Objective To systematically assess the efficacy and safety of acupuncture therapy for essential hypertension. Methods A computerized literature search of the Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), Wanfang Academic Journal Full-text Database (Wanfang), China Biology Medicine Disc (CBM), PubMed, EMBASE, and Cochrane Library was conducted to retrieve randomized controlled clinical trials on acupuncture as the main intervention for the treatment of essential hypertension published from the inception of the database to 30 January 2021. The risk-of-bias assessment was carried out for each included study according to the Cochrane Handbook. Data analysis was performed using Review Manager 5.4.1 and Stata 15.0. Results After the screening, 46 randomized controlled trials involving a total of 3 859 subjects were included. Primary outcomes included changes in the diastolic blood pressure after intervention [eight studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group [mean difference (MD)=1.45, 95% confidence interval (CI) (0.48, 2.43), P=0.004, fixed effects model; I2=39%] and changes in the systolic blood pressure after intervention {11 studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group [MD=8.60, 95%CI (7.12, 10.07), P<0.00001, fixed effects model; I2=26%]}. The secondary outcome was antihypertensive efficacy, 12 studies of acupuncture monotherapy group [risk ratio (RR)=1.20, 95%CI (1.12, 1.28), P<0.00001, fixed effects model; I2=36%] and 15 studies of acupuncture combined with antihypertensive drug group [RR=1.27, 95%CI (1.20, 1.34), P<0.00001, fixed effects model; I2=6%] showed better results than the antihypertensive drug monotherapy group in antihypertensive efficacy. In terms of the adverse events, four studies showed that the acupuncture monotherapy group had fewer adverse events than the antihypertensive drug monotherapy group [RR=0.10, 95%CI (0.04, 0.25), P<0.00001, fixed effects model; I2=0%]. Conclusion Acupuncture combined with antihypertensive drugs is superior to antihypertensive drugs alone in reducing blood pressure, and acupuncture therapy is effective and safe for the treatment of essential hypertension with fewer side effects. However, there is still a lack of high-quality multicenter randomized double-blinded controlled trials in this field. Rigorous large-sample clinical trials are needed to validate these findings.
BackgroundThe purpose of this study was to compare the safety and efficacy of unilateral vs. bilateral pedicle screw fixation (BPSF) for lumbar degenerative diseases.MethodsElectronic databases including PubMed, Web of science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO were searched by computer. The deadline was set for June 1, 2022. This study included all high-quality randomized controlled trials (RCTs), prospective clinical controlled studies (PRO), and retrospective studies (Retro) that compared unilateral and bilateral pedicle screw fixation in the treatment of lumbar degenerative diseases. Revman5.3 software was used for meta-analysis after two researchers independently screened the literature, extracted data, and assessed the risk of bias in the study.ResultsFourteen studies with a total of 1,086 patients were included. Compared with BPSF, unilateral pedicle screw fixation (UPSF) has shorter operation time and hospital time, and less blood loss and operation cost, operation time [SMD = −1.75, 95% CI (−2.46 to −1.03), P < 0.00001], hospital time [SMD = −1.10, 95% CI (−1.97 to −0.22), P = 0.01], Blood loss [SMD = −1.62, 95% CI (−2.42 to −0.82), P < 0.0001], operation cost [SMD = −14.03, 95% CI (−20.08 to −7.98), P < 0.00001], the ODI after bilateral pedicle screw fixation was lower, and the degree of lumbar dysfunction was lighter, [SMD = 0.19, 95% CI (0.05–0.33), P = 0.007], better fusion effect, fusion rate [RR=0.95, 95% CI (0.91–1.00), P = 0.04]. VAS-Low back pain [SMD = 0.07, 95% CI (−0.07–0.20), P = 0.35], VAS-Leg pain [SMD = 0.18, 95% CI (−0.00–0.36), P = 0.05], SF-36 [SMD = 0.00, 95% CI (−0.30–0.30), P = 1.00], complications rate [RR = 0.94, 95% CI (0.9154–1.63), P = 0.82], the overall difference was not statistically significant.ConclusionsCurrently limited evidence suggests that UPSF significantly reduces blood loss, significantly shortens the operative time and hospital stay, and reduces blood loss and costs. After BPSF, the ODI was lower, the degree of lumbar spine dysfunction was lower, and the fusion rate was significantly higher. The VAS, SF-36, and complications scores of the two groups were comparable, and there was no significant clinical difference.
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