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Introduction: Clinically, there is a kind of patients with positional vertigo or dizziness, which occurs when they turn left or right, look down or up, lie down or sit up. With a long duration and varying frequency, it is not consistent with the manifestations of benign paroxysmal positional vertigo (BPPV). In addition, the persistent geotropic direction-changing positional nystagmus (PG-DCPN) was observed in a supine head-roll test. Patient concerns: With no apparent trigger for visual rotation and a sense of self instability, an 81-year-old female patient had suffered from vertigo for 3 days. The vertigo occurred every day, lasting several minutes each time, and associated with head movements and changes in body position. In a supine head-roll test, it appeared persistent geotropic direction-changing positional nystagmus for a long time, without latency, fatigability and in the presence of 3 zero planes. Diagnosis: Light cupula. Interventions: Difenidol hydrochloride 25 mg orally 3 times/day for 2 weeks and betahistine hydrochloride 12 mg orally 3 times/day for 1 month were administered. Outcomes: After 1 month of treatment, the patient's vertigo symptoms disappeared. And in the supine head-roll test, the persistent geotropic direction-changing positional nystagmus disappeared. Conclusion: We report the characteristics of nystagmus produced in a typical patient with light cupula during the supine head-roll test. After reviewing the relevant literatures, we believe that a simpler method can be used to identify canalolithiasis and cupula disease, to distinguish light and heavy cupula, and to determine the pathological semicircular canal to which the lesion belongs.

Outcomes remain poor in children with recurrent ependyomams (rEPNs), despite advances in surgery and radiotherapy. Systemic therapeutic options are limited, given the low response to chemotherapy and targeted drugs. There is an urgent need for efective pharmacotherapy. Apatinib is a multitarget tyrosine kinase inhibitor, which has been reported to exhibit broad antitumor profiles. However, its effects on rEPNs have not been reported thus far.We present a 5-year-old recurrent ependyomam patient benefting from apatinib and temozolomide. The patient was diagnosed with ependyomam in January 2016 and treated with surgery and radiotherapy. After surgery, the patient walked with an mild unsteady gait. He was diagnosed with recurrence in November 2018 following which he was treated with reoperation, reirradiation and chemotherapy (etopside, cisplatin, and temozolomide [TMZ]). The patients increased gait instability in April 2019.Magnetic resonance imaging (MRI) showed progression of the disease. The lession at the left edge of the fourth ventricle and cerebellar peduncles was significantly increased.The patient was administer TMZ (200 mg/m2/d, d1-5, 28 days as a cycle) + apatinib (250 mg, every other day). Twelve cycle of TMZ and apatinib were given.The tumor significantly shrank during the patient received TMZ and apatinib. After 9 months of medication, MRI revealed a nearly complete response However, the tumor progressed on May 5, 2020. From the beginning of the application of TMZ and apatinib, the progression-free survival was 1 year and the survival time was 19 months. Grade 1 leukocytopenia was observed without other adverse effects.Apatinib and temozolomide treatment with mild side effects may be a new option for children with recurrent ependyomams.

Background: Breast cancer is the most common malignancy in women worldwide. Compared with other malignant tumors, breast cancer patients have a higher incidence of depression and other psychiatric symptoms. The purpose of this meta-analysis was to determine the association between long-term survival and depression in patients with breast cancer. Methods: This review will include cohort studies only. Multiple databases will be searched by 2 independent reviewers, including PubMed, EMBASE, the Cochrane Library, and PsycINFO. The language of studies should be English and Chinese, published from inception to the September 2020. Two independent reviewers will carry out literature screening, research selection and data extraction. Revman5.3 software will be used to generate funnel map, assess heterogeneity, make the subgroup analysis and complete sensitivity analysis. Results: This review will summarize the available evidence to determine the association between depression and survival in breast cancer patients. Conclusion: The results of this study will provide reference for the development of comprehensive treatment for breast cancer, and will promote further research. PROSPERO registration number: CRD42020202200

Laparoscopic cholecystectomy is the routine method to treat gallbladder polyps. Nowadays, endoscopic ultrasound (EUS)-guided cholecystostomy as a bridge for per-oral transmural endoscopic resection of gallbladder polyps is introduced because preservation of gallbladder is increasingly getting attention. The aim of our study was to evaluate the approach in the treatment of patients with gallbladder polyps and symptomatic gallstones. EUS-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) was performed for those patients with accompanying gallbladder polyps and symptomatic gallstones. Several days after the cholecystostomy with LAMS, a gastroscope was introduced into the gallbladder to remove gallbladder polyps. All patients were successfully performed with the procedures of EUS-guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 1) and endoscopic resection of gallbladder polyps. One patient experienced severe peritonitis. During the follow-up at 3 months, 1 patient was performed with laparoscopic cholecystectomy because ultrasonography examination showed the reappeared gallstones. No stone recurrence was found in other patients. During the follow-up of 3 to 15 months, no polyp recurrence was found in all the patients. The approach is novel for performing EUS-guided gallbladder fistulization, which can subsequently allow procedures of per-oral transmural endoscopic resection of gallbladder polyps to avoid cholecystectomy in the patients with gallbladder polyps and gallstones. However, further studies are needed before clinical recommendation because of the complications and stone recurrence.

The aim of the study was to analyze the efficacy of posaconazole for the prophylaxis and treatment of invasive fungal diseases (IFDs) in patients with hematological malignancies. In this retrospective observational multi-center study, 762 patients from 25 Chinese hematological centers were enrolled. Inclusion criteria were patients with hematological malignancy or they had undergone hematopoietic stem cell transplantation and received at least 1 dose of posaconazole. The primary endpoints were the observation of breakthrough rates and the clinical efficacy of posaconazole prophylaxis. The secondary endpoint was the efficacy of posaconazole for the treatment of IFDs. Of the 762 enrolled patients, 456 (59.8%) were prescribed posaconazole prophylactically while 243 (31.9%) received posaconazole as an IFD treatment (12 proven, 61 probable, 109 possible, and 61 unclassified IFD cases) for ≥7 days. The overall IFD breakthrough rate (probable cases) for the ≥4 days prophylactic treatment (n = 445) group was 1.6% (95% Cl: 0.6%–3.2%), with breakthrough rates of 2.6% for acute myeloid leukemia/myelodysplastic syndrome patients undergoing chemotherapy and 2.2% for hematopoietic stem cell transplantation patients. For primary antifungal prophylaxis, the breakthrough rate was 1.9% and for secondary antifungal prophylaxis 0%. The overall effective IFD remission rate of patients treated for ≥7 days with posaconazole was 56.0% and the effective remission rate of proven/probable/possible IFD cases was 59.3%. The effective remission rate of posaconazole as salvage therapy was 50% (95% CI: 32.4%–67.6%) including 75% (CI: 19.4%–99.4%) for Aspergillus infections. The present retrospective study confirmed posaconazole as IFD prophylaxis and medication for hematological malignancy patients undergoing various treatments in China.

Background: The high morbidity and mortality of Gastric cancer (GC) is seriously endangered human health. Owing to the low rate of early diagnosis and human body can resistant to the anti-tumor drugs, so an early diagnostic biology marker is essential. However, recently studies indicated that Mammalian target of rapamycin (mTOR) is usually frequently deregulated in many cancers, especially in GC. And the efficacy of mTOR inhibitor was promising in a phase II clinical trial which could inhibited the proliferation of GC cells and delayed tumor progression. Therefore, mTOR were identified as a potential prognosis biomarker for GC, and its inhibitor will be promising in anti-GC therapy. The main aim of this systematic review and meta-analysis is to investigate the relationships between the expression level and prognostic value of mTOR in patients with GC. Methods: Four electronic databases were systematically searched as follow: the PubMed, EMbase, Web of Science databases, and the Cochrane Library. All the data will be extracted by independent researchers from the eligible studies with the inclusion and exclusion criteria. And the data will be analyzed through STATA 12.0 software. Results and conclusion: This meta-analysis indicated that overexpressed mTOR was significantly in predicting a poorer prognosis for GC patients. The expression level of mTOR should be considered as a potential independent prognostic predictor for GC patients. Protocol registration number: CRD42020159690.

Background: Since December 2019, there have been many cases of viral pneumonia of unknown causes in Wuhan City, Hubei Province. During the period of novel coronavirus, according to the observation of limited autopsy and biopsy pathological results, pulmonary interstitial fibrosis appeared in some pathological changes of lung. Idiopathic pulmonary fibrosis (IPF) is a chronic progressive interstitial pneumonia with unknown etiology and pathological changes limited to the lung. At present, there is still a lack of reevaluation of systematic evaluation of traditional Chinese medicine treatment IPF. Therefore, a systematic re-evaluation of the systematic evaluation of traditional Chinese medicine in the treatment of pulmonary fibrosis may help to understand the effective treatment scheme of traditional Chinese medicine in the treatment of pulmonary fibrosis and provide more reliable evidence for the first-line clinicians to treat novel coronavirus. Methods: We will search 3 foreign electronic databases (Cochrane Library, Embase, PubMed) and 4 Chinese electronic databases (China National Knowledge Infrastructure [CNKI], WangFang Database, Chinese Biomedical Literature Database [CBM], and Chinese Scientific Journal Database [VIP]) to collect potential systematic reviews from their inceptions to February 2020. The language of publication is limited to Chinese or English. We will consider SRs and meta-analysis of Traditional Chinese Medicine for the Treatment of pulmonary fibrosis. Two reviewers will identify relevant studies, and then assess the methodological quality by assessment of multiple systematic reviews-2 tool. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) report checklist to assess the quality of reports included in the study. In order to better evaluate the systematic evaluation included in this research, risk of bias in systematic review tool is included in this research to evaluate the methodological quality. The quality of evidence of the included systematic reviews was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Primary outcomes include: Clinical total effective rate, curative effect of TCM symptoms, pulmonary function and blood gas analysis. Results: The results of this study will be published in a peer-reviewed journal. Conclusions: We expect to obtain reliable evidence from systematic analysis of traditional Chinese medicine treatment of pulmonary fibrosis in an available and useful document. Registration number: INPLASY202060029

Background and objectives: Rituximab (RTX) is considered to be a promising drug for curing membranous nephropathy. However, the efficacy and safety of RTX in treating membranous nephropathy remain uncertain. This meta-analysis aimed to investigate the efficacy and safety of RTX in patients with membranous nephropathy. Methods: A literature search was performed using Pubmed, Embase, OVID, and Cochrane Library and randomized controlled trials (RCTs) case-controls and cohort studies published till 30 July 2019 were assessed. The studies assessing the efficacy and safety of RTX in patients with membranous nephropathy were included. Results: Eight relevant trials involving 542 patients were included in the meta-analysis. It was found that RTX did not significantly improve serum albumin levels and e-GFR when compared with the control group (including cyclosporine and cyclophosphamide, chlorambucil, prednisone, non-immunosuppressive anti-proteinuria treatment), serum albumin levels (OR = 0.31, 95%CI–0.12–0.74, P = .15), e-GFR (OR = –1.49, 95%CI–17.14–14.17, P = .85). However, RTX did reduce the serum creatinine (OR = –0.01, 95%CI–0.36–0.34, P = .95) and urinary protein (OR = –2.39, 95%CI –7.30 –2.53, P = .34) levels. Also, in comparison to the control group, RTX did improve the total remission rate (OR = 1.63, 95%CI 0.48–5.54, P = .43), achieve a higher rate of complete remission (OR = 2.54, 95%CI 1.65–3.90, P

Supplemental Digital Content is available in the text, Background: Spasticity is one of the manifestations of motor dysfunction in upper motor neuron syndrome, which is characterized by increased muscle tone. Spasticity seriously affects the motor function and activity of daily life of patients. Some studies have shown that extracorporeal shock wave therapy (ESWT) can relieve spasticity in recent years. However, the effectiveness and safety of ESWT on spasticity after motor neuron injury have not been confirmed. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. Methods: We will search China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wan Fang Data, China Biology Medicine (CBM), PubMed, Embase, The Cochrane Library, and Web of Science systematically from their inception dates through October 2019 to obtain randomized controlled trials (RCTs) using ESWT to relieve spasticity in patients after upper motor neuron injury. The primary outcome will be the Modified Ashworth Scale (MAS). Secondary outcomes will include Composite Spasticity Scale (CSS), Spasm Frequency Scale, Modified Tardieu Scale (MTS), electrophysiological study (ratio of maximum H reflex to maximum M response, root mean square value, integrated electromyogram, co-contraction ratio, etc.), or other spasticity-related outcomes. In addition, adverse events will also be assessed as safety measurement. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager software (RevMan, version 5.3.5) and R (version 3.6.1) software. Results: We will synthesize current studies to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. Conclusion: Our study will provide evidence of ESWT on spasticity after upper motor neuron injury. Ethics and dissemination: The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. PROSPERO registration number: CRD42019131059

Rational: Intravascular large B-cell lymphoma (IVLBCL) is a rare condition with a poor prognosis. The clinical presentation of primary lymphoma of the prostate is non-specific and it is difficult to distinguish from other prostatic diseases. The primary prostate IVLBCL is very rare, the diagnosis and treatment of which remains unclear. We reported a rare case to explore the diagnosis and treatment for the primary prostate IVLBCL. Patients concerns: This report described a case of a 71-year-old male diagnosed as primary prostate IVLBCL who presented with prostatic hyperplasia. Diagnosis: The patient first visited an outpatient clinic of urinary surgery because of urinary urgency and frequency and was diagnosed as benign prostatic hyperplasia in about January 2010. Four years later, the symptoms worsened quickly within two months. The diagnosis was still prostatic hyperplasia according to the physical examination and imaging. However, histopathology showed IVLBCL of prostate after transurethral resection of the prostate. Interventions: With the clear diagnosis of primary prostate stage I IVLBCL, the patient received immunochemotherapy of R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) for 4 cycles and intensity-modulated radiation therapy (IMRT) including the region of prostate with the dose of 45Gy/25f. Outcomes: The response was complete remission after all treatment. The last follow-up time of the patient was June 20th, 2019, and no evidence of disease progression was observed. The progression-free survival of the patient was about 49 months until now. Lessons: The biopsy of prostate by prostatectomy plays an important role in the diagnosis and removal of the original lesion of primary prostate lymphoma. There is no consensus on therapeutic modalities for the treatment of primary prostate IVLBCL till now. Individual treatments include immunochemotherapy and/or radiotherapy according to the National Comprehensive Cancer Network (NCCN) practice guideline of diffuse large B cell lymphoma (DLBCL) based on the performance status and tumor staging of the patient. Timely and accurate diagnosis as well as the appropriate treatment may improve the clinical outcome.

Rationale: Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). Patient concerns: A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. Diagnosis: Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. Interventions: The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. Outcomes: Both patients recovered smoothly after second operation. Lessons: The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.

The objectives of this study were to analyze the clinical features of patients with bone involved lymphoma and identify the prognostic factors and to explore the optimized treatment strategy for bone involved lymphoma. A total of 1948 patients with lymphoma in our cancer center from September 2006 to October 2017 were retrospectively evaluated. Among these, 109 patients with skeletal involvement in lymphoma were enrolled. According to the pathologic subtypes, the patients were divided into 3 subgroups: classic Hodgkin lymphoma (cHL), B-cell non-Hodgkin lymphoma (B-NHL), and T-cell non-Hodgkin lymphoma (T-NHL). The clinical characteristics and overall survival (OS) of 3 groups of patients were reviewed, and the prognostic factors were analyzed. There were 9 (3 unifocal, 6 multifocal) patients with primary bone lymphoma. The 5-year OS of cHL, B-NHL, and T-NHL patients was 88.24%, 54.09%, and 61.58%, respectively. Advanced stage, elevated lactate dehydrogenase (LDH), age above 60, high International Prognostic Index score, and treatment without radiotherapy for the bone involved were significant poor prognostic factors for OS of all patients in univariate analysis. There was a trend toward better OS not only in limited-stage but also in advanced-stage patients with radiotherapy for the bone involved compared with the patients without radiotherapy. Elevated LDH level and age above 60 were the independent unfavorable prognostic factor in multivariate analysis. Elevated LDH level and age above 60 predict the poor prognosis of patients with bone involvement. The potential for long-term survival suggests that additional consolidative radiotherapy for the site of skeleton involvement may have a better chance of long-term success.

Energy metabolism in patients with Hepatocellular carcinoma (HCC) accompanying by hepatitis B cirrhosis is unknown. To compare the differences in liver functions and energy metabolism between patients with hepatitis B-related cirrhosis and patients with HCC. This was a retrospective study of patients with hepatitis B-related cirrhosis (LC group, n = 75) and patients with HCC accompanying by hepatitis B cirrhosis (HCC group, n = 80) treated in Beijing You’an Hospital between January 2013 and June 2017. The resting energy expenditure (REE), respiratory quotient (RQ), carbohydrate oxidation rate (CHO%), fat oxidation rate (FAT%), and protein oxidation rate (PRO%) were measured using a metabolic cart. Liver function, renal function, blood coagulation, etc. were collected. Compared to the LC group, patients with HCC had normal metabolism, but RQ (0.83 ± 0.07 vs 0.85 ± 0.08, P = .073) and CHO% (35.5% vs 49%, P = .013) were lower and FAT% was higher (41% vs 33%, P = .030). Compared with patients with LC group, albumin (ALB), γ-glutamyltranspeptadase (GGT), alkaline phosphatase (AKP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and prothrombin time activity (PTA) were elevated in the HCC group, while total bilirubin (TB), total bile acid (TBA), and international normalized ratio (INR) were reduced (P

Supplemental Digital Content is available in the text, Obstructive sleep apnoea (OSA) is a prevalent sleep disorder considered as an independent risk factor for cardiovascular consequences. It has a strong genetic background and is associated with hypoadiponectinaemia. Target sequencing of whole ADIPONQ gene was performed in 340 participants including 247 patients with OSA and 93 non-OSA participants. Polysomnography was used to diagnose OSA. The associations between variants and OSA were determined by multivariate regression analysis. Thirteen single nucleotide polymorphisms of ADIPOQ were identified in all subjects. Genotype frequencies at rs4686803 (P = .034), rs3774262 (P = .034), and rs2082940 (P = .045) were significantly different between OSA and non-OSA groups. Individuals carrying the CT/TT genotypes of rs4686803, GA/AA genotypes of rs3774262, and CT/TT genotypes of rs1063537 were associated with 2.295-, 2.295- and 2.155-fold increased risk of OSA respectively in dominant model, after adjusting for confounding effects. The subjects with the rs2082940 CC genotype were associated with decreased risk of OSA (OR: 0.455) in recessive model. Additionally, the apnoea–hypopnea index (AHI) was significantly increased in rs3774262 (GA/AA) (P = .001), rs4686803 (CT/TT) (P = .001), and rs1063537 (CT/TT) (P = .004) genotype individuals than those with rs3774262 (GG), rs4686803 (CC), and rs1063537 (CC) genotypes, respectively. The AHI was significantly decreased in individuals with ADIPOQ rs2082940 CC genotypes than in those with the CT and TT genotype (P = .007). Moreover, the stratified analysis found that the genotype of rs3774262 (GA/AA), rs4686803 (CT/TT), and rs1063537 (CT/TT) variants were associated with increased risk of OSA by 2.935-, 2.935- and 2.786-fold in overweight participants. The genotype of rs2082940 CC variants was associated with decreased risk of OSA (OR: 0.373) in overweight participants compared with rs2082940 CT/ TT genotypes. ADIPOQ variants rs3774262, rs4686803, rs1063537, and rs2082940 were associated with the prevalence of OSA in Chinese Han individuals.

In this study, our aim was to compare the efficacy and toxicity profiles of gemcitabine, cisplatin, and dexamethasone (GDP) and ifosfamide, carboplatin, and etoposide (ICE) regimens in the salvage treatment of relapsed/refractory lymphoma. A total of 110 patients with refractory/relapsed classical Hodgkin lymphoma (n = 22) or non-Hodgkin lymphoma (n = 88) who received GDP or ICE salvage regimens from January 2011 to July 2018 were retrospectively analyzed. Of the 110 patients, 50 patients received GDP, and 60 patients received ICE. The response could be evaluated in all patients. In the GDP group, 30 (60.0%) patients achieved overall response rate (ORR), and in the ICE group, the ORR was 56.6%. Of the classical Hodgkin lymphoma patients, the ORR were 72.8% and 54.6% in the GDP and ICE groups, respectively. Of the non-Hodgkin lymphoma patients, the ORR were 56.4% and 57.1% in the GDP and ICE groups, respectively. Grade I-II toxicity occurred in 16 (32.0%) patients in the GDP group and 18 patients (30.0%) in the ICE group; 14 (28.0%) patients had Grade III-IV toxicity in the GDP group, as did 20 (33.3%) patients in the ICE group. As a result, both GDP and ICE regimens are suitable for the treatment of recurrent/refractory lymphoma. The overall adverse reactions of both regimens are acceptable.

Background Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Studies have found that hypothyroidism can significantly increase cardiovascular risk. Meanwhile, hypothyroidism is a common complication of CKD, but the correlation between hypothyroidism and cardiovascular risk in CKD patients has not been verified and paid enough attention. We therefore plan to conduct a systematic review and meta-analysis to explore whether hypothyroidism was independently predictive for the cardiovascular risk in patients with CKD. Methods We will search in PubMed, Embase Database, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), and Wanfang Database, and include the cross-sectional studies, case--control studies, and cohort studies that explore the association between hypothyroidism and cardiovascular risk in CKD patients. According to the eligibility criteria, two researchers will independently screen the retrieved literature, evaluate the methodological quality, and extract data. We will combine the extracted data based on STATA and TSA software. Results This systematic review will assess the association between hypothyroidism and cardiovascular risk in CKD patients based on the incidence of cardiovascular events in CKD people with hypothyroidism. Conclusions This study will provide more evidence for the correlation between hypothyroidism and cardiovascular risk in CKD patients, which will contribute to the management and clinical practice of CKD population. Ethics and dissemination This protocol is based on available literatures so that the ethical approval and informed consent are not applicable. The results of this study will be published in a peer-reviewed journals or relevant conferences. Protocol registration number INPLASY2020100022.

Background Sodium cantharidinate/vitamin B6 (SC/VB6) injection, a famous insect-derived traditional Chinese medicine preparation, has been widely applied as a promising adjunctive drug for hepatocellular carcinoma (HCC). However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy of SC/VB6 injection on survival, liver function, immune function, and quality of life (QoL) in patients with HCC through the meta-analysis. Methods All available randomized controlled trials (RCTs) and high-quality prospective cohort studies that investigated the efficacy and safety of SC/VB6 for patients with HCC were searched from ten electronic databases including PubMed, Google Scholar, Cochrane Library, Excerpt Medica Database (Embase), Medline, Web of Science (WOS), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (CSJ), and Wanfang Database. Papers in Chinese or English published from January 2000 to July 2020 will be included without any restrictions.Study selection and data extraction will be performed independently by 2 researchers. The clinical outcomes including overall survival (OS), QoL, liver function, immune function, and adverse events, were systematically evaluated. Review Manager 5.3 and Stata 14.0 were used for data analysis, and the quality of the clinical trials was also evaluated. Results The results of this study will be published in a peer-reviewed journal, and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for HCC patients. Conclusion Our study will draw an objective conclusion of the efficacy of SC/VB6 on survival, liver function, immune function, and QoL in patients with HCC. Inplasy registration number INPLASY202070121.

Background Essential hypertension is one of the risk factors of cardiovascular and cerebrovascular diseases, which can cause target organ damage such as heart, brain and kidney, and has extremely high disability rate and death rate. With the development of economy and society, the prevalence rate of hypertension in China has increased rapidly from 9.8% in the 1980s to over 30% in the 21st century. According to the data published in "China Cardiovascular Disease Report 2018," China currently has 245 million hypertension patients. Comprehensive prevention and treatment of hypertension has become one of the major public health problems in China. The clinical practice and theoretical innovation of traditional Chinese medicine in the prevention and treatment of hypertension have been carried out for decades. Relevant literature points out that Tianma Gouteng Decoction combined with Qiju Dihuang Pill has ideal effect in the treatment of primary hypertension. However, most of the literatures are small sample studies, with uneven quality and clinical evidence, and lack of evidence-based medical evidence for clinical efficacy. Therefore, this study makes further meta-analysis of Tianma Gouteng Decoction combined with Qiju Dihuang Pill in the treatment of primary hypertension, with a view to providing evidence-based medical evidence for the treatment of primary hypertension. Methods We will search 3 foreign electronic databases (Cochrane Library, Embase, PubMed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database) to collect potential systematic reviews from their inceptions to February 2020. The language of publication is limited to Chinese or English. First, the quality of randomized controlled trials documents included in this study was evaluated by using the improved Jadad scoring scale. Then, the 2 researchers conducted the evaluation independently according to Cochrane bias risk tools. The evidence level of the results will be evaluated by using the recommended evaluation, development and evaluation grading of recommendations assessment, development, and evaluation method. Statistical analysis will be conducted using Revman 5.3. Results The results of this study will be published in a peer-reviewed journal. Conclusions The conclusion of this study will provide evidence for the efficacy of Tianma Gouteng Decoction combined with Qiju Dihuang Pills in the treatment of primary hypertension due to the efficacy of western medicine alone in treating primary hypertension. Registration number prospero INPLASY202050088.

Background: Many research has indicated that some Chinese herb injections (CHIs) might be beneficial in combination with chemotherapy, however, with inconsistent results. Hence, the purpose of this network meta-analysis is to evaluate different CHIs plus cisplatin and gemcitabine (GP) with GP alone in terms of clinical efficacy and safety for treating patients with advanced NSCLC. Methods: A comprehensive systematic search of clinical randomized controlled trials (RCTs) published in the PubMed, Embase, Web of Science (ISI), Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Full-Text Database (VIP), Wanfang Database and China Biological Medicine Database (CBM) databases will be conducted to identify eligible studies up to the date of May 2020. The primary outcome measures objective response rate and adverse reactions (nausea and vomiting, leukopenia). The secondary outcome measures median survival time (MST), disease control rate, and quality of life. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The network meta-analysis will be performed using WinBUGS 14 and Stata 15.1 software. Results: Based on the current evidence, the potential rank of the efficacy and safety of CHIs plus GP chemotherapy for advanced NSCLC will be assessed, and a prioritization regimen will be summarized. Conclusion: Evidence from this systematic review could be useful for patients, clinical practitioners, and guideline-makers to select an optimum proposal of CHIs plus GP for advanced NSCLC. Ethics and dissemination: It is not necessary for ethical approval because it is based on published studies. The protocol will be disseminated in a peer-reviewed journal or presented at a topic-related conference. PROSPERO registration number: CRD42020167142

Supplemental Digital Content is available in the text, Background: At present, there is no effective therapy for preventing myocardial ischemia reperfusion injury (MIRI), and it is inevitable. The methods how to effectively decrease MIRI have attracted the attention of medical researches in recent years. Quercetin is a part of natural flavonoids in plant polyphenols. Many studies have found that quercetin has a positive effect on MIRI. Methods: In order to clarify the effectiveness and potential mechanisms of quercetin for MIRI animals, we searched for animal studies of quercetin for MIRI in Wanfang data Information, Chinese National Knowledge Infrastructure, VIP information database, China Biology Medicine disc, EMBASE, PubMed, and Web of Science. Participant intervention comparator outcomes of this study are as flowing: P, rats in MIRI; I, received quercetin treatment merely; C, received only vehicle or no treatment; O, Main outcomes are myocardial infarction size and markers of myocardial injury. Additional outcomes are serum indices or protein levels tied to the mechanisms of quercetin in myocardial l/R injury. Review Manager 5.2 software and Stata14.0 will be used for data analysis. SYRCLE's risk of bias tool will be used for risk of bias analysis of animal studies. Discussion: This preclinical systematic review and meta-analysis will evaluate the effects and mechanisms of quercetin for MIRI animals, and provide more evidence-based guidance for transforming basic research into clinical treatment. Trial registration: INPLASY202050067, registered on 16/5/2020.

Supplemental Digital Content is available in the text, Background: Single nucleotide polymorphisms (SNPs) have been inconsistently associated with pancreatic cancer (PC) risk. This meta-analysis aimed to synthesize relevant data on SNPs associated with PC. Methods: Databases were searched to identify association studies of SNPs and PC published through January 2020 from the databases of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database (VIP) and Wanfang databases. Network meta-analysis and Thakkinstian algorithm were used to select the most appropriate genetic model, along with false positive report probability (FPRP) for noteworthy associations. The methodological quality of data was assessed based on the STREGA statement Stata 14.0 will be used for systematic review and meta-analysis. Results: This study will provide a high-quality evidence to find the SNP most associated with pancreatic cancer susceptibility and the best genetic model. Conclusions: This study will explore which SNP is most associated with pancreatic cancer susceptibility. Registration: INPLASY202040023.

To evaluate the diagnostic efficiency of computer-aided diagnosis (CAD) system and 111 radiologists with different experience in identifying benign and malignant thyroid nodules, and to summarize the ultrasound features that may affect the diagnostic of CAD and radiologists. Fifty thyroid nodules and 111 radiologists were enrolled in this study. All the 50 nodules were diagnosed by the 111 radiologists and the CAD system simultaneously. The diagnostic performance of the CAD system, senior and junior radiologists with the maximum accuracy were calculated and compared. Interobserver agreement for different ultrasound characteristics between the CAD and senior radiologist were analyzed. CAD system showed a higher specificity than junior radiologist (87.5% vs 70.4%, P = .03), and a lower sensitivity than the senior radiologist and junior radiologist but the statistics were not significant (76.9% vs 86.9%, P > .5; 76.9% vs 82.6%, P > .5). The CAD system and senior radiologist got larger AUC than junior radiologist but the differences were not statistically significant (0.82 vs 0.76, respectively; P = .5). The interobserver agreement for the US characteristics between the CAD system and senior radiologist were: substantial agreement for hypoechoic and taller than wide (kappa value = 0.66, 0.78), and moderate agreement for irregular margin and micro-calcifications (kappa value = 0.52, 0.42). The CAD system achieved equal diagnostic accuracy to the senior radiologists and higher accuracy than the junior radiologists. The interobserver agreements in the US features between the CAD system and senior radiologist were substantial agreement for hypoechoic and taller than wide; moderate agreement for irregular margin and micro-calcifications. The location of a thyroid nodule and the feature of macrocalcification with wide acoustic shadow may influence the analysis of the CAD system.

To evaluate the safety and efficiency of sunitinib and sorafenib in the treatment of renal cell carcinoma (RCC).Databases were searched up till February 28, 2018. Two reviewers independently assessed trials for eligibility, quality, and extracted relevant data. Results are expressed as risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI). Six studies including 3112 patients were accessed. Sorafenib group exhibited higher median progression-free survival (mPFS) compared to sunitinib group (MD, -1.30; 95% CI, -2.56 to -0.03), especially in the first-line treatment (MD, -1.33; 95% CI, -2.61 to -0.04). However, sunitinib significantly reduced the risk of progression-free survival (PFS) compared to sorafenib (HR, 0.71; 95% CI, 0.6-0.82). Sunitinib also significantly reduced risk of overall survival (OS) compared to sorafenib (HR, 0.79; 95% CI, 0.65-0.92), while median OS was similar in both groups (MD, -0.48; 95% CI, -3.40-2.43). With regards to safety, the risk of rash (RR, 0.31, 95% CI, 0.12-0.79) was greater in sunitinib than sorafenib group, while the risk of decreased appetite (RR 2.10, 95% CI: 1.33-3.30) and dehydration (RR 2.73, 95% CI: 1.14-6.56) was smaller in contrast.Based on risk of PFS and OS, sunitinib was a better treatment option for RCC treatment while patients faced with severe skin reaction. And for those Asian patients classified under MSKCC moderate risk, whether in first or second-line treatment, had difficulty in feeding, sorafenib is a better choice for prolong mPFS.

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.

Supplemental Digital Content is available in the text, Background: There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore we aimed to systematically review and analyze the available evidence about the association between HF and dementia. Methods: In the present study, we searched for articles published until August 2019 in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The pooled multivariate odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) were obtained by the use of STATA 12.0 software. Results: The meta-analysis showed a positive association between HF and risk of all-cause dementia (OR/RR = 1.28, 95% CI 1.15 to 1.43, I2 = 70.0%, P

Background Hemifacial spasm (HFS) brings a lot of trouble to patients' daily life, having a severe influence on the psychological and physical wellbeing of patients. Relevant researches suggested that acupuncture therapy has potential benefits for HFS. However, there is no consistent conclusion. The purpose of our study is to assess whether acupuncture therapy is effective and safe for HFS. Methods To collect relevant randomized controlled trials (RCTs), the following electronic databases will be searched: Web of Science, the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge, PsycINFO, Allied and Alternative Medieine, Chinese National Knowledge Infrastructure, Wanfang data, and Chinese Scientific Journals Database. We will take the cure rate and the total effective rate as the primary outcomes, and change in intensity after treatment, change in frequency after treatment, the recurrence rate, and adverse events as secondary outcomes. Endnote software 9.1 will be used for study selection, Review Manager software 5.3, and STATA 13.0 software will be used for analysis and synthesis. Results Current relevant studies will be synthesized to assess whether acupuncture therapy is effective and safe for HFS. Conclusion Our research will provide evidence of acupuncture therapy for HFS. Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019142473.

Rationale: Rhizobium radiobacter is a Gram-negative pathogen present in soil and plants. Cases of R radiobacter infection in immunocompromised hosts have been sporadically reported. However, septic shock caused by R radiobacter is rarely seen. Patient concerns: Here, we describe an elderly patient with a rapid progression of watery diarrhea, anorexia, fever, weakness, oliguria, and shock. Blood results showed increased total white blood cell count and C-reactive protein. Arterial blood gas results showed hypoxia and elevated lactate level. The Sequential Organ Failure Assessment score was 11. Blood culture at admission showed Gram-negative bacteria, which were later confirmed as R radiobacter. Diagnosis: Septic shock caused by R Radiobacter. Interventions: The patient was treated with intravenous cefoperazone/sulbactam and sequential oral levofloxacin. Outcomes: The patient recovered completely. Conclusion: R radiobacter may be considered as a potential opportunistic pathogen that may cause severe sepsis in elderly patients, especially those with multiple underlying diseases.

Background Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of aphasia after cerebrovascular accidents (CVA). This protocol of systematic review (SR) aims to investigate the effectiveness and safety of rTMS in patients with aphasia after CVA. Methods The following databases will be searched: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data, and China Biology Medicine (CBM) from inception to August 2019. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS for aphasia patients after CVA will be included. Primary outcome will include Boston Diagnostic Aphasia Examination (BDAE). Secondary outcomes will include Aphasia Battery of Chinese (ABC), Aachen Aphasia Test (AAT), Aphasia Quotient (AQ), the Western Aphasia Battery (WAB), Standard Language Test of Aphasia (SLTA), Aphasia Severity Rating Scale (ASRS), Concise China Aphasia Test Scale (CCAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), or other related outcomes. Adverse events such as headache, tinnitus, anxiety, fatigue, or epileptic seizure will be considered as safety measurement. Studies screening, data extraction, and methodological quality assessment will be performed independently by two reviewers. Meta-analysis will be conducted with Review Manager 5.3 software and R software 3.6.1. Results This study will provide a high-quality synthesis of RCTs on the effectiveness and safety of rTMS as an adjuvant therapy in the treatment of aphasia. Conclusion The conclusion of this study will help clinicians and patients with aphasia after CVA to make decision. Ethics and dissemination No privacy health information will be collected, thus formal ethics approval is not required. The findings of this SR will be submitted to a peer-reviewed journal. Prospero registration number CRD42019144587.

Background: Persistent and intractable hiccups bring serious inconvenience to patients’ work and daily life, and impair their quality of life. Relevant studies showed that acupuncture therapy might be effective in treating persistent and intractable hiccups. However, there is no consistent conclusion so far. The aim of our research is to investigate the safeties and effectiveness of acupuncture in treating patients with persistent and intractable hiccups. Methods: We will search randomized controlled trials (RCTs) using acupuncture therapy to treat persistent and intractable hiccups in the following 6 English electronic databases and 3 Chinese electronic databases: MEDLINE, EMBASE, the Cochrane Library, Web of Science, PsycINFO, Allied and Alternative Medicine (AMED), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) and Wanfang data. The cure rate and the total effective rate will be considered as the primary outcomes. Complete cessation within a given period post-treatment of hiccups, changes in frequency or intensity of hiccups, concomitant symptom score, and adverse events will be considered as secondary outcomes. We will use Endnote software 9.1 for studies selection, Review Manager software 5.3, and STATA 13.0 software for analysis and synthesis. Results: we will synthesize current studies to evaluate the the safeties and effectiveness of acupuncture for persistent and intractable hiccups. Conclusion: Our study will provide evidence of acupuncture therapy for persistent and intractable hiccups.

So far, liver transplantation (LT) has become the most effective way to treat end-stage liver-related diseases. As we all know, a stable caregiver is crucial to LT recovery. However, compared with LT patients, few studies were focused on LT caregivers. This study aimed to describe the quality of life (QoL), care burden, and their related factors in caregivers of LT patients in Shanghai, China. We collected 225 liver transplanted patients and their corresponding caregivers’ social demographic and medical information; meanwhile, we assessed 225 LT recipients’ caregivers’ life quality; by using Caregiver Quality of Life Index-Liver Transplantation in Chinese version (CQOLC-LT), Zarit caregiver burden inventory in Chinese version (ZBI) was used to access the care burden. Self-Rating Anxiety Scale (SAS) and Center for Epidemiological Survey-Depression Scale (CES-D) were used to assess caregivers’ anxiety and depression status. For physical assessment, we used Fatigue Scale-14 (FS-14). Logistic regression analysis was performed to identify clinical factors influencing QOL of LT primary caregivers. The QoL of LT caregiver was not optimistic; the care burden on caregiver was still heavy. In particular, most caregivers experienced mild to moderate mental health disorders. In general, our findings emphasized the importance of assessment of physical and mental health in primary caregivers during overall process.

This study aimed to determine if the immunoscore (IS) staging system would be a potential prognostic factor in hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) in China. IS was performed in a consecutive cohort of HBV-HCC patients (n= 92). CD3+, CD8+, and CD45RO+ T cells were quantified by immunohistochemical analyses. The patients were stratified into 5 IS groups: I0, I1, I2, I3, I4 for every 2 cell phenotypes (IS1 (CD8/CD45RO, IS2 (CD3/CD8), and IS3 (CD3/CD45RO), respectively. ImagePro Plus software was used in the calculation of the paraffin-embedded tumor sections. The staining of CD3+, CD8+, and CD45RO+ cells in the HBV-HCC tissue demonstrated that there were higher density and larger area of lymphocytes in the invasive margins (IM) region than in the center (CT). Univariate analysis showed that preoperative TNM staging (P = .01), serum gamma-glutamyl transpeptidase (GGT) level (P = .03), vascular invasion (P = .00), and density of CD3+T (CT) (P = 0.01) were correlated significantly with disease-free survival (DFS); serum alpha-fetoprotein (AFP) level (P = .02), tumor size (P = .00), serum cholinesterase (CHE) (P = .04), and GGT level (P = .01), density of CD3+T(CT) (P = .00), CD8+T(CT)(P = .00), CD45RO+T(CT) (P = .00), and CD45RO+T (IM) (P = .02) were correlated with overall survival (OS). Multivariate analysis showed that TNM staging was not an independent prognostic factor of DFS and OS. Our results showed ISs did not have a significantly correlation with DFS (P = .35, .19, and .07, respectively), but it was correlated significantly with OS (P = .00, .00, and .00, respectively). There were statistical differences among the OS of every ISs subgroup except I0 and I1 by the Cox regressions analysis. The IS staging was closely related to the outcome of patients. It can compensate the TNM tumor classification system in predicting the prognosis of HBV-HCC patients.

Background: Competing endogenous RNA (ceRNA) regulation is a novel hypothesized mechanism that states RNA molecules share common target microRNAs (miRNAs) and may competitively combine into the same miRNA pool. Methods: Zinc finger protein 148 (ZNF148) and TOP2A expression were analyzed in 742 colorectal cancer (CRC) tissues using immunohistochemistry (IHC). ZNF148 mRNA, TOP2A mRNA, miR101, miR144, miR335, and miR365 expression were estimated in 53 fresh frozen CRC tissues by reverse transcription polymerase chain reaction. Mechanisms underpinning ceRNA were examined using bioinformatics, correlation analysis, RNA interference, gene over-expression, and luciferase assays. Results: Protein levels of ZNF148 and TOP2A detected by IHC positively correlated (Spearman correlation coefficient [rs] = 0.431, P

Background: To investigate the association between pretreatment corneal parameters and orthokeratology lens decentration. Methods: This retrospective study included a total of 108 eyes in 60 myopia patients, who were divided into a lens-decentration and a control group. Various pretreatment corneal parameters were analyzed by receiver operating characteristic curves (ROC curves), including corneal horizontal and vertical curvatures, diopter, corneal eccentricity (E-value), asphericity (Q-value), diameter, and astigmatism, to establish a reliable predictive model for orthokeratology lens decentration. Results: The temporal and inferior quadrants are preferential sides for lens decentration, which was associated with the occurrence of complications such as ghosting and corneal epithelial staining. By further analysis, we revealed lower corneal horizontal curvature and much higher corneal Q-value differences between the nasal–temporal and superior–inferior quadrants in the lens-decentration group compared to the control group (P

Introduction Spasticity is the most common complication after stroke, which is the main obstacle in the recovery of motor function. Spasticity seriously affects the quality of life and brings a heavy burden to families and society. Acupuncture is an effective method for stroke. However, whether acupuncture is effective for poststroke spasticity is still unknown. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of acupuncture for poststroke spasticity. Methods and analysis We will search the following databases from inception to July 2019: China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang Data, the Chinese Science and Technology Periodical Database (VIP), PubMed, Embase, The Cochrane Library, and Web of Science. All relevant randomized controlled trials (RCTs) utilizing acupuncture for poststroke spasticity will be included. The primary outcome is the modified Ashworth scale. Secondary outcomes include composite spasticity scale, clinic spasticity index, electromyographic activity, Hoffmann reflex activity, or other spasticity-related outcomes. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be conducted using Review Manager V5.3 software. Ethics and dissemination The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. Prospero registration number CRD42019129779.

Introduction:To investigate the effectiveness and safety of electromyography (EMG) biofeedback therapy in improving motor dysfunction among children with cerebral palsy (CP).Methods and analysis:The following databases will be searched: PubMed, EMBASE, ScienceDirect, the Cochrane Library, Ch

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.

Background Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for chronic pulmonary obstructive disease (COPD) treatment and rehabilitation, yet their comparative effectiveness and safety remains unclear. Therefore, this study will aim to compare their effectiveness and safety for COPD by implementing a network-meta analysis. Methods Electronic databases including MEDLINE via Ovid, and EMBASE via Ovid, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and Chinese BioMedical Literature Database (CBM) will be searched for related randomized controlled trials (RCTs) from inceptions to the search date without language restrictions. RCTs that compare TCM nonpharmacological interventions with placebo or conventional treatments will be included. The primary outcome will be lung function measures, dyspnea level and COPD-specified life quality and secondary ones will include functional exercise capacity, and general health-related life quality. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. Continuous data will be expressed as standard mean differences (SMDs) and categorical data as risk ratios (RRs) with 95% confidence intervals. The evidence transitivity and consistency within network will be evaluated with Cochrane Q statistic and net-heat plot. Results The study results will be disseminated through a peer-reviewed journal publication or conference presentation. Conclusions The review findings will provide a ranking evidence of current TCM nonpharmacological interventions and help to inform clinical practitioners, COPD patients, and policy-makers in the decision-making. Trial registration number PROSPERO CRD42019126554.

Introduction:To investigate the effectiveness and safety of Tai Chi for improving balance and reducing falls on people.Methods and analysis:The following databases will be searched: China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Wan Fang Data, the Chinese Scien