• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.539-548
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• 2022

Objective : Although full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. Methods : We systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. Results : Four retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669-35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941-41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. Conclusion : Relative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.2
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• pp.65-81
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• 2022

Objectives This study aimed to assess the effects of oral administration of deer antler extracts on an osteoporosis-induced animal model. We analyzed the results of using deer antler single extracts on animal models with osteoporosis through a systematic review and meta-analysis. Methods We included osteoporosis studies in animal experiments that administrated deer antler extracts orally. We searched the following 13 databases without a language restriction: PubMed, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang, Korean Medical Database (KMbase), National Digital Science Library (NDSL), Korean Traditional Knowledge (Koreantk), Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Sharing Service (RISS), Korea Institute of Science and Technology Information (KISTI), and Koreanstudies Information Service System (KISS). We used Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool for assessing the methodological quality of the included studies. Results A total of 299 potentially relevant studies were searched and 11 were included for a systematic review. Nine studies used a single deer antler extract. A study compared the effects of single extracts of deer antler and antler glue, while another study compared the effects of three single extracts of deer antler, old antler, and antler glue. For evaluating the intervention effect, bone mineral density (BMD) was measured as the primary outcome, while the histomorphometric indicators of the bone and serum alkaline phosphatase and osteocalcin levels were used as the secondary outcome variables. On conducting a meta-analysis of studies on single deer antler extract, BMD was observed to be significantly increased compared to that in control group (standardized mean difference [SMD]=2.11; 95% confidence interval [CI]=1.58~2.65; Z=7.75; p<0.00001; I²=56%). As a result of meta-analysis, according to the concentration of deer antler, the group with high concentration showed statistically significantly higher BMD than the group with low concentration (SMD=1.28; 95% CI=0.74~1.82; Z=4.63; p<0.00001; I²=9%). Conclusions The research shows that the deer antler extracts have significant anti-osteoporotic effects on the osteoporosis-induced animal model. However the studies included in this research had a high methodological risk of bias. This indicates the requirement of considerable attention in the interpretation of the study results.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.1
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• pp.107-124
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• 2022

Objectives This study aimed to identify optimal combinations of acupoints used to treat chemotherapy-induced peripheral neuropathy (CIPN). Methods We searched four international databases (MEDLINE, EMBASE, the Allied and Complementary Medicine Databases [AMED], and China National Knowledge Infrastructure [CNKI]) and five Korean databases (DBpia, Research Information Sharing Service [RISS], Korean Studies Information Service System [KISS], Oriental Medicine Advanced Searching Integrated System [OASIS], and KoreaMed) to identify randomized controlled trials (RCTs) that used acupuncture to treat CIPN. Network analysis was performed on the acupoints used in more than three included articles. We constructed a network by calculating the Jaccard similarity coefficient between acupoints and applied minimum spanning tree. Then, modularity analysis, degree centrality (Cd), and betweenness centrality (Cb) were used to analyze properties of the acupoints. Results A total of 25 articles were included. 24 acupoints were extracted from 25 articles. The combinations of acupoints having the highest Jaccard similarity coefficient were {EX-UE9, EX-LE10} and {ST36, SP6}. In the modularity analysis, acupoints were classified to six modules. ST40, EX-UE11, and KI6 had the highest Cd value while ST40, GB34 had the highest Cb value. Conclusions This study found the systematic framework of acupoint combinations used in CIPN studies. This study is expected to provide new perspectives of CIPN treatment to therapists. A RCT is in progress of using the network of this study as a guideline. If significant results are derived from the RCT, it will be possible to lay the groundwork to consider acupuncture for CIPN treatment.

• The Journal of the Society of Stroke on Korean Medicine
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• v.23 no.1
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• pp.25-40
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• 2022

■Objectives This study aimed to collect and analyze clinical studies on the significance of acupuncture in the treatment of hypertension among Korean patients. ■Methods Among Korean patients with a blood pressure (BP) of 120 mmHg or higher and a diastolic BP of 80 mmHg or higher, those, treated with acupuncture only, were included. A literature search was conducted through 'Embase', 'Medline', 'Science and Technology Information Integration Service (NDSL)', 'Traditional Korean Knowledge Portal (OASIS)', 'PubMed', and 'Scopus'. The search keywords were (hypertension OR 'blood pressure') AND acupuncture. The papers, published before the day of the search (02. January 2022), were included in this study. ■Results Among the 12 selected papers, seven involved randomized controlled trial (RCT), four before-and-after studies, and one case series. The number of RCTs has increased yearly. The treatment methods used in the studies included needle acupuncture in eight studies, auricular acupuncture in two, pharmacopuncture in one, and si-acupuncture in one. The average numbers of patients enrolled in RCTs, before-and-after studies, and case series were 21.1, 30, and 23 respectively. Six studies were conducted on prehypertensive patients, two on stage 1 hypertension patients, and four on stage 2 hypertension patients. The involved acupoints have been reported to be ST36 in eight papers, LI11 in four papers, and PC6 in three papers. The treatment period lasted for < 1 week in eight studies and 8 weeks in four studies. Acupuncture successfully lowered blood pressure in nine out of 12 studies ■Conclusions Acupuncture is a viable alternative treatment option for prehypertensive patients, who are not taking medications. Additionally, it is also useful in further lowering the BP of patients with stage 1 and stage 2 hypertension in the short term. Large-scale and long-term studies on acupuncture for hypertension should be conducted.

• The Journal of Korean Medicine
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• v.43 no.1
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• pp.136-153
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• 2022

Objectives: The aim of this study was to find out whether east asian herbal medicine (EAHM) treatment alone is effective in improving pregnancy-related indicators compared to conventional medicine in women with Diminished Ovarian Reserve (DOR). Methods: We searched eligible studies from PubMed, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure Database, CiNii, Korean Medical Database, Korean Studies Information Service System, Oriental Medicine Advanced Searching Integrated System, ScienceOn. GRADE pro was used to evaluate the current evidence of the study. Result: A total of 5 studies, 325 women with DOR were included. EAHM showed a significant effect on improvement of pregnancy rate (n=270, RR 2.13 [95% CI 1.44 to 3.15], Z=3.78, p=0.0002, I2=0%) and Anti-Mullerian Hormone (AMH) level (n=211, SMD 0.82 [95% CI 0.40 to 1.25], Z=3.80, p=0.0001) compared to conventional medicine. In ovulation rate (n=156, RR 0.86 [95% CI 0.70 to 1.06], Z=1.43, p=0.15, I2=0%), Antral Follicle Count (n=245, SMD 0.27 [95% CI -0.25 to 0.79], Z=1.01, p=0.31), and follicle stimulating hormone (n=245, SMD 0.29 [95% CI -0.13 to 0.70], Z=1.36, p=0.17) level, EAHM showed similar effects to conventional medicine. In this study, the most frequently used herbal medicines were Cuscutae Semen, Dipsaci Radix, and Angelicae Gigantis Radix. Conclusion: This meta-analysis showed that EAHM could improve pregnancy rates and AMH levels in women with DOR. However, more well-designed RCTs will have to be performed further in the future.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.323-338
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• 2022

Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène^®, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0-10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.5
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• pp.353-375
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• 2022

No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA). A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08-0.33; I²=46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00-63.63; I²=96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01-0.73; I²=80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00-0.62; I²=69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00-3.22; I²=86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00-175.21; I²=94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.

• Korean Journal of Acupuncture
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• v.40 no.3
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• pp.62-78
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• 2023

Objectives : This study aims to assess the impact of acupotomy on migraine through an examination of clinical studies conducted since 2015. Methods : We conducted a comprehensive search for randomized controlled trials (RCTs) and non-randomized controlled trials (nRCTs) related to acupotomy treatment for migraine, utilizing five Korean online databases (OASIS, Science ON, DBPIA, KISS, RISS), as well as four foreign online databases (CNKI, PubMed, EMBASE, Cochrane Library). We identified a total of 10 relevant studies for analysis. Participants characteristics, treatment points, combination treatments, treatment cycles or frequencies, evaluation indices, efficacy, and adverse events were analyzed. The risk of bias in the 10 RCTs was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). Results : A total of 931 participants were included in 10 studies. In the intervention group, the average duration of migraine morbidity ranged from 15.5±4.5 months to 15.9±4.2 years. Six studies based their diagnoses on the International Classification of Headache Disorders (ICHD), while five studies relied on Chinese diagnostic criteria. All studies specified the treatment area as the region exhibiting tenderness or induration on the head and neck. Treatment cycles ranged from a minimum of 2 days to a maximum of 1 week, with the number of days per treatment course varied from 5 days to 4 weeks. The diameter of acupuncture needles used varied between 0.3 mm and 1 mm. Of the eight studies specifying needle length, the shortest was 20 mm, and the longest was 40 mm. A total of eight evaluation indices were employed, with total efficacy rate (TER) and visual analogue scale (VAS) being the most frequently used. Statistically, all intervention groups showed more significant results compared to the control groups. Adverse events were reported in only two studies within the intervention group. Overall, the risk of bias assessment for the selected RCTs ranged from 'some concerns' to 'high risk of bias.' Conclusions : This study showed that acupotomy treatments for migraine were effective.

• Journal of Oriental Neuropsychiatry
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• v.34 no.2
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• pp.95-113
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• 2023

Objectives: To review studies evaluating effects of acupuncture on pain and depressive symptoms in fibromyalgia. Methods: Quantitative evidences (RCTs) were systematically reviewed. Literature were searched for a combination of fibromyalgia and depression (The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, medline (via PubMed), Kmbase, KISS, ScienceON, OASIS, CiNii, CNKI). Quantitative research findings were critically appraised by Cochrane risk of bias (RoB) tool and pooled. Meta-analysis was then conducted using Review Manager (RevMan) 5.4. Results: Eighteen studies were selected. American College of Rheumatology (ACR) classification criteria for Fibromyalgia Syndrome was most frequently used as diagnostic criteria for fibromyalgia. As for outcome measurement, Hamilton Rating Scale for Depression (HAMD), Visual Analog Scale (VAS), and Total Effective Rate (TER) were used most commonly. Meta-analysis of ten studies revealed that both Depression and VAS scores of the Acupuncture+Western Medicine group were significantly lower than those of Western Medicine group (Depression: SMD, -0.94, 95% CI, -1.17 to -0.70; VAS: MD, -1.51, 95% CI, -1.83 to -1.19). Also, TERs of both Acupuncture group and Acupuncture+Western Acupuncture+Western Medicine group were significantly higher than those of the Western Medicine group (OR: 2.38, 95% CI: 1.29 to 4.41; and OR: 7.40, 95% CI: 3.41 to 16.07). There was no significant difference in Depression or VAS score between the Acupuncture Group and the Western Medicine Group. Conclusions: Acupuncture might be an effective option for pain and depressive symptoms of fibromyalgia when it is combined with Western Medicine treatment. For more accurate results, more types of Korean medicine treatment should be conducted.

• The Journal of Internal Korean Medicine
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• v.44 no.3
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• pp.485-505
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• 2023

Objective: The purpose of this study is to assess the effectiveness and safety of using Taeksa-tang for dyslipidemia through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The search was conducted using keywords such as "dyslipidemia", "hyperlipidemia", "taeksa tang", "zexie tang", and "takusha to" in 12 databases (Pubmed, Cochrane, Embase, ScienceDirect, CNKI, Wanfang, CiNii, RISS, KISS, ScienceON, OASIS, and DBpia) on April 13, 2023. There were no limits on the publication period and language. Cochrane's risk of bias (RoB) was used to evaluate the quality of the studies. A meta-analysis was conducted according to the outcome measurements such as total effective rate (TER), total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and adverse effects, using the Review Manager web. Results: A total of 9 RCTs were selected. In evaluating the RoB, 2 studies mentioning the random sequence generation, 1 study conducting double blindness, and 8 studies without missing values were evaluated as low risk, while 1 study without mentioning the random sequence generation was evaluated as high risk. All other parts were evaluated as unclear risk. The treatment group (Taeksa-tang or Taeksa-tang-gagam) showed more statistically significant effects compared to the control group (Western medicine or Chinese patent medicine) in TER (RR : 1.24, 95% CI 1.15 to 1.34, P<0.00001), TC (MD : -1.12, 95% CI -1.68 to -0.56, P<0.0001), TG (MD : -1.08, 95% CI -1.65 to -0.51, P=0.0002), HDL-C (MD : 0.63, 95% CI 0.34 to 0.93, P<0.0001), LDL-C (MD : -0.81, 95% CI -1.10 to -0.53, P<0.00001). In addition, the treatment group showed lower adverse effects compared to the control group (RR : 0.30, 95% CI 0.12 to 0.74, P=0.008). Conclusion: This study suggests that Taeksa-tang is effective and safe to use for treating dyslipidemia. However, due to the low quality of the included studies, more clinical studies need to be conducted in the future to increase the possibility of clinical use.