IntroductionDiminished ovarian reserve (DOR) is known to reduce the likelihood of achieving pregnancy or live births in women undergoing in vitro fertilization and embryo transfer (IVF-ET). Acupuncture maybe effective for DOR, but current evidence remains limited and inconclusive.Methods and analysisThis study is a multicenter, randomized, placebo-controlled trial conducted on a large scale. A total of 300 women with DOR preparing for IVF-ET will be randomized 1:1 to acupuncture or placebo acupuncture. Interventions will be administered from the second menstrual cycle preceding the IVF cycle until the day of oocyte retrieval. The primary outcome is the clinical pregnancy rate (CPR) following the first embryo transfer. Secondary outcomes include various IVF-ET indicators, such as the number of follicles ≥ 14 mm, estradiol (E2) levels, and endometrial thickness on the day of human chorionic gonadotropin (hCG) administration; the number of retrieved oocytes, metaphase II (MII) oocytes, and two pronuclei (2PN) fertilizations; as well as the rates of 2PN fertilization, available embryos, high-quality embryos, implantation, cycle cancellation, biochemical pregnancy, pregnancy loss, sustained pregnancy, and live birth. Additionally, ovarian reserve indicators—including antral follicle count (AFC), basal serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2, and anti-Müllerian hormone (AMH)—along with scores from the Self-Rating Anxiety Scale (SAS) will also be evaluated.Ethics and disseminationThe trial has been approved by the ethics committees of all participating centers. The results will be disseminated in academic journals.Clinical Trial Registrationhttp://itmctr.ccebtcm.org.cn/, identifier ID: ITMCTR2024000021.

Objective: This study employs a network meta-analysis method to investigate the clinical effectiveness of acupuncture in patients with polycystic ovary syndrome (PCOS) experiencing infertility. Methods: Prospective randomized controlled trials (RCTs) of clomiphene citrate (CC) and letrozole (LE) combined with acupuncture in PCOS infertility patients were identified through computerized searches in databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chongqing VIP Database. The search period was set from inception until August 1, 2023, with no language restrictions. Two researchers screened articles, extracted data, and independently assessed the risk of bias in eligible trials. Data were analyzed and visualized using the R software gemtc package. With patients with medication treatment only set as controls, a meta-analysis was performed to investigate the difference in the pregnancy outcomes of the PCOS patients following medication amalgamated with different acupuncture treatments, namely, manual acupuncture (MA), electroacupuncture (EA), and warm acupuncture (WA). Results: The serum concentrations of follicle-stimulating hormone (FSH) did not exhibit significant changes following acupuncture treatments. Notably, acupuncture-based medication treatment significantly reduced serum levels of luteinizing hormone (LH) and elevated the testosterone (T) concentrations of patients when compared to medication treatment alone. Patients also showed significantly escalated serum estradiol (E2) levels after receiving CC integrated with acupuncture than those given monotherapy of CC. The combined regimen of medication and acupuncture appeared to improve the pregnancy outcomes compared to the monotherapy of medication, as evidenced by the significantly increased success rate of pregnancy. Furthermore, the treatment combination of CC plus WA and LE plus MA yielded the highest probability of achieving the best pregnancy outcomes. Conclusion: For PCOS infertility patients, acupuncture, as a complementary treatment to CC and LE, holds advantages in improving reproductive hormone levels and enhancing pregnancy success rates. The highest probability of achieving the best pregnancy outcomes is associated with the treatment combination of CC with WA and LE with MA.

Introduction The therapeutic needs of women with diminished ovarian reserve (DOR), coupled with the increasing application of acupuncture in improving ovarian function, have highlighted the need to verify the efficacy and safety of acupuncture for DOR. This study aims to provide high-quality evidence by evaluating both ovarian reserve and in vitro fertilisation (IVF) outcomes.Methods and analysis A large-scale, multicentre, randomised controlled trial will be carried out across seven hospitals in China. 400 women with DOR will be randomised in a 1:1 ratio to an acupuncture group or a sham acupuncture group. Acupuncture or sham acupuncture will consist of 36 sessions per participant over 12 weeks. The primary outcome will be the change in antral follicle count (AFC) at week 12 from baseline. Secondary outcomes are AFC at week 24, the serum levels of basal follicle-stimulating hormone and anti-Mullerian hormone at weeks 12 and 24, the scores of the Self-Rating Anxiety Scale at weeks 12 and 24, clinical pregnancy rate, and IVF embryo transfer related outcomes. Any adverse events during treatment will be documented.Ethics and dissemination The study protocol has been approved by all the participating institutions. Written informed consent will be obtained prior to participant enrolment. The results of this study will be published in peer-reviewed publications.Trial registration number ChiCTR2200062295Protocol version V2.0-20220317

INTRODUCTION:Depression is the most significant contributor to non-fatal health reductions worldwide. Acupuncture is the most commonly used complementary alternative therapy to relieve major depressive disorder (MDD) effectively. Nevertheless, the effects of acupuncture for MDD are uncertain. This review aimed to determine the efficacy and safety of acupuncture for MDD.METHODS:Meta-analysis was performed for randomized controlled trials of acupuncture for MDD data from eight databases searched from inception until February 10, 2022. All RCTs with adult participants undergoing acupuncture treatment for MDD were included. The primary outcome measure was the Hamilton rating scale for depression (HAMD). We used random-effects meta-analysis to synthesize the results with a mean difference or odds ratio. Furthermore, the potential heterogeneity was tested through meta-regression/subgroup analyses/sensitive analysis. The quality of evidence for each outcome was assessed by the Grading of Recommendations Assessment, Development, and Evaluation approach.RESULTS:Forty-three studies were included: 9 acupuncture versus sham acupuncture (n = 920), 26 acupuncture versus antidepressants (n = 2169), and 9 acupuncture plus antidepressants versus antidepressants (n = 667). Of the 43 high-quality articles, 24 and 8 were determined to have a low and moderate risk of bias, respectively. The pooled results for HAMD and SDS revealed the clinical benefits of acupuncture or acupuncture plus antidepressants compared to sham acupuncture or antidepressants, with high-quality evidence. Furthermore, high-quality evidence showed that acupuncture led to fewer adverse effects than antidepressants.CONCLUSIONS:Acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD scores, with high-quality evidence. Also, more rigorous trials are needed to identify the optimal frequency of acupuncture for MDD and integrate such evidence into clinical care to reduce antidepressant use.

OBJECTIVE:The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury.DESIGN:Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software.RESULTS:Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies.CONCLUSIONS:Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation.TO CLAIM CME CREDITS:Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.CME OBJECTIVES:Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity.LEVEL:Advanced.ACCREDITATION:The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

BACKGROUND:The benefits of acupuncture on Major depressive disorder (MDD) have been well established in previous studies. However, uncertainty exists regarding the dose-effect relationship between acupuncture and MDD. This study aims to explore the association between acupuncture and its effects on MDD based on previously published data.METHODS:Nine databases were searched from inception until 10th September 2021. Randomized controlled trials that compared acupuncture with sham acupuncture, or anti-depressants, were included. The data extraction, and assessing the data quality and risk of bias completed by two researcher, respectively. A non-linear meta-regression approach with restricted cubic spline was used to investigate the dose-effect relationship between acupuncture sessions and their effects on the Hamilton rating scale for depression (HAMD) score.RESULTS:Of the 20,835 citations screened, 62 studies (2269 patients of MDD) were included. The dose-effect meta-analysis suggested that acupuncture session was associated with a decline in HAMD scores. Overall, an increase in the number of acupuncture sessions received was associated with symptom improvement in MDD patients. After 8 acupuncture sessions, the HAMD score decreased from 17.68 (95% CI: -11.81, -4.80) to 8.30 (95% CI: 14.23-21.13). After 24 acupuncture sessions, a decrease in HAMD scores was observed in 51% of cases (95% CI: 48% to 54%). After 36 acupuncture sessions, the effect of improvement in HAMD scores peaked at 66% of cases (95% CI: 59% to 72%).CONCLUSIONS:A dose-effect relationship was found between the number of acupuncture sessions and HAMD scores. 36 acupuncture sessions were associated with optimal clinical response.SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42021290143.

Review question / Objective: Whether acupuncture is more benefit for MDD than antidepressant alone?Condition being studied: Acupuncture therapy have been practiced in China for emotions disease.The WHO had analyzed the scope and efficacy of acupuncture therapy, and recommend acupuncture for depression with the level 1 evidence grade6.Previous evidence-based studies have indicated that acupuncture is associated with clinically relevant effect sizes in reducing the severity of depression when compared to sham-acupuncture.However, it is not clear whether acupuncture is more benefit for MDD than antidepressant alone.The randomized controlled trials, and meta-analysis cannot clear answer the question, because the small sample size with low statistic power, methodology defect, potential bias, etc. in RCTs, and include low quality RCTs, no strict methodology, and nonstandard report in metaanalysis.

目的 总结近5年来临床随机对照试验(RCTs)中敏化态与非敏化态关元穴的主治范围与规律.方法 应用计算机检索中国期刊全文数据库(CNKI)、维普数据库(VIP)、中国生物医学光盘数据库(CBM)、万方数据库(WanFang Data)以及PubMed数据库,筛选出符合纳入标准的文献,以文献计量学的方法对纳入文献进行统计,归纳和分析出两种状态关元穴的主治疾病和治疗相关情况.结果 非敏化态关元穴共纳入370篇文献,其文献发表数量呈现先增加再逐渐减少的趋势,治疗的疾病有121种,尿潴留和原发性痛经文献数量最多,其次为多囊卵巢综合征、失眠症等,共纳入15707例患者;作用于关元穴的治疗方式有20种,以单纯针刺和艾灸为主;针刺角度以直刺为主,深度多在1-1.5寸之间,平补平泻法和补法是其常用补泻方法;常见病治疗频次主要为1次/日,不同疾病的配穴和疗程各有不同.敏化态关元穴共纳入24篇文献,文献发表数量趋势无明显变化,主治疾病有16种,共纳入919例患者,治疗方式主要为热敏灸,以热敏化形式为主.结论 非敏化态关元穴的主治疾病范围较广,且治疗方式多样,具体治疗时间、配穴和疗程因疾病种类不同而有所区别;敏化态关元穴有较好的临床疗效,但研究较少,有待进一步探索.

Condition being studied: Major depressive disorder (MDD) is a common psychological condition with an estimated lifetime prevalence of 16%, affecting more than 320 million people across the globe.As of April 2017, depression has been recognized by the World Health Organization (WHO) as the leading cause of health-related disability, accounting for approximately 4.4% of all d i s a b i l i t i e s a n d p r e m a t u r e d e a t h s worldwide.Antidepressants such as selective serotonin reuptake inhibitors or INPLASY

疾病状态下,腧穴从沉寂到激活的转变称为腧穴敏化,即腧穴所携带的病理信息和外在表象等特征随着脏腑功能的变化会发生实时动态的改变,多数研究对腧穴敏化的判断仅凭主观感受,缺乏客观评价标准.近年来对腧穴敏化现象中的客观现象进行了诸多探索,取得了一系列成果.研究综述了穴位敏化的光成像、光声成像、声成像、纳米分子以及显微镜成像5个方面.随着各种成像技术相继应用于穴位敏化研究领域,其客观现象研究不再局限于生物物理现象,对敏化腧穴局部的细胞、分子水平等层面也能进行深入探索,进一步为穴位敏化的确切内涵提供了的科学依据.就目前的研究进展来看,仍存在诸多局限性,如忽略了敏化的最佳时间节点、多为静态成像、观测指标单一以及技术本身的局限等,所以相关研究还有待进一步探索验证.

Background: The effects of acupuncture for major depressive disorder (MDD) uncertain. This review aims to determine the effects of Acupuncture for MDD . Methods: Eight Database were searched to identify randomized control trials (RCTs) on Acupuncture for MDD. All RCTs with adult participants undergoing acupuncture treatment for MDD were included. The primary outcome measure was the 24-item Hamilton rating scale for depression (HAMD-24). We used random-effects meta-analysis to synthesis the results with mean difference or odds ratio. Furthermore, the potential heterogeneity was tested through meta-regression/subgroup analyses/sensitive analysis. The quality of evidence for each outcome was assessed by the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Forty-three studies were included: 9 acupuncture versus sham-acupuncture (n=920), 26 acupuncture versus antidepressants (n=2169), 9 acupuncture plus antidepressants versus antidepressants (n=667). Of the 43 high-quality articles, 24 and 8 were determined to have a low and moderate risk of bias, respectively. The pooled results for HAMD-24 and SDS revealed the clinical benefits of Acupuncture or Acupuncture plus antidepressants compared to sham-acupuncture or antidepressants, with high quality evidence. Furthermore, high quality of evidence showed that acupuncture led to fewer adverse effects compared to antidepressants. Conclusions: Acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD-24 scores, with high-quality evidence. More rigorous trials are needed to identify the optimal frequency of Acupuncture for MDD and integrate such evidence into clinical care to reduce antidepressant use.

目的 评价针灸治疗变应性鼻炎系统评价/Meta分析的方法学质量和结局指标.方法 电子检索The Cochrane Library、Medline(OvidSP)、Embase (OvidSP)、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)和万方(WF)数据库,筛选出符合纳入标准的系统评价/Meta分析文献,检索时限均为建库至2018年8月31日.采用AMSTAR量表评价纳入研究的系统评价文献的方法学质量,运用GRADE系统对纳入研究的结局指标进行证据质量分级.结果 共纳入17个系统评价/Meta分析,AMSTAR评分为9～22分,其中14个研究为中等质量,3个研究为高质量.大部分研究结果显示:针灸治疗变异性鼻炎在治疗有效率、改善鼻部症状等方面疗效优于常规药物.结论 现有证据显示针灸治疗变应性鼻炎的系统评价/Meta分析方法学质量中等;多数结局指标证据质量低,有少部分中等质量证据支持针灸能够有效改善变应性鼻炎症状和体征.

目的 评估太极预防老年跌倒相关系统评价的方法学质量及其结局指标的证据质量.方法 计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、CNKI、WanFang Data、CBM和VIP数据库,收集太极预防老年跌倒相关系统评价/Meta分析,采用AMSTAR 2工具评价所纳入系统评价的方法学质量,并依据GRADE系统进一步对所纳入系统评价的结局指标进行证据质量分级.结果 共纳入11篇系统评价/Meta分析,AMSTAR 2评价结果显示10篇研究方法学质量为极低,1篇为低;GRADE评价结果显示纳入的36个结局指标中,10个结局指标质量为中,20个为低,6个为极低.中等质量的结局指标结果显示,太极组在单腿站立时间[MD=5.33,95％CI (3.35,7.32),P＜ 0.01;WMD=1.76,95％CI(-7.00,10.52),P＜ 0.01]、起立-行走试验[MD=1.04,95％CI (0.67,1.41),P＜ 0.01]、Berg平衡量表评分[MD=2.18,95％CI (0.93,3.43),P＜ 0.01]、总跌倒次数[RR=0.82,95％CI (0.73,0.92),P＜ 0.01]、跌倒2次的发生率[OR=0.69,95％CI (0.49,0.97),P＜ 0.01]和跌倒3次的发生率[OR=0.39,95％CI (0.21,0.73),P＜ 0.01]方面均优于对照组.结论 目前太极预防老年跌倒的相关系统评价方法学质量较低,证据质量可靠程度一般,无法证实太极能有效预防老年跌倒,有待未来开展更多高质量研究证实.

目的:通过对国际上太极拳相关研究进行文献计量、共现分析、共被引分析、聚类分析及可视化分析,探索太极拳近15年研究现状、热点及趋势,以期为未来研究提供一定指导.方法:以Web of Science中的Web of Science Core Collection数据库为文献来源,检索2004-2018年太极拳相关研究.运用CiteSpace软件以作者、国家和机构、关键词作为节点进行共现分析,并对关键词进行聚类分析、时间演化分析和Burst分析,选取被引文献作为节点进行共被引分析,绘制相应的可视化图谱并进行解读.结果:共检索到相关文献2242篇,近年来太极拳研究热度一直持续不减.研究者之间合作密切,贡献较为突出的研究者以Wayne PM为代表.国家及机构间也有密切的合作关系,其中,高产国家以美国、中国为代表,影响力较高的国家以加拿大为代表,研究机构多为大学.研究热点与前沿主要集中在对肌肉、骨骼等运动系统,对心、肺、血管等功能、对精神情志及本体感觉等的调控.预测太极拳研究领域近期将会出现更多的系统评价,同时太极拳对抑郁状态的影响、与瑜伽等运动方式的比较等相关研究近期将持续不断.结论:运用CiteSpace对Web of Science中太极拳近15年的研究进行了文献计量及可视化分析,相对直观地展现了太极拳近15年来的研究概况,初步地揭示了可合作的研究者及机构,对太极拳的研究热点、前沿及研究趋势形成了大致认识,为太极拳研究的选题、发展方向等提供了一定参考.

目的:通过文献研究探寻颈椎病敏化现象及规律,为颈椎病穴位敏化现象的相关科学研究及临床应用提供可靠思路.方法:检索CNKI、CBM、VIP、WF、Cochrane Library、PubMed、EMbase等数据库,收集整理颈椎病穴位敏化相关文献,采用文献计量学及数据挖掘方法进行穴位敏化规律分析研究.结果:共纳入颈椎病穴位敏化相关文献85篇.颈椎病穴位敏化现象有热敏、痛敏、形敏、电敏、化学敏、压敏和声敏,各敏化现象表现各一,特征明显,检测手段多样;颈椎病敏化穴位多见于阿是穴、颈夹脊、大椎、风池和百会;其中大椎和颈夹脊常同时出现敏化(支持度为63.64％,置信度为80.00％);敏化穴位涉及的特定穴多为交会穴、合穴、八会穴和下合穴;敏化穴位归属经脉以督脉和足少阳胆经为主;敏化部位主要集中在上肢部和头颈部.结论:颈椎病敏化现象具有多样性,且特征明显,其中以热敏最多见,敏化穴位主要分布于颈椎病病变局部.

Abstract Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial. To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality. A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain. Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.

Background: Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically. Objective: To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls. Methods: We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure. Results: A total of 14 relevant SRs were included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. Eleven (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was "moderate'' to "high'' for older people and "low'' for those with Parkinson disease. The level of evidence of the Berg Balance Scale was "low'' to "moderate'' for older people and "low'' for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias. Conclusions: Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions. (C) 2020 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Defecation dysfunction (DD) is one of the most common complications following sphincter-preserving surgery for rectal cancer. And there is no effective treatment of DD after sphincter-preserving surgery for rectal cancer. Although some studies suggested that acupuncture and moxibustion (AM) is effective and safe for DD after sphincter-preserving surgery for rectal cancer, lacking strong evidence, for instance, the relevant systematic review, meta-analysis and randomised controlled trial (RCT) of a large, multicentre sample, makes the effects and safety remain uncertain. The present protocol is described for a systematic review and meta-analysis to investigate the effectiveness and safety of AM for DD after sphincter-preserving surgery for rectal cancer.METHODS AND ANALYSIS:We will search nine online databases from inception to 1 October 2019; the language of included trials will not be restricted. This study will include RCTs that performed AM as the main method of the experimental group for patients with DD after sphincter-preserving surgery for rectal cancer. Two of the researchers will independently select the studies, conduct risk of bias assessment and extract the data. We will use the fixed-effects model or random-effects model of RevMan V.5.2 software to analyse data synthesis. The risk ratios with 95% CIs and weighted mean differences or standardised mean differences with 95% CIs will be used to present the data synthesis outcome of dichotomous data respectively and the continuous data. Evidence quality of outcome will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ETHICS AND DISSEMINATION:Ethical approval is not required in this secondary research evidence, and we will publish the results of this study in a journal or concerned conferences.TRIAL REGISTRATION NUMBER:CRD42019140097.

To investigate the effectiveness and safety of Tai Chi for essential hypertension (EH). A total of 9 databases were searched from inception to January 1, 2020. Randomized controlled trials (RCTs) investigating the effectiveness and safety of Tai Chi for EH were included. Study selection, data extraction, and quality assessment were performed independently by 2 reviewers. A total of 28 RCTs involving 2937 participants were ultimately included in this systematic review. Meta-analysis showed that, compared with health education/no treatment, other exercise or antihypertensive drugs (AHD), Tai Chi showed statistically significant difference in lowering systolic blood pressure (SBP) and diastolic blood pressure (DBP). The trial sequential analysis suggested that the evidence in our meta-analysis was reliable and conclusive. Subgroup analyses of Tai Chi vs. AHD demonstrated Tai Chi for hypertension patients < 50 years old showed greater reduction in SBP and DBP. Intervention of 12–24 weeks could significantly lower SBP and DBP. Among 28 included RCTs, 2 RCTs reported that no adverse events occurred. The quality of evidence for the blood pressure (BP) of Tai Chi vs. AHD was moderate, and DBP of Tai Chi vs. health education (HE)/ no treatment (NT) was high. Other outcome indicators were considered low or very low quality according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Tai Chi could be recommended as an adjuvant treatment for hypertension, especially for patients less than 50 years old. However, due to poor methodological qualities of included RCTs and high heterogeneity, this conclusion warrants further investigation.

Abstract Background: Knee osteoarthritis (KOA), known as severe degenerative arthritis, commonly occurs in middle-aged and elderly people all over the world. Acupuncture as traditional oriental intervention is getting widely used and several systematic reviews (SRs) have reported the effectiveness of acupuncture on pain relief and functional recovery in patients with KOA. Objective: Conducting an overview of SRs to provide more reliable evidence-based medical references for clinical practitioners and researchers of the effectiveness and safety of acupuncture for KOA. Data sources: EMBASE, Medline, Web of science, the Cochrane library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, China Biology Medicine, Wan Fang Digital Journals, and PROSPERO databases from inception to December 2018, magazines, websites, and unpublished sources. Selection criteria: Potential SRs were independently selected by 2 reviewers following a predetermined protocol. Data extraction: Data information of included SRs were independently extracted by 2 reviewers following a predetermined standardized data extraction form. Review appraisal: The risk of bias and reporting quality of included SRs were evaluated by the Risk of Bias in Systematic reviews (ROBIS) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The quality of evidence of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 12 SRs were included. All the SRs were published in recent 12 years, ranging from 2006 to 2017. According to ROBIS, 4 SRs were in low risk in domain 1 and 7 in domain 3 of phase 2, and 2 SRs were low risk in phase 3. Among 27 items of PRISMA, 19 items were reported over 70% of compliance. Using GRADE assessment, of 34 outcomes, high quality of evidence was found in 5 outcomes, 17 outcomes were rated moderate quality, and 11 outcomes were low quality. According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating KOA. In terms of Lequesne index and Lysholm knee score scale score, the effectiveness of electroacupuncture was better than that of western medicine. Limitations: There might be missing information. There may be duplicated clinical trials included by each SR that might have impact on the synthetic findings. Conclusions: According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating KOA. However, there are some risk of bias and reporting deficiencies still needed to be improved.