ObjectiveTo systematically review the efficacy and safety of prostacyclin for patients with pulmonary arterial hypertension (PAH).MethodsWe searched PubMed, EMbase, The Cochrane Library, WanFang Data, CBM and CNKI databases for randomized controlled trials (RCTs) compared prostacyclin with placebo from inception to April 2018. Two reviewers independently screened literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software.ResultsEleven RCTs including 2 549 participants were included. The results of meta-analysis showed that, compared with placebo group, prostacyclin group was superior to the placebo group in 6-min walk distance (MD=31.10, 95%CI 16.89 to 45.30, P<0.001), mortality (RR=0.62, 95%CI 0.41 to 0.94,P=0.03), Brog score (MD=–0.88, 95%CI –1.28 to –0.49, P<0.001), mean pulmonary arterial pressure (MD=–3.31, 95%CI –4.34 to –2.29,P<0.001) and cardiac index (MD=0.32, 95%CI 0.14 to 0.51,P<0.001). However, there were no differences between two groups in reducing delaying time to clinical deterioration (RR=1.27, 95%CI 0.99 to 1.63,P=0.06), tolerability (RR=0.74, 95%CI 0.42 to 1.31, P=0.30) and pulmonary vascular resistance (MD=–4.35, 95%CI –8.85 to 0.15, P=0.06).ConclusionsCurrent evidence reveals that prostacyclin therapy appears to be superior to the placebo in reducing the mortality, improving excise capacity, respiratory and cardiac function, and ameliorating mean pulmonary arterial pressure for pulmonary arterial hypertension. However, the efficacy of prostacyclin in delaying time to clinical deterioration, tolerability and pulmonary vascular resistance for PAH is not clear. Due to the limited quality and quantity of included studies, more high quality RCTs are required for further verification.
ObjectiveTo systematically evaluate the correlation between heavy metal exposure, especially Cadmium (Cd), Mercury (Hg), Lead (Pb) and the risk of kidney stone occurrence, and to explore the potential dose-response relationship between them. MethodsWe conducted a computerized search of Web of Science, PubMed, The Cochrane Library, EMBASE, CNKI, WanFang Data, CBM, and VIP databases,with supplementary searches in Scopus, WHO IRIS, and Google Scholar, to collect studies on the correlation between heavy metal exposure and urolithiasis. the search period ranging from the inception of each database to September 14, 2025. Two researchers independently screened the literature, extracted data, and assessed the quality of the included studies. Traditional meta-analysis and dose–response meta-analysis were performed using Stata 15.1 software. ResultsA total of 16 studies were included, comprising 13 cross -sectional studies and 3 case-control studies, involving 117 992 participants. The results of the meta-analysis showed a significant positive correlation between urinary Cd levels and the risk of kidney stone occurrence (OR=1.16, 95%CI 1.05 to 1.27, I2=80.3%). Further subgroup analysis and Meta-regression indicated that region,gender,Cd exposure status and eGFR/proteinuria might be sources of heterogeneity. Blood Cd levels were significantly correlated with the risk of kidney stones (OR=1.31, 95%CI 1.03 to 1.65, I2=47.9%). There was an increasing linear dose-response relationship between blood Cd exposure and the risk of kidney stones (χ2=0.35, P>0.05), with each 1 ug/L increase in blood Cd corresponding to a 20% increase in the risk of kidney stones (OR=1.20, 95%CI 1.08 to 1.33). No significant associations were found between the levels of other metal exposures and the risk of kidney stones (PUHg=0.73, PUPb=0.82, PUCr=0.56, PUNi=0.06, PBHg=0.15, PBPb=0.52). Urinary Cd showed a significant nonlinear dose-response relationship with the risk of kidney stones (χ2=4.52, P<0.05). When urinary Cd exposure was 0.2 ug/L, the risk of kidney stones increased by 35% (OR=1.35, 95%CI 1.23 to 1.49), and for each 1ug/L increase in urinary Cd, the risk of kidney stones increased by 44% (OR=1.44, 95%CI 1.30 to 1.59). ConclusionCd exposure levels are significantly positively correlated with the risk of kidney stone occurrence, suggesting that Cd exposure may be a potential risk factor for kidney stones. No significant association was found between exposure to other metals and the risk of kidney stone occurrence. However, due to limitations in study design, further research is needed in the future to establish the causal relationship of this association.
Objective To systematically review the dose-response relationship between cadmium exposure and the risk of stroke onset. Methods The PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect studies related to objectives from inception to June 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 15.1 software. Results There were 10 studies that involved 28 250 participants, and 7 of them were prospective cohort studies and 3 were case-control studies. Meta-analysis results showed that cadmium exposure significantly increased the risk of stroke (RR=1.39, 95%CI 1.20 to 1.59, P<0.01), blood cadmium exposure significantly increased the risk of stroke (RR=1.79, 95%CI 1.34 to 2.25, P<0.01), urinary cadmium exposure significantly increased the risk of stroke (RR=1.30, 95%CI 1.09 to 1.52, P<0.01). Blood cadmium exposure had a significantly nonlinear dose-response relationship associated with an increased risk of stroke (χ2=8.56, P<0.05). The risk of stroke increased by 15% with the blood cadmium exposure concentration of 0.8 μg/L (RR=1.15, 95%CI 0.98 to 1.36), and 51% with the blood cadmium exposure concentration of 1.2 μg/L (RR=1.51, 95%CI 1.14 to 2.01) than those without blood cadmium exposure. Urinary cadmium exposure had significantly linear dose-response relationship associated with an increased risk of stroke (χ2=2.47, P=0.12). The risk of stroke increased by 26% with the urinary cadmium exposure concentration of 0.8 μg/g (RR=1.26, 95%CI 1.20 to 1.31), and 31% with the urinary cadmium exposure concentration of 1.2 μg/g (RR=1.31, 95%CI 1.27 to 1.36) than those without urinary cadmium exposure. Conclusion Cadmium exposure increases the risk of stroke. There was a significant dose-response relationship between cadmium exposure and the risk of stroke.
Lumbar disc herniation (LDH) is one of the most important causes of back and leg pain, which seriously affects the quality of life of patients. As the first-line treatment for LDH, non-operative treatment can relieve 80% to 90% of symptoms among the patients with LDH. This guideline followed Guidelines for the Formulation/Revision of Clinical Treatment Guidelines in China (2022 edition) and WHO handbook for guideline development (2014 edition) to set up guideline working group. This guideline identified fourteen clinical questions through the literature review and clinical experts’ consensus. We drafted the recommendations after systematically searching and evaluating the evidence; delphi method was adopted for expert consensus on the preliminary recommendations, finally, 19 recommendations were made to guide non-operative treatments for LDH. This guideline can provide guidance for the clinical practice of Chinese and western orthopedics practitioners.
