Journal of Evidence‐Based Medicine最新文献

Case reports represent the earliest form of scientific literature to identify and describe adverse events (AEs) associated with medical interventions, and they still represent important educational resources for ensuring the safe practice of such interventions. Although case reports on AEs related to acupuncture continue to be published, detailed information about the acupuncture procedure is often insufficiently reported in these studies, which may introduce an overstatement or exaggeration of the harm of acupuncture. Consequently, these reports fall short of evaluating causality and achieving the educational purpose of preventing future AEs. To help address these limitations, we developed the "REporting guidelines for aCupuncture-related AdverSe Event case reports" (RECASE) based on the CARE (CAse REports) reporting guidelines for case reports using the expert Delphi methodology. This guideline contains essential items for case reports on acupuncture-related AEs. We anticipate that this reporting guideline will encourage greater transparency, fairness, and comprehensiveness in future case reports on acupuncture-related AEs.

Background: Systematic reviews on acupuncture for obesity report conflicting findings, and the certainty of this evidence remains unclear. This umbrella review appraises the evidence to identify which effects on body mass index (BMI) and body weight (BW) are supported by high-quality findings.

Methods: We conducted an umbrella review by systematically searching PubMed, Embase, and the Cochrane Library through April 28, 2025 to obtain systematic reviews of randomized controlled trials evaluating acupuncture interventions for obesity. Two reviewers independently assessed methodological quality using a measurement tool to assess systematic reviews (AMSTAR) and evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We identified best evidence from high-quality systematic reviews with high or moderate GRADE ratings.

Results: Our analysis included 22 systematic reviews encompassing 60 meta-analyses. Seventeen reviews (77.3%) achieved high methodological quality ratings according to AMSTAR criteria. Five meta-analyses provided high-quality evidence consistently demonstrating significant benefits of acupuncture interventions. The strongest evidence supported acupuncture combined with lifestyle interventions compared to lifestyle interventions alone for both BMI and BW outcomes. Additional high-quality evidence demonstrated significant benefits for acupuncture versus no treatment and versus sham acupuncture. Fourteen meta-analyses provided moderate-quality evidence confirming acupuncture effectiveness, with no significant differences between acupuncture and pharmaceutical treatments.

Conclusions: Based on high-quality evidence, clinicians can recommend acupuncture to patients with obesity, particularly as adjunctive therapy to lifestyle interventions. For patients unable to tolerate pharmacological treatments, acupuncture represents a reasonable alternative. However, optimal benefits require integration with comprehensive lifestyle modifications rather than standalone use.

Objective: This study aimed to describe the incidence, mortality, and disease burden of tracheal, bronchial, and lung cancer (TBL) in both China and worldwide.

Methods: We extracted estimates of the incidence, mortality, and disability-adjusted life years (DALYs) for TBL from the Global Burden of Disease 2021 database. The age-period-cohort model was employed to explore the impacts of age, period, and birth cohort on TBL. Joinpoint regression analysis examined long-term trends in TBL incidence, mortality, and DALYs. Correlation analysis was conducted to investigate the relationship between TBL disease burden in 2021 and the economic development level of the regions.

Results: In 2021, the global age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for TBL were 26 (95% uncertainty intervals [UI]: 24-29), 24 (95% UI: 21-26), and 533 (95% UI: 480-586) per 100,000 population. In all regions, regardless of economic level, male TBL incidence, mortality, and DALYs were significantly higher than those in females. After age 45, the ASIR, ASMR, and ASDR for TBL showed a geometric increase, peaking after age 85. Regions with higher economic levels faced higher TBL incidence and disease burden.

Conclusion: In some less developed regions, the disease burden of TBL has shown an upward trend. The heterogeneous long-term trends observed across different sexes and age groups highlight the need for greater attention to issues such as excessive smoking and environmental exposure among middle-aged and elderly populations, particularly women.

Aim: Hypokalemia is a prevalent complication following pituitary adenoma (PA) surgery, adversely impacting patient prognosis. Identifying predictors of early postoperative hypokalemia is crucial for managing patients effectively. This study aims to develop an interpretable predictive model to predict postoperative hypokalemia in patients with PA and recognizes individualized significant parameters contributing to the predictive outcomes, thereby facilitating early intervention.

Methods: This retrospective cohort study investigated postoperative hypokalemia in 280 patients with PA. We developed a Transformer-based predictive model, CliTab-Transformer, and compared it with an XGBoost-based model and a multilayer perceptron (MLP)-based deep learning model. Model performance was evaluated using metrics such as accuracy, precision, recall, F1 score, and ROC/PR curves, based on five-fold cross-validation. Model interpretability was assessed using a novel Transformer-Explainability method to identify significant parameters contributing to individual predictions.

Results: CliTab-Transformer outperformed XGBoost and MLP in predicting postoperative hypokalemia, showing higher accuracy (0.836 vs. 0.775 vs. 0.771), F1 score (0.845 vs. 0.792 vs. 0.766), sensitivity (0.838 vs. 0.833 vs. 0.771), and AUC (0.835 vs. 0.807 vs. 0.676). The model's interpretability analysis revealed that the preoperative factors, including gender, hypertension, serum potassium concentration, and disease duration, are significantly predictive of postoperative hypokalemia.

Conclusions: Our model outperforms XGBoost in predicting early postoperative hypokalemia in patients with pituitary adenomas. We systematically explore attention mechanisms in clinical tabular data, demonstrating their effectiveness in capturing complex feature interactions, leading to more individualized, interpretable, and clinically meaningful insights.

Aim: Infertility is a growing global health issue affecting millions worldwide. While endometriosis, polycystic ovarian syndrome (PCOS) and unexplained infertility are recognized as the major contributors, their specific burden and impact on infertility among women of childbearing age (WCBA) remain inadequately quantified. This study aimed to evaluate the global burden of three diseases and infertility attributable to them.

Methods: Using data from Global Burden of Disease Study 2021, we assessed the temporal trends of three diseases by average annual percentage change (AAPC) in age-standardized prevalence rate (ASPR) and DALYs rate (ASDR), and evaluated their correlation with socio-demographic index (SDI). We also calculated the age-standardized prevalence and years lived with disability (YLDs) rates of infertility attributable to three diseases.

Results: In 2021, the global ASPRs of endometriosis, PCOS, and unexplained infertility were 1070.7 (AAPC: -1.02%, declining), 3364.5 (AAPC: 0.74%, increasing), and 5586.2 (AAPC: 0.70%, increasing), and infertility attributable to three diseases were 60.6, 638.2, and 5586.2 per 100,000 population, respectively. Regionally, Oceania had the highest ASPR for endometriosis, East Asia for unexplained infertility, and high-income Asia Pacific for PCOS. Infertility attributable to PCOS exhibited higher age-standardized prevalence and YLDs rates compared to endometriosis in most regions. Notably, ASPRs and ASDRs for endometriosis and unexplained infertility decreased with SDI, while PCOS rates increased with SDI.

Conclusions: The increasing global burden of endometriosis, PCOS, and unexplained infertility among WCBA has significantly contributed to rising infertility rates, with distinct regional and demographic disparities. Targeted public health strategies are needed to address these trends.

Background: Anlotinib, a multi-target small-molecule receptor tyrosine kinase inhibitor, can inhibit tumor angiogenesis proliferation and remains underexplored in metastatic breast cancer (MBC). Therefore, we aimed to analyze the efficacy and safety of anlotinib for MBC treatment in a real-world study.

Methods: In this multicenter, retrospective study, patients with MBC who received anlotinib at four Chinese centers between January 2021 and December 2022 were enrolled (data cut-off date: February 1, 2025). The primary end point was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate, and adverse events (AEs). Statistical significance was defined at p < 0.05.

Results: In total, 153 patients were included in this study (median age, 51 years). Median follow-up time was 30.0 months. A total of 86 (56.2%) patients were hormone receptor-positive/human epidermal growth factor receptor 2-negative, whereas the others were human epidermal growth factor receptor 2-positive (9.8%) or triple-negative breast cancer (34.0%). The median PFS and OS were 6.0 months (95% confidence interval [CI] 4.5-7.5) and 28.5 months (95% CI 20.3-36.7). The number of metastatic sites and Eastern Cooperative Oncology Group performance status were significant in Cox multivariate analysis (p = 0.012 and p = 0.030, respectively) and were significantly associated with PFS of anlotinib. Most AEs were clinically manageable, whereas Grade III/IV AEs included neutropenia (29.4%) and fatigue (6.5%).

Conclusion: Anlotinib exhibits effective and safe anti-tumor activity in the treatment of MBC.

The hierarchical diagnosis and treatment system's two-way referral mechanism is crucial for optimizing medical resource allocation, with medical consortia significantly enhancing this process. It evaluates the implementation dynamics of two-way referral systems within China's medical consortia from 2019 to 2024, focusing on policy evolution, regional disparities, and stakeholder engagement. Despite a positive overall trend, referral rates remain low, with notable regional and institutional disparities. The implementation outcomes span various dimensions, including referral metrics, specific services, timing, and costs; however, these effects are inconsistent and warrant further investigation. The current evaluation index system is diverse but tends to prioritize quantity over quality. Additionally, awareness and satisfaction levels among medical personnel and patients regarding the two-way referral system are uneven and influenced by multiple factors. Currently, China's two-way referral system faces challenges, including low referral volumes, an inadequate evaluation framework, limited research perspectives, and insufficient motivation for stakeholder participation. Future efforts should focus on strengthening primary care infrastructure, enhancing resource collaboration, advancing health insurance reforms, refining the evaluation system, and fostering synergy between hierarchical diagnosis and treatment, the Healthy China strategy, and referral model innovation to advance the hierarchical diagnosis and treatment system. Recommendations emphasize strengthening primary care capacity, reforming insurance payment models, and leveraging digital health technologies to align with the "Healthy China 2030" strategic goals.

Aim: Microsatellite instability (MSI) as a result of deficient deoxyribonucleic acid (DNA) mismatch repair (dMMR) is a key contributor to the development of tumors with a high mutation rate and cancer-specific neoantigens. dMMR identification can be beneficial for selection of immune checkpoint inhibitor (ICI) therapy-eligible patients. While multiple studies have focused on dMMR prevalence in colorectal cancer (CRC), fewer investigate the prevalence of dMMR in tumor types besides CRC, especially in Chinese patients. In this study, we aimed to determine the prevalence of dMMR in China across five gastrointestinal and gynecological tumor types.

Methods: Tissue samples from Chinese patients with advanced endometrial, ovarian, cervical, biliary tract, or gastric metastatic or unresectable solid tumors were tested for dMMR status using immunohistochemistry with the Ventana MMR RxDx panel. Data were analyzed to determine the prevalence of dMMR for each tumor type.

Results: A total of 748 patients were included in the study, representing five tumor types. Prevalence of dMMR varied across tumor types, with an overall prevalence of 9.4%. Patients with endometrial tumors had the highest proportion of patients with dMMR at 49/164 (29.9%). Patients with cervical tumors had the lowest prevalence of dMMR with 6/221 (2.7%) patients. The prevalence of dMMR was similar across most demographic characteristics. In the dMMR population, co-occurring MLH1 and PMS2 protein loss across all tumor types was observed most commonly, in 48/70 (68.6%) patients.

Conclusions: These data highlight the importance of dMMR testing in patients with advanced solid tumors in China to optimize biomarker testing and treatment decisions.

Objective: To develop an evidence-based patient version of guideline (PVG) for fibromyalgia, aiming to improve patients' understanding of disease symptoms and therapeutic options and to enhance their self-management abilities.

Methods: Following the World Health Organization Handbook for Guideline Development (2014), a multidisciplinary working group was established, including patient representatives, physicians, pharmacists, nurses, and methodologists. The process comprised (a) systematic retrieval of clinical practice guidelines and expert consensus statements to establish the evidence base; (b) integration of large language models (LLMs) with expert review to identify and refine key patient-centered concerns; (c) a three-round Delphi consensus guided by the Grading of Recommendations Assessment, Development and Evaluation approach to finalize clinical questions and formulate recommendations; and (d) evaluation of understandability using the Patient Education Materials Assessment Tool for Print Materials (PEMAT-P).

Results: The final PVG covers 13 clinical questions across seven domains, including disease awareness, diagnostic evaluation, pharmacological and non-pharmacological interventions, and long-term management. All recommendations were rated as strong. The guideline emphasizes the importance of pharmacological management, emotional regulation, and exercise in the comprehensive management of fibromyalgia. The PEMAT-P assessment showed an understandability score of 100%.

Conclusions: Developed collaboratively by a multidisciplinary team and patient representatives, this PVG is based on 13 evidence-based fibromyalgia guidelines. Combining LLMs with expert review enhanced question generation and readability. The PVG provides a practical and accessible tool to support early self-management in fibromyalgia.