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Background Acupuncture therapy has been widely applied all around the world. But there still lacks high-quality evidence to evaluate its clinical effects, safety and cost-effectiveness, which seriously restricts its further promotion and development. Acupuncture, as an operational intervention, is more complex than drug therapy. Factors involved in the acupuncture operation process, such as individual and interventional factors, may affect the clinical effects. Purposes Through this systematic review, we attempt to analyze the current status of studies about the key factors influencing clinical effects, so as to provide evidence for the design of acupuncture studies. Methods A literature research was conducted in six databases until May, 2020. Studies were screened and assessed by two authors independently. Data extraction was made after screening. We extracted the basic information of these studies, including publishing years and countries, population and factors influencing clinical effects. Results Through the initial search in these six database, 6404 records were retrieved. After duplication and screening, a total of 355 studies were finally included in the qualitative analysis. About 88.5% of these studies were conducted in China with increasing number in the past decades, covering neurological disorders, orthopedic disorders, obstetrical and gynecological diseases, digestive diseases and so on; 239 studies focused on stimulus parameters which may influence effects, accounting for 67.3%, and 128, 44, 39, 32, 15, 11 studies discussed acupoints, patients' pathological states, individual difference, psychological states, deqi, and other factors separately. Conclusion There are more and more studies focusing on factors influencing acupuncture clinical effects, including stimulus parameters, acupoints, individual difference, patient pathological and psychological states. Based on this systematic review, several ignored factors should be considered for future researches, and more scientifically and objectively high quality evidence should also be proved.

RationaleWhile one of the basic axioms of pharmacology postulates that there is a relationship between the concentration and effects of a drug, the value of measuring blood levels is questioned by many clinicians. This is due to the often-missing validation of therapeutic reference ranges.ObjectivesHere, we present a prototypical meta-analysis of the relationships between blood levels of aripiprazole, its target engagement in the human brain, and clinical effects and side effects in patients with schizophrenia and related disorders.MethodsThe relevant literature was systematically searched and reviewed for aripiprazole oral and injectable formulations. Population-based concentration ranges were computed (N = 3,373) and pharmacokinetic influences investigated.ResultsFifty-three study cohorts met the eligibility criteria. Twenty-nine studies report blood level after oral, 15 after injectable formulations, and nine were positron emission tomography studies. Conflicting evidence for a relationship between concentration, efficacy, and side effects exists (assigned level of evidence low, C; and absent, D). Population-based reference ranges are well in-line with findings from neuroimaging data and individual efficacy studies. We suggest a therapeutic reference range of 120–270 ng/ml and 180–380 ng/ml, respectively, for aripiprazole and its active moiety for the treatment of schizophrenia and related disorders.ConclusionsHigh interindividual variability and the influence of CYP2D6 genotypes gives a special indication for Therapeutic Drug Monitoring of oral and long-acting aripiprazole. A starting dose of 10 mg will in most patients result in effective concentrations in blood and brain. 5 mg will be sufficient for known poor metabolizers.

Background Cage subsidence (CS) was previously reported as one of the most common complications following oblique lumbar interbody fusion (OLIF). We aimed to assess the impacts of CS on surgical results following OLIF combined with anterolateral fixation, and determine its radiological characteristics as well as related risk factors. Methods Two hundred and forty-two patients who underwent OLIF at L4-5 and with a minimum 12 months follow-up were reviewed. Patients were divided into three groups according to the extent of disk height (DH) decrease during follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2 mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4 mm). The clinical and radiological results were compared between groups to evaluate radiological features, clinical effects and risk factors of CS. Results CS was identified in 79 (32.6%) patients, including 48 (19.8%) with mild CS and 31 (11.8%) with severe CS. CS was mainly identified within 1 month postoperatively, it did not progress after 3 months postoperatively, and more noted in the caudal endplate (44, 55.7%). In terms of clinical results, patients in the mild CS group were significantly worse than those in the no CS group, and patients in the severe CS group were significantly worse than those in the mild CS group. There was no significant difference in fusion rate between no CS (92.6%, 151/163) and mild CS (83.3%, 40/48) groups. However, significant lower fusion rate was observed in severe CS group (64.5%, 20/31) compared to no CS group. CS related risk factors included osteoporosis (OR = 5.976), DH overdistraction (OR = 1.175), flat disk space (OR = 3.309) and endplate injury (OR = 6.135). Conclusion CS following OLIF was an early postoperative complication. Higher magnitudes of CS were associated with worse clinical improvements and lower intervertebral fusion. Osteoporosis and endplate injury were significant risk factors for CS. Additionally, flat disk space and DH over-distraction were also correlated with an increased probability of CS.

Technological devices with screens—such as computers, smartphones, tablets, video game consoles, and televisions—have become essential in daily life, especially among the pediatric population. This widespread use has significant effects on their physical and mental health, prompting the development of guidelines for appropriate screen use based on age group. In this context, we conducted a narrative review to assess the impact of screen devices on this population, exploring how specific genes and their polymorphisms may act as risk factors for these effects. A systematic literature search was performed to evaluate the clinical and genetic impact of screen exposure, focusing on outcomes such as obesity and overweight, sedentary behavior, depression and anxiety, myopia, behavioral disorders, and sleep and memory disturbances. The findings indicate that screen exposure exceeding 2 hours per day is associated with these outcomes, with the strongest evidence supporting links to obesity and sedentary behavior. Additionally, polymorphisms in genes such as FTO, CACNA1D, and DRD2 were found to influence these outcomes. Overall, the evidence suggests that excessive screen use during childhood is associated with numerous adverse physical and mental health conditions. There is a significant relationship between screen time and increased risk of overweight and obesity, as well as sleep disturbances due to reduced resting hours. Strategies are urgently needed to mitigate these impacts in the pediatric population.

To systematically evaluate clinical features and effects of cyclosporine in the treatment of psoriasis. Databases including Web of Science, PubMed, The Cochrane Library, Embase, CNKI, Wan Fang, and VIP were electronically searched for studies on the use of cyclosporine in the treatment of psoriasis, from inception to March 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. A meta-analysis was then performed. A total of 12 randomised controlled trial (RCT) studies were included. Compared with the control group, there were statistically significant differences in the effective rate, recurrence rate, erythema regression time, pustular resolution time, fever resolution time, and Psoriasis Area Severity Index (PASI) score of cyclosporine in the treatment of psoriasis. Moreover, the sub-group analysis showed that the effective rate of patients aged less than 40 years was significantly higher than that of the control group and the recurrence rate was significantly lower than that of the control group. The effective rate of psoriasis patients without nail lesions was significantly higher than that of control group. The effective rate of cyclosporin was significantly higher than that of dexamethasone acetate. There was no significant change in pooled sensitivity and specificity after each study was excluded one by one, indicating the stability of the meta-analysis. Cyclosporine had a high effective rate and low recurrence rate in the treatment of psoriasis, but it still had similar rate of adverse reactions compared to other drugs. This study systematically evaluated the effect of cyclosporine in the treatment of psoriasis and provided reference for clinical practice.

The resulting findings may not reflect the nature of TCM interventions. [...]an enhanced approach is strongly desirable. [...]all these four research methods, in a collective manner, contribute to reliable and comprehensive assessment of clinical effects of acupuncture and Chinese patent medicines. Despite relatively high degree of standardization when using acupuncture and Chinese patent medicine, objective complex factors continue to present challenges in assessing clinical effects, including outcome measurements that are applicable to TCM features (Wang and Huang, 2019;Zhang et al., 2021), effect estimation in rare event setting (Greenland et al., 2016), study designs involving patient preferences (Angell, 1984;Rücker, 1989;Cameron et al., 2018), repeated measures in TCM setting (Albert, 1999;Twisk, 2004;Goetgeluk and Vansteelandt, 2008;Wang et al., 2012), causal inference of treatment effects in complex design and data settings (Zigler and Dominici, 2014;Koch et al., 2020), and decomposition of effects in complex intervention setting. Use of Integrated Approach for Assessing Clinical Effects of Post-Approval Chinese Patent Medicines: Practical Examples Post-approval Chinese patent medicines are often faced with important evidence gaps. Because the approval of Chinese patent medicines usually relies on traditional clinical trials, the resulting findings are often subject to restrictions in study designs.

In the lumbar discectomy, an annular suture faces challenges when annular defects are located at the attachment area of the fibrous annulus at the edge of the vertebral body. In this study, a novel bone-anchoring annular suture technique was proposed to close this type of defect. Finally, the clinical efficacy of this suture technique was investigated. A total of 84 patients with lumbar intervertebral disc herniation who underwent arthroscopic-assisted uni-portal spinal surgery and novel bone-anchoring annular sutures were selected. Clinical and imaging outcomes were compared before and after surgery, including the visual analog scale (VAS) for back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), disc height, and the Pfirrmann grade of the disc. The average follow-up time was 12.6 ± 0.9 months. Over time, the VAS (low back pain and leg pain) and ODI scores of patients decreased significantly ( P  < 0.05), while the JOA scores increased significantly ( P  < 0.05). At the last follow-up, the excellent and good rate was 91.7% according to the modified MacNab criteria. No significant difference between the preoperative and postoperative disc height and Pfirrmann grade was observed ( P  > 0.05). No reoperation cases were observed during the follow-up period. The novel bone-anchoring annular suture technique showed good safety and preliminary efficacy for annular defects that occur at the attachment area of the fibrous annulus at the edge of the vertebral body.

Allogeneic platelet-rich plasma (al-PRP) is gaining attention in clinical practice for treating chronic refractory wounds, though research results remain controversial. To assess the clinical efficacy of al-PRP for chronic refractory wounds. Databases including PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and WFPD were searched for randomized controlled trials comparing al-PRP with conventional treatments up to October 2023. Two researchers independently screened studies, extracted data, and assessed quality. Statistical analysis was conducted using RevMan 5.4, and potential publication bias was assessed and corrected using funnel plots and Egger’s test. Twelve studies with 717 cases were included. Meta-analysis showed al-PRP significantly improved outcomes compared to non-al-PRP treatments: increased healing rate (RR 2.72, 95% CI 1.77–4.19, p  < 0.00001), shortened healing time (SMD − 1.03, 95% CI -1.31 to -0.75, p  < 0.00001), improved efficacy rate (RR 1.19, 95% CI 1.10–1.28, p  < 0.00001), increased wound shrinkage (MD 35.65%, 95% CI 21.65–49.64, p  < 0.00001), and reduced hospital stays (MD -2.62, 95% CI -4.35 to -0.90, p  = 0.003). Al-PRP is a feasible, effective, and safe biological therapy for chronic refractory wounds. Trial registration : PROSPERO Identifier CRD42022374920.

The marine drug histochrome is a special natural antioxidant. The active substance of the drug is echinochrome A (Ech A, 7-ethyl-2,3,5,6,8-pentahydroxy-1,4-naphthoquinone), the most abundant quinonoid pigment in sea urchins. The medicine is clinically used in cardiology and ophthalmology based on the unique properties of Ech A, which simultaneously block various links of free radical reactions. In the last decade, numerous studies have demonstrated the effectiveness of histochrome in various disease models without adverse effects. Here, we review the data on the various clinical effects and modes of action of Ech A in ophthalmic, cardiovascular, cerebrovascular, inflammatory, metabolic, and malignant diseases.

Three- and four-part proximal humeral fractures are common in young and elderly populations. Open reduction and fixation with a locking plate is a commonly used surgical technique; however, it is associated with a high incidence of complications. This study aimed to retrospectively evaluate the clinical effectiveness of open reduction and fixation with a locking plate for treating three- and four-part proximal humeral fractures and to analyze potential risk factors for complications. The clinical data of 126 patients with three-part (57 cases) or four-part (69 cases) fractures of the proximal humerus who presented to our center between January 2014 and January 2024 were selected. At the final follow-up (i.e., 12 months post-operation), the postoperative clinical efficacy was evaluated by comparing the Constant-Murley score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) score, and range of motion (ROM) of the shoulder joint between the affected side and the unaffected side. Additionally, the relationships between the clinical efficacy and the loss angle of the humeral neck-shaft angle (NSA) as well as the loss humeral head height (HHH) were analyzed. In addition, we also analyzed the most common complications among the patients and the associated risk factors. In the evaluation of clinical efficacy, there were no significant differences in the ROM of the shoulder joint and clinical scores between the unaffected side and the affected side of the patients at 12 months postoperatively ( P  > 0.05). The analysis of the relationship between the clinical efficacy, the loss angle of the NSA, and the loss of HHH showed that for patients with proximal humerus fractures (PHF), there was a significant negative correlation between the postoperative flexion, abduction, external rotation, and internal rotation of the shoulder joint on the affected side, the Constant score, and both the loss angle of the postoperative neck-shaft angle and the height of the humeral head, while there was a positive correlation with the Disabilities of the Arm, Shoulder, and Hand (DASH) score. In the analysis of complications, it was found that the incidence rates of shoulder joint stiffness and internal fixation failure were significantly higher than that of humeral head necrosis. Their occurrences were highly correlated with factors such as age, diabetes, osteoporosis, fracture healing time, rotator cuff repair, rehabilitation methods, medial cortical bone defect, calcar screw, calcar distance, calcar ratio, reduction quality, and so on. In conclusion, in clinical practice, surgical strategies should be tailored to individual patient profiles, incorporating comprehensive preoperative assessments of age, comorbidities (e.g., osteoporosis, diabetes), and fracture morphology. Optimization of surgical precision (e.g., anatomical reduction, calcar screw placement) and adherence to evidence-based postoperative rehabilitation protocols are critical to mitigate risks of complications and maximize therapeutic efficacy.