• Title/Summary/Keyword: Cochrane Risk of Bias

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Lack of Any Association of GST Genetic Polymorphisms with Susceptibility to Ovarian Cancer - a Meta-analysis

  • Han, Li-Yuan;Liu, Kui;Lin, Xia-Lu;Zou, Bao-Bo;Zhao, Jin-Shun
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.15
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    • pp.6131-6136
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    • 2014
  • Objective: Epidemiology studies have reported conflicting results between glutathione S-transferase Mu-1 (GSTM1), glutathione S-transferase theta-1 (GSTT1) and glutathione S-transferase pi-1 (GSTP1) and ovarian cancer (OC) susceptibility. In this study, an updated meta-analysis was applied to determine whether the deletion of GSTM1, GSTT1 and GSTP1 has an influence on OC susceptibility. Methods: A published literature search was performed through PubMed, Embase, Cochrane Library, and Science Citation Index Expanded database for articles published in English. Pooled odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random or fixed effects models. Heterogeneity between studies was assessed using the Cochrane Q test and $I^2$ statistics. Sub-group analysis was conducted to explore the sources of heterogeneity. Sensitivity analysis was employed to evaluate the respective influence of each study on the overall estimate. Results: In total, 10 published studies were included in the final analysis. The combined analysis revealed that there was no significant association between GSTM1 null genotype and OC risk (OR=1.01, 95%CI: 0.91-1.12). Additionally, there was no significant association between GSTT1 genetic polymorphisms and OC risk (OR=0.98, 95% CI: 0.85-1.13). Similalry, no significant associations were found concerning the GSTP1 rs1695 locus and OC risk. Meanwhile, subgroup analysis did not show a significant increase in eligible studies with low heterogeneity. However, sensitivity analysis, publication bias and cumulative analysis demonstrated the reliability and stability of the current meta-analysis. Conclusions: These findings suggest that GSTs genetic polymorphisms may not contribute to OC susceptibility. Large epidemiological studies with the combination of GSTM1 null, GSTT1 null and GSTP1 Ile105Val polymorphisms and more specific histological subtypes of OC are needed to prove our findings.

The effects of remdesivir on mortality and the requirement for mechanical ventilation in patients with COVID-19: a systematic review stratified by disease severity

  • Seungeun Ryoo;Miyoung Choi;Su-Yeon Yu;Young Kyung Yoon;Kyungmin Huh;Eun-Jeong Joo
    • The Korean journal of internal medicine
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    • v.39 no.1
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    • pp.160-171
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    • 2024
  • Background/Aims: The effectiveness of remdesivir treatment in reducing mortality and the requirement for mechanical ventilation (MV) remains uncertain, as randomized controlled trials (RCTs) have produced conflicting results. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other data resources to find RCTs published prior to April 10, 2023. The selection of studies, assessment of risk of bias, and meta-analysis were conducted according to PRISMA guidelines. The primary outcomes were all-cause mortality and the need to initiate MV. Results: A total of 5,068 articles were screened, from eight RCTs comprising 11,945 patients. The meta-analysis found that, compared to standard care or placebo, remdesivir treatment provided no significant all-cause mortality benefit (pooled risk ratio [RR], 0.93; 95% confidence interval [CI], 0.85-1.02; 8 studies; high certainty evidence), while subgroup analyses revealed a trend towards reduced mortality among patients requiring oxygen but not MV (pooled RR, 0.88; 95% CI, 0.77-1.00; 6 studies; I2 = 4%). The need to initiate MV (pooled RR, 0.74; 95% CI, 0.59-0.94; 7 studies; moderate certainty evidence) in remdesivir-treated patients was also reduced compared to controls. Remdesivir significantly increased clinical improvement and discharge and significantly reduced serious adverse events. Conclusions: In this systematic review and meta-analysis of RCTs, it was found that remdesivir treatment did not show a substantial decrease in the risk of mortality. However, it was linked to a reduction in the necessity for additional ventilator support, suggesting remdesivir could be beneficial for COVID-19 patients, particularly those who are not on MV.

Effectiveness of Exercise after Lung Cancer Surgery: A Systematic Review in PubMed Database (폐암 수술 후 운동의 효과: PubMed 내 연구에 대한 체계적 문헌고찰)

  • Jerng, Ui Min
    • Journal of Korean Medicine Rehabilitation
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    • v.31 no.1
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    • pp.149-163
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    • 2021
  • Objectives This study is to review the effectiveness of exercise after lung cancer surgery. Methods Relevant randomized controlled trials (RCTs) were searched in PubMed database. The systematic review was conducted through flow diagram. The risk of biases were assessed through the Cochrane guideline. Characteristics and outcomes were extracted from each study. Meta-analyses of forced expiratory volume in one second (FEV1), 6-minute walk test (6MWT), quality of life (QoL), pulmonary complications were conducted. Results 14 RCTs were selected. In meta-analysis, exercise improved FEV1 (mean difference [MD] 0.14; 95% confidence interval [CI] 0.04 to 0.25; p=0.009; I2=55%) and mean change of FEV1 (MD 0.11; 95% CI 0.02 to 0.20; p=0.02; I2=0%). Exercise increased the distance of 6MWT, but there was considerable heterogeneity (MD 45; 95% CI 21.16 to 68.83; p=0.0002, I2=89%). There was no differences in QoL scores by 2 questionnaires (European Organisation for Research and Treatment of Cancer quality of life questionnaire, short form-36). Exercise reduced the duration of hospital stay (MD -3.32; 95% CI -5.27 to -1.36; I2=0%; 2 studies) but not duration of chest tube intubation (MD -1.37; 95% CI -2.81 to 0.06; I2=0%) and incidence of pulmonary complications (pooled risk ratio 0.54; 95% CI 0.23 to 1.30; I2=0%). Conclusions Exercise might reduce the duration of hospital stay after lung surgery. There was not enough evidence to prove improvement of lung function, aerobic capacity, muscle strength, QoL, and decline of pulmonary complications. Low-quality risk of bias, different units or estimation of outcome, different exercise type and duration, heterogeneity among studies make the evidence of effectiveness weak. Future researches are required to redeem these defects.

Calcium hydroxide intracanal medication effects on pain and flare-up: a systematic review and meta-analysis

  • Ibrahim, Ahmed Mohamed;Zakhary, Siza Yacoub;Amin, Suzan Abdul Wanees
    • Restorative Dentistry and Endodontics
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    • v.45 no.3
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    • pp.26.1-26.18
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    • 2020
  • Objectives: This study aimed to systematically review the pain and flare-up effects of calcium hydroxide (CH) as intracanal medication (ICM) in non-vital mature teeth. Materials and Methods: Electronic-databases searching for published and grey literature and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing CH to other ICMs in non-vital mature teeth. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The main outcomes were pain and flare-up. Qualitative and quantitative analysis, wherever applicable, was performed. The certainty of evidence (CoE) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Sixteen articles were included in 6 comparisons at different time points for different outcomes. CH reduced pain risk than no ICM within the 1-14-days interval (p < 0.05) and than triple-antibiotic paste within the first day (p < 0.05) and was similar to corticosteroid/antibiotics combination (p > 0.05). Chlorhexidine (CHX) or CH/CHX, however, reduced pain levels than CH alone (p < 0.05). CH showed higher flare-up risk than CHX (p < 0.05). CoE, however, ranged from very low to moderate. Conclusion: Most comparisons for different outcomes are based on very few studies, mostly low-powered, with an overall low CoE. Thus, the available evidence is considered insufficient to either support or refute CH effectiveness or to recommend one ICM over another. Therefore, further well-designed, larger RCTs are required.

Effect of Applying Exercise Movement Technique by Physical Therapist on Quality of Life in Breast Cancer Survivors: Meta-analysis

  • Nam, KwangMin;Yoon, TaeLim;Kim, HanNa
    • The Journal of Korean Physical Therapy
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    • v.32 no.1
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    • pp.21-28
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    • 2020
  • Purpose: This study identified the effects of physical therapists on the quality of life when applying exercise-based movement techniques to breast cancer survivors. Methods: To conduct meta-analysis, 186 RCT studies were searched in five databases (RISS, Pubmed, CINAHL, Medline, and Cochrane Library), without limitation, for the year of publication, and papers published in April 2018 were selected. Four studies met the inclusion criteria and were selected for meta-analysis based on the risk of bias. The basic demographic data, athletic characteristics, and outcome data were extracted from all included clinical trials. The data were analyzed using the RevMan 5.2 program. Results: As a result of meta-analysis, exercise-based movement techniques applied by the control group (Pilates, yoga, tai chi, and qigong) or physical therapists showed no significant difference in the impact on the quality of life of breast cancer survivors. Conclusion: In this study, exercise-based movement techniques mediated by control groups or physical therapists showed no significant difference in the quality of life of breast cancer survivors, but the types and duration of exercise in each study varied, and the number of subjects was small. Considering randomized studies, more randomized studies will be needed to draw conclusions.

A Systematic Review of Acupuncture for Tennis Elbow

  • Oh, Ji Hye;Lee, Yun Kyu;Kim, Jae Soo;Lee, Hyun Jong;Lim, Sung Chul
    • Journal of Acupuncture Research
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    • v.36 no.4
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    • pp.211-219
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    • 2019
  • This review analyzed randomized controlled trials and case reports to identify the effectiveness, and level of evidence showing that acupuncture treatment aids the recovery of patients with tennis elbow. A literature search was performed between $1^{st}$ to $10^{th}$ September, 2019 which used PubMed, the Cochrane library, the Korean databases Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System to retrieve Korean and international studies. Amongst the 243 articles retrieved there were 9 randomized controlled trials and 18 case reports. The level of evidence for the recovery of patients with tennis elbow, for efficacy and safety of acupuncture was low. It was observed that the studies had a high risk of bias, missing acupuncture details, multiple combinations of treatments rather than a single treatment, insufficient indicators of assessment, and lacked robustness. Compliance with international standards such as using consolidated standards of reporting trials, will improve the quality of evidence.

Herbal Medicine for the Treatment of Non-Erosive Reflux Disease: A Systematic Review and Meta-Analysis Protocol

  • Minjeong Kim;Chaehyun Park;Jae-Woo Park;Jinsung Kim;Seok-Jae Ko
    • The Journal of Internal Korean Medicine
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    • v.44 no.6
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    • pp.1176-1185
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    • 2023
  • Introduction: Non-erosive reflux disease (NERD) is the most common subtype of gastroesophageal reflux disease (GERD). This study aims to synthesize evidence on the efficacy and safety of various herbal medicines for the treatment of NERD. Methods and analysis: Ten electronic databases will be examined: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, Embase, Allied and Complementary Medicine Database, China National Knowledge Infrastructure Database, Citation Information by Nii, Korean Medical Database, Korean Studies Information Service System, National Digital Science Library, and Oriental Medicine Advanced Searching Integrated System. All randomized controlled trials published from inception to May 2023 that meet the eligibility criteria will be selected. Two independent researchers will extract data, such as publication year, study design, intervention details, outcome measures, main results, and adverse events. The risk of bias and quality of evidence will be assessed, and subgroup analyses will be performed according to the type of control intervention and herbal medicine. The analysis process will be conducted using Review Manager 5.4 software. Discussion: This review will present a summary and rationale for herbal medicine's effectiveness in treating NERD. The findings of this review can help those who want to apply herbal medicine to the treatment of NERD.

The Clinical Effect on Acupuncture Treatment of Postpartum Hypogalactia: A Systematic Review of Randomized Controlled Trials (산후 유즙분비부전에 대한 침 치료 효과 : 체계적 문헌 고찰)

  • Kim, Yu-Jeong;Park, Kyung-Sun;Hwang, Deok-Sang;Lee, Jin-Moo;Jang, Jun-Bok;Lee, Chang-Hoon
    • The Journal of Korean Obstetrics and Gynecology
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    • v.30 no.3
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    • pp.79-91
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    • 2017
  • Objectives: The purpose of this systematic review is to overview and evaluate the effect on postpartum hypogalactia after acupuncture treatment. Methods: Relevant randomized controlled trials (RCTs) were identified by database searches in Embase, Pubmed, CENTRAL, CNKI, KISS. Searching keywords were "Hypogalactia" or "Hypolactaion" and "Acupuncture". After searching qualified articles, we independently assessed the risk of bias according to the Cochrane Rob criteria. Results: Among the 81 articles five RCTs were finally selected. Four of the selected were statistically significant. One of them was not statistically significant because it was comparative study of chinese medicine and acupuncture treatment. The quality of the evidence for specific comparisons ranged from low to high. Conclusions: Our systematic review found encouraging. Acupuncture treatment would be effective way to increase insufficient milk supply on postpartum hypogalactia.

Chuna Manual Therapy for Rheumatoid Arthritis : A Systematic Review and Meta-analysis (류마티스 관절염에 대한 추나요법의 효과 : 체계적 문헌고찰과 메타분석)

  • Heo, In;Han, In-Sik;Cha, Yun-Yeop
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.13 no.1
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    • pp.1-10
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    • 2018
  • Objectives: To evaluate the evidence supporting the effectiveness of Chuna manual therapy for rheumatoid arthritis. Methods: We conducted a search across 9 electronic databases to find all randomized controlled clinical trials (RCTs) that used Chuna manual therapy as a treatment for rheumatoid arthritis. The methodological quality of each RCT was assessed using the Cochrane risk of bias tool. Results: Our inclusion criteria were met by 5 RCTs. The meta-analysis showed positive results for the use of Chuna manual therapy combined with oriental usual care (UC) in terms of the efficacy rate, pain, and duration of morning stiffness when compared to western UC. Positive results were also obtained in terms of the efficacy rate, when Chuna manual therapy combined with medication was compared to medication treatments alone. Conclusions: Our systematic review found encouraging, but limited evidence of Chuna manual therapy for rheumatoid arthritis. However, to obtain stronger evidence without the drawbacks of trial design and the quality of studies, we recommend a comparative research to test the effectiveness of Chuna manual therapy.

Bee Venom Acupuncture for Shoulder Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

  • Shen, Lei;Lee, Jong Ha;Joo, Jong Cheon;Park, Soo Jung;Song, Yung Sun
    • Journal of Pharmacopuncture
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    • v.23 no.2
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    • pp.44-53
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    • 2020
  • Objectives: Our review aimed to summarize and evaluate evidence on the effectiveness of bee venom acupuncture (BVA) in the treatment of shoulder pain. Methods: Randomized controlled trials (RCTs) evaluating the effectiveness of BVA on shoulder pain were searched up to October 2019 in 11 electronic databases (Medline, Embase, CENTRAL, CiNii, CNKI, VIP, Wanfang, Kmbase, NDSL, RISS, OASIS). The methodological quality of the included RCTs were evaluated using Cochrane Risk of Bias tool and a meta-analysis was performed. Results: Seven studies were included in the review, and four studies were included in the meta-analysis. Comparing BVA plus conventional therapy (CT) with saline injection plus CT, it showed an effect in favor of BVA plus CT in visual analog scale (VAS) and pain rating scale (PRS) (p = 0.02, p = 0.009, respectively). Comparing BVA plus physiotherapy (PT) with saline injection plus PT, it showed that there was no significant difference in VAS and verbal rating scale (VRS) between the two groups. Conclusion: This systematic review and meta-analysis suggest that BVA could be beneficial as an adjuvant treatment for shoulder pain.