Objective To conduct an umbrella review of systematic studies/meta-analyses of anti-vascular endotheli-al growth factor(VEGF)drugs for the treatment of diabetes retinopathy(DR),to evaluate literature quality with AMSTAR 2 and PRISMA,and to show the distribution characteristics of evidence quality through both figures and tables.Methods Chinese and English databases including The Cochrane Library,PubMed,EMbase,CBM,Wanfang,and CNKI were searched on computer from the inception of the database up to March 2024 for the retrieval of systematic reviews/meta-ana-lyses on anti-VEGF drug therapy for DR treatment.Two evaluators read the literature and extract data separately before conducting an umbrella review of the methodological and reporting quality of the included literature using the AMSTAR 2 scale and PRISMA statement.Results 27 studies were ultimately included,and the methodological and reporting quality of systematic reviews/meta-analyses on anti-VEGF drugs for DR treatment was moderate-to-low.The evaluation by AM-STAR 2 showed that there was an urgent need to improve the elaboration of the pre-established research plan and funding sources included in the research.PRISMA results showed that items affecting reporting quality mainly included protocol and registration,literature search,supplementary analysis,and funding sources.Conclusion The methodological and repor-ting quality of systematic reviews/meta-analyses on anti-VEGF drug therapy for DR treatment needs to be improved.Re-searchers should strengthen methodological quality and reporting standards following the requirements of the AMSTAR 2 scale and PRISMA statement while writing systematic reviews/meta-analysis reports,so as to provide evidence with higher quality.

OBJECTIVE To evaluate the quality of evidence in the systematic evaluation/meta-analysis of traditional Chinese medicine （TCM） for diabetes retinopathy （DR） based on the GRADE system. METHODS Chinese and English databases were searched to obtain the relevant studies of systematic evaluation/meta-analysis of traditional Chinese medicine in the treatment of DR. The search time was from the establishment of each database to January 13th， 2024. According to the inclusion and exclusion criteria， literature screening was conducted. After extracting relevant information from the included literature， the GRADE system was used to evaluate the quality level of the evidence body in the included studies， and the evidence of the outcome indicators was integrated and summarized. RESULTS A total of 51 studies were ultimately included， encompassing 135 outcome indexes. Among these， 19 indicators （14.1%） were of high quality， 87 （64.4%） were of medium quality， 26 （19.3%） were of low quality， and 3 （2.2%） were of very low quality. Overall， the evidence quality of the outcome indicators in the included studies was medium to low quality. The integrated results of evidence on the efficacy of outcome indexes showed that compared with conventional Western medicine， calcium dobesilate or placebo， TCM had significant advantages in improving overall efficacy， reducing bleeding spot area， reducing macular foveal thickness， and increasing visual improvement rate. In addition，the combination of TCM and conventional Western medicine or calcium dobesilate was significantly more effective than using conventional Western medicine or calcium dobesilate alone. CONCLUSIONS The overall quality of the evidence in the systematic evaluation/meta-analysis study on the treatment of DR with TCM is medium to low quality. Based on existing research findings， TCM demonstrates good clinical efficacy in the treatment of DR.

Objective To conduct an umbrella review of systematic studies/meta-analyses of anti-vascular endotheli-al growth factor(VEGF)drugs for the treatment of diabetes retinopathy(DR),to evaluate literature quality with AMSTAR 2 and PRISMA,and to show the distribution characteristics of evidence quality through both figures and tables.Methods Chinese and English databases including The Cochrane Library,PubMed,EMbase,CBM,Wanfang,and CNKI were searched on computer from the inception of the database up to March 2024 for the retrieval of systematic reviews/meta-ana-lyses on anti-VEGF drug therapy for DR treatment.Two evaluators read the literature and extract data separately before conducting an umbrella review of the methodological and reporting quality of the included literature using the AMSTAR 2 scale and PRISMA statement.Results 27 studies were ultimately included,and the methodological and reporting quality of systematic reviews/meta-analyses on anti-VEGF drugs for DR treatment was moderate-to-low.The evaluation by AM-STAR 2 showed that there was an urgent need to improve the elaboration of the pre-established research plan and funding sources included in the research.PRISMA results showed that items affecting reporting quality mainly included protocol and registration,literature search,supplementary analysis,and funding sources.Conclusion The methodological and repor-ting quality of systematic reviews/meta-analyses on anti-VEGF drug therapy for DR treatment needs to be improved.Re-searchers should strengthen methodological quality and reporting standards following the requirements of the AMSTAR 2 scale and PRISMA statement while writing systematic reviews/meta-analysis reports,so as to provide evidence with higher quality.

AIM: To explore the current status, research hotspots, and trends of global uveitis research to provide a theoretical basis and references for researchers in the field of uveitis, and promote further development in this area.METHODS: Relevant literatures on uveitis were retrieved from the China National Knowledge Infrastructure(CNKI)database, Wanfang database, and Web of Science core collection database since their establishment until 24 August 2023. The country/publishing institutions, research authors, high-frequency keywords, and burst keywords were visual analyzed by using software such as GraphPad Prism 9, CiteSpace 6.2. R2, and VOSviewer.RESULTS: Research teams for uveitis have been formed in various countries globally. The top three countries in terms of publications are the United States of America(7 585 papers), the United Kingdom(2 412 papers)and Germany(1 679 papers). The top three foreign institutions in terms of publications are Harvard University, Oregon Health & Science University, and Moorfields Eye Hospital, while the top three domestic institutions are Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Chongqing Medical University, and Zhongshan Ophthalmic Center, Sun Yat-sen University. The analysis of high-frequency keywords and burst keywords in Chinese and English shows that research hotspots mainly focus on exploring pathogenesis and different treatment methods for uveitis. The research hotspots related to uveitis treatment are transitioning to molecular biology-related research topics, such as molecular biological signaling pathways(NF-κB signaling pathway with a strength value of 22.89), biological agents(adalimumab with a strength value of 32.21), and tumor necrosis factor(with a strength value of 48.44). Related research is also expanding to basic experiments on relevant rats.CONCLUSIONS: In recent years, the research hotspots and trends of global uveitis mainly focus on precise diagnosis, pathogenesis, and more effective treatment methods. It is important for more scholars to dedicate themselves to uveitis-related research in the future to make breakthroughs and progress in the field. More large-scale and multicenter clinical studies on uveitis can provide high-quality research evidence.

Purpose: The interval between neoadjuvant chemotherapy (NAC) and surgery for locally advanced breast cancer (LABC) remains controversial. At the same time, the prognostic effect of delayed surgery in patients with poor responses is currently unclear. Methods: Data was collected from patients who had poor responses to NAC and underwent modified radical surgery from January 2013 to December 2018. The interval from completion of NAC to surgery was divided into two groups: a longer (greater than four weeks) or shorter (four weeks or less) interval. The associations of these interval groups with overall survival (OS) and recurrence-free survival (RFS) were evaluated by multivariable Cox models adjusting for the existing prognostic factors. Propensity score matching (PSM) was used to minimize election bias. Results: A total of 1,229 patients (mean age, 47.2 ± 8.9 years; median follow-up duration, 32.67 [6.57–52.63] months) were included. The 5-year OS rates were 73.2% and 60.8% in the shorter (n = 171) and longer interval group (n = 1,058), respectively, while the 3-year RFS rates were 80.8% and 71.7%, respectively. In multivariate Cox analysis, the longer interval was associated with an increased risk of mortality (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.01–2.02; p = 0.046) and recurrence (HR, 1.50; 95% CI, 1.12–1.99; p = 0.006).There was an interaction between the molecular subtype and the surgery interval for OS (pinteraction = 0.014) and RFS (pinteraction = 0.027). After PSM, no significant difference in OS (p = 0.180) and RFS (p = 0.069) was observed between the two groups. Conclusion Among LABC patients with a poor response, those with a longer interval between NAC and surgery had worse OS and RFS. The results indicate that these patients should receive modified radical surgery timely, which may in turn improve their prognosis.

Objective:To systematically evaluate the risk of hypotension induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which hypotension were evaluated as an outcome indicator of adverse events, were collected by searching relevant databases at home and abroad (up to February 15, 2023). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for hypotension risk under different interventions of SGLT2 inhibitors, and ranking the risks of hypotension induced by different interventions of SGLT2 inhibitors. The effect sizes were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 20 studies were included in the analysis, involving 22 525 patients with 15 260 in the trial group and 7 265 in the control group. Drugs that used in the trial group included dapagliflozin (in 1 517 patients), canagliflozin (in 6 053 patients), and ertugliflozin (in 7 690 patients); drugs that used in the control group included glimepiride (in 482 patients) and placebo (in 6 783 patients). The results of the network meta-analysis showed that the risk of hypotension was higher after treatment with 300 mg of canagliflozin, compared with those with 5 mg and 15 mg of ertugliflozin, and placebo ( RR=2.13, 95% CI: 1.31-3.47; RR=2.21, 95% CI: 1.35-3.61; RR=2.49, 95% CI: 1.62-3.82; all P<0.05); the risk of hypotension was higher after treatment with 100 mg of canagliflozin, compared with placebo ( RR=1.61, 95% CI: 1.04-2.50, P<0.05); the differences in comparison between any other 2 interventions with SGLT2 inhibitors were not statistically significant. According to the relative risks for hypotension of different interventions with SGLT2 inhibitors in the results of SUCRA, interventions were ranked as ertugliflozin 5 mg, placebo, dapagliflozin 2.5 mg, ertugliflozin 10 mg, ertugliflozin 15 mg, canagliflozin 50 mg, canagliflozin 100 mg, dapagliflozin 5 mg, dapagliflozin 10 mg, canagliflozin 150 mg, and canagliflozin 300 mg. Conclusions:Different treatment regimens with SGLT2 inhibitors had different risks of hypotension in patients with type 2 diabetes. The risk of hypotension caused by ertugliflozin is lower, especially at the dose of 5 mg. The risk of hypotension caused by canagliflozin is higher, especially at relatively high doses.

Objective:To systematically evaluate the risk of hypotension induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which hypotension were evaluated as an outcome indicator of adverse events, were collected by searching relevant databases at home and abroad (up to February 15, 2023). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for hypotension risk under different interventions of SGLT2 inhibitors, and ranking the risks of hypotension induced by different interventions of SGLT2 inhibitors. The effect sizes were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 20 studies were included in the analysis, involving 22 525 patients with 15 260 in the trial group and 7 265 in the control group. Drugs that used in the trial group included dapagliflozin (in 1 517 patients), canagliflozin (in 6 053 patients), and ertugliflozin (in 7 690 patients); drugs that used in the control group included glimepiride (in 482 patients) and placebo (in 6 783 patients). The results of the network meta-analysis showed that the risk of hypotension was higher after treatment with 300 mg of canagliflozin, compared with those with 5 mg and 15 mg of ertugliflozin, and placebo ( RR=2.13, 95% CI: 1.31-3.47; RR=2.21, 95% CI: 1.35-3.61; RR=2.49, 95% CI: 1.62-3.82; all P<0.05); the risk of hypotension was higher after treatment with 100 mg of canagliflozin, compared with placebo ( RR=1.61, 95% CI: 1.04-2.50, P<0.05); the differences in comparison between any other 2 interventions with SGLT2 inhibitors were not statistically significant. According to the relative risks for hypotension of different interventions with SGLT2 inhibitors in the results of SUCRA, interventions were ranked as ertugliflozin 5 mg, placebo, dapagliflozin 2.5 mg, ertugliflozin 10 mg, ertugliflozin 15 mg, canagliflozin 50 mg, canagliflozin 100 mg, dapagliflozin 5 mg, dapagliflozin 10 mg, canagliflozin 150 mg, and canagliflozin 300 mg. Conclusions:Different treatment regimens with SGLT2 inhibitors had different risks of hypotension in patients with type 2 diabetes. The risk of hypotension caused by ertugliflozin is lower, especially at the dose of 5 mg. The risk of hypotension caused by canagliflozin is higher, especially at relatively high doses.

Objective:To systematically evaluate the risks of gastrointestinal reactions induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which gastrointestinal reactions were evaluated as one of outcome indicators, were collected by searching relevant databases at home and abroad (up to December 30, 2022). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for gastrointestinal reaction risks with different interventions of SGLT2 inhibitors, and ranking the risks of gastrointestinal reaction of different interventions of SGLT2 inhibitors. The effect sizes of gastrointestinal reaction were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 15 studies were included in the analysis, involving 5 540 patients with 3 949 in the SGLT2 inhibitor treatment group and 1 591 in the control group. Drugs that used in the treatment group included dapagliflozin (in 1 872 patients), canagliflozin (in 1 100 patients), empagliflozin (in 649 patients), ertugliflozin (in 219 patients), ipragliflozin (in 61 patients), and licogliflozin (in 48 patients). All patients in the control group were treated with placebo. The results of the network meta-analysis showed that the risk of gastrointestinal reactions was higher after treatment with 10 mg of ertugliflozin, compared with those with 50 mg and 100 mg of canagliflozin ( RR=1.37, 95% CI: 1.02-3.48; RR=2.98, 95% CI: 1.19-4.09; all P<0.05). There was no statistically significant difference in comparison between other interventions with SGLT2 inhibitors. According to the results of SUCRA on the relative risks for gastrointestinal reactions of different interventions with SGLT2 inhibitors, interventions were ranked as licogliflozin 50 mg, ertugliflozin 25 mg, ertugliflozin 10 mg, empagliflozin 25 mg, ipragliflozin 100 mg, ipragliflozin 300 mg, ipragliflozin 200 mg, ertugliflozin 5 mg, licogliflozin 10 mg, ipragliflozin 50 mg, empagliflozin 10 mg, licogliflozin 2.5 mg, dapagliflozin 20 mg, dapagliflozin 10 mg, empagliflozin 5 mg, ertugliflozin 1 mg, dapagliflozin 5 mg, placebo, canagliflozin 300 mg, canagliflozin 200 mg, dapagliflozin 2.5 mg, dapagliflozin 1 mg, canagliflozin 100 mg, canagliflozin 50 mg. Conclusions:Different SGLT2 inhibitor treatment regimens lead to different risks of gastrointestinal reactions in patients with type 2 diabetes. The risk of gastrointestinal reactions caused by canagliflozin is low, especially under the dose of 50 mg. Licogliflozin and ertugliflozin have greater possibility to cause gastrointestinal reactions, especially when they were used at high doses.

Objective:To systematically evaluate the risks of gastrointestinal reactions induced by sodium-glucose transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus.Methods:Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus, in which gastrointestinal reactions were evaluated as one of outcome indicators, were collected by searching relevant databases at home and abroad (up to December 30, 2022). Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies. Stata 15.1 software was used to conduct Bayesian network meta-analysis, including drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve (SUCRA) for gastrointestinal reaction risks with different interventions of SGLT2 inhibitors, and ranking the risks of gastrointestinal reaction of different interventions of SGLT2 inhibitors. The effect sizes of gastrointestinal reaction were expressed by relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 15 studies were included in the analysis, involving 5 540 patients with 3 949 in the SGLT2 inhibitor treatment group and 1 591 in the control group. Drugs that used in the treatment group included dapagliflozin (in 1 872 patients), canagliflozin (in 1 100 patients), empagliflozin (in 649 patients), ertugliflozin (in 219 patients), ipragliflozin (in 61 patients), and licogliflozin (in 48 patients). All patients in the control group were treated with placebo. The results of the network meta-analysis showed that the risk of gastrointestinal reactions was higher after treatment with 10 mg of ertugliflozin, compared with those with 50 mg and 100 mg of canagliflozin ( RR=1.37, 95% CI: 1.02-3.48; RR=2.98, 95% CI: 1.19-4.09; all P<0.05). There was no statistically significant difference in comparison between other interventions with SGLT2 inhibitors. According to the results of SUCRA on the relative risks for gastrointestinal reactions of different interventions with SGLT2 inhibitors, interventions were ranked as licogliflozin 50 mg, ertugliflozin 25 mg, ertugliflozin 10 mg, empagliflozin 25 mg, ipragliflozin 100 mg, ipragliflozin 300 mg, ipragliflozin 200 mg, ertugliflozin 5 mg, licogliflozin 10 mg, ipragliflozin 50 mg, empagliflozin 10 mg, licogliflozin 2.5 mg, dapagliflozin 20 mg, dapagliflozin 10 mg, empagliflozin 5 mg, ertugliflozin 1 mg, dapagliflozin 5 mg, placebo, canagliflozin 300 mg, canagliflozin 200 mg, dapagliflozin 2.5 mg, dapagliflozin 1 mg, canagliflozin 100 mg, canagliflozin 50 mg. Conclusions:Different SGLT2 inhibitor treatment regimens lead to different risks of gastrointestinal reactions in patients with type 2 diabetes. The risk of gastrointestinal reactions caused by canagliflozin is low, especially under the dose of 50 mg. Licogliflozin and ertugliflozin have greater possibility to cause gastrointestinal reactions, especially when they were used at high doses.

Objective:To determine the effects of menopausal stage, age and other associated risk factors on symptoms of anxiety and depression among women in a community in Beijing.Methods:This study was a community-based prospective cohort. Participants who had transitioned through natural menopause, completed two or more depressive and anxiety symptoms evaluations, aged 35 to 64 years, and did not use hormone therapy were selected from the Peking Union Medical College Hospital aging longitudinal cohort of women in midlife to this analysis. The primary outcome variables were depressive and anxiety symptoms, assessed by hospital anxiety and depression scale (HADS). The generalized estimation equation was used in the statistical analysis.Results:Followed up from 2006 to 2014, 430 women and 2 533 HADS assessments were retained in the cohort. Depressive symptoms were more common than anxiety symptoms during all menopausal stages. The incidences of depressive and anxiety symptoms were 14.5% (19/191) and 3.1% (4/191) in the premenopausal -3 stage, respectively. The incidence increased in both menopausal transition and postmenopausal stage, with the highest incidence in the +1c stage [20.6% (155/751) and 8.8% (66/751), respectively]. However, these differences were not statistically significant (all P>0.05). Depressive symptoms were highest in the ≥60-<65 age group [20.8% (74/355)], and anxiety symptoms were highest in the ≥50-<55 age group [8.2% (62/754)]; but there were no statistical significances between different age groups and depressive and anxiety symptoms (all P>0.05). Multivariable analysis showed that high body mass index, low education status, and poor health status were independently associated with depressive symptoms (all P<0.05), and that poor health status, trouble falling asleep, and early awakening were independently associated with anxiety symptoms (all P<0.01). Conclusions:Depressive and anxiety symptoms are more common during menopausal transition and postmenopausal stage compared with reproductive stage. Depressive symptoms are more common than anxiety symptoms. To screen and assess depressive and anxiety symptoms in perimenopausal women is essential, especially for women with high risk factors.