简介：AbstractBackground:Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent. This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.Methods:Multiple databases with relevant studies were searched with an end date of October 31, 2021, and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31, 2022. Randomized controlled trials (RCTs) that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed. Primary outcomes included neutralizing antibodies against the original strain and serious adverse events (SAEs). A network meta-analysis (NMA) was conducted using a random-effects model.Results:In all, 11 RCTs were included in the systematic review, and nine were ultimately included in the NMA. Among participants who received two doses of CoronaVac, another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit (SU); a dose of BNT162b2 induced the highest geometric mean ratio (GMR) of 15.24, 95% confidence interval [CI]: 9.53-24.39. Following one dose of BNT162b2 vaccination, a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone (GMR = 1.32; 95% CI: 1.06-1.64), NVX-CoV2373 (GMR = 1.60; 95% CI: 1.16-2.21), or ChAdOx1 (GMR = 1.80; 95% CI: 1.25-2.59). Following one dose of ChAdOx1, a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1 (GMR = 11.09; 95% CI: 8.36-14.71) or NVX-CoV2373 (GMR= 2.87; 95% CI: 1.08-3.91). No significant difference in the risk for SAEs was found in any comparisons.Conclusions:Relative to vaccination with two doses of CoronaVac, a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines. For primary vaccination, schedules including mRNA vaccines induce a greater immune response. However, the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.Registration:PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; No. CRD42021278149.

简介：AbstractBackground:Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM.Methods:The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated.Results:Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%-12%) and incremental yield of CMA in VM was 11% (95% CI: 7%-16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%-16%), 5% (95% CI: 1%-11%), 3% (95% CI: 1%-6%), and 13% (95% CI: 4%-25%), respectively.Conclusions:Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.

简介：AbstractBackground:Several recent genome-wide association studies suggested insomnia and anemia may share some common genetic components. We thus examined whether adults with anemia had higher odds of having insomnia relative to those without anemia in a cross-sectional study and a meta-analysis.Methods:Included in this cross-sectional study were 12,614 Chinese adults who participated in an ongoing cohort, the Kailuan Study. Anemia was defined as hemoglobin levels below 12.0 g/dL in women and 13.0 g/dL in men. Insomnia was assessed using the Chinese version of the Athens Insomnia Scale (AIS). A total AIS score ≥6 was considered insomnia. The association between anemia and insomnia was assessed using a logistic regression model, adjusting for potential confounders such as age, sex, chronic disease status, and plasma C-reactive protein concentrations. A meta-analysis was conducted using the fixed effects model to pool results from our study and three previously published cross-sectional studies on this topic in adult populations.Results:Individuals with anemia had greater odds of having insomnia (adjusted odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.03-1.70) compared with individuals without anemia. A significant association persisted after we excluded individuals with chronic inflammation, as suggested by C-reactive protein levels >1 mg/L (adjusted OR: 1.68; 95% CI: 1.22-2.32). The meta-analysis results, including 22,134 participants, also identified a positive association between anemia and insomnia (pooled OR: 1.39; 95% CI: 1.22-1.57).Conclusions:The presence of anemia was significantly associated with a higher likelihood of having insomnia in adults. Due to the nature of the cross-sectional study design, results should be interpreted with caution.

简介：OBJECTIVE:Ameta-analysisofpublishedrandomizedcontrolledtrialsinvestigatingthelongtermeffectofdexamethasoneonthenervoussystemofpreterminfants.DATASOURCES:OnlineliteratureretrievalwasconductedusingTheCochraneLibrary(fromJanuary1993toJune2013),EMBASE(fromJanuary1980toJune2013),MEDLINE(fromJanuary1963toJune2013),OVID(fromJanuary1993toJune2013),Springer(fromJanuary1994toJune2013)andChineseAcademicJournalFull-textDatabase(fromJanuary1994toJune2013).KeywordswerepreterminfantsanddexamethasoneinEnglishandChinese.STUDYSELECTION:Selectedstudieswererandomizedcontrolledtrialsassessingtheeffectofintravenousdexamethasoneinpreterminfants.Thequalityoftheincludedpaperswasevaluatedandthosewithoutthedevelopmentofthenervoussystemandanimalexperimentswereexcluded.QualityassessmentwasperformedthroughbiasriskevaluationinaccordancewithCochraneHandbook5.1.0softwareintheCochraneCollaboration.ThehomogeneousstudieswereanalyzedandcomparedusingRevman5.2.6software,andtheneffectmodelwasselectedandanalyzed.Thosepapersfailedtobeincludedinthemeta-analysisweresubjectedtodescriptiveanalysis.MAINOUTCOMEMEASURES:Nervoussysteminjuryinpreterminfants.RESULTS:Tenrandomizedcontrolledtrialswerescreened,involving1,038subjects.Amongthem512casesreceiveddexamethasonetreatmentwhile526casesservedasplacebocontrolgroupandblankcontrolgroup.Meta-analysisresultsshowedthattheincidenceofcerebralpalsy,visualimpairmentandhearinglossinpreterminfantsafterdexamethasonetreatmentwithin7daysafterbirthwassimilartothatinthecontrolgroup(RR=1.47,95%CI:0.97–2.21;RR=1.46,95%CI:0.97–2.20;RR=0.80,95%CI:0.54–1.18;P>0.05),butintelligencequotientwassignificantlydecreasedcomparedwiththecontrolgroup(MD=-3.55,95%CI:-6.59to-0.51;P=0.02).Preterminfantstreatedwithdexamethasone7daysafterbirthdemonstratedaninci

简介：AIM:Toreviewpublishedclinicalstudiesexaminingtheeffectofnatamycininthetreatmentoffungalkeratitis.METHODS:WeselectedthepublicationsinCENTRAL,MEDLINE,EMBASE,CNKI,andCBM.Thisstudysystematicallyreviewedpublishedrandomizedcontrolledtrials(RCTs)thatcomparednatamycintootherantifungalagents,andconductedfeasibleMeta-analysisofefficacyresultsusingRevman5.2software.RESULTS:WeincludedseventrialswhichweremainlycarriedoutindevelopingcountriesofAsia,withfivetrialsconductedinIndia,oneeachinChinaandBangladesh.Atotalof804participantswererandomizedtofollowingcomparisons:2%econazoleversus5%natamycinshowedlittledifferenceintheeffectsoftreatmentoffungalkeratitis[RR=0.99,95%confidenceinterval(CI),0.8to1.21];chlorhexidinegluconateversus5%natamycinindicatedthattheresultsonhealingoftheulcerat21dwaslessconclusive(RR=0.77,95%CI,0.55to1.08;I2=0%);1%voriconazoleversus5%natamycinsuggestedthatnatamycintreatmentappearedtobesignificantlybetteroutcomesthanvoriconazole(regressioncoefficient=-0.18logMAR;95%CI,-0.30to-0.05;P=0.006),especiallyinFusariumcases(regressioncoefficient=-0.41logMAR;95%CI,-0.61to-0.20;P<0.001);natamycinversusfluconazoleshowedasignificantdifferenceincurerate(χ2=5.048,P<0.05)andnatamycingroupwasmoreeffectivethanfluconazoleinaverageperiodoftherapy(t=7.94,P<0.01).CONCLUSION:Natamycinwasapreferablechoiceinthetreatmentoffungalkeratitis,especiallyintheearlyperiodofFusariumcases.

简介：AIM:Toestimateoverallprevalenceofretinopathyofprematurity(ROP)inIranusingasystematicreviewandMeta-analysis.METHODS:AsystematicreviewandMeta-analysiswasperformedofallpublishedstudiespertainingtoprevalenceofROPusinginternationalandnationalelectronicdatabases(ISIWebofSciences,PubMed,Scopus,GoogleScholar,SID,MagIran,andIranMedex)fromtheirinceptionuntilMay2016withstandardkeywords.BeggandEggertestswereusedtoexaminethepublicationbiasandCochrantestandI~2statisticswereusedtoevaluatethestatisticalheterogeneity.PooledestimateoftheprevalenceofROPwerecalculatedusingrandomeffectsMetaanalysis.RESULTS:ThepublicationbiasassumptionwasrejectedbyEggertestswithP-valueequalto0.024.TheresultsofCochrantestandI~2statisticsrevealedsubstantialheterogeneity(Q=1099.02,df=25,I~2=97.7%,P=0.001).TheoverallprevalenceofROPusingtherandomeffectmodelinIranwas26.1%(95%CI:20.3%-31.8%).CONCLUSION:TheprevalenceofROPisrelativelyhighinIran.Lowbirthweightandgestationalagearesignificantriskfactorsforthedisease.Improvedcare,includingoxygendeliveryandmonitoring,forpretermbabiesinallfacilitysettingswouldreducethenumberofbabiesaffectedwithROP.

简介：AbstractBackgrounds:Previous surveys have found that children with iron deficiency (ID) were likely to suffer from early childhood caries (ECC). We aimed to assess the scientific evidence about whether ID is intrinsically related to ECC.Methods:The medical subject headings (MeSH) terms and free words were searched on PubMed, Web of Science, Cochrane, China National Knowledge Infrastructure, Wanfang, and the Database for Chinese Technical Periodicals from March 2020 to September 2020. Two researchers independently screened the articles. Data extraction and cross-checking were performed for the studies that met the inclusion criteria. Meta-analysis was performed using the Cochrane Collaboration’s Review Manager 5.3 software.Results:After excluding duplication and irrelevant literature, 12 case-control studies were included in the study. The meta-analysis demonstrated that children with ECC were more likely to have ID (odds ratio [OR] = 2.63, 95% confidence interval [CI]: [1.85, 3.73], P < 0.001). There was no statistically significant association found between the level of serum ferritin and ECC (weighted mean difference (WMD) = -5.80, 95% CI: [-11.97, 0.37], P= 0.07). Children with ECC were more likely to have iron-deficiency anemia (OR = 2.74, 95% CI: [2.41,3.11], P < 0.001). The hemoglobin (HGB) levels in the ECC group were significantly lower compared with that in the ECC-free group (WMD = -9.96, 95% CI: [-15.45, -4.46], P = 0.0004). The mean corpuscular volume (MCV) levels in the ECC group were significantly lower compared with that in the ECC-free group (WMD = -3.72, 95% CI: [-6.65, -0.79], P= 0.01).Conclusions:ID was more prevalent in children with ECC, and the markers of iron status in the ECC group, such as serum ferritin, HGB, and MCV, were relatively lower than the ECC-free group.

简介：BackgroundAtrialfibrillation(AF)wasusedtobeconsideredasnongeneticsdisorder,butrecentstudieshaverevealedthatgeneticsvariantsconferredsusceptibilitytoAFdevelopment,butmostwithlimitedevidence.Inordertosystematicallyevaluatetheoverallcontributionsofgene-diseaseassociationstudiestocurrentunderstandingsofthegeneticsusceptibilitytoatrialfibrillation,weperformasystematicreviewandmeta-analysisbasedoncomprehensivesearches.MethodAllstudiesontheassociationsofgeneticsvariantswithAFriskwereidentifiedbysearchingthefollowingdatabases:Medline,Embase,BIOSIS,GlobalHealth,LILACSandCBMDisc.Oddsratios(CI)and95%confidenceintervals(CI)werecalculatedunderhomozygotecomparison(HC),dominantmodel(DM)andrecessivemodel(RM),respectively.ResultsAtotalof41studieson32genesand72polymorphismslocationswereidentified.ThesummaryORwasstatisticallysignificantassociationsin23(31.94%)singlenucleotidepolymorphisms(SNPs).Thegenesinrenin-angiotensin-aldosteronesystem(RAAS)andionchannelswerethemostlystudied.FourSNPs(50.00%)inRAASgenesweresignificantlyassociatedwithAFsusceptibility:ACEI/D(HC:OR=1.53,95%CI:1.14-2.0DM:OR=1.47,95%CI:0.86-1.53;RM:OR=0.49,95%CI:0.41-0.59);AGTA-20C(HC:OR=1.56,95%CI:1.41-2.12);AGTM235T(HC:OR=2.37,95%CI:1.21-4.65).StatisticallysignificantassociationswerealsofoundinthefollowinggenesandSNPs:ABCA1G1051A,BCHEG1615A,CETPA1061G,I405V,TaqIB,CRPC1444T,EDN2A985G,eNOST-786C,IL-10T-819C,A-592C,MinKG38S,KCNH2rs1805120,Kir3.4C171T,G810T,MMP2C-1306T,FactorⅡG20210A,SCN5AH58R,SLC26A8I639V,G-proteinβ-subunitC825T,chromatosome4q25rs2200733andrs10033464.ConclusionsNearlyone-thirdofSNPswerestatisticallysignificantassociatedwithAFrisk,withvariantsinRAASgenesmosthighlysignificantassociation.Morestudiesonawiderangeofgenesaremerited.

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简介：AIM:Tosystematicallyreviewwhethertheincreasedfluctuationofintraocularpressure(IOP)isariskfactorforopenangleglaucoma(OAG)progression.METHODS:ScientificstudiesrelevanttoIOPfluctuationandglaucomaprogressionwereretrievedfromMEDLINE,EMBASEandCENTRALdatabases,andwerelistedasreferencesinthispaper.Thehazardratio(HR)wascalculatedbyusingfixedorrandom-effectsmodelsaccordingtotheheterogeneityofincludedstudies.RESULTS:Individualdatafor2211eyesof2637OAGpatientsinfourteenprospectivestudieswereincludedinthisMeta-analysis.Allstudieswerelongitudinalclinicalstudieswithfollow-upperiodrangingfrom3to8.5y.ThecombinedHRwas1.23(95%CI1.04-1.46,P=0.02)fortheassociationbetweenIOPfluctuationandglaucomaonsetorprogressionwiththeevidenceofheterogeneity(P<0.1).SubgroupanalyseswithdifferenttypesofIOPfluctuationwerealsoevaluated.ResultsindicatedthatthesummaryHRwas0.98(95%CI0.78-1.24)inshort-termIOPfluctuationgroup,whichshowednostatisticalsignificancewithheterogeneity,whereas,thecombinedHRwas1.43(95%CI1.13-1.82,P=0.003)inlong-termIOPfluctuationgroupwithouthomogeneity.SensitivityanalysisfurthershowedthatthepooledHRwas1.10(95%CI1.03-1.18,P=0.004)forlong-termIOPfluctuationandvisualfunctionprogressionwithhomogeneityamongstudies(P=0.3).CONCLUSION:Long-termIOPfluctuationcanbeariskfactorforglaucomaprogressionbasedonthepresentedevidence.Thus,controllingtheswingofIOPiscrucialforglaucomaorglaucomasuspectingpatients.

简介：AbstractBackground:The global pandemic coronavirus disease 2019 (COVID-19) has become a major public health problem and presents an unprecedented challenge. However, no specific drugs were currently proven. This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.Methods:Medline, Embase, the Cochrane Library, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/SARS-CoV. Random-effects network meta-analysis within the Bayesian framework was performed, followed by the Grading of Recommendations Assessment, Development, and Evaluation system assessing the quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion, and overall adverse events (OAEs). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.Results:Sixty-six RCTs with 19,095 patients were included, involving standard of care (SOC), eight different antiviral agents, six different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids (COR), and other treatments. Compared with SOC, a significant reduction of mortality was observed for TCM (OR = 0.34, 95% CI: 0.20-0.56, moderate quality) and COR (OR = 0.84, 95% CI: 0.75-0.96, low quality) with improved cure rate (OR = 2.16, 95% CI: 1.60-2.91, low quality for TCM; OR = 1.17, 95% CI: 1.05-1.30, low quality for COR). However, an increased risk of mortality was found for CQ_HD vs. SOC (OR = 3.20, 95% CI: 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR = 0.52, 95% CI: 0.38-0.70, very low quality) but CQ_HD (OR = 2.51, 95% CI: 1.20-5.24) and interferons (IFN) (OR = 2.69, 95% CI: 1.02-7.08) vs. SOC with very low quality were associated with an increased risk.Conclusions:COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN, and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low-quality and further high-quality trials are needed.

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简介：AbstractBackground:Indoor residual spraying (IRS) is one of the key interventions recommended by World Health Organization in preventing malaria infection. We aimed to conduct a systematic review and meta-analysis of global studies about the impact of IRS on malaria control.Method:We searched PubMed, Web of Science, Embase, and Scopus for relevant studies published from database establishment to 31 December 2021. Random-effects models were used to perform meta-analysis and subgroup analysis to pool the odds ratio (OR) and 95% confidence interval (CI). Meta-regression was used to investigate potential factors of heterogeneity across studies.Results:Thirty-eight articles including 81 reports and 1,174,970 individuals were included in the meta-analysis. IRS was associated with lower rates of malaria infection (OR= 0.35, 95% CI: 0.27-0.44). The significantly higher effectiveness was observed in IRS coverage ≥ 80% than in IRS coverage < 80%. Pyrethroids was identified to show the greatest performance in malaria control. In addition, higher effectiveness was associated with a lower gross domestic product as well as a higher coverage of IRS and bed net utilization.Conclusions:IRS could induce a positive effect on malaria infection globally. The high IRS coverage and the use of pyrethroids are key measures to reduce malaria infection. More efforts should focus on increasing IRS coverage, developing more effective new insecticides against malaria, and using multiple interventions comprehensively to achieve malaria control goals.

简介：Background:Cognitiveimpairmentisprevalentamongolderadultsandresultsindegradedqualityoflifeforolderadults.Asthepopulationages,thismaycauseahugeburdentosociety.Researchhasdemonstratedthatphysicalexerciseisbeneficialtocognitivefunction.Thepurposeofthismeta-analysiswastocriticallyassesstheeffectofTaiChiexerciseonglobalcognitive,executive,andmemoryfunctionsinolderadults.Methods:Afterathoroughelectronicsearchandselection,eightstudieswereincludedinthismeta-analysiswithtwocross-sectionalandsixinterventionstudies.Ninevariablesincludedinthismeta-analysiswere:minimentalstatusexamination(MMSE),Alzheimer’sdiseaseassessmentscale-cognitivesubscale(ADAS-cog),trailmakingtestpartA(TMA),trailmakingtestpartB(TMB),digitspantestforward(DSF),digitspantestbackward(DSB),visualspantestbackward(VSB),verbalfluencytest(VFT),andworddelayrecalltest(WDR).Theeffectsizesandforestplotsoftheseninevariablesweregenerated.Results:Four(MMSE,DSB,VSB,andVFT)outofninevariablesweresignificantlyimprovedafterTaiChiexercisewiththeeffectsizesrangedfrom0.20to0.46(smalltomedium).MMSErepresentedglobalcognitivefunction,andDSB,VSB,andVFTrepresentedmemoryfunction.Conclusion:TaiChiasamind-bodyexercisehasthepositiveeffectsonglobalcognitiveandmemoryfunctions,andmoreconsistentpositiveeffectswerefoundonmemoryfunction,especiallyverbalworkingmemory.

简介：在在IOP上调查了triamcinoloneintravitrealtriamcinoloneacetonide的注射的效果的研究的triamcinoloneacetonide.METHODSSystematic文学评论的intravitreal注射以后的intraocular压力(IOP)上的AIMTo报告根据Cochrane合作方法论被进行，报导效果被分析了，Meta-analysis.RESULTSWe发现了IOP跟随inverted-U随着时间的过去以14.81±的平均价值开始的形状模式；1.22而且，学习的土地，变老，绿内障和性作文物质为的以前的历史跨学习在报导IOPchanges.CONCLUSIONOur调查结果是不同的可能在象象反脉管的endothelial生长因素代理人那样的更最近的治疗把它与那些作比较一样决定intravitrealtriamcinoloneacetonide治疗的压力举起风险有用。

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简介：AbstractBackground:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and sub-group analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD]= -27.1 min, 95% confidence interval [CI]: -40.8 to -13.4 min) and lengths of hospital stay (WMD = -1.43 days, 95% CI: -2.31 to -0.56 days) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 to 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31-25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = -41.03 min, 95% CI: -59.53 to -22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57-10.34).Conclusions:In general, endoscopic resection is an alternative method for gastric GISTs ≤5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.