Background There are debates in acupuncture related systematic reviews and meta-analyses on whether searching Chinese databases to get more Chinese-language studies may increase the risk of bias and overestimate the effect size, and whether the treatment effects of acupuncture differ between Chinese and non-Chinese populations.Methods In this meta-epidemiological study, we searched the Cochrane library from its inception until December 2021, and identified systematic reviews and meta-analyses with acupuncture as one of the interventions. Paired reviewers independently screened the reviews and extracted the information. We repeated the meta-analysis of the selected outcomes to separately pool the results of Chinese- and non-Chinese-language acupuncture studies and presented the pooled estimates as odds ratios (OR) with 95% confidence interval (CI). We calculated the Ratio of ORs (ROR) by dividing the OR of the Chinese-language trials by the OR of the non-Chinese-language trials, and the ROR by dividing the OR of trials addressing Chinese population by the OR of trials addressing non-Chinese population. We explored whether the impact of a high risk of bias on the effect size differed between studies published in Chinese- and in non-Chinese-language, and whether the treatment effects of acupuncture differed between Chinese and non-Chinese population.Results We identified 84 Cochrane acupuncture reviews involving 33 Cochrane groups, of which 31 reviews (37%) searched Chinese databases. Searching versus not searching Chinese databases significantly increased the contribution of Chinese-language literature both to the total number of included trials (54% vs. 15%) and the sample size (40% vs. 15%). When compared with non-Chinese-language trials, Chinese-language trials were associated with a larger effect size (pooled ROR 0.51, 95% CI 0.29 to 0.91). We also observed a higher risk of bias in Chinese-language trials in blinding of participants and personnel (97% vs. 51%) and blinding of outcome assessment (93% vs. 47%). The higher risk of bias was associated with a larger effect estimate in both Chinese-language (allocation concealment: high/unclear risk vs. low risk, ROR 0.43, 95% CI 0.21 to 0.87) and non-Chinese-language studies (blinding of participants and personnel: high/unclear risk vs. low risk, ROR 0.41, 95% CI 0.23 to 0.74). However, we found no evidence that the higher risk of bias would increase the effect size of acupuncture in Chinese-language studies more often than in non-Chinese-language studies (the confidence intervals of all ROR in the high-risk group included 1, Table 3). We further found acupuncture appeared to be more effective in Chinese than in non-Chinese population (Table 4).Conclusions The findings of this study suggest the higher risk of bias may lead to an overestimation of the treatment effects of acupuncture but would not increase the treatment effects in Chinese-language studies more often than in other language studies. The difference in treatment effects of acupuncture was probably associated with differences in population characteristics.

Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant postoperative complications in children. This study aims to evaluate the efficacy and safety of using dexamethasone alone or combined other drugs on the incidence of PONV in children. A systematic search of the literature was conducted from inception until March, 2019. Literature selection and data extraction were conducted by two independent reviewers. Statistical analysis was performed using the software package Review Manager Version 5.3.3. Twenty studies with total 2505 participants were included. The pooled analysis used a random-effect model showed that dexamethasone had significantly greater efficacy in incidence of POV and PON in postoperative 24 h than control. Subgroup analysis indicated the RR of dexamethasone >= 0.5 mg/kg group was the lowest compared subgroup dexamethasone <= 0.3 mg/kg and 0.3-0.5 mg/kg. There was no difference for early POV between dexamethasone and placebo groups. Dexamethasone combined with others also could significantly reduce the incidence of POV in postoperative 24 h. Few adverse effects were reported. This study indicates that dexamethasone is effective for preventing incidence of PONV in children. And multimodal approaches have shown more effectively to prevent the incidence of POV. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.

Objectives: The aim of the study was to assess the quality of guidelines on irritable bowel syndrome (IBS) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and identify concordance of different commendations. Materials and Methods: A systematic search was undertaken from inception to May 2018. Two reviewers independently selected the titles and abstracts. The guidelines included were assessed using the AGREE II instrument. The consistency of evaluations was calculated using intra-class correlation coefficients with 95% CI. Results: From 994 records, 7 guidelines were included. Most of guidelines got a moderate score of AGREE II. The highest median scores were achieved for scope and purpose and clarity and presentation (69.4%), while the lowest median scores across guidelines were for applicability (50.0%). Most of the nonpharmacologic management recommendations for IBS were similar. However, there also existed some differences on pharmacologic between different guidelines. Conclusions: The guidelines on IBS varied in quality and there were discrepancies about recommendations and recommendation grades. There is some space to improvement the quality of methodological rigor in development and reporting within clinical guidelines.

Background Traditional Chinese medicine (TCM) has been widely accepted and applied worldwide, and many publications related to Angelica sinensis (Oliv.) Diels (AS, Chinese name is "Danggui") have been published. However, to date, there has not been a scientometric study to systematically analyze the intellectual landscape and emerging research trends regarding AS. Therefore, we performed a scientometric study to address this gap. Methods Publications related to AS published from 2009 to 2018 were identified and selected from the Web of Science (WoS) Core Collection on May 30, 2019 using relevant keywords. HistCite, CiteSpace, and Excel 2016 software tools were used to conduct this scientometric study. Results Seven hundred and sixty-seven articles (including 717 primary articles and 60 review articles) and their cited references were included and analyzed. The majority of publications (N = 565, 73.7%) were published in mainland China, with Nanjing University of Chinese Medicine contributing the most publications (N = 42, 5.5%). The first core journal was Journal of Ethnopharmacology (N = 58, 7.6%; impact factor = 3.414). The identification and assessment of active components (like ferulic acid) of AS and their pharmacological actions (such as immunomodulatory effects) are the current research foci for AS research. Conclusion The present scientometric study provides an overview of the development of AS research over the previous decade using quantitative and qualitative methods, and this overview can provide references for researchers focusing on AS.

Aims We aim to systematically review the existing guidelines on physical activity for T2DM and assess the consistency of their recommendations, methodological quality, and reporting quality. Methods We performed a literature search on PubMed, China Biology Medicine disc, and four main guideline databases in order to identify existing T2DM guidelines. We then evaluated the methodological and reporting qualities of the guidelines using the AGREE II instrument and the RIGHT checklist. Fifteen guidelines were included in total, with eight of these (53.33%) assessed being "recommended" and five graded as having good reporting quality. Result A total of 30 physical activity recommendations were extracted. Fifteen recommendations reported the levels of evidence, and of these, five were found to be based on a high quality of evidence. Aerobic exercise at least 3 days per week was recommended by most guidelines (10/15, 66.67%). Eight guidelines (53.33%) recommended resistance exercise, while combined aerobic and resistance exercise was recommended in three of the guidelines (20.0%). Only two guidelines recommended supervised exercise, and one recommended flexibility exercise. Four of the guidelines (26.67%) solely recommended physical activity or exercise, but with no added details. Conclusions The quality of the guidelines concerning physical activity for T2DM was found to be moderate to low and varied substantially. Recommendations regarding physical activity for T2DM are not very specific or clear and remain incompletely consistent, while the level of evidence and the strength of the recommendations were seldom reported. Our findings suggest a need for guidelines for diabetes based on high levels of evidence.

Growing evidence indicates that insomnia may be associated with mortality. However, these findings have been inconsistent. We systematically searched MEDLINE and EMBASE to identify prospective cohort studies that assessed the association between insomnia disorder/individual insomnia symptoms and the risk of mortality among adults aged ≥18 yrs. We addressed this association using summary hazard ratios (HRs) and 95% confidence intervals (CIs) calculated using random-effects meta-analysis, and the GRADE approach to rate the certainty of evidence. Twenty-nine cohorts including 1,598,628 individuals (55.3% men; mean age 63.7 yrs old) with a median follow-up duration of 10.5 yrs proved eligible. Difficulty falling asleep (DFA) and non-restorative sleep (NRS) were associated with an increased risk of all-cause mortality (DFA: HR = 1.13, 95%CI 1.03 to 1.23, p = 0.009, moderate certainty; NRS: HR = 1.23, 95%CI 1.07 to 1.42, p = 0.003, high certainty) and cardiovascular disease mortality (DFA: 1.20, 95%CI: 1.01, 1.43; p = 0.04, moderate certainty; NRS: HR = 1.48, 95%CI 1.06 to 2.06, p = 0.02, moderate certainty). Convincing associations between DFA and all-cause mortality were restricted to the mid to older-aged population (moderate credibility). Insomnia disorder, difficulty maintaining sleep, and early morning awakening proved to be unassociated with all-cause and cardiovascular disease mortality. No insomnia symptoms proved to be associated with cancer-related mortality.

Introduction and hypothesis There is conflicting evidence on whether intermittent catheterization (IC) is less associated with urinary tract infection (UTI) and more likely to prevent urinary retention than continuous catheterization (CC). We aimed to compare the effect of IC with that of CC on the incidence of postpartum UTI, urinary retention and hemorrhage in laboring women with epidural analgesia. Methods Electronic searches were performed in PubMed, EMBASE and Cochrane Library from their inception to October 2018. We selected RCTs comparing IC with CC in laboring women with epidural analgesia. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence. Results Six RCTs (N = 850) were included in this review. The meta-analyses indicated that there was no significant difference between the IC and CC group in the incidence of postpartum UTI (RR = 1.25, 95% CI: 0.91 to 1.71, P = 0.16), postpartum urinary retention (RR = 0.76, 95% CI: 0.21 to 2.77, P = 0.68) and postpartum hemorrhage (RR = 1.72, 95% CI: 0.60 to 4.95, P = 0.31). GRADE assessment results showed that the quality of evidence was low. Conclusions Based on the available evidence, there is no measurable difference in rates of UTI between CC and IC, not that neither stragety decreases UTI, since the included trials do not address this.

Objectives: To summarize the evidence from systematic reviews (SRs) and meta-analyses that evaluated the efficacy of ginger in treating any conditions and critically assess the quality of these evidence. Methods: A systematic search of the literature was conducted from inception until February 28, 2019 using the PubMed, EMBASE, Web of science, Cochrane library, and four Chinese databases. Literature selection and data extraction were conducted by two independent reviewers. The quality of SRs was evaluated using the AMSTAR-2 tool. The GRADE system was used to assess the quality of evidence. Results: Twenty-seven SRs were included. The number of included studies were various, range from 3 to 27. The condition with the most included SRs was nausea and vomiting (n = 12, 44.4%). Many SRs showed a promising efficacy of ginger, including nausea and vomiting, metabolic syndrome and pain, while the effect of ginger for platelet aggregation failed to draw a certain conclusion. The quality of SRs was heterogeneous. All of included SRs well complied with the Item 1 ("research questions included the components of PICO") and Item 3 ("explained selection of the study designs for inclusion"). Twenty review failed to provide registration information. Only one SR reported the sources of funding for studies included. Conclusions: In our overview, most of SRs suggest ginger is a promising herbal medicine for health care, which is beneficial for nausea and vomiting, metabolic syndrome and pain. However, considering the limited quality of included evidence and heterogeneity of different clinical trials, more well-design studies are required to confirm the conclusion further.

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