Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease

Effect of different oral anticoagulants on cognitive function in patients with atrial fibrillation: A Bayesian network meta-analysis

BACKGROUND

Atrial fibrillation (AF) is 1 of the most common types of arrhythmias. At present, the treatment for patients with AF mainly includes oral anticoagulants (OACs). Studies have shown that OACs are associated with cognitive decline in patients with atrial fibrillation; however, there is a lack of relevant evidence. This study used Bayesian network meta-analysis (NMA) to investigate the effects of different oral anticoagulants on cognitive decline in patients with AF.

METHODS

We systematically searched for clinical studies on oral anticoagulants in patients with AF in PubMed, Web of Science, Embase, and the Cochrane Library as of July 3, 2023. Cochrane's randomized controlled trial bias risk assessment tool and the Newcastle-Ottawa Scale were used to assess the bias risk of the included studies. The main outcome measure was decreased cognitive functioning.

RESULTS

Ten studies were included, including 2 RCTs and 7 RCSs, including 882,847 patients with AF. Five oral anticoagulants and 2 anticoagulants were included: VKAs (especially warfarin), Dabigatran, Edoxaban, Rivaroxaban, Apixaban, and Aspirin, Clopidogrel. The results of the mesh meta-analysis showed that VKAs were superior to warfarin in reducing the risk of cognitive decline in patients with AF (OR = -1.19, 95% CI (-2.35, -0.06), P < .05) (Table 5). The top 3 drugs in terms of the probability of reducing the incidence of cognitive impairment in patients with AF with different oral anticoagulants were VKAs (87%), rivaroxaban (62.2%), and dabigatran (60.8%).

CONCLUSION

Based on the results of this study, VKAs may be the best intervention measure for reducing the risk of cognitive decline in patients with AF. Owing to the limitations of this study, more high-quality randomized controlled trials with large sample sizes and multiple centers are required to provide more evidence.

Effects of different psychosocial interventions on death anxiety in patients: a network meta-analysis of randomized controlled trials

Objective

This research intended to assess and compare influence of psychosocial interventions in death anxiety in patients, providing evidence-based guidance for both patients and healthcare providers.

Design

The present study exclusively gathered randomized controlled trials by comprehensively searching across multiple databases, comprising of PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The methodological quality of the enrolled studies involved in the analysis was assessed using the Cochrane bias risk assessment tool, and data analysis was performed utilizing appropriate software.

Results

This research, encompassing 15 randomized controlled trials with a cumulative sample size of 926 patients, spanned from the earliest possible date to December 2023. The findings of network meta-analysis unveiled that the Rational-Emotive Hospice Care Therapy significantly reduced death anxiety among patients (Sequentially Updated Cumulative Ranking Analysis: 100%).

Conclusion

The ranking plot of the network suggested that the rational-emotive hospice care therapy exhibited superior efficacy as a psychological treatment for reducing the death anxiety of patients.Systematic review registration: [https://clinicaltrials.gov/], identifier: [CRD42023484767].

Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.

Effects of mind-body therapies on schizophrenia: A systematic review and network meta-analysis

OBJECTIVE

The objective of this meta-analysis is to evaluate and compare the effectiveness of different mind-body therapies in reducing the symptoms of schizophrenia.

METHODS

A systematic search was performed using databases such as PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Randomized controlled trials that assessed the effects of mind-body therapies on patients with schizophrenia were included. The search covered the period between the inception of each database and November 17th, 2022. The methodological quality of the trials was assessed using the Cochrane risk of bias tool. A network meta-analysis was conducted to compare the effects of various mind-body therapies, including Yoga, Mindfulness, Tai Chi, Baduanjin, and Yijinjing.

RESULTS

The analysis included 22 randomized controlled trials involving a total of 2064 subjects. The network meta-analysis revealed that Yoga and Mindfulness interventions were more effective than other mind-body therapies in reducing the symptoms of schizophrenia. Specifically, Yoga improved PANSS-positive symptom scores (SUCRA: 74.8 %) and PANSS-negative symptom scores (SUCRA: 80.4 %), whereas Mindfulness improved PANSS-positive symptom scores (SUCRA: 85.6 %).

CONCLUSION

The findings of this study indicate that Yoga may be a promising intervention for the treatment of schizophrenia. However, the small sample size and the low quality of the included studies have limited the generalizability of our findings Therefore, this study must be understood with caution, and further investigation is warranted when more relevant studies emerge.

Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals

Respiratory function has become a global health priority. Not only is chronic respiratory disease a leading cause of worldwide morbidity and mortality, but the COVID-19 pandemic has heightened attention on respiratory health and the means of enhancing it. Subsequently, and inevitably, the respiratory system has become a target of the multi-trillion-dollar health and wellness industry. Numerous commercial, respiratory-related interventions are now coupled to therapeutic and/or ergogenic claims that vary in their plausibility: from the reasonable to the absurd. Moreover, legitimate and illegitimate claims are often conflated in a wellness space that lacks regulation. The abundance of interventions, the range of potential therapeutic targets in the respiratory system, and the wealth of research that varies in quality, all confound the ability for health and exercise professionals to make informed risk-to-benefit assessments with their patients and clients. This review focuses on numerous commercial interventions that purport to improve respiratory health, including nasal dilators, nasal breathing, and systematized breathing interventions (such as pursed-lips breathing), respiratory muscle training, canned oxygen, nutritional supplements, and inhaled L-menthol. For each intervention we describe the premise, examine the plausibility, and systematically contrast commercial claims against the published literature. The overarching aim is to assist health and exercise professionals to distinguish science from pseudoscience and make pragmatic and safe risk-to-benefit decisions.

Effect of dietary antioxidants on the risk of prostate cancer. Systematic review and network meta-analysis

OBJECTIVE

the purpose of this study was to assess the impact of 14 treatments including a total of 10 dietary antioxidants on the risk of prostate cancer.

MATERIAL AND METHODS

we searched PubMed, Embase, the Cochrane Library, and the Web of Science for only randomized controlled trials (RCTs) to investigate the effect of these 10 antioxidants on the risk of getting prostate cancer. Using the Cochrane Risk of Bias Assessment Tool, the methodological quality of the included studies was evaluated.

DATA EXTRACTION

studies were appraised by two investigators and data were extracted. Using a surface under cumulative ranking (SUCRA) probability, a Bayesian network meta-analysis was undertaken to evaluate the relative ranking of agents.

RESULTS

from the earliest accessible date through August 2022, RCTs were gathered. A total of 14 randomized controlled trials were included with a total sample size of 73,365 males. The results of the network meta-analysis showed that green tea catechins (GTCs) significantly reduced the risk of prostate cancer (SUCRA, 88.6 %) followed by vitamin D (SUCRA, 55.1 %), vitamin B6 (54.1 %), and folic acid was the lowest (22.0 %).

CONCLUSION

based on the Ranking Plot of the Network, we can state that GTCs might have an impact on the prevention of prostate cancer compared to other dietary antioxidants, but we still need quality literature to further prove it.

Yoga Meets Intelligent Internet of Things: Recent Challenges and Future Directions

The physical and mental health of people can be enhanced through yoga, an excellent form of exercise. As part of the breathing procedure, yoga involves stretching the body organs. The guidance and monitoring of yoga are crucial to ripe the full benefits of it, as wrong postures possess multiple antagonistic effects, including physical hazards and stroke. The detection and monitoring of the yoga postures are possible with the Intelligent Internet of Things (IIoT), which is the integration of intelligent approaches (machine learning) and the Internet of Things (IoT). Considering the increment in yoga practitioners in recent years, the integration of IIoT and yoga has led to the successful implementation of IIoT-based yoga training systems. This paper provides a comprehensive survey on integrating yoga with IIoT. The paper also discusses the multiple types of yoga and the procedure for the detection of yoga using IIoT. Additionally, this paper highlights various applications of yoga, safety measures, various challenges, and future directions. This survey provides the latest developments and findings on yoga and its integration with IIoT.

Different interventions for the treatment of patent ductus arteriosus in children: a protocol for a network meta-analysis

INTRODUCTION

Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Once the PDA is diagnosed, it needs to be dealt with in time. At present, main methods include pharmacological treatment, surgical closure, and interventional closure for treatment of PDA. However, the effect of different interventions in PDA management is still controversial. Thus, our study aims to assess the effectiveness of different interventions together and estimate the sequence of these therapies for PDA children. Meanwhile, it is necessary to conduct a Bayesian network meta-analysis to compare the safety of different interventions comprehensively.

METHODS AND ANALYSIS

To the best of our knowledge, this is the first Bayesian network meta-analysis comparing the efficacy and safety of different interventions for the treatment of PDA. PubMed, Embase, Cochrane Library, Web of Science, gray literature, and trial registry databases were searched from inception to December 2022. We will extract and report data according to methodological guidelines for Bayesian network meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Primary PDA closure, overall PDA closure, technical success, surgical success rate, mortality during hospital stay, operation time, intensive care unit stay, intraoperative radiation dose, radiation exposure time, total postoperative complication rate, and postoperative major complication rate will be defined as the outcomes. The quality of all random studies will be assessed using ROB, and quality of evidence for all outcomes will be judged by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

ETHICS AND DISSEMINATION

The results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol.

SYSTEMATIC REVIEW REGISTRATION

INPLASY2020110067.

Effect of various types of photodynamic therapy on inflammatory and non-inflammatory lesions in patients with acne: A network meta-analysis of randomized controlled trials

BACKGROUND

Recent studies have demonstrated that photodynamic therapy (PDT) is safe and effective in treating acne vulgaris. The present study aimed to evaluate various PDTs on inflammatory and non-inflammatory lesions in patients with acne by a network meta-analysis (NMA) of randomized controlled trials (RCTs).

METHODS

The researchers of this paper searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to March 2022 to identify suitable RCTs. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool. Twenty-one RCTs were included, with a total sample size of 898 participants.

RESULTS

Network meta-analysis (NMA) revealed that indocyanine green (ICG) + near-infrared (NIR) diode laser, ICG+830 nm light-emitting diode (LED), indole-3-acetic acid (IAA) + 520 nm LED, and 5-aminolevulinic acid (ALA) + sunlight demonstrated obvious curative effects in patients with acne vulgaris. Importantly, ICG+NIR diode laser provided the greatest improvement in both inflammatory and non-inflammatory acne lesions (surface under the cumulative ranking curve [SUCRA]: 84.4% and 93.5%, respectively).

CONCLUSIONS

Based on the NWM and SUCRA ranking, ICG + NIR diode laser can be considered more effective in treating acne than the other PDTs of the RCTs. However, this conclusion should be interpreted with caution due to the limitations of the present study.

Comparison of efficacy of anti-diabetics on non-diabetic NAFLD: A network meta-analysis

Objective: This study aimed to assess the efficacy of currently used anti-diabetic medications in the treatment of non-alcoholic fatty liver disease (NAFLD) without diabetes.

DESIGN

The efficacy of various anti-diabetic medicines on non-alcoholic fatty liver disease in the absence of diabetes was evaluated by searching Pubmed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCT) only. The methodological quality was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), and the data were analyzed using Stata software (version 15.1).

RESULTS

All papers published between the time of the pooling and September 2022 were searched. There were a total of 18 randomized controlled studies with a total sample size of 1141 cases. The outcomes of interest included variations in alanine transaminase (ALT) and aspartate transaminase (AST). Rosiglitazone (SUCRA: 100%) and vildagliptin (SUCRA: 99.9%) were the best anti-diabetic medicines to improve ALT and AST, respectively, in patients with NAFLD without diabetes, according to the findings of this network meta-analysis.

CONCLUSION

In accordance with the Network Ranking plot, Rosiglitazone was the best anti-diabetic medicine for improving ALT, and vildagliptin was the best for improving AST in patients with non-diabetic NAFLD.

Endocrine Therapy-Based Strategies for Metastatic Breast Cancer with Different Endocrine Sensitivity Statuses: A Systematic Review and Network Meta-Analysis

BACKGROUND

Novel endocrine therapies (ETs) and targeted therapeutic regimens have been developed to dramatically improve the outcome of hormone receptor-positive (HR+)/HER2-negative (HER2-) metastatic breast cancer (mBC).

METHODS

We performed a systematic search with a predefined search strategy in PubMed, Embase and Cochrane CENTRAL databases to perform a network meta-analysis and evaluate the relative efficacies of ET-based treatment regimens in HR+/HER2- mBC patients with different endocrine sensitivity statuses. The study was registered in the PROSPERO database (CRD42021235570).

RESULTS

A total of 47 trials (20,267 patients) were included. Analysis of progression-free survival (PFS) in endocrine therapy-sensitive (ETS) patients revealed cyclin-dependent kinases 4/6 inhibitors (CDK4/6i) + fulvestrant 500 mg (Ful 500) (random effect (RE): hazard ratio (HR), 0.46; 95% credibility interval (CrI), 0.27-0.78; surface under the cumulative ranking curve (SUCRA), 0.93; fixed effect (FE): HR, 0.48; 95% CrI, 0.40-0.58; SUCRA, 0.99) to be the best therapy followed by CDK4/6i + aromatase inhibitors (AIs) (RE: HR, 0.53; 95% CrI, 0.40-0.72; SUCRA, 0.86; FE: HR, 0.54; 95% CrI, 0.48-0.61; SUCRA, 0.91). Chemotherapy followed by CDK4/6i + Ful 500 appears to be the most effective option for the endocrine therapy-resistant (ETR) group. Analysis of overall survival revealed CDK4/6i + Ful 500 (SUCRA: 0.99) and AKTi + Ful 500 (SUCRA: 0.87) to be the first-rank regimen for the ETS group and ETR groups, respectively.

CONCLUSION

Our comprehensive analysis suggests that CDK4/6i combined with ETs may be the best treatment option in terms of PFS for ETS patients and chemotherapy for ETR patients with HR+/HER2- mBC. Different endocrine sensitivity statuses required various optimal treatment strategies, which may provide guidance for clinical practice.

Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews

Background

The effectiveness of breathing exercises in the treatment of chronic obstructive pulmonary disease (COPD) has been demonstrated in several systematic reviews (SRs), but a comprehensive review is still lacking. The aim of this study was to synthesize evidence from SRs, to summarise the effects of breathing exercises interventions for COPD patients.

Methods

We conducted an overview of the SRs of breathing exercises in the treatment of COPD. We include Systematic Reviews of randomized-controlled clinical trials. In the included COPD, control of breathing exercises alone was the only variable and no restriction was placed on relevant outcome measures. The SRs were screened by computer retrieval from the Chinese National Knowledge Infrastructure (CNKI), WanFang database, Chinese Science and Technology Journal Database (CSTJ), Chinese Biological Medicine (CBM), MEDLINE (PubMed), Embase, Cochrane library, and Web of Science. The Risk of Bias in Systematic reviews (ROBIS) tool, the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement, a Measure Tool to Assess Systematic Reviews (AMSTAR) 2, and the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) were used to evaluate the risk of bias, reporting quality, methodology quality, and evidence quality.

Results

Nine SRs met the inclusion criteria and were included in the overview, 4 SRs in Chinese, and 3 SRs in English. All the SRs were published between 2015-2021. According to the ROBIS tool, 4 SRs (57.14%) were rated as low risk of bias. The PRISMA scale showed that 5 SRs had some defects, and 2 SRs were relatively complete. Reporting deficiencies exist primarily in protocol and registration (28.6%), search (42.9%), risk of bias across studies (0%), additional analyses (42.9%), and funding (28.6%). Based on the AMSTAR-2 scale, 3 SRs were low quality, and the other 4 SRs were very low. The result of evidence quality assessment showed that among the 34 outcomes involved in the 7 studies, 19 were low-level outcomes, 15 were very low-level outcomes, and there were no moderate and high-level quality outcomes. Limitations and publication bias were two major factors that reduced the quality of evidence.

Conclusion

Breathing exercises in certain can improve pulmonary function, exercise endurance, dyspnea, quality of life, and respiratory muscle strength of COPD patients. However, there is an urgent need for high-quality studies to guide clinical practice due to certain deficiencies in reporting quality and the low quality of methodology and outcomes.

Accuracy of novel urinary biomarker tests in the diagnosis of prostate cancer: A systematic review and network meta-analysis

Objective

The purpose of this study was to conduct a network meta-analysis comparing the diagnostic value of different urinary markers for prostate cancer.

Methods

As of June 2022, the literature was retrieved by searching Pubmed, EMBASE, Web of Science databases and other databases. The methodological quality of included studies was assessed using the Cochrane Collaboration’s risk of bias tool, and publication bias was assessed using funnel plots. The surface under the cumulative ranking curve (SUCRA) values ​​was used to determine the most effective diagnostic method and the data were analyzed accordingly using data analysis software.

Results

A total of 16 articles was included including 9952 patients. The ranking results of network meta-analysis showed that the diagnostic performance of the four urine markers Selectmdx, MIPS, PCA3 and EPI was better than that of PSA. Among them, the specificity, positive predictive value and diagnostic accuracy of Selectmdx ranked first in the SUCRA ranking (SUCRA values: 85.2%, 88.3%, 97.1%), and the sensitivity ranked second in the SUCRA ranking (SUCRA value: 54.4%), and the negative predictive value ranked fourth in SUCRA (SUCRA value: 51.6%). The most sensitive screening tool was MIPS (SUCRA value: 67.1%), and it was also the second screening tool ranked higher in specificity, positive predictive value, negative predictive value and diagnostic accuracy (SUCRA value: 56.5%, respectively)., 57.1%, 67.9%, 74.3%). The high negative predictive value SUCRA ranking is EPI (SUCRA value: 68.0%), its sensitivity ranks third (SUCRA value: 45.6%), and its specificity, positive predictive value and diagnostic accuracy are ranked fourth (SUCRA values are: 45%, 38.2%, 35.8%).

Conclusion

According to the network ranking diagram, we finally concluded that Selectmdx and MIPS can be used as the most suitable urine markers for prostate cancer screening and diagnosis. To further explore the diagnostic value of different urinary markers in the screening of PCa patients.

Systematic Review Registration

https://inplasy.com/, identifier INPLASY202290094.

Analysis of the Effect of Mindfulness Behavior Intervention Combined with Progressive Breathing Training on Pulmonary Function Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

Purpose

Studies have shown that 50%-70% of patients with chronic obstructive pulmonary disease (COPD) have fatigue in addition to respiratory symptoms, so relieving respiratory symptoms and reducing fatigue are the main treatment objectives for COPD patients. This study focuses on the effect of positive behavioral intervention combined with progressive breathing training on pulmonary function rehabilitation in patients with COPD.

Methods

86 patients who underwent COPD treatment in our hospital between August 2020 and December 2021 were selected as study subjects and were divided into control (n = 43) and study groups (n = 43) using the random number table method. Patients in the control group were given conventional care, treatment, and health guidance, while patients in the study group were given positive behavioral intervention combined with progressive breathing training on this basis. Patients in both groups were compared on the basis of Multidimensional Fatigue Inventory 20 (MFI-20) score, the Medical Coping Questionnaire (MCMQ score), the Massive Attentional Awareness Scale (MAAS) score, and pulmonary function indicators (including the percentage of forced expiratory volume one second (FEV1%), peak expiratory flow (PEF), forced vital capacity (FVC), and 6-min walk distance (6MWD)) and quality of life (MCMQ) scores before and after 12 weeks of intervention.

Results

After 12 weeks of intervention, the study group had higher MFI-20 scores (comprehensive fatigue, physical fatigue, reduced activity, decreased power, and mental fatigue), confrontation scores on the MCMQ scale, MAAS scores (observation, description, nonjudgmental to intrinsic experience, nonresponsiveness to intrinsic experience, and perceived behavior), FEV1%, PEF, FVC, and 6MWD levels than the control group (P < 0.05). The scores of avoidance and submission on the MCMQ scale, and all scores of quality of life (cough, expectoration, shortness of breath, chest tightness, housework, going out, sleep, and energy) were lower than those of the control group (P < 0.05).

Conclusion

Positive behavioral interventions combined with progressive breathing training have a strengthening effect on the clinical treatment of COPD patients. Positive behavioral interventions combined with progressive breathing training are simple to implement as individual self-regulation methods and can be practiced on their own after being familiar with certain methods and techniques, and long-term adherence helps individuals cope with the stimulation of adverse events. Trail Registration. The clinical registration number for this research is L2020083.

Efficacy and Safety of Different Bioactive Coils in Intracranial Aneurysm Interventional Treatment, a Systematic Review and Bayesian Network Meta-Analysis

Background: Bioactive coils have been used for nearly 20 years to improve aneurysm treatments. Previous studies are inadequate for comparing the efficacy and safety between different coils. The aim of this study was to investigate the safety and efficacy of different coils by comparing the percentage of people with different modified Raymond scale grades, re-rupture rates, and mortality in patients with intracranial aneurysms embolized with different coils. Method: Randomized controlled trials (RCTs) containing coils for aneurysm interventional treatment were collected from Web of Science, PubMed, and the Cochrane Library up to December 2021. Bayesian network meta-analysis with a randomized or fixed model was performed to compare the efficacy and safety among different bioactive coils and bare platinum coils. Results: We pooled 3362 patients from eight RCTs. No significant differences were found between coils in the proportion of patients with a three-grade classification assessed with the modified Raymond scale immediately after surgery. Hydrogel coils did not show a significant difference in the percentage of patients with a modified Raymond scale grade I postoperatively compared with bare platinum coils (OR, −0.1080; 95% CI, −0.4201–0.2423), but at follow-up, the percentage of patients with modified Raymond scale grade I was significantly higher with hydrogel coils than with bare platinum coils (OR, 0.4957; 95% CI, 0.0060–0.9442). There were no statistical differences between these four coils in terms of aneurysm rupture or re-rupture rate and mortality. Conclusion: Though there was no significant difference in the embolization effect between the several coils in the postoperative period, complete embolization was more likely to be achieved with hydrogel coils compared to bare platinum coils at follow-up. There were no significant differences in safety between the several coil materials.

Safety Assessment on Serious Adverse Events of Targeted Therapeutic Agents Prescribed for RAS Wild-Type Metastatic Colorectal Cancer: Systematic Review and Network Meta-Analysis

Despite substantially elevated risk of serious adverse events (SAEs) from targeted therapy in combination with chemotherapy, comprehensive pharmacovigilance research is limited. This study aims to systematically assess SAE risks of commonly prescribed targeted agents (bevacizumab, cetuximab, and panitumumab) in patients with rat sarcoma viral oncogene homolog (RAS) wild-type metastatic colon cancer. Keyword searches of Cochrane Library, Clinical Key and MEDLINE were conducted per PRISMA-NMA guidelines. Frequentist network meta-analysis was performed with eight randomized controlled trials to compare relative risk (RR) of 21 SAE profiles. The risks of hematological, gastrointestinal, neurological SAE were insignificant among targeted agents (p > 0.05). The risk of serious hypertension was substantially elevated in bevacizumab-based chemotherapy (p < 0.05), whereas panitumumab-based chemotherapy had markedly elevated risk of serious thromboembolism (RR 3.65; 95% CI 1.30−10.26). Although both cetuximab and panitumumab demonstrated increased risk of serious dermatological and renal toxicities, panitumumab-based chemotherapy has relatively higher risk of skin toxicity (RR 15.22; 95% CI 7.17−32.35), mucositis (RR 3.18; 95% CI 1.52−6.65), hypomagnesemia (RR 20.10; 95% CI 5.92−68.21), and dehydration (RR 2.81; 95% CI 1.03−7.67) than cetuximab-based chemotherapy. Thus, further studies on risk stratification and SAE management are warranted for safe administration of targeted agents.

Effects of Different Exercise Therapies on Balance Function and Functional Walking Ability in Multiple Sclerosis Disease Patients-A Network Meta-Analysis of Randomized Controlled Trials

The objective of this research is to assess the effects of seven different exercise therapies (aquatic exercise, aerobic exercise, yoga, Pilates, virtual reality exercise, whole-body vibration exercise, and resistance exercise) on the balance function and functional walking ability of multiple sclerosis disease patients. Materials and Methods: The effects of different exercise interventions on the balance function and functional walking ability in people with multiple sclerosis were assessed by searching five databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI; only randomized controlled trials were included. The included studies were assessed for risk of bias using the Cochrane assessment tool. Results: The RCTs were collected between the initial date of the electronic databases’ creation and May 2022. We included 31 RCTs with 904 patients. The results of the collected data analysis showed that yoga can significantly improve patients’ BBS scores (SUCRA = 79.7%) and that aquatic exercise can significantly decrease patients’ TUG scores (SUCRA = 78.8%). Conclusion: Based on the network meta-analysis, we suggest that although each type of exercise is useful, yoga, virtual reality training, and aerobic training are more effective in improving the balance function of people with MS; aquatic exercise, virtual reality training, and aerobic training are more effective in improving the functional walking ability of people with MS.

Effects of Ten Different Exercise Interventions on Motor Function in Parkinson’s Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials

Objective: The aim of this study was to evaluate ten exercise interventions (YOGA: yoga training, RT: resistance training, AQU: aquatic training, TAI: Taiji Qigong training, TRD: treadmill training, VR: virtual reality training, DANCE: musical dance training, WKT: walking training, CYC: cycling training, BDJ: Baduanjin Qigong training) on motor function in Parkinson’s disease (PD) patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, and CNKI, only randomized controlled trials (RCTs) were collected to study the effects of the ten exercise interventions on motor function in patients with Parkinson’s disease. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool. Results: The RCTs were collected between the earliest available date and April 2022. Sixty RCTs were included and the total sample size used in the study was 2859. The results of the network meta-analysis showed that DANCE can significantly improve patients’ Berg Balance Scale (BBS) (SUCRA = 78.4%); DANCE can significantly decline patients’ Unified Parkinson’s Disease Rating Scale score (UPDRS) (SUCRA = 72.3%) and YOGA can significantly decline patients’ Timed-Up-and-Go score (TUGT) (SUCRA = 78.0%). Conclusion: Based on the network meta-analysis and SUCRA ranking, we can state that dance, yoga, virtual reality training and resistance training offers better advantages than other exercise interventions for patients’ motor function.

Effectiveness and Cost-Effectiveness of Non-Pharmacological Interventions among Chinese Adults with Prediabetes: A Protocol for Network Meta-Analysis and CHIME-Modeled Cost-Effectiveness Analysis

Patients with prediabetes who are at a high risk of progressing to diabetes are recommended early-stage intervention, according to guidelines. Non-pharmacological interventions are effective and cost-effective for glycemic control compared with medicines. We aim to explore which non-pharmacological interventions have the greatest potential effectiveness, cost-effectiveness, and feasibility in community-based diabetes management in China. We will perform a systematic review and network meta-analysis to compare the effectiveness of included non-pharmacological interventions, then use Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) to model the yearly incidence of complications, costs, and health utility for the lifetime. Published studies (only randomized controlled trials (RCTs) and cluster RCTs with at least one study arm of any non-pharmacological intervention) will be retrieved and screened using several databases. Primary outcomes included blood glucose, glycated hemoglobin, incidence of type 2 diabetes mellitus, and achievement of normoglycemia. Health utilities and cost parameters are to be calculated using a societal perspective and integrated into the modified CHIME model to achieve quality-adjusted life-year (QALY) estimates and lifetime costs. QALYs and incremental cost-effectiveness ratio will then be used to determine effectiveness and cost-effectiveness, respectively. Our study findings can inform improved diabetes management in countries with no intervention programs for these patients.

Tailored patient self-management and supervised, home-based, pulmonary rehabilitation for mild and moderate chronic obstructive pulmonary disease

[Purpose] Our study aimed to estimate the effects of a supervised, intensive, home-based-pulmonary-rehabilitation (HBPR) program for mild and moderate chronic-obstructive-pulmonary-disease (COPD) patients. [Participants and Methods] A retrospective, case-control study. Forty-three (N=43) patients were observed, divided into Treatment-Group (TG) and Control-Group (CG). The TG (N=23) underwent a 4-week training program, consisting of endurance and strength training sessions, performed 4-times per week. In addition, inspiration muscle training was performed, with a threshold device. The primary outcome was dyspnea improvements, measured by the modified-Borg-scale (mBS), and the secondary outcome was the determination of diaphragm excursion and function, using ultrasound (US) assessment to measure clinical parameters. [Results] The results suggested significantly improved mBS scores, measured for the ΔT0-T1 and ΔT0-T2 time points; improved diaphragm-excursion (Dia-Ex) at ΔT0-T1 and ΔT0-T2; and improved maximum Dia-Ex at ΔT0-T1 and ΔT1-T2 in the TG compared with the CG. Moreover, the results showed improvements over time for all parameters in the TG versus CG, suggesting a constant improvement in respiratory pathology. [Conclusion] A supervised HBPR plan was effective in reducing dyspnea by the mBS, and improving diaphragmatic function, as determined by US evaluation, and lastly improving quality of life in patients with mild-to-moderate COPD.

Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40-79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD-five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

Comparative Efficacy of Xianling Gubao Capsules in Improving Bone Mineral Density in Postmenopausal Osteoporosis: A Network Meta-Analysis

OBJECTIVE

The clinical efficacy of Xianling Gubao capsule (XLGB) and its combination therapy in the treatment of postmenopausal osteoporosis (PMOP) was systematically evaluated by frequency-based network meta-analysis.

METHODS

We searched the China National Knowledge Infrastructure (CNKI), Wanfang, SinoMed, PubMed, Embase and Cochrane Library databases to identify clinical trials of XLGB for the treatment of PMOP from the establishment of each database to November 22, 2021. The quality of the included studies was evaluated by using the risk of bias assessment tool version 2.0 (Rob 2.0) recommended by Cochrane. Stata 14.0 was applied for statistical analysis of the data, and the surface under the cumulative ranking curve (SUCRA) was used to rank the intervention measures of each outcome index.

RESULTS

This study included 22 clinical trials (including 19 RCTs and 3 non-RCTs) involving 12 drug therapies. According to the results of the network meta-analysis and SUCRA, the best three interventions for improving lumbar bone mineral density (BMD) are XLGB+BP+calcium (83.7%), XLGB+BP (68.5.7%) and XLGB+VD (67.1%). XLGB+calcium was the best combination regimen for improving femoral neck BMD and increasing bone Gla protein (BGP) and alkaline phosphatase (ALP) contents in serum. The SUCRA values of XLGB+calcium for improving the three outcome indicators were 68.0%, 59.5% and 82.1%, respectively.

CONCLUSIONS

The results of this network meta-analysis show that combined application of XLGB can effectively improve BMD and serum BGP and ALP compared to calcium alone, VD or BP. In the future, multicenter, large-sample and double-blind clinical RCTs should be carried out to supplement and verify the results of this study.

Comparative Effectiveness of Botulinum Toxin Injections and Extracorporeal Shockwave Therapy for Post-Stroke Spasticity: A Systematic Review and Network Meta-Analysis

BACKGROUND

The anti-spasticity efficacy of botulinum toxin (BoNT) injection has been well established for patients with chronic stroke; however, extracorporeal shock wave therapy (ESWT), i.e. focused shockwave (FSW) and radial shockwave (RSW), has recently been applied. We aimed to investigate the comparative effectiveness of BoNT vs. ESWT in the reduction of spasticity among stroke survivors.

METHODS

PubMed, EMBASE, MEDLINE and Cochrane CENTRAL were searched from the earliest record to September 2021 for randomized controlled trials. Weighted mean differences (WMDs) on the reduction of the Modified Ashworth Scale before or at the 6th post-treatment week (short-term) and between the 7th and 12th weeks (mid-term) after the intervention were calculated. Ranking probabilities of the WMD were simulated to determine which treatment had the potential to possess the best effectiveness. inplasy.com registration: INPLASY202170018.

FINDINGS

A total of 33 studies comprising 1,930 patients were enrolled. The network meta-analysis revealed that BoNT injections, FSW and RSW were better in spasticity reduction than the control treatment(s) at the short term, with WMDs of -0.69 (95% CI, -0.87 to -0.50), -0.36 (95% CI, -0.69 to -0.03) and -0.62 (95% CI, -0.84 to -0.40), respectively. Likewise, mid-term effects of BoNT injections, FSW and RSW also revealed superiority, with WMDs of -0.44 (95% CI, -0.62 to -0.26), -0.74 (95% CI, -1.26 to -0.23) and -0.79 (95% CI, -1.07 to -0.51), respectively. Ranking probability analysis revealed that RSW had the highest probability of being the best treatment for spasticity reduction at the short-term (62.2%) and mid-term (72.3%) periods during the follow up.

INTERPRETATION

BoNT injections and ESWT are effective in alleviating post-stroke spasticity at the mid-term. The effectiveness of ESWT was comparable to BoNT injections, and RSW had the potential to be the best treatment for spasticity reduction among the three treatment options. More prospective trials incorporating head-to-head comparisons of BoNT injections vs. ESWT are needed to validate the role of ESWT in reducing post-stroke spasticity.

FUNDING

The current research project was supported by (1) National Taiwan University Hospital, Bei-Hu Branch; (2) Ministry of Science and Technology (MOST 106-2314-B-002-180-MY3 and 109-2314-B-002-114-MY3); 3) Taiwan Society of Ultrasound in Medicine.

Effect of deep breathing exercise with Triflo on dyspnoea, anxiety and quality of life in patients receiving covid-19 treatment: A randomized controlled trial

AIMS AND OBJECTIVES

Determination of the effect of deep breathing exercise applied with Triflo on dyspnoea, anxiety and quality of life in patients who are hospitalized for COVID-19 and have dyspnoea.

BACKROUND

COVID-19 is a viral infection that can cause severe pulmonary disease. Deep breathing exercise with Triflo in patients with COVID-19 may contribute to the reduction/elimination of dyspnoea and anxiety, and improvement of respiratory and quality of life.

DESIGN

The study was a randomized controlled clinical trial and conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines.

METHODS

The study was conducted in the clinic of COVID-19 of a tertiary hospital. A total of 44 eligible participants were enrolled from January to April 2021. Primary outcomes included oxygen saturation in the blood, respiratory assessment and dyspnoea level. Secondary outcomes included anxiety and quality of life. In the statistical analysis of the data, the independent sample t-test, Wilcoxon test, Mann-Whitney U test and Spearman correlation were used to examine the intervention effect on primary outcomes and secondary outcomes, according to numbers, percentage, mean, standard deviation and conformity to normal distribution.

RESULTS

It was determined that the patients in the deep breathing group had a statistically significant shorter hospitalization time (3.04 ± 0.65), higher SpO₂  level (97.05 ± 1.46) and higher quality of life (77.82 ± 6.77) compared with the patients in the usual care group (p < 0.05).

CONCLUSIONS

Deep breathing exercise with Triflo increases the SpO₂  level and quality of life in patients with COVID-19 and contributes to a decrease in dyspnoea and anxiety levels. Moreover, the duration of hospital stay is shortened in patients who are applied deep breathing exercise with Triflo.

RELEVANCE TO CLINICAL PRACTICE

With deep breathing exercise applied with Triflo, respiratory rate reaches normal limits in a short time, SpO₂  levels increase significantly, and quality of life improves significantly in patients with COVID-19 pneumonia. CLINICAL TRIALS REGISTRATION NUMBER: https://clinicaltrials.gov; NCT04696562.

Use of Singing for Lung Health as an alternative training modality within pulmonary rehabilitation for COPD: an RCT

Background

Pulmonary rehabilitation (PR) is a cornerstone in chronic obstructive pulmonary disease (COPD) management. However, PR adherence is generally low, and barriers include availability, economic issues, motivation and an inability to attend or perform physical training. Therefore, alternative, evidence-based PR activities are required. Singing may have benefits for quality of life (QoL), respiratory control and well-being in COPD, but the impact on the PR key outcome, physical exercise capacity, is uncertain.

Methods

In this randomised controlled trial (NCT03280355), we investigated the effectiveness of 10 weeks of PR, including either “Singing for Lung Health” (SLH) training or standard physical exercise training (PExT). The primary outcome was a change in exercise capacity (6-min walk distance (6MWD)) from baseline to post-PR. Secondary outcomes were changes in QoL (St George's Respiratory Questionnaire (SGRQ)), Hospital Anxiety and Depression Score (HADS), lung function, dyspnoea and adherence.

Results

We included 270 COPD patients, and 195 completed the study. Demographics across groups were comparable, and both groups improved significantly in 6MWD and SGRQ score. SLH was non-inferior to PExT in improving 6MWD (mean±sd 13.1±36.3 m versus 14.1±32.3 m, p=0.81; difference 1.0 m, 95% CI −7.3–9.3 m) with 21.8% and 25.0%, respectively (p=0.57), reaching the 6MWD minimal important difference of 30 m. We found no significant between-group differences concerning SGRQ, HADS, lung function, dyspnoea or adherence.

Conclusion

Our study suggests that SLH is non-inferior to PExT in improving 6MWD during a 10-week PR programme. Future studies addressing reproducibility, long-term effects and health economics are needed.

Singing for Lung Health was non-inferior to physical exercise training in short-term improvement of 6-min walk test distance in COPD patients attending pulmonary rehabilitation. In both groups, the effect was related to high adherence.https://bit.ly/3uoP4Q8

Exoskeleton versus end-effector robot-assisted therapy for finger-hand motor recovery in stroke survivors: systematic review and meta-analysis

INTRODUCTION

The growing number of stroke survivors with residual hand disabilities requires the development of efficient recovery therapy, and robotic rehabilitation can play an important role.

OBJECTIVE

The study aims to compare the relative effects of end-effector (EE) and exoskeleton (EXO) hand devices in motor recovery of patients with finger-hand motor impairment stroke.

METHODS

We identified randomized controlled trials (RCTs) through search in database on PubMed, Embase, MEDLINE, Cochrane library until October 2020. We included as outcomes: motricity index (MI), quick version of disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire, and Fugl-Meyer assessment for upper extremity (FMAUE). We performed a systematic review, a meta-analysis, and a surface under the cumulative ranking analysis (SUCRA).

RESULTS

We included five RTCs and 149 subjects. MI showed a signifìcant improvement (p < .05) in robotic intervention group compared to control group (effect size, ES: 9.47; confidence interval, CI: 3.91, 15.03). QuickDASH reported a significant reduction (p < .05) in EXO group (ES: -6.71; CI: -9.17, -4.25). FMAUE showed a significant improvement (p < .05) in the EE group (ES:3; CI:1.97, 4.04). SUCRA analysis of MI demonstrated that robotic interventions are more likely to be the best option for motor recovery (97.3% of probability EXO; 48.3% EE; 4.4% control).

CONCLUSION

Despite the limited number of studies included, exoskeleton robotic devices might be a better option than end-effector devices in the treatment of fingers motor impairment in stroke patients. Further studies are still needed to confirm the findings and should focus on a direct comparison of the two devices.

Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis

Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.