To conduct a cross-sectional survey on the application status of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in Cochrane systematic reviews (CSRs) of traditional ...Chinese medicine (TCM).
: We searched CSRs of TCM from the inception to December 2020 in the Cochrane Library database. General characteristics and details of GRADE were extracted.
Among 226 CSRs of TCM, 86 (38.05%) involving 711 outcomes used GRADE to rate the certainty of evidence. Topics mainly focused on genitourinary diseases (17.44%), diseases of the musculoskeletal system or connective tissue (11.63%), and diseases of the nervous system (10.47%). Only 15.89% of the outcomes reported high or moderate certainty of evidence. Acupuncture was the most common intervention. There were no significant differences in evidence certainty between acupuncture and non-acupuncture, between TCM alone and integrated Chinese and western medicine, or between Chinese patent medicines and non-Chinese patent medicines (P > 0.05). Among 1 273 instances of downgrading, 44.62% were due to the risk of bias and 40.14% due to imprecision.
Overall, GRADE approach is not widely used in CSRs of TCM. The certainty of evidence is generally low to very low, mainly because of the serious risk of bias and imprecision.
Artemisinin has immunomodulatory, anti-inflammatory, and antifibrotic effects. Some studies have demonstrated that artemisinins have a protective effect on the kidney. DHA is a derivative of ...artemisinin and has effects similar to those of artemisinin. Human bone marrow-derived mesenchymal stem cells (BMSCs) accelerate renal repair following acute injury. In the study, we investigated the effects of combination therapy with DHA and BMSCs on membranous nephropathy (MN) mice. The 24-h urinary protein, serum total cholesterol (TC) and triglyceride (TG) levels, and renal histopathology, were measured to evaluate kidney damage. Anti-PLA2R, IgG, and complement 3 (C3) were detected by ELISA. The expression levels of the podocyte injury-related proteins were analyzed by immunohistochemistry. The protein expression levels of
-SMA, ED-1, TGF-
1, p-Smad2, and p-Smad3 were detected by western blot to analyze renal fibrosis and its regulatory mechanism. Results showed that combination therapy with DHA and BMSCs significantly ameliorated kidney damage in MN model mice by decreasing the levels of 24 h urinary protein, TC and TG. This combination therapy also improved renal histology and reduced the expression of IgG and C3 in the glomerulus. In addition, this combination therapy decreased the expression of podocin and nephrin and relieved renal fibrosis by downregulating
-SMA and ED-1. Furthermore, this combination therapy suppressed TGF-
1 expression and Smad2/3 phosphorylation. This result (i.e., this combination therapy inhibited the TGF-
1/Smad pathway) was also supported
. Taken together, combination therapy with DHA and BMSCs ameliorated podocyte injury and renal fibrosis in MN mice by downregulating the TGF
1/Smad pathway.
Background
Membranous nephropathy (MN), one of the primary pathogenic forms of adult nephrotic syndromes, frequently coexists with hypercoagulability and hyperviscosity. MN is prone to thrombosis, ...embolism, and other complications, leading to the accelerated occurrence of glomerulosclerosis and renal fibrosis. Therefore, it is particularly important to promote blood circulation and remove stasis through anticoagulant therapy. Salvianolate (SAL) is a Chinese patent anticoagulant commonly used in clinical practice to promote blood circulation and remove blood stasis. SAL plays an important role in alleviating urinary protein and renal pathological damage in MN patients.
Objectives
In the present study, we aimed to investigate the kidney-protective effect of SAL on MN in a rat model.
Materials and Methods
The rat model of MN was established by tail vein injection of cationic bovine serum albumin (C-BSA). After the treatment, urinary proteins, hypercoagulable state index (fibrinogen (Fib), D dimer (D-D)), hepatic and renal functions, renal pathology, and podocyte marker proteins were analyzed to explore the renal protective effect of SAL on MN rats and its underlying mechanism.
Results
In the modeled rats, we discovered a significant rise in urinary protein, a hypercoagulable state, and hypoproteinemia. Additionally, the expressions of Wilms’ tumor protein 1 (WT-1), podocalyxin (PCX), and vascular endothelial growth factor (VEGF) in renal tissues were significantly downregulated, indicating remarkable pathological damage to podocytes and renal tissues in MN rats. The expressions of the above-mentioned indices could be greatly reversed by SAL, which could also regulate the hypercoagulable state and suppress podocyte damage and renal pathological harm.
Conclusion
Our results suggested that the renal protective effect of SAL on C-BSA-induced MN was related to its ability to inhibit hypercoagulable states, upregulate the expressions of WT-1, PCX, and VEGF in the renal tissue, and repair podocyte injury.
Acupuncture has been widely practiced for primary insomnia (PI). However, the relative benefit and harm among acupuncture therapies remain uncertain.
To compare and evaluate the effect differences of ...multiple acupuncture therapies for patients with PI.
Systematic literature search for randomized controlled trials (RCTs). Pairs of reviewers independently conducted literature screening, data extraction, and risk of bias assessment. Meta-analysis was conducted using R and Stata software. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to assess certainty of evidence and interpret results.
Fifty-seven RCTs with 4678 patients were included. Compared with usual treatment, multiple acupuncture therapies showed a better effect for Pittsburgh sleep quality index score. And acupoints catgut embedding (ACE) was proved to be the most effective with a moderate certainty of evidence; auricular acupressure or auricular acupuncture plus manual acupuncture (AP + MA), electroacupuncture plus acupoint application (EA + APA), and intradermal needle (IN) might be also the most effective with low certainty of evidence. ACE, ACE + MA, AP + MA, EA, EA + APA, HPN, MA and PBN + MA showed significantly improvement in effective rate when compared with usual treatment. Insufficient evidence reported on Epworth Sleepiness Scale, Athens Insomnia Scale, and recurrence rate. The most common slight adverse events mainly included hematoma, pain, headache, and bleeding.
With moderate to low certainty of evidence, multiple acupuncture therapies showed impressive insomnia improvement, especially ACE, AP + MA, and EA + APA. Differences between therapies were small or insignificant and based-on low or very low certainty of evidence.
•Multiple acupuncture therapies showed the benefit in the insomnia improvement.•Differences between therapies were small or insignificant.•The evidence body is usually low certainty in the field of acupuncture for insomnia.•Integrating randomized and non-randomized studies in evidence syntheses is needed.•Future studies should enhance the reporting of the patient important outcomes.
Danggui Liuhuang (DLH) decoction is a traditional herbal medicine that is widely used in East Asia to treat menopausal symptoms. Most of the available clinical trials that investigated DLH decoction ...have been included in this review. The objectives of this protocol are to provide the information of how to evaluate the effectiveness and safety of DLH decoction for the treatment of menopausal symptoms.
Fourteen databases will be searched from inception until February 2018. We will include randomized controlled trials (RCTs) testing any type of DLH decoction. All RCTs investigating DLH decoction or modified DLH decoction will be included. The methodological quality of the RCTs will be evaluated using the Cochrane's risk of bias assessment tool.
The full systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. Updates of the review will be conducted to inform and guide healthcare practice and policy.
PROSPERO 2017 CRD42017079189.
ObjectiveThis study aimed to assess the efficacy and safety of QiMing granules (QM) in the treatment of patients with diabetic retinopathy (DR).MethodsWe systematically searched multiple databases, ...including Pubmed, Embase, Web of Science, Cochrane Library, SinoMed, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database. Randomized controlled trials (RCTs) of QM in the treatment of DR were collected, and the search time limit was from the establishment of the database to 27 March 2024. Two independent researchers were involved in literature screening, data extraction, and bias risk assessment. The risk of bias in the included studies was assessed using the Risk of Bias Assessment tool for randomized controlled trials of Cochrane Collaboration 2.0 (RoB 2.0). The main outcomes were the overall efficacy, visual acuity, retinal circulation time, macular thickness. The secondary outcomes were the levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1c). The adverse events was considered the safety outcome. Review Manager 5.4.1 and Stata 15.1 were used for meta-analysis. Data were pooled by random-effects or fixed-effects model to obtain the mean difference (MD), risk ratio (RR), and 95% confidence interval (CI).ResultsA total of 33 RCTs involving 3,042 patients were included in this study. Overall, we demonstrated that QM had a significant clinical effect on DR. QM alone was superior to conventional treatment (CT) in terms of overall efficacy RR = 1.45, 95% CI: (1.34, 1.58), p < 0.00001, moderate certainty, retinal circulation time MD = −0.56, 95% CI: (−1.01, −0.12), p = 0.01 and macular thickness MD = −11.99, 95% CI: (−23.15, −0.83), p = 0.04. QM plus CT was superior to CT in terms of overall efficacy RR = 1.29, 95% CI: (1.24, 1.33), p < 0.00001, visual acuity MD = 0.14, 95% CI: (0.11, 0.17), p < 0.00001, macular thickness MD = −14.70, 95% CI: (−21.56, −7.83), p < 0.0001, TG MD = −0.20, 95% CI: (−0.33, −0.08), p = 0.001, moderate certainty, TC MD = −0.57, 95% CI: (−1.06, −0.07), p = 0.02, and LDL-C MD = −0.36, 95% CI: (−0.70, −0.03), p = 0.03. In terms of safety, the incidence of adverse events in the experimental group was less than that in the control group. The results of the GRADE evidence quality evaluation showed that the evidence quality of outcome indicators was mostly low.ConclusionQM can effectively improve overall efficacy, visual acuity, macular thickness, retinal circulation time, and reduce the levels of TG, TC, and LDL-C. However, due to the limited number of studies included, a small sample size, and a lack of high-quality literature, the possibility of publication bias cannot be excluded. Moreover, biases are present due to differences in study design, such as the absence of placebo use in the control group and a predominant use of combined intervention designs in the control group, along with deficiencies in allocation concealment and blinding methods. Therefore, more multi-center, large-sample, and rigorously designed studies are needed to substantiate this conclusion.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023465165.
Chinese herbal injections (CHIs) are commonly used for the treatment of heart failure in China. Due to the variety of CHIs used in clinic, selecting a suitable CHI for patients with heart failure is ...vital. This study aims to assess and compare the effect of different CHIs for heart failure using network meta-analysis (NMA).
Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials, Embase, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database will be search from inception to January 2018. Randomized controlled trial (RCT) comparing CHI with another CHI will be included. The primary outcome will be changes in heart function classification and left ventricular ejection fraction. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed using WinBUGS 14 software and the result figures will be generated using Stata 13 software. GRADE will be used to explore the quality of evidence.
The results of this NMA will be published in a peer-reviewed journal.
Our study will generate evidence of CHIs for patients with heart failure and provide suggestions for Chinese medicine clinical practice or guideline.
Ethics approval and patient consent are not required because this study is an NMA based solely on the published literature. The results of this NMA will be submitted to a peer-reviewed journal.
PROSPERO CRD 42018086740.
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