Dysphagia is one of the most common symptoms in patients after stroke onset, which has multiple unfavorable effects on quality of life and functional recovery. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation that is widely used to improve deglutition function. Recently, some studies have confirmed that tDCS enhances deglutition function after stroke. However, the number of evaluation indexes used in those studies was small, and the number of trials included was limited. Most importantly, the optimal stimulation protocol is still uncertain and the safety of tDCS has not been reviewed. Therefore, we conducted a systematic review and meta-analysis to address these shortcomings. Methods: Seven databases were searched entirely, including Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. Two reviewers independently evaluated the eligibility of retrieved data according to the selection criteria and assessed the methodological quality of the studies using the Cochrane risk of bias tool. Outcomes, measures, and indicators used in this study included the dysphagia outcome and severity scale (DOSS), modified Mann assessment of swallowing ability (MMASA), functional oral intake scale (FOIS), functional dysphagia scale (FDS), and Kubota’s water-drinking test (KWDT). Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. Results: Fifteen trials with a total of 787 participants (394 subjects in the tDCS groups were treated with true tDCS, and 393 subjects in the control groups were wait-listed or treated with sham tDCS) involving tDCS for dysphagia after stroke and were included in the meta-analysis. Results of this meta-analysis confirmed that tDCS had a positive effect on post-stroke dysphagia. Subgroup analyses revealed that bilateral and high-intensity stimulation with tDCS had a more significant impact on post-stroke dysphagia. Furthermore, no adverse events occurred during the application of tDCS for post-stroke dysphagia. Conclusion: tDCS can promote the recovery of deglutition function in patients with dysphagia after stroke. In addition, bilateral stimulation and high-intensity stimulation may have better effects. However, the safety evidence for tDCS and post-stroke dysphagia is insufficient.
BackgroundAnaplastic thyroid carcinoma (ATC) is a very rare, highly lethal malignant cancer. Our aim in this study was to develop nomograms that predict survival in ATC patients.Material/MethodsATC incidence and mortality were assessed via joinpoint regression analysis of 567 ATC patients selected from the Surveillance, Epidemiology, and End Results 18 Registries Research database. Predictive models were established via univariate and multivariate Cox regression analysis of potential risk factors and used to produce nomograms. Performance of the nomograms in terms of discrimination ability and calibration was evaluated by determining the concordance index (C-index) and by generating calibration plots, respectively.ResultsThe incidence and mortality rates for ATC increased from 2000 to 2015 according to the collected data (p<0.05). Two nomograms were constructed based on 2 predictive models: nomogram 1 considered age, tumor size, and metastasis (all before surgery), and nomogram 2 considered age, tumor size, metastasis, surgery, and extrathyroidal extension (all after surgery). Both nomogram 1 (C-index, 0.6803; 95% confidence interval, 0.6517–0.7089) and nomogram 2 (C-index, 0.7064; 95% confidence interval, 0.6783–0.7345) had good discrimination ability. The validated C-index values were 0.6783 and 0.7029 for nomogram 1 and 2, respectively. The observed values were in agreement with the calibration curves.ConclusionsNomogram 1 can assist in preoperative prediction of survival time in ATC patients, whereas nomogram 2 can provide additional outcome-related information.
Introduction: Spinal cord injury (SCI) is a severe disease of the central nervous system with a very high disability rate that seriously a ects the daily life of patients. Acupuncture is one of the rehabilitation therapies that has shown significant e cacy in treating post-SCI complications such as motor disorders, neuropathic pain, and neurogenic bladder. Current studies have focused on the e ectiveness and mechanisms of acupuncture for SCI, but no studies are available to analyze the bibliometrics of publications related to this area.Methods: Publications related to acupuncture for SCI were retrieved from the Web of Science Core Collection for quantitative and qualitative analyses. The quantitative analysis was unfolded in the following six main areas: annual publications, countries, institutions, authors, sources, and keywords. The qualitative analysis section screened out publications with high annual citation rates and categorized them according to the study content.Results: There were relevant publications, more than half of which were journal articles. The number of publications showed a fluctuating upward trend. China and the United States were hub countries for related publications and had extensive cooperation with other countries. The most relevant author was Yuanshan Zeng from Sun Yat-sen University, China. The e cacy and mechanism of acupuncture for neuropathic pain after SCI was the first research hotspot in this field, and electroacupuncture was the most widely used technique. In the past years, the mechanism of acupuncture to improve the local microenvironment of SCI and promote nerve regeneration had become a new research trend. At the same time, acupuncture had been gradually applied to various complications after SCI and in veterinary medicine. Conclusion:The findings suggest that research on acupuncture for SCI is still flourishing, and more research on electroacupuncture for promoting nerve repair and regeneration after SCI will be available in the future.
BackgroundUrinary retention is one of the most frequent complications of spinal cord injuries (SCI) and negatively impacts patient satisfaction and quality of life. Acupuncture as an integral part of traditional Chinese medicine (TCM) has recently drawn widespread attention for its potential in the management of urinary retention. However, there are many different styles of acupuncture-related techniques, and the optimal choice of acupuncture for urinary retention after SCI is still unclear. Hence, this study uses a Bayesian network meta-analysis (NMA) to compare the efficacy of different types of acupuncture therapies using both direct and indirect evidence.MethodsRandomized controlled trials of acupuncture-related techniques for treating urinary retention after SCI were retrieved from the following electronic databases: Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Service System (SinoMed), the Wan-Fang database, and the Chinese Scientific Journals Database (VIP). The retrieval time was from inception to November 2020. Clinical effective rate (CER) was the primary outcome indicator and residual urine volume (RUV) was the secondary outcome indicator. A Bayesian NMA was performed using the Markov chain Monte Carlo method in R software (version 3.6.1) interfacing with JAGS software (version 4.3.0). The node-splitting method was used to identify inconsistencies. In addition, a comparative adjusted funnel plot was used to assess publication bias.ResultsA total of 26 randomized controlled trials involving 1,652 patients were included. Bayesian NMA showed that electroacupuncture combined with moxibustion ranks first in both CER and RUV. In addition, in terms of cumulative probability, electro-acupuncture combined with moxibustion ranked first in CER. The results of the node splitting method revealed that direct and indirect evidence were consistent (P > 0.05). In addition, publication bias was detected.ConclusionA Bayesian NMA that combined direct and indirect comparisons showed that electro-acupuncture combined with moxibustion had a better effect on urinary retention due to SCI. However, it still needs a large sample size and high-quality randomized controlled trials to verify this finding.Systematic Review Registration:https://inplasy.com/, identifier: INPLASY2021110005.
Introduction. Neuropathic pain is a commonly seen symptom and one of the most intractable comorbidities following spinal cord injury (SCI). Acupuncture has been widely used for neuropathic pain after SCI in clinical settings. There is no systematic review or meta‐analysis evaluating the efficacy of acupuncture in the treatment of SCI-induced neuropathic pain. Thus, this study aimed to conduct a systematic review and meta-analysis to assess the efficacy of acupuncture on SCI-induced neuropathic pain. Methods. Seven databases were comprehensively searched, including PubMed, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Service System (SinoMed), the Wanfang Database, and the Chinese Scientific Journals Database (VIP) from their inception to 30 September 2021. Two independent reviewers evaluated the eligibility of the data retrieved based on the pre-established eligibility criteria and assessed the methodological quality of the included studies using the Cochrane Risk of Bias Tool. The outcome indexes in this study included the visual analogue scale, the numeric rating scale, the present pain intensity, and the pain region index. Sensitivity and subgroup analyses were also performed to specifically evaluate the intervention effects. In addition, publication bias was analyzed. Results. Six randomized controlled trials (145 participants in the experimental groups and 141 participants in the control groups) were identified that evaluated the application of acupuncture for neuropathic pain after SCI and were included in this study. The results of our study revealed that acupuncture had a positive effect on the pain severity (standardized mean difference (SMD): −1.40, 95% confidence interval (CI): −2.23; −0.57), the present pain intensity (MD = −0.61, 95% CIs = −0.98; −0.23), and the pain region index (MD = −3.04, 95% CI = −3.98; −2.11). In addition, sensitivity analyses showed that these results were robust and stable. Subgroup analyses indicated that electroacupuncture (EA) had better effects on SCI-induced neuropathic pain. However, a publication bias was observed. Conclusion. Available evidence appears to suggest that acupuncture may have a role in SCI-induced neuropathic pain management, but this remains to be determined.
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