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The objectives of this study are to conduct a comprehensive literature search and bibliometric analysis to identify the breadth and volume of pharmacological and clinical studies on pine pollen (Pinus pollen) and to identify the potential effects and the use of pine pollen. Three Chinese electronic databases and two English electronic databases were searched for pharmacological and clinical studies on pine pollen. Data were extracted and analyzed and included publication year, authors, study type, pharmacological research topics or clinical diseases/conditions, usage and type of preparation, authors' conclusions, and adverse effects. Of 239 publications identified, 180 were pharmacological studies, 37 were clinical trials, and 22 were reviews. Numbers of publications increased particularly from 2004 onward. The top 10 most frequent topics in pharmacological studies were immune regulation, antisenility, antioxidation, liver protection, inhibiting prostate hyperplasia, inhibiting tumor cell proliferation, lowering blood glucose, lowering blood lipids, antifatigue, and improving intestinal function. The top 10 most frequent clinical diseases treated or where pine pollen was used as an adjuvant were bedsores, diaper dermatitis, hyperlipidemia, oral mucositis, eczema, hyperplasia of prostate, hypertension, prostatitis, type 2 diabetes mellitus, and radiodermatitis. Eight trials reported no adverse events associated with pine pollen, one reported mild gastrointestinal reactions, but symptoms disappeared without special management. There have been an increasing number of publications on pine pollen during the past 20 years. Pharmacological studies have shown many potential benefits, and clinical studies have indicated some positive effects when it is either used as a single herb or as an adjuvant to treat disease. Its use as a topical agent, especially for skin diseases, was notable.

Background: Herbal remedies have been widely utilized in treating chronic hepatitis C (CHC) worldwide. Selecting appropriate outcomes to reflect both beneficial and harmful effects is a crucial step in designing randomized controlled trials (RCTs). This study evaluated the outcomes reported in RCTs on herbal remedies for CHC with comparison to the core outcomes recommended by the Cochrane Hepato-Biliary Group (CHBG), to check the consistency of the outcomes and to provide recommendation for future researches. Methods: A systematic literature search was conducted in Western and Chinese databases to identify RCTs on herbal remedies for adults with CHC. For each trial, all the outcomes reported in the results section were collected. Comparison between trial outcomes and CHBG core outcomes were evaluated and summarized with descriptive statistics. Results: A total of 116 RCTs involving 9154 participants were included; 27 outcomes were identified. Commonly reported outcomes included alanine aminotransferase (64 trials, 55.2%), adverse events (58 trials, 50.0%), and end-of-treatment virological response (50 trials, 43.1%). All trials indicated that the herbal remedies under investigation had a positive effect and was markedly more effective than the control. Nearly half of the trials reported that the combination of herbal medicine and antiviral drugs could ameliorate adverse events. Very few trials reported primary core outcomes relating survival and quality of life. The most frequently reported core outcomes are non-serious adverse events (54 trials, 46.6%), viral response (27 trials, 23.3%), and biochemical response (24 trials, 20.7%). Conclusion: The variation and inconsistency in trial outcomes impedes research synthesis efforts, and indicate the need for comparable outcomes through the development of core outcome sets in CHC. The low concordance of outcome reporting could be improved by following CHBG core outcomes recommendation. Keywords: Chronic hepatitis C, Herbal, Core outcome set, Randomized controlled trial, Cochrane Hepato-Biliary Group

BackgroundNon-traditional acupuncture (NTA) therapies widely used for smoking cessation include acupressure, transcutaneous electrical acupoint stimulation (TEAS), laser acupuncture, intradermal needle, and acupoint catgut embedding (ACE). Our aim was to evaluate their therapeutic effects and safety for smoking cessation. MethodsRandomized controlled trials (RCTs) comparing NTA therapies with sham NTA or conventional therapy for smoking cessation were included. Ten databases were searched from their inception to February 2021. Two review authors independently screened studies, extracted data, and assessed the risk of bias. Meta-analysis was conducted with RevMan 5.4 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to assess the quality of evidence. The primary outcome was abstinence rate at short-term (1-3months), mid-term (3-6months), and long-term (≥6months). ResultsTwenty-five RCTs involving 2600 smokers were identified. Acupressure was found more effective than sham acupressure or conventional therapy in improving short-term (RR 1.41, 95% CI [1.04 to1.91]; low certainty; 8 trials, n=637) and mid-term abstinence rate (RR 1.63, 95% CI [1.27 to 2.09]; low certainty; 8 trials, n=749). Intradermal needle was not superior to sham control or counseling for short-term (RR 1.62, 95% CI [0.85 to 3.08]; low certainty; 5 trials, n=346) and mid-term abstinence rate (RR 1.49, 95% CI [0.68 to 3.27]; low certainty; 3 trials, n=187).TEAS failed to show a better effect than sham TEAS or counseling for short-term abstinence rate (RR 1.27, 95% CI [0.96 to 1.67];moderate certainty;5 trials, n=485), TEAS appeared more beneficial for mid-term abstinence (RR 1.58, 95% CI [1.10 to 2.27]; moderate certainty; 3 trials, n=325). Laser acupuncture was superior to sham control for long-term abstinence rate (RR 2.25, 95% CI [1.23 to 4.11]; moderate certainty; 2 trials, n=160). ACE was comparable to Bupropion for mid-term abstinence rate (RR 0.99, 95% CI [0.70 to 1.40]; low certainty; 2 trials, n=177). No serious adverse events were reported in the included trials. Conclusions Low to moderate certainty evidence suggests that acupressure, TEAS, laser acupuncture and ACE maybe effective in achieving short-term, middle-term or long-term smoking cessation. Further large, long-term follow-up RCTs are warranted to verify their benefits and safety.Systematic review registration: INPLASY 202120054.

To evaluate the efficacy and safety of Compound Glycyrrhizin Injection(CGI) in improving liver damage in chronic hepatitis B(CHB). PubMed, Web of Science, SinoMed, CNKI, Wanfang and VIP databases were retrieved from their inception to February 10, 2020. The randomized controlled trial(RCT) of CGI in the treatment of CHB was included. Data were independently extracted by two authors, and the methodological quality was evaluated using the Cochrane bias risk assessment tool by other two authors. Statistical analysis was performed using RevMan 5.3 software. A total of 18 two-armed RCTs were included, involving 1 915 participants. The methodological quality of all studies included was generally low. In the comparison between CGI and diammonium glycyrrhizinate, the results showed that CGI was superior to the control group in improving the overall clinical effectiveness, but there was no statistical difference between the two groups in increasing ALT normalization rate, reducing ALT and AST level. In the comparison between CGI and diammonium glycyrrhizinate+other general hepatoprotective drugs, the results showed that CGI was superior to the control group in reducing AST level, while there was no statistical difference between the two groups in reducing ALT level and increasing overall clinical effectiveness. In the comparison between CGI+other commonly used drugs(including energy mixture, glutathione, vitamins, potassium magnesium aspartate) and diammonium glycyrrhizinate+other commonly used drugs, the results showed that CGI combined with other commonly used drugs was better than the control group in reducing ALT and AST level and improving the clinical total effective rate, and there was no statistical difference between the two groups in increasing the rate of ALT normalization. In the comparison between CGI+other commonly used drugs and other commonly used drugs, the results showed that CGI combined with other commonly used drugs was superior to the control group in reducing ALT and AST level and improving the overall clinical effectiveness. In the comparison between CGI+vitamins and diammonium glycyrrhizinate+potassium magnesium aspartate+vitamins, the results showed no statistical difference between the two groups in reducing AST level. A small number of studies included reported that CGI caused mild adverse reactions when used alone or in combination with other drugs. Based on the results, CGI has a certain effect in improving CHB liver damage, but the evidence is not enough to prove that CGI would cause serious adverse events. In the future, more well-designed and strictly-enforced RCT with an adequate sample size are needed to further evaluate the effect CGI in alleviating CHB liver damage.

Objective: To present the evidence of the therapeutic effects and safety of Chinese herbal medicine (CHM) used with or without conventional western therapy for COVID-19.Methods: Clinical studies on the therapeutic effects and safety of CHM for COVID-19 were included. We summarized the general characteristics of included studies, evaluated methodological quality of randomized controlled trials (RCTs) using the Cochrane risk of bias tool, analyzed the use of CHM, used Revman 5.4 software to present the risk ratio (RR) or mean difference (MD) and their 95% confidence interval (CI) to estimate the therapeutic effects and safety of CHM.Results: A total of 58 clinical studies were identified including RCTs (17.24%, 10), non-randomized controlled trials (1.72%, 1), retrospective studies with a control group (18.97%, 11), case-series (20.69%, 12) and case-reports (41.38%, 24). No RCTs of high methodological quality were identified. The most frequently tested oral Chinese patent medicine, Chinese herbal medicine injection or prescribed herbal decoction were: Lianhua Qingwen granule/capsule, Xuebijing injection and Maxing Shigan Tang. In terms of aggravation rate, pooled analyses showed that there were statistical differences between the intervention group and the comparator group (RR 0.42, 95% CI 0.21 to 0.82, six RCTs; RR 0.38, 95% CI 0.23 to 0.64, five retrospective studies with a control group), that is, CHM plus conventional western therapy appeared better than conventional western therapy alone in reducing aggravation rate. In addition, compared with conventional western therapy, CHM plus conventional western therapy had potential advantages in increasing the recovery rate and shortening the duration of fever, cough and fatigue, improving the negative conversion rate of nucleic acid test, and increasing the improvement rate of chest CT manifestations and shortening the time from receiving the treatment to the beginning of chest CT manifestations improvement. For adverse events, pooled data showed that there were no statistical differences between the CHM and the control groups.Conclusion: Current low certainty evidence suggests that there maybe a tendency that CHM plus conventional western therapy is superior to conventional western therapy alone. The use of CHM did not increase the risk of adverse events.

Background Lactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor. Material and methods Six major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. Results Fourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45–13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17–9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66–9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92–5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34–6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17–4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09–2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58–3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58–2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25–2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09–2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26–1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25–1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06–2.02; PAR 21.27%). Conclusions This review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.

Background Compound glycyrrhizin injection (CGI) is a preparation with glycyrrhizin as the main active ingredient extracted from licorice. As clinical trials suggest that CGI is effective in improving liver function for acute icteric hepatitis in children (AIHC), this systematic review aimed to evaluate and verify its therapeutic effects and safety. Methods Six electronic databases were searched from their inception to 15 May 2021. Randomized controlled trials (RCTs) assessing therapeutic effects and safety of CGI for AIHC were included. The risk of bias for each trial was assessed using the Cochrane Risk of Bias Tool 2.0. Primary outcomes were indexes related to liver function, including total bilirubin (TBiL), alanine aminotransferase (ALT) and aspartate transaminase (AST). RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool. Results Six RCTs involving 608 children were included. The overall bias was assessed as having "high risk of bias" in all trials. All trials compared the combination of CGI and conventional western medicine (CWM) with CWM alone. Regarding the effects of CGI for AIHC, results showed that CGI plus CWM was superior to CWM alone in reducing the levels of TBiL (mean difference (MD) = -8.19 mmol/L, 95% CI -9.86 to -6.53), ALT (MD = -24.09 U/L, 95% CI -30.83 to -17.34) and AST (MD = -18.67 U/L, 95% CI -21.88 to -15.45). No trial reported adverse events. The certainty of the evidence for outcomes were all evaluated as low or very low. Conclusion CGI may have adjuvant therapeutic effects on improving the liver function of children with AIHC. There is no evidence to determine the safety of CGI for AIHC. As current evidence is weak, further well-designed RCTs are required for verification of the therapeutic effects of CGI.

Background: Lactation mastitis (LM) is one of the most common breast disorders experienced by postpartum women, affecting approximately 3% to 20% breastfeeding mothers. Although a few researches have studied the risk factors related to LM, there are still some inconsistent problems on this topic and nationally representative evidence is scarce. This study was aimed to determine the well-accepted risk factors for LM in Chinese women. Methods: Six electronic literature databases were searched from their inception to June 1st, 2020. We used RevMan5.3 and Stata14.0 for data analysis. The strength of the association was summarized using odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. The fail-safe number (Nfs) was used to estimate publication bias and robustness of the current results. Results: Twelve studies involving 6539 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper breastfeeding posture (OR 2.47, 95%CI 2.09-2.92; PAR 26.51%), improper milking method (OR 6.79, 95%CI 3.45-13.34; PAR 59.14%), repeated milk stasis (OR 6.08, 95%CI 3.75-9.88; PAR 37.42%), little or no cleaning of nipples (OR 2.38, 95%CI 1.88-3.03; PAR 31.28%), abnormal nipple or crater nipple (OR 2.94, 95%CI 1.76-4.91; PAR 33.99%), primipara (OR 1.91, 95%CI 1.26-2.90; PAR 39.06%), history of breast trauma (OR 3.57, 95%CI 2.86-4.46; PAR 13.36%), experience of cesarean section (OR 1.77, 95%CI 1.32-2.38; PAR 28.34%), low educational level (OR 1.85, 95%CI 1.04-3.28, PAR 23.67%), breast massage experience of non-medical personnel (OR 1.90, 95%CI 1.36-2.65, PAR 20.89%), postpartum within 6 months (OR 5.11, 95%CI 2.66-9.82; PAR 65.93%), prone sleeping position (OR 2.53, 95%CI1.51-4.22; PAR 22.72%) and postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92-5.65; PAR 56.95%). There seemed to be good robustness of the pooled results for most of the included risk factors.Conclusion: This study found several important risk factors of LM in Chinese women. In particular, the incidence of LM can be reduced by controlling several modifiable factors such as breastfeeding posture, milking method, milk stasis situation and nipple cleaning condition, etc.

Since December 2019, an outbreak of corona virus disease 2019 (COVID-19) occurred in Wuhan, and rapidly spread to almost all parts of China. This was followed by prevention programs recommending Chinese medicine (CM) for the prevention. In order to provide evidence for CM recommendations, we reviewed ancient classics and human studies. Historical records on prevention and treatment of infections in CM classics, clinical evidence of CM on the prevention of severe acute respiratory syndrome (SARS) and H1N1 influenza, and CM prevention programs issued by health authorities in China since the COVID-19 outbreak were retrieved from different databases and websites till 12 February, 2020. Research evidence included data from clinical trials, cohort or other population studies using CM for preventing contagious respiratory virus diseases. The use of CM to prevent epidemics of infectious diseases was traced back to ancient Chinese practice cited in Huangdi’s Internal Classic (Huang Di Nei Jing) where preventive effects were recorded. There were 3 studies using CM for prevention of SARS and 4 studies for H1N1 influenza. None of the participants who took CM contracted SARS in the 3 studies. The infection rate of H1N1 influenza in the CM group was significantly lower than the non-CM group (relative risk 0.36, 95% confidence interval 0.24–0.52; n=4). For prevention of COVID-19, 23 provinces in China issued CM programs. The main principles of CM use were to tonify qi to protect from external pathogens, disperse wind and discharge heat, and resolve dampness. The most frequently used herbs included Radix astragali (Huangqi), Radix glycyrrhizae (Gancao), Radix saposhnikoviae (Fangfeng), Rhizoma Atractylodis Macrocephalae (Baizhu), Lonicerae Japonicae Flos (Jinyinhua), and Fructus forsythia (Lianqiao). Based on historical records and human evidence of SARS and H1N1 influenza prevention, Chinese herbal formula could be an alternative approach for prevention of COVID-19 in high-risk population. Prospective, rigorous population studies are warranted to confirm the potential preventive effect of CM.

Introduction Non-traditional acupuncture (NTA), defined as the stimulation of certain parts of the body includes; acupressure, transcutaneous electrical acupoint stimulation (TEAS), laser acupuncture, intradermal needle, and acupoint catgut embedding (ACE). This systematic review evaluated their efficacy and safety for smoking cessation. Methods Randomized controlled trials (RCTs) comparing NTA with sham NTA or conventional therapy for smoking cessation were included. Ten databases were searched from their inception to March 2021. Data were synthesized using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). The primary outcome was abstinence rate defined as abstinence between date of quitting and follow-up. Results Acupressure was more effective than sham acupressure or conventional therapy in the short-term (RR 1.41, 95% CI [1.04 to1.91]; low certainty; 8 trials, n=637) and for mid-term smoking cessation (RR 1.63, 95% CI [1.27 to 2.09]; low certainty; 8 trials, n=749). TEAS appeared more beneficial for mid-term abstinence (RR 1.58, 95% CI [1.10 to 2.27]; moderate certainty; 3 trials, n=325). Laser acupuncture was superior to sham control for long-term abstinence (RR 2.25, 95% CI [1.23 to 4.11]; moderate certainty; 2 trials, n=160). ACE was comparable to Bupropion for mid-term smoking cessation (RR 0.99, 95% CI [0.70 to 1.40]; low certainty; 2 trials, n=177). No serious adverse events were reported. Conclusions Low certainty evidence suggests that NTA was effective in short-term, middle-term or long-term smoking cessation. Further long-term follow-up RCTs are warranted to verify these benefits. Registration INPLASY 202120054.

Background Breast pain is one of the most common breast disorders, affecting 41%–69% women in the clinical populations. Chinese herbal medicine (Rupi Sanjie, RPSJ) capsule has been recommended to be commonly used for breast pain in China. This review aimed to systematically collect latest evidence and critically evaluate the eff ;ectiveness and safety of RPSJ capsule for breast pain. Methods We searched 6 databases from their inception to June 1, 2020 for randomized clinical trials (RCTs) comparing RPSJ capsule with conventional drug therapies, placebo or no treatment. Primary outcomes were breast pain relief, reduction of breast mass and clinical cure rate. Results Seventeen RCTs were included in total, involving 2899 participants with breast pain. RPSJ capsule showed a significant effects in shortening duration of the breast pain (MD-6.51 days, 95%CI [-8.57, -4.45], n = 82, 1 trial), shortening the duration of breast mass (MD-5.17 days, 95%CI [-7.56, -2.78], n = 82, 1 trial), improving clinical cure rate (RR 1.55, 95% CI [1.21, 2.00], I² = 64%, n = 1398, 10 trials) and total effective rate (RR 1.08, 95% CI [1.03, 1.14], I² = 71%, n = 2170, 14 trials) compared to Tamoxifen (TAM). The meta-analysis showed that the incidence of total adverse events was higher in TAM group than the RPSJ capsule group (RR 0.30, 95%CI [0.21, 0.42], I² = 49%, n = 2122, 13 trials). Conclusions RPSJ capsule appears to be a potentially effective in treating breast pain and seems generally safe for clinical application. However, this potential benefit is inconclusive due to generally weak evidence, and the findings should be further confirmed in large and rigorous trials.

Introduction - Diarrhea-predominant irritable bowel syndrome (IBS-D) is a gastrointestinal disease with a high incidence and no effective drugs available. Compound Glutamine Entersoluble Capsules (CGEC) is a compound preparation integrating Sijunzi Decoction and L-Glutamine. The aim of this systematic review was to evaluate the clinical effects and safety of CGEC for IBS-D. Methods - PubMed, Web of Science, the Cochrane library, CNKI, VIP and Wanfang Databases were searched from inception to June 30, 2019. Randomized controlled trials (RCTs) assessing the clinical effects and safety of CGEC for IBS-D were included. Global improvement of IBS-D symptoms was used as the primary outcome. The data were analyzed by RevMan5.3 software. Risk ratio (RR) calculations and 95% confidence intervals (CI) were used for dichotomous outcomes, and mean difference (MD) with 95% CI were used for continuous outcomes. Results - Twelve RCTs involving 1232 participants were included. Compared with western conventional medicine (WCM) alone (i.e. gastrointestinal spasmodic and probiotics), CGEC demonstrated no significant differences in global improvement of IBS-D symptoms (RR 1.09, 95% CI [0.97, 1.23]), reduction in stool frequency (MD 0.14, 95% CI [−0.18, 0.46]) and relief of abdominal pain (MD 0.12, 95% CI [−0.27, 0.52]). The combination of CGEC and WCM had advantages over WCM alone in terms of global improvement of IBS-D symptoms (RR 1.37, 95% CI [1.25, 1.49]). Regarding the recurrence rate, both the CGEC group and the combined drug group were lower than the WCM group. In terms of safety, there is currently no evidence to suggest that CGEC can cause adverse reactions/events in patients with IBS-D. Conclusions - Low or very low certainty evidence indicated that there was no difference between CGEC and WCM for the treatment of IBS-D. The combination of CGEC and WCM had a better therapeutic effect than WCM alone for the treatment of IBS-D.

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Methods: Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2–96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.

Objective This bibliometric study aimed to systematically and comprehensively summarize the volume, breadth and evidence for clinical research on Qigong. And this bibliometric analysis also can provide the evidence of this field. Design Bibliometric analysis. Methods All types of primary and secondary studies on humans were included: systematic reviews, randomized clinical trials, non-randomized controlled clinical studies, case series and case reports. Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Academic Conference Papers Database and Chinese Dissertation Database, PubMed and the Cochrane Library were searched from the date of inception to December 10, 2018. Bibliometric information, such as publication information, disease/condition, Qigong intervention and research results were extracted and analyzed. Results A total of 886 clinical studies were identified: including 47 systematic reviews, 705 randomized clinical trials, 116 non-randomized controlled clinical studies, 12 case series and 6 case reports. The studies were conducted in 14 countries. The top 15 diseases/conditions studied were: diabetes, chronic obstructive pulmonary disease, hypertension, stroke, cervical spondylosis, lumbar disc herniation, insomnia, knee osteoarthritis, low back pain, and osteoporosis, Coronary heart disease, breast cancer, periarthritis of shoulder, depression, metabolic syndrome. Of the various Qigong exercises reported in these 886 clinical studies, Ba Duan Jin was the most frequently researched in 492 (55.5%) studies, followed by Health Qigong 107 (12.1%), Dao Yin Shu 85 (9.6%), Wu Qin Xi 67 (7.6%) and Yi Jin Jing 66 (7.4%). The most frequently used comparisons in randomized trials were maintaining normal way of life unchanged 149 (18.1%), the remaining controls included conventional treatment, mainly western medicine, Chinese herbal medicine, acupuncture, health education, psychological therapy, Yoga, Tai Chi and other non-drug therapy. The most frequently reported outcomes were physical function, quality of life, symptoms, pain and mental health indicators. Beneficial results from practicing Qigong were reported in 97% of studies. Conclusions Qigong research publications have been increasing gradually. Reports on study types, participants, Qigong Intervention, and outcomes are diverse and inconsistent. There is an urgent need to develop a set of reporting standards for various interventions of Qigong. Further trials of high methodological quality with sufficient sample size and real world studies are needed to verify the effects of Qigong in health and disease management.

Background: To systematically evaluate the effect and safety of Xing Nao Jing (XNJ) injection as an add-on treatment on the treatment for viral encephalitis (VE). Methods: Trials assessing the adjunctive effectiveness of XNJ injection for VE were searched from 4 electronic databases from inception to October 31, 2018. Two authors independently extracted data and assessed risk of bias. Statistical analyses were performed using RevMan 5.3 software. Meta-analysis and additional analysis were conducted if data permitted. Trial Sequential Analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were also performed. Results: This review involved 23 trials and 1757 participants, all trials were assessed as having unclear risk of bias. Results from 5 meta-analyses, 13 subgroup meta-analyses, and the single studies showed that based on conventional therapy XNJ injection (0.4–0.6 mL/kg daily for children, 20 mL/day for adults) may have better effect on increasing the numbers of cured patients and decreasing the time of recovery of main symptoms for patients with viral encephalitis. Patients used combination of XNJ injection and conventional therapy had higher cured rate (risk ratio 1.61, 95% confidence interval 1.45–1.80, 19 trials, 1456 participants) and less mortality rate (risk ratio 0.26, 95% confidence interval 0.10–0.71, 9 trials, 595 participants). The average difference of time for fever, conscious, or convulsive recovery was average 2 hours shorter in combination group than in control. No difference was found between children and adults according to the subgroup analysis. Safety of the XNJ injection was failed to evaluate due to the insufficient evidence in this review. Conclusions: This review found “very low” quality evidence which showed the potential effectiveness of combination of XNJ injection and conventional therapies for VE. Considering the TSA results, conclusion could only be draw on effectiveness of the XNJ injection as add-on treatment for VE patients on increasing the cured rate. Firm conclusion on other outcome measures for effectiveness assessment or safety of XNJ injection could not be draw according to this review due to the insufficient evidence.

Supplemental Digital Content is available in the text, Background: The relapse is character of relapsing-remitting multiple sclerosis. The therapeutic goal is to reduce the risk of relapse. Factors associated with relapses can help to manage and prevent relapses. In addition, patients and doctors all pay attention to it. However, there are differences between studies. Our aim is to summarize factors associated with relapses in relapsing-remitting multiple sclerosis (RRMS). Methods: PubMed, EMBASE, Web of science, Cochrane library, CNKI, Wanfang, SinoMed, and VIP were searched to identify risk factors about relapses in RRMS, which should be in cohort or case-control studies. This article was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The quality of studies was evaluated by the Newcastle-Ottawa Scale (NOS). Meta-analysis, subgroup and sensitivity analyses, and publication bias were all performed with Stata. This research has been registered on the international prospective register of systematic reviews (PROSPERO, CRD42019120502). Results: 43 articles were included. Infection, postpartum period, risk gene, stress, and vitamin D were risk factors for relapses in RRMS. Pregnancy period was the protective factor. Among those, infection increased the risk of relapses in infection period (relative risk [RR], 2.07 [confidence interval (CI), 1.64 to 2.60]). Women in the postpartum period increased the risk of relapses compared with women before pregnancy (RR, 1.43 [CI, 1.19 to 1.72]), or women in pregnancy period (RR, 2.07 [CI, 1.49 to 2.88]). Women in the pregnancy period decreased the risk of relapses (RR, 0.56 [CI, 0.37 to 0.84]) compared with women before pregnancy. However, fewer studies, heterogeneity, and sample size were the limitations. Conclusion: It is reliable to adopt results about infection, pregnancy period, and postpartum period.

Source at https://doi.org/10.1186/s12906-018-2306-6. © The Author(s). 2018 Background: Due to limitations of conventional medicine for atopic eczema (AE), complementary and alternative medicine (CAM) is widely used as an alternative, maintaining, or simultaneous treatment for AE. We aimed to evaluate the beneficial and harmful effects of CAM for children with AE under 14 years old. Methods: We searched for randomized trials on CAM in 12 Chinese and English databases from their inception to May 2018. We included children (< 14 years) diagnosed with AE, who received CAM therapy alone or combined with conventional medicine. We extracted data, and used the Cochrane “Risk of bias” tool to assess methodological quality. Effect was presented as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using RevMan 5.3. Results: Twenty-four randomized controlled trials involving 2233 children with AE were included. Methodological quality was of unclear or high risk of bias in general. The trials tested 5 different types of CAM therapies, including probiotics, diet, biofilm, borage oil, and swimming. Compared to placebo, probiotics showed improved effect for the SCORAD index (MD 9.01, 95% CI 7.12–10.90; n = 5). For symptoms and signs such as itching, skin lesions, CAM combined with usual care was more effective for symptom relief ≥95% (RR 1.47, 95% CI 1.30–1.68; n = 8), and for ≥50% symptoms improvement (RR 1.34, 1.25–1.45; n = 9) compared to usual care. There was no statistic significant difference between CAM and usual care on ≥95% improvement or ≥ 50% improvement of symptoms. However, swimming, diet and biofilm showed improvement of clinical symptoms compared with usual care. At follow-up of 8 weeks to 3 years, CAM alone or combined with usual care showed lower relapse rate (RR 0.38, 0.28–0.51, n = 2; RR 0.31, 0.24–0.40, n = 7; respectively) compared to usual care. Twelve out of 24 trials reported no occurrence of severe adverse events. Conclusions: Low evidence demonstrates that some CAM modalities may improve symptoms of childhood AE and reduce relapse rate. Safety remains unclear due to insufficient reporting. Further well-designed randomized trials are needed to confirm the potential beneficial effect and to establish safety use.

Searching strategy for electronic databases. (DOCX 20 kb)

Introduction The results of previous systematic reviews (SRs) and meta-analyses on acupuncture for post-acute stroke dysphagia have provided conflicting evidence. This systematic review of overviews will aim to summarize and evaluate the quality of the existing SRs and meta-analyses with the aim of identifying whether acupuncture could provide a therapeutic option to treat patients with dysphagia post-acute stroke. Methods A systematic search of seven electronic databases (Pubmed, EMBASE, Cochrane library, CNKI, Wanfang, SinoMed and VIP) will be performed according to a predefined search strategy for SRs and meta-analyses of randomized controlled trials (RCTs) and quasi-RCTs on acupuncture for dysphagia post-acute stroke. Two authors will independently select SRs and meta-analyses and collect appropriate data. The reporting quality of included SRs and meta-analyses will be assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The revised Assessment of Multiple Systematic Reviews (AMSTAR 2) will be used to assess the quality of the SRs and meta-analyses. If necessary, GRADE will be used to rate the quality of evidence. Results This overview will identify current SRs and meta-analyses of RCTs or quasi-RCTs of acupuncture treatment for dysphagia post-acute stroke. Discussion The current evidence will be evaluated to help answer the question - is acupuncture a potentially effective treatment for dysphagia after stroke? Prospero Registration Number CRD42019134163.