Analysis of clinical evidence on traditional Chinese medicine for the treatment of diabetic nephropathy: a comprehensive review with evidence mapping

Objective

This study aims to map evidence from Randomized Controlled Trials (RCTs) and systematic reviews/Meta-analyses concerning the treatment of Diabetic Nephropathy (DN) with Traditional Chinese Medicine (TCM), understand the distribution of evidence in this field, and summarize the efficacy and existing problems of TCM in treating DN. The intention is to provide evidence-based data for TCM in preventing and treating DN and to offer a reference for defining future research directions.

Methods

Comprehensive searches of major databases were performed, spanning from January 2016 to May 2023, to include clinical RCTs and systematic reviews/Meta-analyses of TCM in treating DN. The analysis encompasses the publishing trend of clinical studies, the staging of research subjects, TCM syndrome differentiation, study scale, intervention plans, and outcome indicators. Methodological quality of systematic reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist, and evidence distribution characteristics were analyzed using a combination of text and charts.

Results

A total of 1926 RCTs and 110 systematic reviews/Meta-analyses were included. The majority of studies focused on stage III DN, with Qi-Yin deficiency being the predominant syndrome type, and sample sizes most commonly ranging from 60 to 100. The TCM intervention durations were primarily between 12-24 weeks. Therapeutic measures mainly consisted of Chinese herbal decoctions and patented Chinese medicines, with a substantial focus on clinical efficacy rate, TCM symptomatology, and renal function indicators, while attention to quality of life, dosage of Western medicine, and disease progression was inadequate. Systematic reviews mostly scored between 5 and 8 on the AMSTAR scale, and evidence from 94 studies indicated potential positive effects.

Conclusion

DN represents a significant health challenge, particularly for the elderly, with TCM showing promise in symptom alleviation and renal protection. Yet, the field is marred by research inconsistencies and methodological shortcomings. Future investigations should prioritize the development of standardized outcome sets tailored to DN, carefully select evaluation indicators that reflect TCM's unique intervention strategies, and aim to improve the robustness of clinical evidence. Emphasizing TCM's foundational theories while incorporating advanced scientific technologies will be essential for innovating research methodologies and uncovering the mechanisms underlying TCM's efficacy in DN management.

Up-regulated serum lactate dehydrogenase could become a poor prognostic marker in patients with bladder cancer by an evidence-based analysis of 2,182 patients

Background

A growing number of studies have considered serum lactate dehydrogenase (LDH) as an indicator of bladder cancer (BC) prognosis. However, a meta-analysis of the serum LDH's influence on BC prognosis is still missing.

Methods

PubMed, EMBASE, Web of Science and Cochrane Library were exhaustively searched for studies comparing oncological outcomes between high-LDH and low-LDH patients. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3) for overall survival (OS) in patients with BC.

Results

Six studies involving 2,182 patients were selected according to predefined eligibility criteria. The results showed that serum LDH level was significantly associated with OS (HR = 1.86, 95%CI = 1.54-2.25, p<0.0001) in BC. Sensitivity analysis showed the stability of the results. Subgroup analysis revealed that the levels of serum LDH had a significant impact on the OS of BC patients among different groups including publication time, research country, sample size, tumor stage, LDH cut-off value, therapy and follow-up time (all HR>1 and p<0.05), revealing that the ability of serum LDH is not affected by other factors.

Conclusion

Our findings indicated that a high level of serum LDH was associated with inferior OS in patients with BC. However, caution must be taken before recommendations are given because this interpretation is based upon very few clinical studies and a small sample.

Evidence-Based Analysis of Social Impact Bonds for Homelessness: A Scoping Review

Social impact bonds (SIBs) have emerged as an innovative financial instrument designed to support the social service sector in delivering innovative social programs. In particular, SIBs can be used to finance prevention of homelessness among those regarded as vulnerable. There is little evidence that outcomes from SIB-funded programs are significantly different compared to more traditional programs. This is the first scoping review of academic and gray literature that explores the main features and outcomes from all SIBs for homelessness based on evidence, addressing an important gap in the literature. The scoping review provides a transparent and comprehensive approach for mapping areas of this research. A total of 73 studies and articles were found eligible for inclusion. These concerned 32 SIBs for homelessness implemented in the United Kingdom, the United States, Australia, and Belgium. The review found that academic papers on SIBs for homelessness lack evidence-based analysis, while gray literature lacks transparency, especially in evaluation method and outcome. We found that fourteen projects met their target outcomes. The common features of these SIBs were a navigator intervention model, effective partnership working, and use of Special Purpose Vehicles. Our findings show that it is necessary for the managers of SIBs to improve outcome metrics and evaluation methods, support target groups fairly, and attract more private investors to finance SIBs for better addressing homelessness.

Overview of genetic testing in cancer

Until recently, hereditary tendencies toward multiple diseases, including cancer, were mainly determined by examining the family history of the affected individuals. However, the Human Genome Project has ushered in a genomics revolution and boosted the diagnostic testing industry with the emergence of genetic tests that may be used for the diagnosis and management of both inherited and noninherited malignancies. Genetic tests are already available to identify patients carrying cancer susceptibility genes and predict drug response, thus enabling physicians to carefully tailor a more personalized drug regimen that is more likely to result in a favorable outcome for the patient. However, before gene-based tests become widely available, thought leaders and society in general need to understand and discuss the major technical, ethical and economic ramifications of genetic testing. These issues are currently being reviewed by government, academia, regulatory agencies and professional societies using evidence-based principles.