Astragalus Membranaceus Injection Combined with Conventional Treatment for Viral Myocarditis: A Systematic Review of Randomized Controlled Trials

Objective：To assess the efficacy and safety of Astragalus membranaceus Injection combined with conventional therapy in the treatment of viral myocarditis.Methods：Randomized controlled trials（RCTs） of A.membranaceus Injection combined with conventional treatment compared with conventional treatment alone were included.Study population characteristics and outcome results were extracted independently by two assessors.Meta-analysis was performed for data available.Results：Six RCTs,involving 639 participants,were included in this study.The methodological quality of the included trials was generally low,and there was high risk of publication bias in the included trials.The total effective rate of A.membranaceus Injection combined with conventional treatment was significantly higher than that of conventional treatment alone.Compared with conventional treatment,the cointervention treatment group showed significant recovery in myocardium enzyme levels and electrocardiography.Two RCTs reported there were no adverse effects from A.membranaceus Injection combined with conventional treatment.Conclusion：A.membranaceus Injection combined with conventional treatment appeared to be more efficacious compared with conventional treatment alone for treating viral myocarditis.However,this conclusion should be cautiously interpreted due to low methodological quality,small sample size,limited number of trials,and high risk of publication bias and other unidentified risks of bias.The safety of A.membranaceus Injection combined with conventional treatment remains uncertain.     

Moxibustion for managing type 2 diabetes mellitus: A systematic review

Objective:Moxibustion is currently used for treating diabetes mellitus（DM） as a non-drug intervention in East Asian countries.This systematic review aims to evaluate the effectiveness of moxibustion for managing the symptoms of type 2 DM patients.Methods:We searched MEDLINE,AMED,EMBASE,CINAHL, The Cochrane Library,six Korean databases,and four Chinese databases.Risk of bias was used for evaluating the quality of the included studies.Results:A total of 5 studies met the inclusion criteria for this review.All of the included studies had high risks of bias.One randomized clinical trial（RCT） compared the effectiveness of one-time moxibustion use with oral administration of glibenclimide and showed the significant effects of moxibustion on glycemic control.Another RCT tested the effectiveness of moxibustion plus conventional treatment,and the moxibustion group reported significant improvement in fasting and postprandial blood glucose levels compared with the conventional treatment group.Two RCTs compared the effectiveness of moxibustion versus acupuncture or moxibustion plus acupuncture,and the combined treatment showed the most favorable effects on the control of blood glucose,urine glucose,and glycocylated hemoglobin A_1C(HbA_1C).One uncontrolled observational study showed favorable effects of moxibustion on the response rate.Conclusions:It is difficult to conclude that moxibustion is an effective intervention for the control of type 2 DM due to the scarcity of trials and the low methodological quality of included studies.Further rigorous RCTs may be necessary to evaluate the effectiveness of moxibustion for type 2 DM.     

Effect of Jianpi therapy in treatment of chronic obstructive pulmonary disease:a systematic review

OBJECTIVE:To evaluate the efficacy of Jianpi therapy in Traditional Chinese Medicine (TCM) for treatment of chronic obstructive pulmonary disease (COPD) in stable phase by performing a systematic review and meta-analysis. METHODS: The literatures concerning randomized controlled trials (RCTs) and quasi-RCTs comparing TCM treatment plus Western Medicine (WM) treatment with TCM alone, orTCM treatment vs no treatment, placebo for stable phase of COPD were searched in PubMed (1990-December 2010), in English and using Chinese National Knowledge Infrastructure (CNKI, 1990-December 2010), Chinese Biomedical Database (1990-December 2010), Wangfang Database (1990-December 2010), and Weipu (VIP) Database in Chinese. The quality assessment and data extraction for RCTs were conducted by two reviewers independently. Jadad scale and allocation concealment were used to assess the quality of the included studies, and meta-analyses were conducted with the Collaboration’s Revman 5.0 software. RESULTS: Seventeen RCTs or quasi-RCTs involving 1269 patients were included. The methodological quality was poor in all trials except one trial (Jadad score=4). In the meta-analysis, TCM-WM treatment was significantly superior to WM treatment in cure rate [OR=3.82, 95%CI (2.45, 5.95)], and the effective rate between TCM treatment and placebo also had significant difference [OR=4.31, 95%CI (2.35, 7.91)]. Moreover, pulmonary function of the patients in TCM-WM group and TCM group was significantly improved [forced vital capacity (FVC), P=0.01, quality of life, P<0.001]. CONCLUSION: The experience in TCM-WM treatment of COPD in stable phase was encouraging. The current evidence shows that TCM-WM treatment might be more efficient in effective rate, quaity of life, and FVC than WM treatment alone. But for forced expiratory volume in one second (FEV1) and FEV1/FVC, no matter TCM-WM treatment compared with WM treatment alone or TCM treatment compared with placebo, there was no significant difference, with no obvious adverse reactions. Due to the low methodological quality of trials included, more RCTs of high quality in large scale are required.     

Systematic review on randomized controlled clinical trials of acupuncture therapy for neurovascular headache

Objective:To evaluate the effectiveness of acupuncture as a treatment for neurovascular headache and to analyze the current situation related to acupuncture treatment.Methods:PubMed database (1966-2010),EMBASE database(1986-2010),Cochrane Library(Issue 1,2010),Chinese Biomedical Literature Database(1979-2010),China HowNet Knowledge Database(1979-2010),VIP Journals Database(1989-2010), and Wanfang database(1998-2010) were retrieved.Randomized or quasi-randomized controlled studies were included.The priority was given to high-quality randomized,controlled trials.Statistical outcome indicators were measured using RevMan 5.0.20 software.Results:A total of 16 articles and 1 535 cases were included. Meta-analysis showed a significant difference between the acupuncture therapy and Western medicine therapy [combined RR(random efficacy model)=1.46,95%CI(1.21,1.75),Z=3.96,P<0.0001],indicating an obvious superior effect of the acupuncture therapy;significant difference also existed between the comprehensive acupuncture therapy and acupuncture therapy alone[combined RR(fixed efficacy model)=3.35,95%CI (1.92,5.82),Z=4.28,P<0.0001],indicating that acupuncture combined with other therapies,such as points injection,scalp acupuncture,auricular acupuncture,etc.,were superior to the conventional body acupuncture therapy alone.Conclusions:The inclusion of limited clinical studies had verified the efficacy of acupuncture in the treatment of neurovascular headache.Although acupuncture or its combined therapies provides certain advantages,most clinical studies are of small sample sizes.Large sample size,randomized,controlled trials are needed in the future for more definitive results.     

Wendan Decoction(温胆汤) for Treatment of Schizophrenia: A Systematic Review of Randomized Controlled Trials

Objective: To assess the beneficial and adverse effects of Wendan Decoction(温胆汤, WDD) for the treatment of schizophrenia. Methods: Five electronic databases were searched until May 2014, including the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Scientist Journal Database, Pub Med, and the Cochrane Central Register of Controlled Trials in the Cochrane Library. The randomized controlled trials(RCTs) testing WDD against placebo, antipsychotic drugs, or WDD combined with antipsychotic drugs against antipsychotic drugs alone were included. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results: Thirteen RCTs(involving 1,174 patients) were included and the methodological quality was evaluated as generally low. The pooled results showed that WDD combined with antipsychotic drugs were more effective in clinical comprehensive effect, Positive and Negative Syndrome Scale(PANSS) scores and Brief Psychiatric Rating Scale scores compared with antipsychotic drugs alone. However, WDD had less effectiveness compared with antipsychotics in clinical comprehensive effect; and WDD was not different from antipsychotic drugs for PANSS scores. The side effects were significantly reduced in the intervention group compared with the control group. Conclusions: WDD appears to be effective on improving symptoms in patients with schizophrenia. However, due to poor methodological quality in the majority of the included trials, the potential benefit from WDD needs to be confirmed in rigorous trials and the design and reporting of trials should follow the international standards.     

Sodium Tanshinone Ⅱ A Sulfonate for Coronary Heart Disease: A Systematic Review of Randomized Controlled Trials

Objective: To assess whether an adjunctive therapy of Sodium Tanshinone ⅡA Sulfonate Injection(STS) is effective and safe in improving clinical outcomes in patients with coronary heart disease(CHD). Methods: A literature search was conducted through PubMed, the Cochrane Library, Knowledge Infrastructure Databases(CNKI), Chinese Biomedical Literature Database(SinoMed), Chinese Science and Technology Periodical Database(VIP) and Wanfang Database up to August 2017. Randomized controlled trials(RCTs) comparing STS with placebo or no additional treatments on the basis of standard conventional medicine therapies were included. The outcomes were all-cause mortality, major acute cardiovascular events(MACEs), cardiac function and inflammatory factors. The risk of bias assessment according to the Cochrane Handbook was used to evaluate the methodological quality of the included trials. Revman 5.3 software was used for data analyses. Results: A total of 22 RCTs involving 1,873 participants were included. All of the trials used STS as adjunctive treatment to standard conventional medicine therapy. Due to the poor quality of methodologies of most trials, only limited evidence showed that a combination of STS with percutaneous coronary intervention(PCI) or thrombolytic therapy(TT) might be more effective on reduction of all cause death rate than TT alone [risk ratio(RR) 0.25, 95% confidence interval(CI) 0.07 to 0.87] or PCI alone(RR 0.42, 95% CI 0.04 to 4.36). The results of 6 trials comparing STS plus TT with TT alone showed that the addition of STS significantly reduced the incidence of cardiac shock(RR 0.35, 95% CI 0.14 to 0.86), heart failure(RR 0.41, 95% CI 0.20 to 0.83) and arrhythmia(RR 0.21, 95% CI 0.12 to 0.46). STS combined with TT also showed a superior effect on cardiac function and inflammatory factor. No severe adverse event was reported related to STS. Conclusions: As an adjunctive therapy, STS combined with standard conventional medicine seems to be more effective on all-cause mortality or MACEs than conventional medicine treatment alone with less side effects. However, we cannot make a firm conclusion due to low quality of inclusion trials. Well-designed trials with high methodological quality are needed to validate the effect of STS for CHD patients.     

Acupuncture therapy for angina pectoris:a systematic review

OBJECTIVE:To assess the effectiveness and safety of acupuncture therapy for angina pectoris.METHODS:Randomized controlled trials(RCTs) concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier,MEDLINE,Science Citation Index Expanded,and three Chinese databases(China biology medicine database,China national knowledge infrastructure,and VIP database for Chinese technical periodicals).The valid data were extracted in accordance with our inclusion and exclusion criteria.The main outcomes of the included studies were synthesized using Revman 5.1.RESULTS:Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the standards of the Cochrane Collaboration.Meta-analysis indicated that acupuncture combined with conventional drugs(ACCD) was superior to conventional drugs alone in reducing the incidence of acute myocardial infarction(AMI) [OR=0.18,95%CI(0.04,0.84),P=0.03].Moreover,ACCD was superior to conventional drugs in the relief of angina symptoms [OR=4.23,95%CI(2.73,6.56),P<0.00001],and improvement of electrocardiography(ECG) [OR=2.61,95%CI(1.83,3.73),P<0.00001].Acupuncture by itselfwasalsosuperiortoconventionaldrugsforanginasymptoms[OR=3.59,95%CI(1.76,7.92),P=0.0004] and ECG improvement [OR=3.07,95%CI(1.54,6.10),P=0.001].ACCD was superior to conventional drugs in shortening the time to onset of angina relief [WMD=-1.40,95% CI(-1.65,-1.15),P< 0.00001].However,the time to onset was significantly longer for acupuncture treatment than for conventional treatment alone [WMD=2.43,95%CI(1.63,3.23),P<0.000 01].CONCLUSION:ACCD reduced the occurrence of AMI,and both acupuncture and ACCD relieved angina symptoms and improved ECG.However,compared with conventional treatment,acupuncture showed a longer delay before its onset of action.This indicates that acupuncture is not suitable for emergency treatment of heart attack.Owing to the poor quality of the current evidence,the findings of this systematic review need to be verified by more RCTs to enhance statistical power.     

Clinical Efficacy and Safety of Miniscalpel-Needle Treatment for Tension-Type Headache: A Systematic Review and Meta-Analysis

Objective: To investigate the clinical efficacy and safety of miniscalpel-needle(MSN) treatment for tension-type headache(TTH). Method: Seven medical databases were searched to identify randomized controlled trials(RCTs) evaluating the effect and safety of MSN treatment. All articles published up to November 15, 2018 were retrieved. A meta-analysis was conducted for the included studies, and the risk of bias was assessed. Primary outcomes were visual analogue scale(VAS) or numeric rating scale(NRS) score. Secondary outcomes were clinical effective rates including total effective rate(TER), markedly effective rate(MER), and totally cured rate(TCR) determined by improvement in clinical symptoms or VAS scores, the frequency of adverse events(AEs) that occurred during the study, and participant quality of life(QOL). Results: Seven RCTs involving 724 participants were included. MSN treatment showed significantly higher MER and TCR [relative risk(RR) 1.27, 95% confidence interval(CI) 1.01 to 1.61; RR 1.31, 95% CI 1.09 to 1.57, respectively], but not TER(RR 1.03, 95% CI 0.96 to 1.10) compared to acupuncture. MSN treatment plus conventional treatment showed significant lower VAS and higher TER, MER, and TCR(mean difference –3.54, 95% CI –3.80 to –3.28; RR 1.14, 95% CI 1.06 to 1.23; RR 2.31, 95% CI 1.50 to 3.58; RR 3.01, 95% CI 2.25 to 4.02, respectively) compared to conventional treatment. Conclusions: According to current evidence, MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH. However, since the number and the sample size of studies included were both small and the methodological quality was poor, the findings of this review should be interpreted with great caution, and our confidence in the results is low. A high quality RCT using objective outcomes should be performed on this topic.     

Conventional Acupuncture for Cardiac Arrhythmia: A Systematic Review of Randomized Controlled Trials

Objective:To exam the effect and safety of conventional acupuncture(CA) on cardiac arrhythmia.Methods:Nine medical databases were searched until February 2016 for randomized controlled trials.Heterogeneity was measured by Cochran Q test.Meta-analysis was conducted if I2 was less than 85% and the characteristics of included trials were similar.Results:Nine qualified studies involving 638 patients were included.Only 1 study had definitely low risk of bias,while 7 trials were rated as unclear and 1 as high.Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation(Af) and atrial flutter(AF) [relative risk(RR):1.09;95% confidence interval(CI):0.79–1.49;P=0.61;I2=61%,P=0.11].However,1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment,and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study,as well as the response rate in CA plus deslanoside group by another study.Meta-analysis of CA plus anti-arrhythmia drug(AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat(VPB) patients(RR,1.19,95% CI:1.05–1.34;P=0.005;I2=13%,P=0.32),and an improvement in quality-of-life score(QOLS) of VPB also showed in 1 individual study.Besides,a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients(MD –21.84 [–27.21,–16.47]) and lower adverse events of CA alone were reported than amiodarone.Conclusions:CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia,especially in VPB and Af patients,which mainly based on a pooled estimate and result from 1 study with higher methodological quality.However,we could not reach a robust conclusion due to low quality of overall evidence.     

穴位埋线治疗过敏性鼻炎：一项系统综述

Objective： To assess the effectiveness and the possible adverse effects of catgut implantation at acupoints for allergic rhinitis （AR）. Methods： This systematic review was carried out in accordance with the Cochrane Handbook version 5.1.0 and the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. Extensive literature searches were conducted in PubMed, Excerpta Medical Databases, the Cochrane Library, the China National Infrastructure, Wanfang Chinese Digital Periodical and Conference Database, and the Weipu Chinese Science and Technique Journals Database. The Chinese Clinical Trial Registry Center was also searched for ongoing trials up to September 2012. Randomized controlled trials （RCTs） or quasi-RCTs were included. Risk of bias assessment was performed using the Cochrane tool for assessing risk of bias. Results： Five RCTs with 285 participants were found from 49 relevant studies, but there was just one RCT which met the inclusion criteria for this review. The study showed that treatment of catgut implantation at acupoints could lead to a better alleviation of the signs and symptoms of AR than the crude herb moxibustion. No adverse events were reported in this study. Conclusions： Because of the methodological shortcoming and the risk of bias of the included trial catgut implantation was proved with only limited evidence for the treatment of AR. Robust RCTs with high quality and larger sample size in this field are hoped to be carried out in the future.     

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Objective: To evaluate the effectiveness and safety of oral Chinese herbal medicines(CHMs) on post-percutaneous coronary intervention(PCI) patients with depressive disorder in coronary heart disease(CHD). Methods: A literature search was conducted through databases including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure Databases(CNKI), Chinese Biomedical Literature Database(SinoMed), Chongqing VIP Chinese Science and Technology Periodical Database(VIP) and Wanfang Database up to August 2018. Randomized controlled trials(RCTs) comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 software was used to synthesize the results. Results: A total of 16 RCTs enrolling 1,443 participants were included in this systematic review. When compared with antidepressants alone, CHMs showed similar benefits with less side effects [risk ratio=0.54, 95% confidence interval(CI) 0.43 to 0.69, 582 patients]; meanwhile, the combination therapy may have more advantages than antidepressants alone [mean difference(MD)=–1.03, 95%CI –1.81 to –0.25, 267 patients). When identified with placebo, CHMs seem to have more advantages in relieving depressive symptoms(MD=–19.00, 95%CI –20.02 to –17.98, 189 patients). However, when compared with basic treatment of postPCI, CHMs showed different results in two trials. In terms of post-PCI related clinical symptoms, CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms. However, the heterogeneity in this review was generally high, it may be caused by different interventions used in each trial and the low quality of the trials. Conclusions: In total, CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.     

Red ginseng for type 2 diabetes mellitus: A systematic review of randomized controlled trials

Objective:Red ginseng（RG,Panax ginseng C.A.Meyer） is one of the widely used herbs for treating type 2 diabetes mellitus（DM）.However,no systematic review of the effectiveness of RG for type 2 DM is available.This systematic review aimed to evaluate the current evidence for the effectiveness of RG in patients with type 2 DM.Methods:Electronic searches of 14 electronic databases were conducted without language restrictions.All randomized clinical trials（RCTs） with RG as a treatment for type 2 DM were considered for inclusion.Their methodological quality was assessed using the Cochrane criteria.Results:Four RCTs met our inclusion criteria.Their methodological quality was variable.Three of the RCTs compared the effectiveness of RG with placebo.The meta-analysis of these data failed to favor RG over placebo for fasting plasma glucose （FPG）[n=76,weighted mean difference（WMD）:-0.43 mmol/L;95%confidence interval（CI）:-1.16 to 0.30, P=0.25]and fasting plasma insulin（FPI）（n=76,WMD:-8.43 pmol/L;95%CI:-19.54 to 2.68,P=0.14） for 12 weeks of treatment.One RCT compared the effects of RG with no treatment.The results did not suggest favorable effects of RG on FPG,hemoglobin A_1c(HbA_1c) or 2-h blood glucose after a meal（PP2h）.Conclusions: The evidence for the effectiveness of RG in controlling glucose in type 2 DM is not convincing.Few included studies with various treatment regimens prohibit definitive conclusions.More rigorous studies are needed to clarify the effects of RG on this condition.     

Recent clinical trials of acupuncture in the west: Responses from the practitioners

In the West,hundreds of randomized controlled trials（RCTs）have been performed testing acupuncture.They include two types：those that compare acupuncture to other therapies,usual care or no treatment（pragmatic trials）,and those that have placebo controls（efficacy trials）.Acupuncture has generally performed well against other therapies or no treatment,but until recently,the evidence from placebo controlled trials has been considered equivocal or contradictory.A recent series of large RCTs,mostly performed in Germany and also in the US have included both pragmatic and placebo comparisons.The evidence poises a conundrum for the profession of acupuncture.This essay first describes the two types of RCTs used to examine acupuncture and examine the results of two recent large RCTs for chronic low back pain as representative examples of recent large studies.The essay then presents the most common Euro-American acupuncture professions＇ interpretation of these results.Western responses have included：（1）methodological weaknesses; （2）inappropriateness of placebo controls; （3）questions as to whether acupuncture placebo controls are＂inert＂; （4）rejection of evidence-based medicine epistemology; （5）discrepancy between acupuncture performed in RCTs with real world acupuncture; （6）enhanced placebo effects of acupuncture; and（7）needs to re-evaluate acupuncture theory.The authors do not necessarily agree with all of these responses; they are presented in an attempt to foster critical discussion.The paper also looks at recent neuroimaging experiments on acupuncture that may point to some worthwhile new avenues of investigation.Finally,the Euro-American health care policy consequences of these recent RCTs are discussed.     

Heat-sensitive moxibustion for lumbar disc herniation:a meta-analysis of randomized controlled trials

OBJECTIVE:To assess the efficacy and safety of heat-sensitive moxibustion in the treatment of lumbar disc herniation(LDH).METHODS:Randomized controlled trials(RCTs) involving heat-sensitive moxibustion in the treatment of LDH were retrieved from the Chinese Biological Medical Literature database(1978-20011),Weipu database(1989-2011),Wanfang digital journal(1998-2011),China National Knowledge Internet(1979-2011),PubMed(1966-2011),EMBASE(1980-2011),and Cochrane Library(Issue 1,2011).Hand-search of the relevant journals from the Library of Jiangxi University of Traditional Chinese Medicine was also adopted for the collection of data.Data were extracted and evaluated by two reviewers independently with a specially designed extraction form.The Cochrane Collaboration’s RevMan 5.0.20 software was used for data analyses.RESULTS:A total of 6 trials involving 580 patients were included.Meta-analysis showed that the total effectiveness rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.19,95% CI [1.06,1.33)] and diclofenac sodium [RR=1.47,95% CI [1.17,1.85)],but similar to that of acupuncture.The cure rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.58,95% CI(1.04,2.40)] and diclofenac sodium [RR=1.91,95% CI(1.01,3.60)],but similar with that of acupuncture.In terms of the Japanese Orthopaedic Association scores,significant differences were noted in subjective indices,objective indices,and daily life subscales.Two trials reported that there were no adverse events over the duration of treatment.CONCLUSION:Compared with conventional moxibustion,acupuncture,and diclofenac sodium,heat-sensitive moxibustion in the treatment of LDH is superior in efficacy.Further large-scale trials are required to define the role of heat-sensitive moxibustion in the treatment of this disease.     

Meta Analysis of Lentinan Injection plus Cisplatin in Treatment of Malignant Pleural Effusion

Objective To evaluate the efficacy and safety of lentinan injection plus cisplatin (LIC) in the treatment of malignant pleural effusion (MPE). Methods We searched the database of Cochrane Library, PubMed, EMBASE, ISI Web of Knowledge, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Journal Full-text, and Google Scholar, etc., up to February 28th, 2011 to identify randomized controlled trials (RCTs) about lentinan injection (LI) for MPE, evaluate the quality of the included studies, and analyze the data by Cochrane Collaboration’s RevMan5.0 software. Results Twenty-nine RCTs involving 1831 patients were included. Meta analysis results suggested that there were some differences when comparing LIC with control groups suffering from MPE, for LIC could improve the near-term curative effect and the quality of life to some extent. Besides, compared with chemotherapy alone, LI plus chemotherapy had an advantage in relieving adverse reactions, such as gastrointestinal reactions, myelosuppression, chest pain, and general malaise. Conclusion The current evidence indicates that LI may have adjuvant therapeutic effects for MPE.     

Meta analysis of the curative effect of acupuncture on post-stroke depression

OBJECTIVE:To systematically evaluate the curative effect of acupuncture on post-stroke depression(PSD).METHODS:The internet was used to retrieve the Wanfang Medical Data System,Chinese Periodical Net,the Weipu Information Resources System,PubMed and the Cochrane Library Database.Relevant articles,up to September 2010,were manually retrieved.These papers included studies that had performed random and semi-random control trials for the use of acupuncture to treat PSD.Fifteen random control tests involving 1096 patients were included in this study and individual cases,interventional measures and curative effects were extracted from this research.Grade methodological quality evaluation and meta-analysis were performed on these studies.RESULTS:Comparison between the acupuncture group and the Western medicine group for the curative rate on PSD revealed an OR of 1.48,95% CI = [1.11 1.97] and P=0.008.Comparison of obviously effective rate shows that OR=1.39,95% CI=[1.08 1.80] and P=0.01.Comparison of effective rate showsthatOR=0.83,95%CI=[0.631.09]andP=0.18.CONCLUSION:Comparison between the acupuncture group and Western medicine group in treating PSD revealed that there is a statistical difference in curative rate and remarkably effective rate,but no difference in effective rate.     

Songling Xuemaikang Capsule(松龄血脉康胶嚢)for Primary Hypertension: A Systematic Review of Randomized Controlled Trials

Objective:To evaluate the effectiveness and safety of Songling Xuemaikang Capsule(松龄血脉康胶囊,SXC) for the treatment of primary hypertension.Methods:An extensive search including Cochrane Library,PubMed,Cochrane Central Register of Controlled Trials(CENTRAL),Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure(CNKI),Chinese Scientific Journal Database(VIP),KoreaMed,Japanese database,and online clinical trial registry websites was performed up to February 2013.Randomized controlled trials(RCTs) regarding SXC for the treatment of primary hypertension were searched without no language restrictions.The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0,and RevMan 5.0 provided by the Cochrane Collaboration.Result:A total of 17 RCTs involving1,778 patients were included.Meta-analysis showed that there was no significant difference between SXC and antihypertensive agents on systolic blood pressure[mean difference(MD):-0.10[-4.83,4.63];P=0.97]and diastolic blood pressure(MD:1.00[-1.16,3.16];P=0.36),but SXC combined with antihypertensive drugs was more effective in lowering systolic blood pressure(MD:-6.17[-7.86,-4.49];P0.00001) and diastolic blood pressure(MD:-7.24[-8.62,-5.85];P0.00001) compared with the antihypertensive drugs alone.Conclusions:SXC used alone or combined with antihypertensive drugs appear to be an effective treatment for lowering elevated blood pressure and improving symptoms in patients with primary hypertension.However,the conclusion cannot be drawn definitely due to the poor quality of the included studies.There is still an urgent need for well-designed,long-term studies to address the benefits of SXC for treating primary hypertension.     

Effectiveness of Auricular Acupressure for Acute Postoperative Pain after Surgery: A Systematic Review and Meta-Analysis

Objective: To identify the effectiveness of auricular acupressure(AA) in patients with acute postoperative pain after surgery by systematic review. Methods: A search of randomized controlled trials was conducted in 5 English medical electronic databases and 4 Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. Results: A total of 26 studies with 1,682 participants were included. Results showed that compared with conventional therapy, AA significantly improved the total effective rate [risk ratio=1.25, 95% confidence interval(CI), 1.13 to 1.37, P0.0001; heterogeneity: P0.0001, I~2=85%]. In the subgroup analysis, the results changed in different follow-up time and surgery categories. The pain relief in the AA group might be the most significant at 72 h after surgery(mean difference=–0.85, 95% CI, –1.20 to –0.50, P0.0001) and in abdominal surgery(mean difference=–1.15, 95% CI, –1.41 to –0.90, P0.0001). Sensitivity analysis demonstrated that the results of this meta-analysis were stable. No serious adverse effects were recorded. Conclusions: It was recommended to provide AA to patients with acute postoperative pain. However, a more accurate estimate of the effect requires further rigorously designed large-scale and high-quality RCTs for improving acute postoperative pain after surgery.     

Tongxinluo Capsule (通心络胶囊) for Cardiac Syndrome X: A Systematic Review and Meta-Analysis

Objective: To evaluate the efficacy and safety of Tongxinluo Capsule(通心络胶囊, TXL) for patients with cardiac syndrome X(CSX). Methods: Randomized controlled trials(RCTs) regarding TXL in the treatment of CSX were searched in Chinese Biomedicine Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, Pub Med, EMBASE, Cochrane Central Register of Controlled Trial, websites of the Chinese and International Clinical Trial Registry platform up to June 30, 2015. The intervention was either TXL alone or TXL combined with conventional treatment, while the control intervention was conventional treatment with or without placebo. Data extraction, methodological quality assessment and data analyses were performed according to the Cochrane criteria. The primary outcome was a composite event of death, acute myocardial infarction(AMI), angina requiring hospitalization, revascularization, and heart failure. The secondary outcome measures were angina symptom improvement, electrocardiograph(ECG) improvement, and serum endothelin-1(ET-1) level. The adverse events were also recorded. RevMan 5.3 software was applied for data analyses. Results: Twelve RCTs(696 patients) were included. Compared with conventional treatment, the addition of TXL to conventional treatment showed some benefits on relieving angina symptoms [risk ratio(RR): 1.46, 95% confidence interval(CI)(1.25, 1.71), P0.01], and improving ECG [RR: 1.45, 95% CI(1.21, 1.74), P0.01]. The pooled result did not support a benefit of TXL on reducing the incidence of primary outcome [RR: 0.20, 95% CI(0.02, 1.61), P=0.13]. In addition, TXL decreased serum ET-1 concentration of CSX patients [standardized mean number: –1.63, 95% CI(–2.29, –0.96), P0.01]. No serious adverse events were reported. Conclusions: TXL documents potential benefits on attenuating angina symptoms, improving ECG and decreasing serum ET-1 level for CSX patients. However, more rigorous RCTs with high quality are needed to confirm its efficacy and safety.     

Shenqi Fuzheng Injection(参芪扶正注射液) for Advanced Gastric Cancer:A Systematic Review of Randomized Controlled Trials

Objective:To evaluate the effectiveness of Shenqi Fuzheng Injection(参芪扶正注射液,SFI)combined with chemotherapy for advanced gastric cancer.Methods:Randomized controlled trials(RCTs) from10 databases were searched for this meta-analysis till December 31,2012 without language restriction.Grey literature and potential unpublished literature was also searched.The key search terms were "chemotherapy","Shenqi Fuzheng Injection" and "advanced gastric cancer".Criteria were built to select these clinical trials,in which SFI combined with chemotherapy was compared with chemotherapy alone for advanced gastric cancer.The methodological quality of each RCT was assessed using the Cochrane risk of bias tool.RevMan 5.1software was applied for data analyses.Results:Thirteen RCTs involving 860 patients met the selection criteria(all articles were from Chinese databases).The meta-analysis showed positive results for the use of SFI combined with chemotherapy according to quality of life in terms of the scores when compared with chemotherapy alone.Positive results were also obtained for the combination treatment,in terms of complete remission and partial remission efficacy rate,body weight and decreased adverse events including nausea and vomiting at grade 3-4,oral mucositis at grade 1-2,leucopenia at grade 3-4,and myelo-suppression at grade 1-2.Conclusions:This systematic review found encouraging albeit limited evidence for SFI combined with chemotherapy.However,to obtain stronger evidence without the drawbacks of trial design and the quality of studies,we recommend comparative effectiveness researches to test the effectiveness of combination treatment.