse reactions occurred in both groups. Sequential analysis of the trial showed that in the studies with cumulative inclusion of clinical effective rate, the data passed the traditional threshold and TSA threshold, further confirming its clinical efficacy. GRADE evaluation showed that the evidence level was low to extremely low. Western medicine treatment combined with Qingjin Huatan Decoction may improve clinical efficiency in the treatment of community-acquired pneumonia in the elderly, improve clinical symptoms faster, reduce CRP, WBC and other inflammatory indicators, and shorten hospital stay. The level of evidence obtained in this study is low, which needs to be further verified by high-quality multi-center, randomized controlled trials.

Circulating mitochondrial DNA as a biomarker in critically ill patients: A meta-analysis and trial sequential analysis / 解放军医学杂志

Objective To systematically review the association between circulating cell-free mitochondrial DNA (mtDNA) and prognosis in critically ill patients by using Meta-analysis and trial sequential analysis (TSA). Methods The PubMed, Embase, Cochrane Library, CNKI, VIP, and WanFang Data were searched from creating of the database up to October, 2018 for cross-sectional studies, case-control studies, or cohort studies on the relevance between mtDNA and prognosis in critically ill patients. Then, Meta-analysis and TSA were performed using Stata 12.0 software and TSA v0.9 software. Results A total of 15 prospective cohort studies involves 1318 patients. The results of Meta-analysis showed that mtDNA was associated with prognosis in critically ill patients (SMD=1.08, 95%CI 0.66-1.49, P=0.000). Subgroup analysis of mitochondrial DNA specific primer, centrifugal parameters, source of mitochondrial DNA as mtDNA standard curve, types of sample, extraction technology, types of outcome and disease, and age showed that, except for the types of the sample, outcome and disease, and age, results were affected apparently and differently by the rest factors. Sensitivity analysis indicated that the model is stable and reliable. Egger test revealed there were maybe publication bias. And the results of TSA displayed that all of the cumulative Z-curve strode traditional threshold value and TSA threshold value which suggested that affirmative conclusions had been reached, namely mtDNA could predict the prognosis of serious diseases as its biomarker clearly. Conclusions Current evidence suggests that mtDNA in circulation could be considered as a biomarker for the prognosis of severe disease. However, due to possible publication bias, the above conclusions should be treated with caution and it also requires a standard process to extract mtDNA from peripheral blood and more trials to prove it.

Systematic review and sequential analysis on treatment of herpes zoster pain mainly by fire needle therapy / 针刺研究

OBJECTIVE: To assess the therapeutic effect and safety of fire needle therapy in the treatment of herpes zoster pain. METHODS: We collected randomized controlled trials about treatment of herpes zoster pain mainly by fire needle therapy (published from the date of establishment of each database to Dec 1 of 2018) from databases of CNKI, Wanfang, VIP, Chinese Biomedical Document Service System (SinoMed), PubMed, Embase, Cochrane Library by using key words of "fire needle" "burnt needle" "red-hot needle" "herpes zoster" "postherpetic neuralgia" and "herpetic neuralgia". Then, we conducted Meta-analysis and sequential analysis about the outcomes of studies met our inclusion criteria using RevMan5.3.5 and TSA0.9.10 Beta softwares and employed GRADE profiler 3.6.1 to grade the quality of evidence. RESULTS: A total of 25 studies including 2 024 patients were brought into the present analysis. Outcomes of the qualitative analysis indicated that the fire needle therapy has a higher effective rate than the western medicine group. Meta-analysis showed that after the treatment mainly with fire needle therapy, 1) the VAS score is evidently lower [WMD=-0.96, 95% CI(-1.22, -0.71), P<0.000 01], 2) the duration of 30% pain relief is obviously shorter [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], 3) the duration of pain is evidently shorter {fire needle combined with electroacupuncture [WMD=-11.53, 95% CI(-14.57, -8.48), P<0.000 01]; fire needle combined with cupping [WMD=-4.75, 95% CI (-7.99, -1.51), P=0.004]; pure fire needle therapy [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], and 4) the occurrence rate of post-herpetic neuralgia is considerably lower [RR=0.16, 95% CI (0.09, 0.30), P<0.000 01]. The occurrence and management of adverse events were not mentioned in all the included studies, suggesting no safety problem of the therapy, but the publication bias has not been taken seriously. CONCLUSION: In the treatment of herpes zoster pain, fire needle as the main treatment approach can significantly relieve pain, shorten the pain duration, and reduce the incidence of post-herpetic neuralgia.

Meta-analysis of Effectiveness and Safety of Xingpi Yang ’er Granules Combined wit h Clostridium butyricum Live Powder in the Treatment of Pediatric Dyspeptic Diarrhea / 中国药房

OBJECTIVE： To systematically evaluate the effectiveness and safety of Xingpi yang’er granules（XYG） combined with Clostridium butyricum live powder （CBLP） in the treatment of pediatric dyspeptic diarrhea， and provide evidence-based reference for clinical medication. METHODS： Retrieved from Cochrane Library， PubMed， Embase， CBM， CNKI， VIP and Wanfang database， randomized controlled trials （RCTs） about XYG combined with CBLP（trial group）vs. CBLP alone（control group）in the treatment of pediatric dyspeptic diarrhea were collected. After literature screening， data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software. TSA 0.9 software was used for trail sequential analysis. RESULTS： A total of 8 RCTs with 857 participants were included. Total response rate of trial group [RR＝1.20，95％CI（1.13，1.28），P＜0.000 01] was significantly higher than that of control group. Abdominal pain relief time [MD＝－1.18，95％CI（－1.42，－0.94），P＜0.000 01]， abdominal distension relief time [MD＝－1.32， 95％CI（－1.94，－0.70），P＜0.000 1]， diarrhea relief time [MD＝－2.07， 95％CI（－2.38，－1.76），P＜0.000 01]， the time of stool traits returned to normal[MD＝－2.16，95％CI（－2.43，－1.88）， P＜0.000 01] in trial group were significantly shorter than control group. The stool frequency [MD＝－1.72，95％CI（－2.18，－1.24）， P＜0.000 01] in trial group were significantly less than control group. The incidence of ADR in trial group was significantly lower than control group （P＜0.05）， or there was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）， or no significant ADR was founded in 2 groups. Trial sequential analysis showed that the evidence of total response rate of XYG combined with CBLP in the treatment of pediatric dyspeptic diarrhea was accurate. CONCLUSIONS： XYG combined with CBLP is effective and safe for pediatric dyspeptic diarrhea.

Meta-analysis and Trial Sequential Analysis of Therapeutic Efficacy of Compound Xuanju Capsules Combined with Chemical Medicine versus Chemical Medicine Alone in the Treatment of Polycystic Ovarian Syndrome / 中国药房

OBJECTIVE： To systematically evaluate the efficacy of Compound xuanju capsules combined with chemical medicine versus chemical medicine alone in the treatment of polycystic ovarian syndrome （PCOS）， in order to provide evidence-based medicine guidelines for clinical medication. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， VIP， CJFD and Wanfang database from database establishment to Apr. 5， 2019， randomized controlled trials （RCTs） about therapeutic efficacy （total response rate， ovulation rate， pregnancy rate， FSH level， LH level， testosterone level， degree of endometrial thickening） of Compound xuanju capsules combined with chemical medicine （trial group） versus chemical medicine alone （control group） in the treatment of PCOS were collected. After data extraction and quality evaluation of included studies with modified Jadad scale， Meta-analysis was conducted by using STATA 14.0 software. Trial sequential analysis （TSA） was conducted by using TSA 0.9 software. RESULTS： A total of 15 RCTs were included， involving 1 259 patients. The results of Meta-analysis showed that the total response rate [RR＝1.27，95％CI（1.13，1.44），P＜0.001]， ovulation rate [RR＝1.18，95％CI（1.03，1.37），P＜0.001]， pregnancy rate [RR＝1.34，95％CI（1.11，1.61），P＜0.001]， serum hormone level {FSH [SMD＝－0.66，95％CI （－0.51，  －0.82），P＜0.001]， 95％CI（－1.76，－1.41），P＜0.001]， LH [SMD＝－1.24，95％CI（－1.39， －1.08），P＜0.001]， testosterone [SMD＝－1.59，95％CI（－1.76，－1.41），P＜0.001]} and endometrial thickness [SMD＝1.20，95％CI（1.04，1.37），P＜0.001] of the trial group were better than those of the control group， with statistical significance. The results of TSA were reliable. CONCLUSIONS： In the treatment of PCOS， Compound xuanju capsules combined with chemical medicine is better than chemical medicine alone in improving total response rate， pregnancy rate， ovulation rate and endometrial thickness， and reducing serum hormone levels.

Meta-analysis of Efficacy and Safety of Yinxie Capsules Combined with Acitretin Capsules in the Treatment of Psoriasis Vulgaris / 中国药房

OBJECTIVE： To evaluate the efficacy and safety of Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris in order to provide reference for clinical drug use. METHODS： Retrieved from PubMed， Embase， Cochrane Library， CBM， CNKI， VIP， Wanfang database， randomized controlled trials （RCTs） about Yinxie capsules combined with Acitretin capsules （trial group） vs. Acitretin capsules （control group） in the treatment of psoriasis vulgaris were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software， and trial sequence analysis （TSA） was conducted with TSA 0.9 software. RESULTS： A total of 7 RCTs with 660 patients were included. Results of Meta-analysis showed that the total response rate [RR＝1.15，95％CI（1.04， 1.28）， P＝0.007]， the levels of IL-4 [SMD＝0.85，95％CI（0.02， 1.68），P＝0.04] and IL-10 [SMD＝0.56，95％CI（0.28， 0.83）， P＜0.000 1] in trial group were significantly higher than control group. The psoriasis area and severity index score [MD＝－2.34，95％CI（－2.77，  －1.91），P＜0.000 01]， incidence of dry eye [RR＝0.32，95％CI（0.23， 0.45），P＜0.001]， dry skin [RR＝0.47，95％CI（0.32， 0.71），P＜0.001]， folliculitis [RR＝0.42，95％CI（0.30， 0.59），P＜0.001]， the elevation of ALT [RR＝0.18，95％CI（0.05， 0.61），P＝0.005] and hyperlipidemia [RR＝0.48，95％CI（0.35， 0.65），P＜0.001] in trial group were significantly lower than control group. There was no statistical significance in nose bleeding between 2 groups [RR＝0.46，95％CI（0.16， 0.37），P＝0.16]. TSA showed that the evidence of enhancing total response rate by Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris was reliable. CONCLUSIONS： Yinxie capsules combined with Acitretin capsules show good efficacy and safety for psoriasis vulgaris.