Effects Of Four Types Of Integrated Chinese And Western .
ORIGINAL ARTICLEEffects of four types of integrated Chinese andWestern medicines for the treatment of COVID-19in China: a network meta-analysisLairun Jin1Yan Xu1Hui Yuan21. Office of Educational Administration, the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College), Wuhu 241001, Anhui, China.2. School of Public Health, Wannan Medical College, Wuhu 241001, Anhui, SUMMARYOBJECTIVE: Various integrated Chinese and Western medicines might be beneficial for the treatment of Coronavirus disease 2019 (COVID-19). This study aims to evaluate the efficacy of lung computed tomography (CT) of four integrated Chinese and Western medicines inthe treatment of COVID-19 using network meta-analysis (NMA).Multiple databases were consulted to find randomized controlled trials of four different types of integrated Chinese andWestern medicines for the treatment of COVID-19. NMA was conducted on the data using Stata (13.0) software. The odds ratio (OR)was calculated. The studies included in this paper were divided into a control group (Western medicine) and an observation group (oneof four integrated Chinese and Western medicines).METHODS:5 eligible publications were identified. A total of 598 cases were included in the study, and the results showed that the fourtypes of integrated Chinese and Western medicines (symptomatic and supportive care with Qingfei Touxie Fuzheng, Lianhua Qingke,and Xuebijing) were significantly superior (P 0.05) to symptomatic and supportive care alone, except for symptomatic and supportivecare with Lianhua Qingwen. The combination of symptomatic and supportive care with Lianhua Qingke had the highest probability ofbeing the most clinically efficacious intervention, with a surface under the cumulative ranking (SUCRA) curve of 85.7.RESULTS:A combination of symptomatic and supportive care with Lianhua Qingke is the best option among the four integratedChinese and Western medicines considered for the treatment of COVID-19.CONCLUSIONS:KEYWORDS: Coronavirus Infections. Coronavirus. Medicine, Chinese Traditional. Drugs, Chinese Herbal. Meta-Analysis.INTRODUCTIONThe coronavirus disease 2019 (COVID-19) is anacute respiratory-tract-based clinical syndrome causedby a new coronavirus, which is currently widespreadon a global scale. The infectious disease seriouslyendangers human health and public safety, and thisDATE OF SUBMISSION:damage continues to increase every day1. Cliniciansmainly use symptomatic support therapy since thereis currently no specific medicine that can be used tocure the disease. Some studies have shown that thecombination of Chinese and Western medicine can23-May-2020DATE OF ACCEPTANCE: 23-May-2020CORRESPONDING AUTHOR: Yan XuSchool of Public Health, Wannan Medical College, No. 22 Road of Wenchangxi – Wuhu – 241002 – Anhui, China – Tel: 86 13955362912E-mail: yuanhui0553@126.com771REV ASSOC MED BRAS 2020; 66(6):771-777
EFFECTS OF FOUR TYPES OF INTEGRATED CHINESE AND WESTERN MEDICINES FOR THE TREATMENT OF COVID-19 IN CHINA: A NETWORK META-ANALYSIS.achieve some effect on the treatment of COVID-192.A network meta-analysis (NMA) is a meta-analysisthat combines traditional direct/head-to-head comparison and indirect comparison. Traditional meta analysis (TMA) focuses on comparing two groups, whileNMA emphasizes comparing multiple interventionsunder the same conditions based on its high statistical power and precision, so it is also called multipletreatments meta-analysis3.The aim of this study was to evaluate the lungcomputed tomography (CT) efficacy of four types ofintegrated Chinese and western medicines in the treatment of COVID-19 using NMA and rank them according to their performance. Combinations includedsymptomatic and supportive care with Qingfei TouxieFuzheng recipe, Lianhua Qingwen granule, LianhuaQingke granule, and Xuebijing injection. This studymay provide a useful guide for the selection of medication treatments for COVID-19.METHODSSearch StrategyThe databases used for this study includedPubMed, EMBASE, Web of Science, SciFinder andSino Med, Cochrane Library, BIOSIS Previews, ChinaNational Knowledge Index, China Biomedical Medicine, Wan fang, Chinese Science Citation, ChongqingVIP Network, China Science and Technology Journal,and China Academic Journal Network Publishing. Thesearch words used included Chinese medicine, combination therapy, Qingfei Touxie Fuzheng, LianhuaQingwen, Lianhua Qingke, Xuebijing, efficacy, drugtherapy, randomized controlled trials, pneumonia, andcoronavirus disease 2019.Inclusion and Exclusion CriteriaThe inclusion criteria were as follows: (1) randomized controlled trials; (2) patients with COVID-19 whomet the criteria of Coronavirus disease 2019 diagnosis,and the treatment plan (6th edition) of the ChineseNational Health Commission4; (3) patients aged 18years and above; (4) provision of an effective numberof cases for measurement of outcomes; (5) studiesthat used symptomatic and supportive care4 as thecontrol group, while the observation group was oneof the integrated Chinese and Western medicines forthe treatment of COVID-19.The exclusion criteria were as follows: (1) studies with incomplete or repeated data; (2) purelyREV ASSOC MED BRAS 2020; 66(6):771-777descriptive studies with no control group; (3) researchtypes that were summaries of experience, theoreticaldiscussions, case reports, animal-based experiments,and reviews; (4) patients with dementia or severe mental illness; (5) patients with severe liver, kidney, orheart damage, tumor, or autoimmune disease.Efficacy Evaluation CriteriaThe curative effect in this study was based onlung computed tomography (CT) findings. The totaleffective cases were defined as the number of patientswhose pulmonary lesions had significant change orprogression compared with the previous CT.Data Extraction and Quality EvaluationTwo reviewers searched the literature andextracted data independently based on the exclusionand inclusion criteria. The contents of extracted dataincluded the following: (1) basic information of thepublication; (2) outcome indicators of CT findings; (3)quality indicators of the publication. Disagreementswere resolved through discussion with a third evaluator. The Jadad quality scoring standard was used toevaluate the quality of the publications.Statistical AnalysisCommands of the network package in Stata(13.0) were used to construct the network, evidencecontribution, confidence interval (CI), funnel, andranking plots. The efficacy of interventions wasranked according to the value of the surface underthe cumulative ranking (SUCRA) curve. The selectedindicators were count data, while OR was used as thecombined effect, and the confidence interval (CI) wasset at 95 %. A P-value 0.05 was defined as statistically significant.Ethics statementAll analyses were adapted from previously published work. Thus, no ethical approval and patientconsent were required.RESULTSCharacteristics of Included StudiesA total of 5 randomized controlled trials involving598 patients were ultimately included in this study5-9.Figure 1 shows the selection details of the studiesincluded, while their basic information is presentedin Table 1.772
JIN, L. ET AL.FIGURE 1. FLOW DIAGRAM OF THE SELECTION DETAILS OF INCLUDED PUBLICATIONS.TABLE 1. BASIC INFORMATION OF STUDIES INCLUDED IN THE NETWORK META-ANALYSISAuthorYearDing et al.ComparisonCountrySimple size (Total effective cases/Totalcases)DoseABCDECombined Chinese medicineDuration(Days)Jadadqualityscore2020B vs AChina21/4932/51---150 milliliters each time, 2 times a day 103Cheng et al.6 2020C vs AChina23/51-28/51--6 grams each time, 3 times a day72Yu et al.72020C vs AChina93/148-102/147 --6 grams each time, 3 times a day732020D vs AChina18/25--31/32 -1 bag each time, 3 times a day143Zhang et al.9 2020E vs AChina15/22---21/22 50 milliliters each time, 2 times a day715Sun et al.8Notes: A, Symptomatic and supportive care; B, Symptomatic and supportive care Qingfei Touxie Fuzheng Recipe; C, Symptomatic and supportive care Lianhua Qingwen Granule; D, Symptomatic and supportive care Lianhua Qingke Granule; E, Symptomatic and supportive care Xuebijing Injection.Network Meta-analysisNetwork Plot of Four Types of Integrated Chineseand Western MedicinesOf the 5 studies, publications on the combinationof symptomatic and supportive care with Lianhua773Qingwen were the most frequent. The group of symptomatic and supportive care alone had the highestnumber of subjects, while symptomatic and supportive care Xuebijing had the lowest number of subjects(Figure 2).REV ASSOC MED BRAS 2020; 66(6):771-777
EFFECTS OF FOUR TYPES OF INTEGRATED CHINESE AND WESTERN MEDICINES FOR THE TREATMENT OF COVID-19 IN CHINA: A NETWORK META-ANALYSIS.FIGURE 2.NETWORK PLOT OF DIFFERENTINTERVENTIONS FOR TREATMENT OF MYCOPLASMAPNEUMONIA IN CHILDREN.FIGURE 3. EVIDENCE CONTRIBUTION PLOT.The size of the point in the network graph is proportional tothe number of subjects, while the thickness of the line is proportional to the number of studies. Abbreviations: A, Symptomatic and supportive care; B, Symptomatic and supportivecare Qingfei Touxie Fuzheng Recipe; C, Symptomatic andsupportive care Lianhua Qingwen Granule; D, Symptomaticand supportive care Lianhua Qingke Granule; E, Symptomatic and supportive care Xuebijing Injection.The matrix showed the effect of comparing the results ofdifferent control measures directly against the results of theirnetwork meta-analysis. Abbreviations: A, Symptomatic andsupportive care; B, Symptomatic and supportive care Qingfei Touxie Fuzheng Recipe; C, Symptomatic and supportivecare Lianhua Qingwen Granule; D, Symptomatic and supportive care Lianhua Qingke Granule; E, Symptomatic andsupportive care Xuebijing Injection.Evidence Contribution PlotFigure 3 shows that the direct comparison of symptomatic and supportive care alone and the combination of symptomatic and supportive care with QingfeiTouxie Fuzheng had a 100 % effect on the mixed comparison. The direct comparison between symptomaticand supportive care alone and symptomatic and supportive care Qingfei Touxie Fuzheng had a 50 % effecton the indirect comparison between symptomatic andsupportive care Qingfei Touxie Fuzheng, and symptomatic and supportive care Lianhua Qingwen. Thedirect comparison of symptomatic and supportive carealone and symptomatic and supportive care QingfeiTouxie Fuzheng had a 25.0 % effect on the results ofthe meta-analysis.Confidence Interval (CI) PlotThe meta-analysis results showed that the pooledOR and 95% CI of COVID-19 improvement comparedwith symptomatic and supportive care alone was2.25 (1.01 to 5.01) for symptomatic and supportivecare Qingfei Touxie Fuzheng, 1.38 (0.91 to 2.08) forsymptomatic and supportive care Lianhua Qingwen,12.06 (1.37 to 106.04) for symptomatic and supportivecare Lianhua Qingke, and 9.80 (1.09 to 88.23) forREV ASSOC MED BRAS 2020; 66(6):771-777symptomatic and supportive care Xuebijing, whichindicates a significant difference in lung CT efficacy,except for symptomatic and supportive care LianhuaQingwen. For the comparison between Chinese andwestern combinations, no significant differences werefound. The OR for the network estimates along with95% CI is presented in Figure 4.Publication BiasRegarding publication bias, all the outcomes in thestudy were almost symmetrical (Figure 5), indicatingthat the publication bias may not have existed.TABLE 2. SUCRA RANKINGS OF MYCOPLASMAPNEUMONIA IN CHILDREN TREATMENTSTreatmentSUCRAPr BestMean 2.144.71.7Notes: A, Symptomatic and supportive care; B, Symptomatic and supportive care Qingfei Touxie Fuzheng Recipe; C, Symptomatic and supportive care Lianhua Qingwen Granule; D, Symptomatic and supportive care Lianhua Qingke Granule; E,Symptomatic and supportive care Xuebijing Injection.774
JIN, L. ET AL.FIGURE 4. FNETWORKESTIMATES OF MEANOR, THEIR 95 % CIS ANDPREDICTION INTERVALS.Abbreviations: PrI, predictionintervals; A, Symptomatic andsupportive care; B, Symptomaticand supportive care Qingfei Touxie Fuzheng Recipe; C,Symptomatic and supportive care Lianhua Qingwen Granule; D,Symptomatic and supportive care Lianhua Qingke Granule; E,Symptomatic and supportive care Xuebijing Injection.FIGURE 5. FUNNEL PLOTFOR PUBLICATION BIAS INSELECTED STUDIES.Abbreviations: A, Symptomaticand supportive care; B, Symptomatic and supportive care Qingfei Touxie Fuzheng Recipe;C, Symptomatic and supportivecare Lianhua Qingwen Granule;D, Symptomatic and supportivecare Lianhua Qingke Granule; E,Symptomatic and supportive care Xuebijing Injection.Ranking PlotThe distribution of probabilities for each treatmentranked for their efficacy in COVID-19 according toSUCRA values are shown in Figure 6 and Table 2. Theorder of SUCRA values for different types of integratedChinese and Western medicines was as follows: symptomatic and supportive care Lianhua Qingke (85.7),symptomatic and supportive care Xuebijing (82.1),symptomatic and supportive care Qingfei TouxieFuzheng (50.5), and symptomatic and supportive care Lianhua Qingwen (28.8). Therefore, the combination ofsymptomatic and supportive care with Lianhua Qingkehad the highest probability of being the best intervention option in terms of lung CT efficacy.775DISCUSSIONThis study analyzed four types of integrated Chinese and Western medicines and conducted a pairwise comparison. The resulting network plot makesthe results more intuitive. The results showed thatthe combination of symptomatic and supportive carewith Qingfei Touxie Fuzheng, Lianhua Qingke, andXuebijing was more effective when compared to symptomatic and supportive care alone in the treatmentof COVID-19. The combination of symptomatic andsupportive care with Lianhua Qingke had the highestSUCRA value and the highest probability of being thebest treatment option.REV ASSOC MED BRAS 2020; 66(6):771-777
EFFECTS OF FOUR TYPES OF INTEGRATED CHINESE AND WESTERN MEDICINES FOR THE TREATMENT OF COVID-19 IN CHINA: A NETWORK META-ANALYSIS.FIGURE 6. SUCRA FORTHE CUMULATIVEPROBABILITIES.Abbreviations: A, Symptomatic and supportivecare; B, Symptomatic andsupportive care QingfeiTouxie Fuzheng Recipe;C, Symptomatic andsupportive care Lianhua Qingwen Granule; D,Symptomatic and supportive care Lianhua QingkeGranule; E, Symptomaticand supportive care Xuebijing Injection.As the COVID-19 epidemic continues to spread,the respiratory infectious disease poses a seriousthreat to human health and is characterized by highinfectivity. Fever, dry cough, and fatigue are the mainclinical manifestations of COVID-19 in patients 10.Pathological anatomy shows the formation of mucusand mucus plugs in the bronchial lumen, and theformation of serous, fibrinous exudate and transparent membrane in the alveolar cavity11. These viscousexudates obstruct the airways and are difficult tobe coughed out, seriously affecting the ventilationfunction of the lungs, reducing the efficacy of oxygentherapy and mechanical ventilation, and even causingsuffocation and death11. In the early stage of COVID19, the lungs show multiple small patchy shadowsand interstitial changes, especially in the extrapulmonary zone. Then it develops multiple ground glassshadows and infiltration shadows. In severe cases,lung consolidation may occur, and pleural effusionsare rare11.For clinical treatment, no specific drugs have beenfound. At present, Western medicine mainly adoptssymptomatic supportive treatments such as anti-virus, oxygen therapy, and nutritional support4. Chinesemedicine has a long history in epidemic treatmentand has accumulated rich clinical experience, such asoutstanding contributions to the outbreak of Severeacute respiratory syndrome (SARS)12.Respiratory mucus or phlegm belongs to theREV ASSOC MED BRAS 2020; 66(6):771-777category of “phlegm” in traditional Chinese medicine8. Lianhuaqingke granule is an innovative Chinese medicine developed under the guidance of thisChinese medicine theory during the outbreak ofthe new coronavirus pneumonia8. The combinationof symptomatic and supportive care with LianhuaQingke had the highest probability of being the bestintervention option in terms of lung CT efficacy, indicating that Lianhua Qingke has a better improvementeffect on the lung deterioration. Lianhua Qingke iscomposed of ephedra, gypsum, forsythia, mulberryskin, fried bitter almond, honeysuckle, rhubarb,and platycodon grandiflorum, which have the function of clearing away heat and detoxifying, clearingthe lungs, and relieving fever, cough, and phlegm.Lianhuaqingke can block the cascade reaction chainwith airway inflammation as the core while antiviraland bacteriostatic drugs regulate immune function,relieve airway spasm, protect airway mucosa, reduceairway resistance, and improve respiratory function.In addition, no adverse events related to Lianhua Qingke have been found8.This study may be very helpful for the clinicaltreatment of COVID-19, and its limitations includethe following: (1) the number of publications includedin this paper is small; (2) lack of uniformity in theduration of treatment; and (3) there is no quantitative analysis of clinical symptoms or immune systemcytokines. Future studies involving a large sample size776
JIN, L. ET AL.and high-quality RCT are needed in the treatment ofCOVID-19.Sources of FundingNone.Conflict of interestAll authors have no conflicts of interest to declareand have approved the submitted manuscript and areresponsible for the reported research. Approval fromthe Research Ethics Committee is not applicable tothis study.Authors’ contributionsLairun Jin was responsible for the concept anddesign of the manuscript. Hui Yuan and Yan Xu wereresponsible for data collection. Lairun Jin and HuiYuan were responsible for the analysis and interpretation of data. Lairun Jin and Yan Xu were responsiblefor the writing and revision. All authors approved thefinal version of the submitted manuscript.AcknowledgmentSpecial thanks to Miss Wang XR for bringing megood luck.RESUMOOBJETIVO: Vários medicamentos chineses e ocidentais integrados podem ser benéficos para o tratamento da COVID-19. O objetivo desteestudo é avaliar a eficácia da tomografia computadorizada (TC) de pulmão de quatro medicamentos chineses e ocidentais integradospara o tratamento da COVID-19 usando uma meta-análise em rede (NMA).Vários bancos de dados foram consultados para encontrar ensaios clínicos randomizados de quatro tipos diferentes demedicamentos chineses e ocidentais integrados para o tratamento da COVID-19. A NMA foi realizada nos dados usando o softwareStata (13.0). O odds ratio (OR) foi calculado. Os estudos incluídos neste artigo foram divididos em um grupo de controle (medicinaocidental) e um grupo de observação (um dos quatro medicamentos chineses e ocidentais integrados).MÉTODOS:RESULTADOS: 5 publicações elegíveis foram identificadas. Um total de 598 casos foram incluídos no estudo, e os resultados mostraramque os quatro tipos de medicamentos chineses e ocidentais integrados (tratamento sintomático e de suporte com Qingfei TouxieFuzheng, Lianhua Qingke e Xuebijing) foram significativamente superiores (P 0,05) a somente cuidados sintomáticos e de suporte,exceto cuidados sintomáticos e de suporte com Lianhua Qingwen. A combinação de cuidados sintomáticos e de suporte com LianhuaQingke teve a maior probabilidade de ser a intervenção clinicamente mais eficaz, com uma superfície abaixo da curva de classificaçãocumulativa (SUCRA) de 85,7.CONCLUSÕES: Uma combinação de tratamento sintomático e de suporte com Lianhua Qingke é a melhor opção entre os quatro medica-mentos integrados chineses e ocidentais considerados para o tratamento de COVID-19.PALAVRAS-CHAVE: Infecções por Coronavirus. Coronavirus. Medicina Tradicional Chinesa. Medicamentos de Ervas Chinesas. Metanálise.REFERENCES1. Vaira LA, Salzano G, Pet
EFFECTS OF FOUR TYES OF INTEGRATED CHINESE AND WESTERN MEDICINES FOR THE TREATMENT OF COVIDff19 IN CHINA: A NETWOR METAffANALYSIS. REV ASSOC MED BRAS 2020; 66(6):771-777 772 achieve some effect on the treatment of CO
you learn what the full range of media effects are and how the media influence contributes to those many effects. Need to Organize Media Effects Because this definition is so broad as to capture the full range of media effects, it encom-passes a great many such effects. See a partial list of those effects in Exhibit 3.1.
Social Studies Textbook Effects 3 study focused on the effects of social studies textbooks on stu-dent achievement.1 To our knowledge, all prior empirical studies on the effects of textbooks on student learning focused on the dif-ferential effects of mathematics textbooks. Several recent reviews included studies of mathematics textbook effects in
QS6 Reference Manual 87 CHAPTER 7 EDITING EFFECTS ABOUT SIGNAL PROCESSING The built-in effects processor of the QS6 is similar to that of the Alesis QuadraVerb 2, capable of generating multiple, fully digital effects simultaneously. The QS6 effects processor has four inputs, called effect sends. You might think of these as the typical
Bolero, Jazz Waltz, Add Style). A total of 16 types of accompaniment. 12 types of pop accompaniment. 5 types of Power Chord 3 types of octave play 4 types of guitar chords (Maj, Min, 7, mb5). Styles for Gypsy Jazz have other chord types (Maj6
Guide 47: Advanced Fortran 90/95 Programming 3 3. Derived Data Types and Pointers 3.1 Derived data types It is possible to create new data types in Fortran 90/95, alongside the intrinsic data types. These are called derived data types and are build from any number of components. The components can be intrinsic data types and any other
Radiation Effects and Spacecraft Critical areas for design in the natural space radiation environment – Long-term effects Total ionizing dose (TID) Displacement damage – Transient or single particle effects (Single event effects or SEE) Soft or hard errors Mission requirements and philosophies vary to ensure mission .
Home Taking VIAGRA VIAGRA Side Effects POSSIBLE VIAGRA Side Effects Safety is important. And it helps to know about possible side effects. VIAGRA (SILDENAFIL CITRATE) CAN CAUSE SERIOUS SIDE EFFECTS. Rarely reported side effects include: an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get
95 Chapter 3 Health Effects of E‑Cigarette Use Among U.S. Youth and Young Adults Introduction 97 Conclusions from Previous Surgeon General’s Reports 97 Health Effects of E‑Cigarette Use 100 Effects of Aerosol Inhalation by the E‑Cigarette User 100 Dose and Effects of Inhaling Aerosolized Nicotine 100 Aerosolized Nicotine and Cardiovascular Function 101
