Pub Date : 2024-12-20DOI: 10.1002/14651858.CD009508.pub2
E Jean C Hay-Smith, Małgorzata Starzec-Proserpio, Brittany Moller, Daniela Aldabe, Licia Cacciari, Ana Carolina R Pitangui, Giovana Vesentini, Stephanie J Woodley, Chantale Dumoulin, Helena C Frawley, Cristine H Jorge, Mélanie Morin, Sheila A Wallace, Mark Weatherall
<p><strong>Background: </strong>Pelvic floor muscle training (PFMT) is a recommended treatment for female stress, urgency, and mixed urinary incontinence. Training varies in exercise type (pelvic floor muscles contracting with and without other muscles), dose, and delivery (e.g. amount and type of supervision).</p><p><strong>Objectives: </strong>To assess the effects of alternative approaches (exercise type, dose, and delivery) to pelvic floor muscle training (PFMT) in the management of urinary incontinence (stress, urgency, and mixed) in women.</p><p><strong>Search methods: </strong>We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023; which contains CENTRAL, MEDLINE, ClinicalTrials.gov, and World Health Organization ICTRP), handsearched journals and conference proceedings, and reviewed reference lists of relevant articles.</p><p><strong>Selection criteria: </strong>Randomised, quasi-randomised, or cluster-randomised trials in female stress, urge, or mixed urinary incontinence where one trial arm included PFMT and another was an alternative approach to PFMT type, dose, or intervention delivery. We excluded studies with participants with neurological conditions or pregnant or recently postpartum.</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed trials for eligibility and methodological quality using the Cochrane RoB 1 tool. We extracted and cross-checked data and resolved disagreements by discussion. Data processing was as described in the Cochrane Handbook for Systematic Reviews of Interventions (Version 6). Synthesis was completed in intervention subgroups.</p><p><strong>Main results: </strong>This is a review update. The analysis included 63 trials with 4920 women; the previous version included 21 trials with 1490 women. Samples sizes ranged from 11 to 362. Overall, study participants were mid-age (45 to 65 years) parous women with stress or stress-predominant mixed urinary incontinence (46 trials), who had no prior incontinence treatment or pelvic surgery, or appreciable pelvic floor dysfunction. Trials were conducted in countries around the world, mostly in middle- or high-income settings (53 trials). All trials had one or more arms using 'direct' PFMT, defined as repeated, isolated, voluntary pelvic floor muscle contractions. Trials were categorised as comparisons of exercise type (27 trials, 3 subgroups), dose (11 trials, 5 subgroups, 1 with no data), and delivery (25 trials, 5 subgroups). Incontinence quality of life data are reported here as the primary outcome. Adverse event data were summarised narratively. Comparison 1: exercise type Co-ordinated training (body movements with concurrent pelvic floor muscle contraction) versus direct PFMT Co-ordinated training may slightly improve quality of life (standardised mean difference (SMD) -0.22, 95% confidence interval (CI) -0.44 to -0.01; I<sup>2</sup> = 81%; 8 trials, 356 women; low-certainty evidence). Indirect
通过电子医疗提供的PFMT指导与书面指导相比，电子医疗提供可能略微改善生活质量(SMD -0.21, 95% CI -0.43至0.01；I2 = 25%；3项研究，318名女性；确定性的证据)。9项试验收集了不良事件数据；66/1083（6%）女性有不良事件。几乎所有的事件都与使用阴道内或直肠内训练装置有关。不良事件为阴道分泌物、点滴或不适。有四个主要因素影响证据的确定性：44项试验存在不明确或高风险的选择偏倚；在一些试验较少的亚组中，数据稀疏，试验没有测量感兴趣的结果，或者没有报告可用数据；结果不一致；而且许多试验规模很小（不精确）。作者的结论是：尽管有低到中等确定性的证据表明，一些PFMT方法比其他方法更好，但有些方法几乎没有差异。第七届国际尿失禁咨询会议推荐PFMT作为女性尿失禁的一线治疗。与间接训练相比，直接PFMT（一组重复的、孤立的、自愿的盆底肌肉收缩）可能会导致尿失禁生活质量的小幅改善。就改善生活质量而言，PFMT可以单独或集体进行监督，因为它在实现这一结果方面可能几乎没有区别。许多比较具有低或极低确定性的证据，通常是因为只有一个试验或几个小试验具有方法学上的局限性。需要更多更好的设计和报道的试验，直接比较PFMT方法，特别是研究运动剂量的试验。
{"title":"Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women.","authors":"E Jean C Hay-Smith, Małgorzata Starzec-Proserpio, Brittany Moller, Daniela Aldabe, Licia Cacciari, Ana Carolina R Pitangui, Giovana Vesentini, Stephanie J Woodley, Chantale Dumoulin, Helena C Frawley, Cristine H Jorge, Mélanie Morin, Sheila A Wallace, Mark Weatherall","doi":"10.1002/14651858.CD009508.pub2","DOIUrl":"10.1002/14651858.CD009508.pub2","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor muscle training (PFMT) is a recommended treatment for female stress, urgency, and mixed urinary incontinence. Training varies in exercise type (pelvic floor muscles contracting with and without other muscles), dose, and delivery (e.g. amount and type of supervision).</p><p><strong>Objectives: </strong>To assess the effects of alternative approaches (exercise type, dose, and delivery) to pelvic floor muscle training (PFMT) in the management of urinary incontinence (stress, urgency, and mixed) in women.</p><p><strong>Search methods: </strong>We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023; which contains CENTRAL, MEDLINE, ClinicalTrials.gov, and World Health Organization ICTRP), handsearched journals and conference proceedings, and reviewed reference lists of relevant articles.</p><p><strong>Selection criteria: </strong>Randomised, quasi-randomised, or cluster-randomised trials in female stress, urge, or mixed urinary incontinence where one trial arm included PFMT and another was an alternative approach to PFMT type, dose, or intervention delivery. We excluded studies with participants with neurological conditions or pregnant or recently postpartum.</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed trials for eligibility and methodological quality using the Cochrane RoB 1 tool. We extracted and cross-checked data and resolved disagreements by discussion. Data processing was as described in the Cochrane Handbook for Systematic Reviews of Interventions (Version 6). Synthesis was completed in intervention subgroups.</p><p><strong>Main results: </strong>This is a review update. The analysis included 63 trials with 4920 women; the previous version included 21 trials with 1490 women. Samples sizes ranged from 11 to 362. Overall, study participants were mid-age (45 to 65 years) parous women with stress or stress-predominant mixed urinary incontinence (46 trials), who had no prior incontinence treatment or pelvic surgery, or appreciable pelvic floor dysfunction. Trials were conducted in countries around the world, mostly in middle- or high-income settings (53 trials). All trials had one or more arms using 'direct' PFMT, defined as repeated, isolated, voluntary pelvic floor muscle contractions. Trials were categorised as comparisons of exercise type (27 trials, 3 subgroups), dose (11 trials, 5 subgroups, 1 with no data), and delivery (25 trials, 5 subgroups). Incontinence quality of life data are reported here as the primary outcome. Adverse event data were summarised narratively. Comparison 1: exercise type Co-ordinated training (body movements with concurrent pelvic floor muscle contraction) versus direct PFMT Co-ordinated training may slightly improve quality of life (standardised mean difference (SMD) -0.22, 95% confidence interval (CI) -0.44 to -0.01; I<sup>2</sup> = 81%; 8 trials, 356 women; low-certainty evidence). Indirect","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD009508"},"PeriodicalIF":8.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-19DOI: 10.1002/14651858.CD014966.pub2
Sumedh Jayanti, Nadim A Beruni, Juanita N Chui, Danny Deng, Amy Liang, Anita S Chong, Jonathan C Craig, Bethany Foster, Martin Howell, Siah Kim, Roslyn B Mannon, Ruth Sapir-Pichhadze, Nicole J Scholes-Robertson, Alexandra T Strauss, Allison Jaure, Lori West, Tess E Cooper, Germaine Wong
<p><strong>Background: </strong>Sex, as a biological construct, and gender, defined as the cultural attitudes and behaviours attributed by society, may be associated with allograft loss, death, cancer, and rejection. Other factors, such as recipient age and donor sex, may modify the association between sex/gender and post-transplant outcomes.</p><p><strong>Objectives: </strong>We sought to evaluate the prognostic effects of recipient sex and, separately, gender as independent predictors of graft loss, death, cancer, and allograft rejection following kidney or simultaneous pancreas-kidney (SPK) transplantation. We aimed to evaluate this prognostic effect by defining the relationship between recipient sex or gender and post-transplantation outcomes identifying reasons for variations between sexes and genders, and then quantifying the magnitude of this relationship.</p><p><strong>Search methods: </strong>We searched MEDLINE and EMBASE databases from inception up to 12 April 2023, through contact with the Cochrane Kidney and Transplant Information Specialist, using search terms relevant to this review and no language restrictions.</p><p><strong>Selection criteria: </strong>Cohort, case-control, or cross-sectional studies were included if sex or gender were the primary exposure and clearly defined. Studies needed to focus on our defined outcomes post-transplantation. Sex was defined as the chromosomal, gonadal, and anatomical characteristics associated with the biological sex, and we used the terms "males" and "females". Gender was defined as the attitudes and behaviours that a given culture associates with a person's biological sex, and we used the terms "men" and "women".</p><p><strong>Data collection and analysis: </strong>Two authors independently assessed the references for eligibility, extracted the data and assessed the risk of bias using the Quality in Prognosis Studies (QUIPS) tool. Whenever appropriate, we performed random-effects meta-analyses to estimate the mean difference in outcomes. The outcomes of interest included the Standardised Outcomes in Nephrology-Kidney Transplant (SONG-Tx) core outcomes, allograft loss, death, cancer (overall incidence and site-specific) and acute or chronic graft rejection.</p><p><strong>Main results: </strong>Fifty-three studies (2,144,613 patients; range 59 to 407,963) conducted between 1990 and 2023 were included. Sixteen studies were conducted in the Americas, 12 in Europe, 11 in the Western Pacific, four in the Eastern Mediterranean, three in Africa, two in Southeast Asia, and five across multiple regions. All but one study focused on sex rather than gender as the primary exposure of interest. The number identified as male was 54%; 49 studies included kidney transplant recipients, and four studies included SPK transplant recipients. Twenty-four studies included adults and children, 25 studies included only adults, and four studies included only children. Data from 33 studies were included in the meta-an
背景：生理性别作为一种生物结构，而社会性别则被定义为社会所赋予的文化态度和行为，它们可能与同种异体移植物损失、死亡、癌症和排斥反应有关。其他因素，如受者年龄和供者性别，可能会改变性别/性别与移植后结果之间的关系。目的：我们试图评估受体性别和性别作为肾或胰肾联合移植（SPK）后移植物损失、死亡、癌症和同种异体移植排斥反应的独立预测因素对预后的影响。我们的目的是通过定义受体性别和移植后结果之间的关系来评估这种预后效果，确定性别和性别之间差异的原因，然后量化这种关系的程度。检索方法：通过与Cochrane肾脏和移植信息专家联系，我们检索了MEDLINE和EMBASE数据库，从建立到2023年4月12日，使用与本综述相关的检索词，无语言限制。选择标准：如果性别或性别是主要暴露者且定义明确，则纳入队列、病例对照或横断面研究。研究需要关注我们定义的移植后结果。性别被定义为与生理性别相关的染色体、性腺和解剖学特征，我们使用“男性”和“女性”这两个术语。性别被定义为特定文化中与一个人的生理性别相关的态度和行为，我们使用了“男性”和“女性”这两个术语。资料收集和分析：两位作者独立评估了文献的合格性，提取了资料，并使用预后研究质量（QUIPS）工具评估了偏倚风险。在适当的时候，我们进行随机效应荟萃分析来估计结果的平均差异。感兴趣的结果包括肾脏移植标准化结果（SONG-Tx）核心结果、同种异体移植物损失、死亡、癌症（总发病率和部位特异性）和急性或慢性移植物排斥反应。主要结果：53项研究(2144613例患者；范围59至407,963)，包括在1990年至2023年间进行的研究。在美洲进行了16项研究，在欧洲进行了12项研究，在西太平洋进行了11项研究，在东地中海进行了4项研究，在非洲进行了3项研究，在东南亚进行了2项研究，在多个地区进行了5项研究。除了一项研究外，所有的研究都关注性，而不是性别作为兴趣的主要暴露。被确认为男性的占54%；49项研究纳入肾移植受者，4项研究纳入SPK移植受者。24项研究包括成人和儿童，25项研究仅包括成人，4项研究仅包括儿童。meta分析纳入了33项研究的数据。其中，有6项研究提出了未经调整的风险比（hr），评估了受体性别对同种异体肾移植损失的影响。其他研究报告了预定义结果的风险比（rr）。值得注意的是，将meta分析限制为未调整估计值的决定源于各研究中协变量调整方法的差异，缺乏一组共同的调整变量。只有三项研究考虑了受体年龄对移植物丢失或死亡的影响，这可能是评估移植后结果性别差异的关键。没有研究考虑受体年龄对癌症发病率或同种异体移植排斥风险的调节作用。在低确定性证据中，与男性受体相比，女性对移植后肾移植损失的影响可能很小或没有差异(7项研究，5843例患者：RR 0.91, 95% CI 0.73至1.12；I2 = 73%)。在包括事件时间分析(6项研究，238,937例患者；HR 1.07, 95% CI 0.95 ~ 1.20；I2 = 44%)。最近两项基于登记的大型队列研究考虑了供体性别和受体年龄的改变效应，结果表明，在男性供体的情况下，45岁以下的女性受体的移植物失失率明显高于年龄匹配的男性受体。相比之下，无论供体性别如何，60岁及以上的女性受体的移植物失失率低于年龄匹配的男性受体。与男性受体相比，女性在移植后30年内的死亡率几乎没有差异；然而，证据非常不确定(13项研究，60,818例患者：RR 0.94, 95% CI 0.81至1.09；I2 = 92%)。考虑到受体年龄和供体性别的改变效应的研究表明，在男性供体的情况下，女性受体的超额死亡风险高于45岁以下的男性。与男性受体相比，女性在移植后20年内的癌症发病率可能几乎没有差异；然而，证据非常不确定(7项研究，25,076例患者；RR 0.84, 95% CI 0.70 ~ 1。 01;I2 = 60%)。与男性受体相比，女性在移植后15年的急性和慢性同种异体肾移植排斥反应发生率方面几乎没有或没有差异(9项研究，6158例患者：RR 0.89, 95% CI 0.75至1.05；I2 = 54%;低确定性证据)。一项研究评估了性别，并报告说，与男性相比，女性在高收入地区（HR 0.71, 95% CI 0.59至0.87）和中等收入地区（HR 0.82, 95% CI 0.74至0.92）的五年生存率更高，而在低收入地区（HR 0.85, 95% CI 0.72至1.01）没有差异。性别或性别与移植后患者相关结果之间存在相当大的不确定性。这主要是由于临床和方法的异质性。观察到的研究之间的临床异质性可归因于样本人群中不同的患者特征。由于提供的性别分层人口统计数据有限，因此对这种异质性的进一步调查受到限制。然而，导致这一发现的因素可能包括受体年龄、供体年龄、类型和性别。方法上的异质性被注意到，包括性别和性别的互换使用、结果错误分类、使用不同的效果测量方法、不一致的协变量概况，以及忽视重要的效果修改。作者的结论是：有非常低到低确定性的证据表明，男性和女性肾脏和SPK移植受者在肾脏和胰腺同种异体移植存活率、患者存活率、癌症以及急性和慢性同种异体移植排斥反应方面没有差异。
{"title":"Sex and gender as predictors for allograft and patient-relevant outcomes after kidney transplantation.","authors":"Sumedh Jayanti, Nadim A Beruni, Juanita N Chui, Danny Deng, Amy Liang, Anita S Chong, Jonathan C Craig, Bethany Foster, Martin Howell, Siah Kim, Roslyn B Mannon, Ruth Sapir-Pichhadze, Nicole J Scholes-Robertson, Alexandra T Strauss, Allison Jaure, Lori West, Tess E Cooper, Germaine Wong","doi":"10.1002/14651858.CD014966.pub2","DOIUrl":"10.1002/14651858.CD014966.pub2","url":null,"abstract":"<p><strong>Background: </strong>Sex, as a biological construct, and gender, defined as the cultural attitudes and behaviours attributed by society, may be associated with allograft loss, death, cancer, and rejection. Other factors, such as recipient age and donor sex, may modify the association between sex/gender and post-transplant outcomes.</p><p><strong>Objectives: </strong>We sought to evaluate the prognostic effects of recipient sex and, separately, gender as independent predictors of graft loss, death, cancer, and allograft rejection following kidney or simultaneous pancreas-kidney (SPK) transplantation. We aimed to evaluate this prognostic effect by defining the relationship between recipient sex or gender and post-transplantation outcomes identifying reasons for variations between sexes and genders, and then quantifying the magnitude of this relationship.</p><p><strong>Search methods: </strong>We searched MEDLINE and EMBASE databases from inception up to 12 April 2023, through contact with the Cochrane Kidney and Transplant Information Specialist, using search terms relevant to this review and no language restrictions.</p><p><strong>Selection criteria: </strong>Cohort, case-control, or cross-sectional studies were included if sex or gender were the primary exposure and clearly defined. Studies needed to focus on our defined outcomes post-transplantation. Sex was defined as the chromosomal, gonadal, and anatomical characteristics associated with the biological sex, and we used the terms \"males\" and \"females\". Gender was defined as the attitudes and behaviours that a given culture associates with a person's biological sex, and we used the terms \"men\" and \"women\".</p><p><strong>Data collection and analysis: </strong>Two authors independently assessed the references for eligibility, extracted the data and assessed the risk of bias using the Quality in Prognosis Studies (QUIPS) tool. Whenever appropriate, we performed random-effects meta-analyses to estimate the mean difference in outcomes. The outcomes of interest included the Standardised Outcomes in Nephrology-Kidney Transplant (SONG-Tx) core outcomes, allograft loss, death, cancer (overall incidence and site-specific) and acute or chronic graft rejection.</p><p><strong>Main results: </strong>Fifty-three studies (2,144,613 patients; range 59 to 407,963) conducted between 1990 and 2023 were included. Sixteen studies were conducted in the Americas, 12 in Europe, 11 in the Western Pacific, four in the Eastern Mediterranean, three in Africa, two in Southeast Asia, and five across multiple regions. All but one study focused on sex rather than gender as the primary exposure of interest. The number identified as male was 54%; 49 studies included kidney transplant recipients, and four studies included SPK transplant recipients. Twenty-four studies included adults and children, 25 studies included only adults, and four studies included only children. Data from 33 studies were included in the meta-an","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD014966"},"PeriodicalIF":8.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-19DOI: 10.1002/14651858.CD006982.pub5
Iris Morag, Yu-Tian Xiao, Matteo Bruschettini
<p><strong>Background: </strong>Preterm and low birth weight infants are at an early stage of development, and do not receive adequate maternal circadian signals. They are often cared for over prolonged periods of hospitalisation in neonatal intensive care units (NICU), where environmental circadian stimuli are lacking. Exposure to artificial light-dark cycles may stimulate the development of the circadian system and improve clinical outcomes. However, it remains uncertain whether cycled light (CL) is preferable to near darkness (ND) or continuous bright light (CBL) in fostering development and maturation, and reducing adverse neonatal health outcomes. This is an update of an earlier Cochrane review, last published in 2016.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of CL in preterm and low birth weight infants compared to ND or CBL.</p><p><strong>Search methods: </strong>We searched CENTRAL, PubMed, Embase, and two trial registries to September 2023. We also checked reference lists, and searched for retractions of included studies.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (< 37 weeks' postmenstrual age (PMA)), or those with a low birth weight (< 2500 g), admitted and cared for in an NICU or a step-down unit, comparing CL with ND or CBL.</p><p><strong>Data collection and analysis: </strong>We used the standard review methods of the Cochrane Neonatal Review Group to assess the methodological quality of studies. We used the fixed-effect model with risk ratio (RR) and mean difference (MD), with their 95% confidence intervals (CIs) for dichotomous data. Our primary outcomes were (1) growth at three and six months' corrected age, (2) major neurodevelopmental disability, and (3) adverse effects. Our secondary outcomes were (4) retinopathy of prematurity, (5) duration of initial hospitalisation, (6) duration of oxygen treatment, and (7) parent satisfaction. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Main results: </strong>We included 20 studies with 1633 infants. Data for meta-analysis were available for 11 studies (1126 infants). One study with multiple arms was included in both comparisons. We rated the overall risk of bias at the study level as high or unclear for all 20 studies that had one or several unclear or high risk of bias judgements across the domains. Cycled light versus dimmed light or near darkness (10 studies) The evidence is very uncertain about the effect of cycled light compared to dimmed light (reduction of illumination levels) or near darkness on weight at three months (MD 24.79, 95% CI -262.33 to 311.91; 2 studies, 187 infants; very low-certainty evidence), and weight at six months (MD 202, 95% CI -109.68 to 513.68; 1 study, 147 infants; very low-certainty evidence). The studies did not report any data for major neurodevelopmental disability. No data are available for adverse effects;
背景：早产和低出生体重儿处于发育的早期阶段，无法接收到充足的母体昼夜节律信号。他们通常在缺乏环境昼夜刺激的新生儿重症监护病房（NICU）长时间住院。暴露于人工光暗周期可能会刺激昼夜节律系统的发育并改善临床结果。然而，在促进发育和成熟以及减少新生儿不良健康结果方面，循环光（CL）是否优于近黑暗光（ND）或连续强光（CBL）仍不确定。这是一篇较早的Cochrane综述的更新，上次发表于2016年。目的：评价与ND或CBL相比，CL对早产儿和低出生体重儿的利与弊。检索方法：我们检索了CENTRAL、PubMed、Embase和两个截至2023年9月的试验注册中心。我们还检查了参考文献列表，并搜索了纳入研究的撤回。选择标准：我们纳入了随机对照试验（rct）或准rct，纳入了在NICU或降压病房住院和护理的早产儿（< 37周经后年龄（PMA））或低出生体重（< 2500 g）的随机对照试验（rct），比较了CL与ND或CBL。资料收集和分析：我们使用Cochrane新生儿回顾组的标准回顾方法来评估研究的方法学质量。我们使用带有风险比（RR）和均值差（MD）的固定效应模型，其95%置信区间（ci）用于二分类数据。我们的主要结局是：(1)矫正年龄3个月和6个月的生长，(2)主要神经发育障碍，(3)不良反应。我们的次要结局是(4)早产儿视网膜病变，(5)初次住院时间，(6)氧气治疗时间，(7)父母满意度。我们使用GRADE来评估每个结果证据的确定性。主要结果：我们纳入了20项研究，涉及1633名婴儿。荟萃分析的数据来自11项研究（1126名婴儿）。两种比较均包括一项多组研究。我们将研究水平的总体偏倚风险评定为高或不明确，所有20项研究在各个领域都有一个或多个不明确或高风险的偏倚判断。循环光照与暗光或近暗（10项研究）相比，循环光照对三个月体重的影响(MD 24.79, 95% CI -262.33至311.91；2项研究，187名婴儿；极低确定性证据)和6个月时的体重(MD 202, 95% CI -109.68至513.68；1项研究，147名婴儿；非常低确定性证据)。这些研究没有报告任何关于主要神经发育障碍的数据。没有关于不良反应的数据；不确定是否没有不良反应是因为没有发生，还是因为没有发现和记录不良反应。与昏暗的光线或接近黑暗的光线相比，循环光照对任何阶段早产儿视网膜病变发生可能性的影响尚无明确的证据(RR 0.89, 95% CI 0.76至1.03；3项研究，307名婴儿；极低确定性证据)和严重的3期或以上早产儿视网膜病变(RR 0.98, 95% CI 0.59 ~ 1.61；4项研究，454名婴儿；非常低确定性证据)。与昏暗的光线或接近黑暗的光线相比，循环光线对初次住院时间的影响可能很小或没有影响(MD -3.04, 95% CI -7.86至1.78；5项研究，550名婴儿；非常低确定性的证据)，但证据非常不确定。循环光照与连续强光（11项研究）由于没有研究报道，以下主要结局没有数据可用：3个月和6个月矫正年龄的生长、主要神经发育障碍和不良反应。不确定是否没有不良反应是因为没有发生，还是因为没有发现和记录不良反应。没有关于早产儿视网膜病变的数据，因为没有研究报道。与连续强光相比，循环光照可能缩短初次住院时间，但证据非常不确定(MD -9.86, 95% CI -10.09至-9.63；5项研究，499名婴儿；非常低确定性证据)。作者的结论：尽管确定了20项研究，我们仍然不确定CL与ND或CBL相比对本综述中所有感兴趣的结果的影响。此外，一些关键的结果没有在任何纳入的研究中报告。证据仍然不确定CL是否是NICU的正确选择。医生应该根据不同治疗方案在特定情况下的效果，权衡利弊。
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Pub Date : 2024-12-19DOI: 10.1002/14651858.CD014762.pub2
Ashwin Sachdeva, Bhavan Prasad Rai, Rajan Veeratterapillay, Christopher Harding, Arjun Nambiar
<p><strong>Background: </strong>Almost half of all women will have at least one symptomatic urinary tract infection (UTI) in their lifetime. Although usually self-remitting, 74% of women contacting a health professional are prescribed an antibiotic, and in rare instances, they may progress to more severe infections. Therefore, the standard of care for the treatment of symptomatic uncomplicated UTIs is oral antibiotic therapy, which aims to achieve symptom resolution and prevent the development of complications such as pyelonephritis. Given that a number of UTIs are self-remitting, non-antibiotic treatments that may help reduce the severity or duration of symptoms or reduce the need for antibiotics may be of benefit.</p><p><strong>Objectives: </strong>This review aims to investigate the benefits and risks associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women.</p><p><strong>Search methods: </strong>We searched the Cochrane Kidney and Transplant Register of Studies up to 18 November 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov.</p><p><strong>Selection criteria: </strong>We included all randomised controlled trials (RCTs) and quasi-RCTs looking at the effectiveness of NSAIDs in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women. The outcomes of interest were: 1) short-term resolution of symptoms (days 1 to 4); 2) medium-term resolution of symptoms (days 5 to 10); and 3) incidence of adverse events (including progression to sepsis or complicated UTI, hospitalisation or need for intravenous antibiotics, gastrointestinal complications, or death) up to 30 days from randomisation.</p><p><strong>Data collection and analysis: </strong>Screening, abstract selection, and data extraction were carried out independently by two authors, and any disagreements were resolved by discussion with a third author. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Main results: </strong>Six studies (1646 randomised women) published between 2010 and 2019 met our inclusion criteria. The mean age ranged from 28 to 50 years; previous UTIs were reported in 7.2% to 77% of participants. There were five multicentre studies, and studies were carried out in Denmark, Germany, Korea, Norway, Sweden, Switzerland, and
背景：几乎一半的女性一生中至少会有一次症状性尿路感染（UTI）。虽然通常是自我缓解，74%的妇女在联系卫生专业人员时会被开抗生素，在极少数情况下，她们可能会发展成更严重的感染。因此，有症状的无并发症uti治疗的护理标准是口服抗生素治疗，目的是实现症状的缓解，防止肾盂肾炎等并发症的发生。鉴于许多尿路感染是自我缓解的，非抗生素治疗可能有助于减轻症状的严重程度或持续时间，或减少对抗生素的需求。目的：本综述旨在探讨使用非甾体抗炎药（NSAIDs）治疗非妊娠成年女性症状性无并发症尿路感染的获益和风险。检索方法：我们通过与信息专家联系，使用与本综述相关的检索词检索了截至2024年11月18日的Cochrane肾脏和移植研究登记册。通过检索Cochrane中央对照试验注册库（Central）、MEDLINE和EMBASE、会议记录、国际临床试验注册平台（ICTRP）检索门户网站和clinicaltrials .gov来确定该注册库中的研究。选择标准：我们纳入了所有随机对照试验（rct）和准rct，这些试验观察了非妊娠成年妇女使用非甾体抗炎药治疗症状性无并发症uti的有效性。关注的结果是：1)症状短期缓解（第1天至第4天）；2)症状中期缓解（第5 - 10天）；3)随机分组后30天内的不良事件发生率（包括进展为败血症或合并UTI、住院或需要静脉注射抗生素、胃肠道并发症或死亡）。数据收集和分析：筛选、摘要选择和数据提取由两位作者独立进行，任何分歧均通过与第三作者讨论解决。使用随机效应模型获得效果的总结估计，结果用风险比（RR）及其95%置信区间（CI）表示二分类结局，用平均差（MD）和95% CI表示连续结局。证据的可信度采用推荐分级评估、发展和评价（GRADE）方法进行评估。主要结果：2010年至2019年间发表的6项研究（1646名随机女性）符合我们的纳入标准。平均年龄28 ~ 50岁；7.2%至77%的参与者报告了以前的尿路感染。共有5项多中心研究，分别在丹麦、德国、韩国、挪威、瑞典、瑞士和英国进行。总体而言，偏倚风险较低或不明确。与抗生素相比，非甾体抗炎药可能导致症状的短期缓解时间较短(4项研究，1144名受试者：RR 0.67, 95% CI 0.49至0.91；I2 = 75%；中度确定性)，也可能导致中期症状缓解较少(4项研究，1140名受试者：RR 0.84, 95% CI 0.71至1.01；I2 = 78%；低确定性)。非甾体抗炎药可能对第30天的不良事件数量影响很小或没有影响(4项研究，1165名受试者：RR 1.08, 95% CI 0.88至1.33；I2 = 64%；温和的确定性)。非甾体抗炎药可能导致症状持续时间延长(2项研究，553名受试者：MD 1.00天，95% CI 0.61至1.39；I2 = 0%；低确定性)。与抗生素相比，非甾体抗炎药可能导致女性在第10天出现微生物消退的比例更低(2项研究，322名参与者：RR 0.76, 95% CI 0.68至0.85；I2 = 0%；低确定性)，并可能导致更多的妇女在第30天使用救助性抗生素治疗(4项研究，1165名参与者：RR 3.14, 95% CI 2.23至4.42；I2 = 49%；温和的确定性)。与安慰剂相比，非甾体抗炎药可能减少抢救抗生素治疗的使用(1项研究，183名受试者：RR 0.56, 95% CI 0.36至0.87；低确定性证据)，但可能对第30天的不良事件影响很小或没有影响。与草药产品Uva-Ursi相比，非甾体抗炎药可能对第30天的不良事件几乎没有影响。作者的结论是：与初级抗生素治疗相比，使用非甾体抗炎药对非复杂性尿路感染的症状管理可能导致症状的短期缓解较少，并且在第30天使用更多的抢救抗生素。未来的研究应考虑各种混杂因素，如症状程度、微生物学、所涉及细菌的类型和耐药模式，以及在开始治疗前几个月内尿路感染发作的次数。
{"title":"Non-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women.","authors":"Ashwin Sachdeva, Bhavan Prasad Rai, Rajan Veeratterapillay, Christopher Harding, Arjun Nambiar","doi":"10.1002/14651858.CD014762.pub2","DOIUrl":"10.1002/14651858.CD014762.pub2","url":null,"abstract":"<p><strong>Background: </strong>Almost half of all women will have at least one symptomatic urinary tract infection (UTI) in their lifetime. Although usually self-remitting, 74% of women contacting a health professional are prescribed an antibiotic, and in rare instances, they may progress to more severe infections. Therefore, the standard of care for the treatment of symptomatic uncomplicated UTIs is oral antibiotic therapy, which aims to achieve symptom resolution and prevent the development of complications such as pyelonephritis. Given that a number of UTIs are self-remitting, non-antibiotic treatments that may help reduce the severity or duration of symptoms or reduce the need for antibiotics may be of benefit.</p><p><strong>Objectives: </strong>This review aims to investigate the benefits and risks associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women.</p><p><strong>Search methods: </strong>We searched the Cochrane Kidney and Transplant Register of Studies up to 18 November 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov.</p><p><strong>Selection criteria: </strong>We included all randomised controlled trials (RCTs) and quasi-RCTs looking at the effectiveness of NSAIDs in the treatment of symptomatic uncomplicated UTIs in non-pregnant adult women. The outcomes of interest were: 1) short-term resolution of symptoms (days 1 to 4); 2) medium-term resolution of symptoms (days 5 to 10); and 3) incidence of adverse events (including progression to sepsis or complicated UTI, hospitalisation or need for intravenous antibiotics, gastrointestinal complications, or death) up to 30 days from randomisation.</p><p><strong>Data collection and analysis: </strong>Screening, abstract selection, and data extraction were carried out independently by two authors, and any disagreements were resolved by discussion with a third author. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Main results: </strong>Six studies (1646 randomised women) published between 2010 and 2019 met our inclusion criteria. The mean age ranged from 28 to 50 years; previous UTIs were reported in 7.2% to 77% of participants. There were five multicentre studies, and studies were carried out in Denmark, Germany, Korea, Norway, Sweden, Switzerland, and ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD014762"},"PeriodicalIF":8.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-19DOI: 10.1002/14651858.CD013725.pub2
Fariha Naeem, Jenny McCleery, Tuuli M Hietamies, Fatene Abakar Ismail, Stephanie Clinton, Aoife O'Mahony, Oscar J Ponce, Terry J Quinn
<p><strong>Background: </strong>Dementia is a chronic and progressive clinical syndrome that can present with a range of cognitive and behavioural symptoms. Global prevalence is projected to increase due to ageing populations, particularly in resource-limited settings, with significant associated health and social care costs. There is a critical need for accurate cognitive assessment as part of the diagnostic workup for dementia. Although self-administered cognitive assessment tools are not diagnostic, they can be used to assess cognition. The role of these tests is uncertain, and their diagnostic test accuracy remains unclear, but they may be useful tools in circumstances where face-to-face assessment may be difficult.</p><p><strong>Objectives: </strong>Primary objective To assess the test accuracy of any self-administered cognitive assessment tool for the diagnosis of any form of dementia in any setting, including community and secondary health care. Secondary objectives To identify: the quality and quantity of the research evidence describing test accuracy of self-administered testing; sources of heterogeneity in the test accuracy described; and gaps in the evidence where further research is required.</p><p><strong>Search methods: </strong>We searched MEDLINE (Ovid SP), Embase (Ovid), Web of Science - BIOSIS Citation Index, PsycINFO (Ovid), LILACS (BIREME), and CINAHL (EBSCO). The most recent searches were run on 2 November 2022.</p><p><strong>Selection criteria: </strong>We included cross-sectional studies investigating the accuracy of a self-administered cognitive assessment tool. We included all settings, including community and secondary health care. The target condition of interest was a clinical diagnosis of dementia, therefore, we included only studies where the index test was administered alongside a reference standard clinical assessment. Our population of interest was any adult (over 18 years of age).</p><p><strong>Data collection and analysis: </strong>Two review authors independently reviewed included studies, assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and extracted data. We obtained information on study design and participant characteristics, setting of index test, details of index text, reference standard used, and results reported as sensitivity and specificity. We performed a meta-analysis on three studies that used the same threshold score.</p><p><strong>Main results: </strong>The review included 11 eligible studies, with a total of 2303 participants, which evaluated the diagnostic test accuracy of six different self-administered cognitive-assessment tools. The studies were conducted in Europe, North America, and South Korea within a variety of community and healthcare settings. Our quality assessment found that four studies had a low risk of bias across all domains. Six studies had a high or unclear risk of bias due to patient selection, with concerns around lack of a cl
背景：痴呆是一种慢性进行性临床综合征，可表现为一系列认知和行为症状。由于人口老龄化，特别是在资源有限的情况下，预计全球流行率将上升，并带来巨大的保健和社会保健费用。作为痴呆症诊断检查的一部分，对准确的认知能力评估非常有必要。虽然自我管理的认知评估工具不是诊断性的，但它们可以用来评估认知。这些测试的作用尚不确定，其诊断测试的准确性仍不清楚，但在面对面评估可能困难的情况下，它们可能是有用的工具。主要目的：评估在任何环境下，包括社区和二级卫生保健机构中，任何自我管理的认知评估工具用于诊断任何形式的痴呆的测试准确性。次要目的确定：描述自我管理测试的测试准确性的研究证据的质量和数量；所述测试精度的异质性来源；以及需要进一步研究的证据缺口。检索方法：检索MEDLINE （Ovid SP）、Embase （Ovid）、Web of Science - BIOSIS引文索引、PsycINFO （Ovid）、LILACS （BIREME）、CINAHL （EBSCO）。最近一次搜索是在2022年11月2日。选择标准：我们纳入了调查自我管理的认知评估工具准确性的横断面研究。我们纳入了所有环境，包括社区和二级卫生保健。我们关注的目标条件是痴呆的临床诊断，因此，我们只纳入了指数测试与参考标准临床评估同时进行的研究。我们感兴趣的人群是任何成年人（18岁以上）。数据收集和分析：两位综述作者独立地回顾了纳入的研究，使用诊断准确性研究质量评估（QUADAS-2）工具评估偏倚风险，并提取数据。我们获得了有关研究设计和参与者特征、指标试验设置、指标文本细节、使用的参考标准以及报告敏感性和特异性结果的信息。我们对使用相同阈值评分的三项研究进行了荟萃分析。主要结果：该综述包括11项符合条件的研究，共有2303名参与者，评估了六种不同的自我管理认知评估工具的诊断测试准确性。这些研究是在欧洲、北美和韩国的各种社区和医疗机构中进行的。我们的质量评估发现，四项研究在所有领域的偏倚风险都很低。由于患者选择，有6项研究存在较高或不明确的偏倚风险，担心缺乏明确的抽样策略或排除标准，或两者兼而有之。由于缺乏关于如何进行和评估测试的信息，六项研究在指数测试方面存在较高或不明确的偏倚风险。对于痴呆症的诊断，自我给予的认知评估工具的敏感性为55%至100%，特异性为45%至100%。三项研究描述了“测试你的记忆”的诊断测试准确率在42/50的阈值。定量荟萃分析估计该阈值的总结点灵敏度为94%(95%置信区间（CI） 90%至96%)，特异性为66% （95% CI 45%至82%）。作者的结论是：没有足够的证据推荐使用任何单一的自我管理的认知评估工具。这些工具的测试准确性得分与临床医生进行的标准铅笔和纸认知筛选测试的范围相似。需要进一步研究最佳测试和阈值，以及环境、语言和教育水平对其的影响。
{"title":"Diagnostic test accuracy of self-administered cognitive assessment tools for dementia.","authors":"Fariha Naeem, Jenny McCleery, Tuuli M Hietamies, Fatene Abakar Ismail, Stephanie Clinton, Aoife O'Mahony, Oscar J Ponce, Terry J Quinn","doi":"10.1002/14651858.CD013725.pub2","DOIUrl":"10.1002/14651858.CD013725.pub2","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a chronic and progressive clinical syndrome that can present with a range of cognitive and behavioural symptoms. Global prevalence is projected to increase due to ageing populations, particularly in resource-limited settings, with significant associated health and social care costs. There is a critical need for accurate cognitive assessment as part of the diagnostic workup for dementia. Although self-administered cognitive assessment tools are not diagnostic, they can be used to assess cognition. The role of these tests is uncertain, and their diagnostic test accuracy remains unclear, but they may be useful tools in circumstances where face-to-face assessment may be difficult.</p><p><strong>Objectives: </strong>Primary objective To assess the test accuracy of any self-administered cognitive assessment tool for the diagnosis of any form of dementia in any setting, including community and secondary health care. Secondary objectives To identify: the quality and quantity of the research evidence describing test accuracy of self-administered testing; sources of heterogeneity in the test accuracy described; and gaps in the evidence where further research is required.</p><p><strong>Search methods: </strong>We searched MEDLINE (Ovid SP), Embase (Ovid), Web of Science - BIOSIS Citation Index, PsycINFO (Ovid), LILACS (BIREME), and CINAHL (EBSCO). The most recent searches were run on 2 November 2022.</p><p><strong>Selection criteria: </strong>We included cross-sectional studies investigating the accuracy of a self-administered cognitive assessment tool. We included all settings, including community and secondary health care. The target condition of interest was a clinical diagnosis of dementia, therefore, we included only studies where the index test was administered alongside a reference standard clinical assessment. Our population of interest was any adult (over 18 years of age).</p><p><strong>Data collection and analysis: </strong>Two review authors independently reviewed included studies, assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and extracted data. We obtained information on study design and participant characteristics, setting of index test, details of index text, reference standard used, and results reported as sensitivity and specificity. We performed a meta-analysis on three studies that used the same threshold score.</p><p><strong>Main results: </strong>The review included 11 eligible studies, with a total of 2303 participants, which evaluated the diagnostic test accuracy of six different self-administered cognitive-assessment tools. The studies were conducted in Europe, North America, and South Korea within a variety of community and healthcare settings. Our quality assessment found that four studies had a low risk of bias across all domains. Six studies had a high or unclear risk of bias due to patient selection, with concerns around lack of a cl","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD013725"},"PeriodicalIF":8.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-19DOI: 10.1002/14651858.CD003200.pub9
Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price
<p><strong>Editorial note: </strong>Editorial note (19 December 2024; amended 31 January 2025): Larun L, Brurberg KG, Odgaard‐Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003200. DOI: 10.1002/14651858.CD003200.pub8. Accessed 18 December 2024. This Editorial Note is for the above article, published online on 2 October 2019 on the Cochrane Library (https://www.cochranelibrary.com/), and has been issued by the Publisher, John Wiley & Sons Ltd, in agreement with the Cochrane Collaboration. The Editorial note has been agreed to inform readers that Cochrane is ceasing the production of a full update of this Cochrane review. A pilot project for engaging interest holders in the development of this Cochrane review was initiated on 2 October 2019 (see Editorial Note below) and has now been disbanded. Cochrane maintains its decision to publish this Cochrane review in 2019, which includes studies from searches up to 9 May 2014. Editorial note (2 October 2019): A statement from the Editor in Chief about this review and its planned update is available at https://www.cochrane.org/news/cfs</p><p><strong>Background: </strong>Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a serious disorder characterised by persistent postexertional fatigue and substantial symptoms related to cognitive, immune and autonomous dysfunction. There is no specific diagnostic test, therefore diagnostic criteria are used to diagnose CFS. The prevalence of CFS varies by type of diagnostic criteria used. Existing treatment strategies primarily aim to relieve symptoms and improve function. One treatment option is exercise therapy.</p><p><strong>Objectives: </strong>The objective of this review was to determine the effects of exercise therapy for adults with CFS compared with any other intervention or control on fatigue, adverse outcomes, pain, physical functioning, quality of life, mood disorders, sleep, self-perceived changes in overall health, health service resources use and dropout.</p><p><strong>Search methods: </strong>We searched the Cochrane Common Mental Disorders Group controlled trials register, CENTRAL, and SPORTDiscus up to May 2014, using a comprehensive list of free-text terms for CFS and exercise. We located unpublished and ongoing studies through the World Health Organization International Clinical Trials Registry Platform up to May 2014. We screened reference lists of retrieved articles and contacted experts in the field for additional studies.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) about adults with a primary diagnosis of CFS, from all diagnostic criteria, who were able to participate in exercise therapy.</p><p><strong>Data collection and analysis: </strong>Two review authors independently performed study selection, 'Risk of bias' assessments and data extraction. We combined continuous measures of outcomes usin
背景：慢性疲劳综合征（CFS）或肌痛性脑脊髓炎（ME）是一种严重的疾病，其特征是持续的运动后疲劳和与认知、免疫和自主功能障碍相关的实质性症状。目前尚无专门的诊断试验，故采用诊断标准对CFS进行诊断。CFS的患病率因使用的诊断标准类型而异。现有的治疗策略主要旨在缓解症状和改善功能。一种治疗方法是运动疗法。目的：本综述的目的是确定运动治疗对成人CFS的影响，与任何其他干预或控制相比，在疲劳、不良后果、疼痛、身体功能、生活质量、情绪障碍、睡眠、整体健康自我感知变化、卫生服务资源使用和辍学方面。检索方法：我们检索了截至2014年5月的Cochrane常见精神障碍组对照试验注册、CENTRAL和SPORTDiscus，使用了CFS和运动的完整的自由文本术语列表。截至2014年5月，我们通过世界卫生组织国际临床试验注册平台找到了未发表和正在进行的研究。我们筛选了检索文章的参考文献列表，并联系了该领域的专家进行进一步的研究。选择标准：我们纳入了初步诊断为慢性疲劳综合症的成年人的随机对照试验（rct），符合所有诊断标准，能够参加运动治疗。数据收集和分析：两位综述作者独立进行研究选择、“偏倚风险”评估和数据提取。我们使用平均差异（md）或标准化平均差异（SMDs）结合连续测量结果。为了便于解释SMD，我们将SMD估计重新表示为更常见的测量尺度上的md。我们使用风险比（rr）合并二分类结果。我们使用GRADE评估证据的确定性。主要结果：我们纳入了8项随机对照试验，数据来自1518名参与者。运动疗法持续12 ~ 26周。这些研究测量了治疗结束时的效果，以及50周或72周后的长期随访。七项研究使用了有氧运动疗法，如散步、游泳、骑自行车或跳舞，有氧运动的强度从非常低到相当高不等，一项研究使用了无氧运动。对照组由被动控制组成，包括常规治疗、放松或柔韧性（8项研究）；认知行为疗法（CBT）（两项研究）；认知疗法（一项研究）；支持性倾听（一项研究）；节奏（一项研究）；药物治疗（1项研究）和联合治疗（1项研究）。大多数研究的选择偏倚风险较低。所有人的表现和检测偏差风险都很高。运动疗法与“被动”对照相比运动疗法可能减少治疗结束时的疲劳(SMD -0.66, 95% CI -1.01至-0.31；7项研究，840名参与者；moderate-certainty证据;重表达MD -3.4, 95% CI -5.3 ~ -1.6；等级0到33)。我们不确定疲劳是否会在长期内减少，因为证据的确定性非常低(SMD -0.62, 95% CI -1.32至0.07；4项研究，670名参与者；再表达MD -3.2, 95% CI -6.9 ~ 0.4；等级0到33)。我们不确定发生严重不良反应的风险，因为证据的确定性非常低(RR 0.99, 95% CI 0.14 ~ 6.97；1项研究，319名参与者)。运动疗法可能在治疗结束时适度改善身体功能，但长期效果尚不确定，因为证据的确定性非常低。运动疗法在治疗结束和长期治疗中也能略微改善睡眠。运动疗法对疼痛、生活质量和抑郁的影响是不确定的，因为证据缺失或确定性非常低。运动疗法与CBT的比较运动疗法在治疗结束时对疲劳的影响可能很小或没有影响(MD = 0.20, 95% CI = -1.49 ~ 1.89；1项研究，298名参与者；低确定性证据)或长期随访(SMD = 0.07, 95% CI = -0.13 ~ 0.28；2项研究，351名受试者；moderate-certainty证据)。我们不确定严重不良反应的风险，因为证据的确定性非常低(RR 0.67, 95% CI 0.11至3.96；1项研究，321名参与者)。现有的证据表明，运动疗法和CBT在身体功能或睡眠方面可能几乎没有区别（低确定性证据），对抑郁症的影响可能很少或没有区别（中等确定性证据）。我们不确定运动疗法与认知行为疗法相比是否能改善生活质量或减轻疼痛，因为证据的确定性非常低。运动疗法与适应性起搏的比较运动疗法可在治疗结束时轻微减轻疲劳（MD -2.00, 95% CI -3.57 ~ -0）。
{"title":"Exercise therapy for chronic fatigue syndrome.","authors":"Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price","doi":"10.1002/14651858.CD003200.pub9","DOIUrl":"10.1002/14651858.CD003200.pub9","url":null,"abstract":"<p><strong>Editorial note: </strong>Editorial note (19 December 2024; amended 31 January 2025):\u0000Larun L, Brurberg KG, Odgaard‐Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003200. DOI: 10.1002/14651858.CD003200.pub8. Accessed 18 December 2024.\u0000\u0000This Editorial Note is for the above article, published online on 2 October 2019 on the Cochrane Library (https://www.cochranelibrary.com/), and has been issued by the Publisher, John Wiley & Sons Ltd, in agreement with the Cochrane Collaboration. The Editorial note has been agreed to inform readers that Cochrane is ceasing the production of a full update of this Cochrane review. A pilot project for engaging interest holders in the development of this Cochrane review was initiated on 2 October 2019 (see Editorial Note below) and has now been disbanded. Cochrane maintains its decision to publish this Cochrane review in 2019, which includes studies from searches up to 9 May 2014.\u0000\u0000Editorial note (2 October 2019):\u0000A statement from the Editor in Chief about this review and its planned update is available at https://www.cochrane.org/news/cfs</p><p><strong>Background: </strong>Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a serious disorder characterised by persistent postexertional fatigue and substantial symptoms related to cognitive, immune and autonomous dysfunction. There is no specific diagnostic test, therefore diagnostic criteria are used to diagnose CFS. The prevalence of CFS varies by type of diagnostic criteria used. Existing treatment strategies primarily aim to relieve symptoms and improve function. One treatment option is exercise therapy.</p><p><strong>Objectives: </strong>The objective of this review was to determine the effects of exercise therapy for adults with CFS compared with any other intervention or control on fatigue, adverse outcomes, pain, physical functioning, quality of life, mood disorders, sleep, self-perceived changes in overall health, health service resources use and dropout.</p><p><strong>Search methods: </strong>We searched the Cochrane Common Mental Disorders Group controlled trials register, CENTRAL, and SPORTDiscus up to May 2014, using a comprehensive list of free-text terms for CFS and exercise. We located unpublished and ongoing studies through the World Health Organization International Clinical Trials Registry Platform up to May 2014. We screened reference lists of retrieved articles and contacted experts in the field for additional studies.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) about adults with a primary diagnosis of CFS, from all diagnostic criteria, who were able to participate in exercise therapy.</p><p><strong>Data collection and analysis: </strong>Two review authors independently performed study selection, 'Risk of bias' assessments and data extraction. We combined continuous measures of outcomes usin","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD003200"},"PeriodicalIF":8.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1002/14651858.CD007968.pub3
Greta Sibrecht, Ming Yin Wong, Rujan Shrestha, Matteo Bruschettini
<p><strong>Background: </strong>Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used.</p><p><strong>Objectives: </strong>To determine the benefits and harms of acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure) on mortality and morbidity in neonates with HIE, compared with 1) no treatment, 2) placebo or sham treatment, 3) any pharmacologic treatment, or 4) different types of acupuncture.</p><p><strong>Search methods: </strong>We searched CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the WHO ICTRP in March 2023. We conducted a search of the grey literature to identify reports of trials conducted by or referenced in research by CORDIS EU, National Institute for Health and Care Excellence (NICE), and NHSGGC Paediatrics for Health Professionals. We also checked the reference lists of relevant articles to identify additional studies.</p><p><strong>Selection criteria: </strong>We included randomized controlled trials (RCTs) or quasi-RCTs and cluster-randomized trials. We included studies where participants were term infants (37 weeks or greater) and late preterm infants (34 + 0 to 36 + 6 weeks' gestation) 10 days of age or less, with evidence of peripartum asphyxia. We included studies on acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure). We included studies where acupuncture was compared with: 1) no treatment; 2) placebo or sham treatment; 3) any pharmacologic treatment; or 4) different types of acupuncture.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our primary outcomes were all-cause mortality at the latest follow-up, major neurodevelopmental disability in children aged 18 to 24 months and aged 3 to 5 years, adverse events until hospital discharge, and length of hospital stay.</p><p><strong>Main results: </strong>We included four studies (enrolling 464 infants) that compared acupuncture with no treatment. The studies ranged in size from 60 to 200 infants. Three studies were conducted in China and one in Russia. None of the four studies reported on any of the prespecified outcomes of our review. We did not identify any ongoing studies.</p><p><strong>Authors' conclusions: </strong>There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are
{"title":"Acupuncture for hypoxic ischemic encephalopathy in neonates.","authors":"Greta Sibrecht, Ming Yin Wong, Rujan Shrestha, Matteo Bruschettini","doi":"10.1002/14651858.CD007968.pub3","DOIUrl":"10.1002/14651858.CD007968.pub3","url":null,"abstract":"<p><strong>Background: </strong>Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used.</p><p><strong>Objectives: </strong>To determine the benefits and harms of acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure) on mortality and morbidity in neonates with HIE, compared with 1) no treatment, 2) placebo or sham treatment, 3) any pharmacologic treatment, or 4) different types of acupuncture.</p><p><strong>Search methods: </strong>We searched CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the WHO ICTRP in March 2023. We conducted a search of the grey literature to identify reports of trials conducted by or referenced in research by CORDIS EU, National Institute for Health and Care Excellence (NICE), and NHSGGC Paediatrics for Health Professionals. We also checked the reference lists of relevant articles to identify additional studies.</p><p><strong>Selection criteria: </strong>We included randomized controlled trials (RCTs) or quasi-RCTs and cluster-randomized trials. We included studies where participants were term infants (37 weeks or greater) and late preterm infants (34 + 0 to 36 + 6 weeks' gestation) 10 days of age or less, with evidence of peripartum asphyxia. We included studies on acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure). We included studies where acupuncture was compared with: 1) no treatment; 2) placebo or sham treatment; 3) any pharmacologic treatment; or 4) different types of acupuncture.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our primary outcomes were all-cause mortality at the latest follow-up, major neurodevelopmental disability in children aged 18 to 24 months and aged 3 to 5 years, adverse events until hospital discharge, and length of hospital stay.</p><p><strong>Main results: </strong>We included four studies (enrolling 464 infants) that compared acupuncture with no treatment. The studies ranged in size from 60 to 200 infants. Three studies were conducted in China and one in Russia. None of the four studies reported on any of the prespecified outcomes of our review. We did not identify any ongoing studies.</p><p><strong>Authors' conclusions: </strong>There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD007968"},"PeriodicalIF":8.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1002/14651858.CD015942
Mengqi Li, Sam Yuen, Mohit Arora, Xu Liu, Tella Lantta, Ashley Craig, Yan Li
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the effects of peer-supported interventions on quality of life and self-management compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with spinal cord injury (SCI). Secondary objective To assess the effects of peer-supported interventions on health service utilisation, secondary health conditions, mood disorders, and social participation compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with SCI, as well as to assess the adverse outcomes of peer-supported interventions in people with SCI.
{"title":"Peer-supported interventions for people with spinal cord injury.","authors":"Mengqi Li, Sam Yuen, Mohit Arora, Xu Liu, Tella Lantta, Ashley Craig, Yan Li","doi":"10.1002/14651858.CD015942","DOIUrl":"10.1002/14651858.CD015942","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the effects of peer-supported interventions on quality of life and self-management compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with spinal cord injury (SCI). Secondary objective To assess the effects of peer-supported interventions on health service utilisation, secondary health conditions, mood disorders, and social participation compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with SCI, as well as to assess the adverse outcomes of peer-supported interventions in people with SCI.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015942"},"PeriodicalIF":8.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1002/14651858.CD015424.pub2
Abigale MacLellan, Austin J Cameron-Nola, Chris Cooper, Souvik Mitra
<p><strong>Background: </strong>The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA). If a PDA is clinically symptomatic, it can lead to overcirculation in the lungs, and reduced perfusion to the gut and kidneys. Most clinical practice guidelines suggest fluid restriction as a conservative management strategy for the treatment of symptomatic PDA. Restricting fluid has been shown to reduce the incidence of PDA in older preterm infants. However, aggressive restriction of fluids may affect systemic blood flow in extremely preterm infants. Given the potential adverse effects, it is important to systematically evaluate the evidence on the use of fluid restriction to treat symptomatic PDA to inform clinical decisions.</p><p><strong>Objectives: </strong>To assess the effects of fluid restriction on morbidity and mortality for symptomatic PDA in preterm infants.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, and Embase in October 2023. We also searched Clinicaltrials.gov, ICTRP, ANZCTR, and Epistemonikos. We planned to search the reference list of included studies and relevant systematic reviews for studies not identified by the database searches, but did not identify any.</p><p><strong>Selection criteria: </strong>We planned to include randomized controlled trials (RCTs), quasi-RCTs, cluster-RCTs, and cross-over RCTs. We planned to include neonates who were born preterm (less than 37 weeks' gestational age), or with low birth weight (less than 2500 g), with a symptomatic PDA, diagnosed either clinically or by echocardiographic criteria, in the neonatal period. We planned to include studies that compared therapeutic restriction of parenteral or enteral fluids, or both, with or without diuretics, with control groups that received standard fluid intake, defined as no parenteral or enteral restriction, with or without diuretic use.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our primary outcome was closure of PDA. Other relevant outcomes were all-cause mortality by 36 weeks' postmenstrual age, need for interventional closure of the PDA, need for treatment with a cyclooxygenase inhibitor, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and duration of hospitalization. We planned to use GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Main results: </strong>We did not identify any completed or ongoing RCTs that met our inclusion criteria and explored the effectiveness and safety of fluid restriction to treat symptomatic PDA.</p><p><strong>Authors' conclusions: </strong>No evidence from RCTs is currently available to evaluate the benefits and harms of fluid restriction for the treatment of symptomatic patent ductus arteriosus in preterm i
{"title":"Fluid restriction for treatment of symptomatic patent ductus arteriosus in preterm infants.","authors":"Abigale MacLellan, Austin J Cameron-Nola, Chris Cooper, Souvik Mitra","doi":"10.1002/14651858.CD015424.pub2","DOIUrl":"10.1002/14651858.CD015424.pub2","url":null,"abstract":"<p><strong>Background: </strong>The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA). If a PDA is clinically symptomatic, it can lead to overcirculation in the lungs, and reduced perfusion to the gut and kidneys. Most clinical practice guidelines suggest fluid restriction as a conservative management strategy for the treatment of symptomatic PDA. Restricting fluid has been shown to reduce the incidence of PDA in older preterm infants. However, aggressive restriction of fluids may affect systemic blood flow in extremely preterm infants. Given the potential adverse effects, it is important to systematically evaluate the evidence on the use of fluid restriction to treat symptomatic PDA to inform clinical decisions.</p><p><strong>Objectives: </strong>To assess the effects of fluid restriction on morbidity and mortality for symptomatic PDA in preterm infants.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, and Embase in October 2023. We also searched Clinicaltrials.gov, ICTRP, ANZCTR, and Epistemonikos. We planned to search the reference list of included studies and relevant systematic reviews for studies not identified by the database searches, but did not identify any.</p><p><strong>Selection criteria: </strong>We planned to include randomized controlled trials (RCTs), quasi-RCTs, cluster-RCTs, and cross-over RCTs. We planned to include neonates who were born preterm (less than 37 weeks' gestational age), or with low birth weight (less than 2500 g), with a symptomatic PDA, diagnosed either clinically or by echocardiographic criteria, in the neonatal period. We planned to include studies that compared therapeutic restriction of parenteral or enteral fluids, or both, with or without diuretics, with control groups that received standard fluid intake, defined as no parenteral or enteral restriction, with or without diuretic use.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our primary outcome was closure of PDA. Other relevant outcomes were all-cause mortality by 36 weeks' postmenstrual age, need for interventional closure of the PDA, need for treatment with a cyclooxygenase inhibitor, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and duration of hospitalization. We planned to use GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Main results: </strong>We did not identify any completed or ongoing RCTs that met our inclusion criteria and explored the effectiveness and safety of fluid restriction to treat symptomatic PDA.</p><p><strong>Authors' conclusions: </strong>No evidence from RCTs is currently available to evaluate the benefits and harms of fluid restriction for the treatment of symptomatic patent ductus arteriosus in preterm i","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015424"},"PeriodicalIF":8.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1002/14651858.CD016028
Franciszek Borys, Marcus G Prescott, Michelle Fiander, Roger F Soll, Matteo Bruschettini
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of clustering of care activities for promoting development and preventing morbidity in preterm infants.
{"title":"Clustering of care activities for promoting development and preventing morbidity in hospitalized preterm infants.","authors":"Franciszek Borys, Marcus G Prescott, Michelle Fiander, Roger F Soll, Matteo Bruschettini","doi":"10.1002/14651858.CD016028","DOIUrl":"10.1002/14651858.CD016028","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of clustering of care activities for promoting development and preventing morbidity in preterm infants.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016028"},"PeriodicalIF":8.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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