Objective: The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful diabetic neuropathy (PDN).Methods: We searched databases for randomized controlled trials (RCTs) of CHM in the treatment of PDN. Outcome indicators included nerve conduction velocity, clinical efficiency, pain score, TCM syndrome score, and adverse events. Stata 16.0 was used to carry out the Meta-analysis.Results: A total of 21 RCTs with 1,737 participants were included. This meta-analysis found that using CHM as adjuvant treatment or as monotherapy for PDN can improve SCV of median nerve [mean difference (MD) = 3.56, 95% Confidence interval (CI) (2.19, 4.92) ], MCV of median nerve [ MD = 3.82, 95% CI (2.51, 5.12) ], SCV of common peroneal nerve [ MD = 4.16, 95% CI (1.62, 6.70) ], MCV of common peroneal nerve [ MD = 4.37, 95% CI (1.82, 6.93) ], SCV of gastrocnemius nerve [ MD = 4.95, 95% CI (3.52, 6.37) ], SCV of tibial nerve [ MD = 3.17, 95% CI (−2.64, 8.99) ], MCV of tibial nerve [MD = 6.30, 95%CI (5.00, 7.60)] and clinical effective rate [ odds ratio (OR) = 4.00, 95% CI (2.89, 5.52) ] and reduce pain score [standardized mean difference (SMD) = -2.23, 95% CI (-3.04, -1.41) ], TCM syndrome score [ MD = -4.70, 95% CI (-6.61, -2.80) ]. In addition, compared to the control group, adverse events of Chinese medicine intervention occurred less.Conclusion: CHM as adjuvant therapy or single treatment has a good curative effect and is safe for patients with PDN, which is worthy of clinical promotion and use, however; higher quality clinical studies are still needed to prove.Systematic Review Registration:https://www.crd.york.ac.uk/, identifier CRD42022327967

Background and purposes:Tuberculosis (TB) is the most lethal infectious disease worldwide. About 24.6% of tuberculosis cases are extrapulmonary TB which commonly affects spine. Spinal tuberculosis (STB) is difficult to diagnose. This study aims to evaluate the diagnostic performance of MGIT-960 culture, T-SPOT.TB, Xpert MTB/RIF, and Metagenomic Next-Generation Sequencing (mNGS) in detecting STB. Methods: 126 patients presumed to have STB were tested by 4 methods. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated considering the clinical diagnosis as the reference. Results: 126 patients were enrolled in this study, 41 with STB and 85 with non-STB infection. In the STB group, the sensitivity, specificity, PPV and NPV of MGIT-960 culture were 29.3% (12/41), 100% (85/85), 100% (12/12), and 74.6% (85/114).The sensitivity of T-SPOT.TB was 92.7% (38/41), and the specificity, PPV and NPV were 82.4% (70/85), 58.5% (31/53) and 95.9% (70/73). The sensitivity, specificity, PPV and NPV of Xpert MTB/RIF were 53.7% (22/41), 100% (85/85), 100% (22/22) and 81.7% (85/104). The sensitivity, specificity, PPV and NPV of mNGS were 39.0% (16/41), 98.8% (84/85), 94.1% (16/17) and 77.1% (84/109).The sensitivity, specificity, PPV and NPV of the mNGS+Xpert MTB/RIF group were 73.2% (30/41), 100% (85/85), 96.8% (30/31) and 72.0% (85/118). The sensitivity, specificity, PPV and NPV of the mNGS+T-spot group were 97.6% (40/41), 100% (85/85), 67.9% (38/56) and 75.9% (85/113).The sensitivity, specificity, PPV and NPV of the T-spot+Xpert MTB/RIF group were 95.1% (39/41), 100% (85/85), 72.2% (39/54) and 81.0% (85/105). Conclusions: Among the 4 detection methods, T-SPOT.TB is the most effective technique for diagnosing STB, but Xpert MTB/RIF is more reliable and can detect RIF resistance. mNGS can be used to identify pathogens in patients with spinal infections, and pathogens identified by mNGS appear to be more meaningful in guiding clinical management in patients in the non-STB group. The combination of Xpert MTB/RIF and mNGS can improve the early diagnosis rate and detection of drug resistance of STB, reduce the diagnosis cycle, and provide early targeted anti-tuberculosis treatment.