Evidence synthesis is the process of systematically gathering, analyzing, and integrating available research evidence. The quality of evidence synthesis depends on the quality of the original studies included. Validity assessment, also known as risk of bias assessment, is an essential method for assessing the quality of these original studies. Currently, there are numerous validity assessment tools available, but some of them lack a rigorous development process and evaluation. The application of inappropriate validity assessment tools to assessing the quality of the original studies during the evidence synthesis process may compromise the accuracy of study conclusions and mislead the clinical practice. To address this dilemma, the LATITUDES Network, a one-stop resource website for validity assessment tools, was established in September 2023, led by academics at the University of Bristol, U.K. This Network is dedicated to collecting, sorting and promoting validity assessment tools to improve the accuracy of original study validity assessments and increase the robustness and reliability of the results of evidence synthesis. This study introduces the background of the establishment of the LATITUDES Network, the included validity assessment tools, and the training resources for the use of validity assessment tools, in order to provide a reference for domestic scholars to learn more about the LATITUDES Network, to better use the appropriate validity assessment tools to conduct study quality assessments, and to provide references for the development of validity assessment tools.
ObjectivesTo evaluate the improvement of symptoms in patients with moderate to severe asthma aged 5-18 years treated with GINA (Global Initiative for Asthma) guidelines by network meta-analysis. Methods Randomized controlled trials (RCTs) about asthma patients aged 5 to 18 years with reported asthma symptom scores were collected from PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP, SinoMed and clinical trial registry platform (ClinicalTrials.gov). The search time limit was from the inception to August 26, 2023. After two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, Stata 15.0 software was used for network meta-analysis. ResultsA total of 23 studies were included, 23 of which reported daytime asthma symptom scores. Compared with symptom scores in the low-dose ICS group, there was a statistically significant difference in improvement of daytime symptoms between low-dose ICS+LABA+LTRA (SMD=−1.4, 95%CI −1.99 to −0.81) and low-dose ICS+LABA+SABA (SMD=−1.43, 95%CI −2.48 to −0.39). Symptom scores for nighttime asthma were reported in 20 RCTs, and there was a statistically significant difference in symptom scores for low-dose ICS+LABA+LTRA (SMD=−1.20, 95%CI −2.20 to −0.21) compared with the low-dose ICS group. After the ranking of efficacy, the number one asthma symptom score in both daytime and nighttime was low-dose ICS+LABA+LTRA group. ConclusionLow dose ICS+LABA+LTRA has the best efficacy in improving daytime and nighttime asthma symptom scores.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.
ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
Objective To systematically review the efficacy of eight time-restricted eating strategies on overweight/obese adults using network meta-analysis. MethodsThe Scopus, MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the intervention effects of eight time-restricted eating strategies on overweight/obese adults from inception to September 18, 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was performed using ADDIS 1.16.8 and Stata 18.0 software. ResultsA total of 23 RCTs involving 1 306 overweight/obese adults were included. The network meta-analysis revealed that compared with standard diets, the 8-hour time-restricted eating combined with a low-carbohydrate diet (MD=−4.01, 95%CI −5.95 to −2.08, P<0.05) showed better weight reduction effects. Compared with standard diets, the 8-hour time-restricted eating combined with a low-carbohydrate diet (MD=−3.54, 95%CI −5.44 to −1.63, P<0.05) and the 8-hour time-restricted eating combined with a low-sugar diet (MD=−4.19, 95%CI −8.33 to −0.05, P<0.05) significantly improved overall fat mass. Compared with standard diets, the 8-hour time-restricted eating combined with a low-sugar diet (MD=−15.42, 95%CI −29.12 to −1.72, P<0.05) had a better effect on fasting blood glucose control. The 8-hour time-restricted eating combined with high-intensity interval training (MD=−3.68, 95%CI −6.57 to −0.79, P<0.05) showed better results in reducing waist circumference. No statistical significance was found in direct comparisons regarding bone mineral content. The efficacy ranking showed that the 8-hour time-restricted eating combined with a low-carbohydrate diet was most effective for weight reduction; the 8-hour time-restricted eating combined with a low-sugar diet was more effective in reducing overall fat mass and controlling fasting blood glucose; the 8-hour time-restricted eating combined with calorie restriction had significant effects on waist circumference improvement; and the 8-hour time-restricted eating combined with high-intensity interval training was more effective for increasing bone mineral content. ConclusionBased on the results of the network meta-analysis and ranking, different time-restricted eating strategies have specific advantages for the intervention of overweight or obese individuals. The choice of the appropriate strategy should consider individual dietary habits and health conditions. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective The aim of this study is to construct reporting standards for acupuncture network meta-analysis, providing guidance to enhance the quality of evidence reported in acupuncture therapy research. Methods A Delphi questionnaire was developed based on the preliminary research and literature findings, 20 experts were selected for correspondence to determine the final checklists of items, and then finalized the list of report items. Results A total of two rounds of Delphi questionnaires were made. The expert positivity coefficient (100%), the expert familiarity (0.80) and the expert authority (0.83) were the same in both rounds, the Kendall's coordination coefficients were 0.117 (P<0.001) and 0.332 (P<0.001), respectively, which ultimately led to the formation of the 7 fields of title, abstract, introduction, methods, results, discussion and other, including 23 specific items of the acupuncture-related therapies NMA standards. Conclusion The PRINMA-A statement will help to improve the reporting quality of evidence on acupuncture-related therapies, promote the dissemination and translation of evidence on acupuncture-related therapies.
ObjectiveTo evaluate the diagnostic performance of different screening tools for sarcopenia in the community for the elderly with sarcopenia, and to provide evidence-based support for the accurate screening of elderly patients with sarcopenia. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CINAHL, VIP, CBM, and WanFang Data databases were searched by computer, and the relevant research on the diagnosis of sarcopenia in the elderly by publicly published risk screening tools was found. The retrieval time was from inception to June 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies, and then data analysis was performed by using Stata 15.1 and Meta Disc 1.4 software. ResultsA total of 24 studies were included, including 10 961 patients, involving 8 risk screening tools for sarcopenia in the elderly: leg circumference, MSRA-5, MSRA-7, upper arm circumference, ring test, Ishii score, SARC-CalF and SARC-F. Meta-analysis showed that the combined sensitivities of eight screening tools were 0.84 (95% CI 0.61 to 1.15), 0.82 (95% CI 0.48 to 1.38), 0.80 (95% CI 0.47 to 1.36) and 0.72 (95%CI 0.33 to 1.55), 0.67 (95%CI 0.37 to 1.21), 0.63 (95%CI 0.33 to 1.19), 0.49 (95%CI 0.38 to 0.63), 0.24 (95%CI 0.18 to 0.30), and the combined specificities were 0.39 (95%CI 0.18 to 0.82)、0.52 (95%CI 0.29 to 0.93)、0.54 (95%CI 0.29 to 1.03)、0.62 (95%CI 0.49 to 0.79)、0.63 (95%CI 0.50 to 0.78).The results of reticular meta-analysis showed that the surface under the cumulative ranking curve (SUCRA) of the eight screening tools ranked from high to low according to the cumulative sensitivity: calf circumference (67.4%) > MSRA-5 (65.3%) > MSRA-7 (64.1%) > upper arm circumference (54.5%) > ring test (46.5%) > Ishii score. The values of specificity SUCRA from highest to lowest were as follows: SARC-F (72.2%) > SARC-CALF (71.3%) > Ishii score (60.2%) > ring test (57.1%) > upper arm circumference (40.1%) > lower leg circumference (36.2%) > MSRA-5. ConclusionThe simple screening tool for common sarcopenia has high sensitivity and high specificity, so medical staff can give priority to the combination of the two screening tools, namely SARC-CalF. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
OBJECTIVE: To study the stimulating effects of basic fibroblast growth factor(bFGF) on fibroblast function and its ability to expression of c-fos gene. Furthermore, to explore the possible network action between bFGF and oncogene in modulating wound healing. METHODS: Cultured rat fibroblasts were divided into bFGF stimulating group and control group. Fibroblasts in bFGF stimulating group were treated with bFGF in a dosage of 40 ng/culture hole, while the control fibroblasts were treated with the same vehicle without bFGF. The morphology, cell vitality and their ability to express c-fos gene in the fibroblasts in both groups were studied with MTT and immunohistochemical methods. RESULTS: All fibroblasts in bFGF treated groups were enlarged and showed increased vitality with MTT method. C-fos gene expression in bFGF stimulating group was increased, especially in nucleus when compared with those in control group. CONCLUSION: The results show that the function and the ability to express c-fos gene in bFGF treated fibroblasts are enhanced. Combined with our previous studies, it may make a conclusion that there is a network regulation mechanism between growth factors and some oncogenes.
Objective To analyze the efficacy and safety of different acupuncture methods on outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods The PubMed, EMbase, Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched to collect randomized controlled trials (RCTs) related to the objectives of the study from the inception to April 16, 2023. After two investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, a network meta-analysis was performed using Stata 16.0 software. Results There were 62 trials total with 9844 patients, involving 7 interventions. Network meta-findings analysis revealed the following: ① Clinical pregnancy rate (CPR): needle warming > auricular acupressure > transcutaneous electrical acupoint stimulation (TEAS) > electroacupuncture > acupuncture > sham acupuncture > no adjunctive treatment; ② Live birth rate (LBR): electroacupuncture > auricular acupressure > TEAS > acupuncture > sham acupuncture > no adjunctive treatment. Conclusion Needle warming assisted IVF-ET is superior to other acupuncture therapies in improving CPR, especially during the promotion period of excretion, and the selection of Zusanli, Guanyuan and uterine acupoints for 3-month cycles may have the best effect. And for the LBR, the effect of electroacupuncture is better than that of other therapies. Besides, auricular acupressure may have good therapeutic potential. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
Objectives To train postgraduate medical students the ability of effectively using network resources and independently studying, and to explore new model of clinical liver cancer teaching. Methods The teaching model of problembased learning (PBL) to clinical liver cancer teaching was applied. Results The teaching model of PBL changed graduate student the status of passive acceptance to active participation. The teaching process was full of livingness, and the teaching quality was improved.Conclusion The teaching model of PBL can break through the limitations of passive acceptance of book knowledge in traditional teaching model and improve the ability to handle the comprehensive clinical knowledge of liver cancer, which provides a new model to the teaching of liver cancer to graduate medical students in clinic.