Trial sequential analysis (TSA) was performed using TSA software, version 0.9.5.10 (https://ctu.dk/tsa/), with the following parameters: type I error (5%), 95% CI, relative risk reduction (20%), and type II error (20%). Evidence was confirmed as reliable if the cumulative Z-curve surpassed the required information size (RIS) line or passed through the sequential monitoring boundary of the trial; otherwise, more articles were deemed to be required. 16
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