AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searc...AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.展开更多
AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the brigh...AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.展开更多
Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsis...Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.展开更多
Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly...Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.展开更多
Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analys...Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analysing heart rate variability（HRV）.Design, setting, participants and intervention： This study was a randomised, controlled and single-blinded trial, involving 44 healthy women（mean age：（26.20 ± 4.71） years）. The subjects were randomised to one of three arms： RMT with aromatic oil（RA）, RMT without aromatic oil（RM） or standardised sham massage（SM）. In the study the subjects were exposed to a standardised stress situation followed by one of the study techniques and Holter electrocardiograms（ECGs） were recorded for 24 h.Main outcome measures： HRV parameters were calculated from linear（time and frequency domain） and nonlinear dynamics（symbolic dynamics, Poincare plot analysis） of the 24-h Holter ECG records.Results： Short-and long-term effects of massage on autonomic regulation differed significantly among the three groups. Immediately after an RMT session, stimulation of HRV was found in the groups RA and RM. The use of an aromatic oil produced greater short-term measurable changes in HRV compared with rhythmic massage alone, but after 24 h the effect was no longer distinguishable from the RM group.The lowest stimulation of HRV parameters was measured in the SM group.Conclusion： RMT causes specific and marked stimulation of the autonomic nervous system. Use of a medicinal aromatic oil had only a temporary effect on HRV, indicating that the RM causes the most relevant long-term effect. The effect is relatively specific, as the physiological effects seen in the group of subjects who received only SM were considerably less pronounced.展开更多
OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention...OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention transfer and attention span.METHODS:A total of 48 adolescents with mild to moderate mental disabilities were recruited.The participants were randomly divided into four groups:control group(C),Traditional Chinese Medicine acupuncture group(M),moderate-intensity aerobic exercise group(E)and exercise and acupuncture combined intervention group(J).Before and after the experimental intervention,the participant’s height,weight and attention ability were measured.RESULTS:The improved range of attention total duration of the J group after the intervention was significantly higher than that of the E and M groups(P<0.05),whereas that of the latter groups was significantly higher compared to that of the C group(P<0.05).The J group showed significantly higher(P<0.05)attention span values after the intervention compared to the E,M and C groups.The C group did not show a significant difference in attention transfer at 12 weeks compared to before intervention(P>0.05),whereas the E,M and J groups increased significantly(P<0.05)after intervention than the C group.CONCLUSIONS:Moderate-intensity aerobic exercise combined with acupuncture can more effectively improve the attention concentration and attention span of mentally-retarded adolescents than aerobic exercise or acupuncture alone.展开更多
Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>&...Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>®</sup> in addition to vestibular exercises in central vestibular vertigo caused by vertebro-basilar ischaemia. Subjects and Methods: In this randomised, placebo-controlled, double-blind trial, 40 patients were enrolled in the vertigo clinic of a neurological university hospital and treated with daily doses of 240 mg EGb 761<sup>®</sup> or placebo for a period of 180 days. All patients regularly performed vestibular exercises in addition. Efficacy was assessed using: a visual analogue scale for the patients to rate the overall intensity of vertigo;a numeric scale for physician-rated change;a vertigo score based on intensity, duration, and frequency of vertigo;and electronystagmography. Results: Until day 180, the mean patient-rated intensity of vertigo decreased by 46% during EGb 761<sup>®</sup> treatment and by 19% with placebo (p <sup>®</sup> group compared to the placebo group. Nystagmus or other eye movement disorders were present only in small subgroups of patients without sufficient statistical power to detect differences between treatment groups. Conclusions: EGb 761<sup>®</sup> alleviated vertigo caused by ischaemic lesions in the brainstem or cerebellum in patients undergoing vestibular exercises.展开更多
Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabe...Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabetes control outcomes in Singaporeans with poorly controlled type 2 diabetes.Methods:Eighteen individuals with mild-moderate DR and poor glycemic control[HbA1c≥64 mmol/mol(≥8.0%)over two consecutive 6-month readings]were randomized to DR-IPCP(n=9)or usual care(UC,n=9).The intervention included a physician consultation,an initial personalised eye consultation with a experienced diabetes nurse educator,and three behaviour change follow-up calls.HbA1c(primary outcome),lipids and blood pressure were assessed at baseline and three months post-intervention.Participant feedback regarding the DR-IPCP program was collected at three months via a semi-structured telephone interview.Results:While no significant between-group differences were observed,DR-IPCP participants experienced significant within-group reductions in HbA1c,total cholesterol,and low density lipoprotein at follow-up compared to baseline[7 mmol/mol(−0.8%),−0.64 mmol/L,and−0.66 mmol/L,respectively].No significant within-group changes in these parameters were observed in the UC group.Following the DR-IPCP intervention,participants reported a clearer understanding of the link between diabetes management;the development and progression of DR.Conclusions:DR-IPCP provides an effective short-term improvement in diabetes control parameters in DR patients with poor diabetes control.An adequately powered and longitudinal RCT is warranted to assess the clinical,patient-centred and economic potential of this programme in this population.展开更多
The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A rando...The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A randomised clinical trial was carried out on 163 mothers of children under 5 years old. Data collection was conducted during two months, at two different moments (M0 and M1);at the moment M0 only the intervention group watched the educational video to promote self-efficacy for child diarrhoea prevention;at M1 (two months later) the scale was applied to both groups. In the intervention group, greater mean self-efficacy scores were obtained compared with the control group. The following variables showed statistically significant associations (p < 0.05) with maternal self-efficacy: age 35 or over;high school education;working outside the home;residence with 4 to 5 people;house not of brick or mortar;public refuse collection;piped water supply;consumption of mineral water;and public sewerage network. After use of the video “Diarrhoea: you can prevent it”, the maternal self-efficacy increased, proving that this strategy is able to assist the nursing staff in educational practices.展开更多
Objective:To evaluate the efficacy and safety of Baimai ointment in patients with lumbar disc herniation(LDH).Methods:This study presents a prospective randomized,double-blind,placebo-controlled,multicenter clinical t...Objective:To evaluate the efficacy and safety of Baimai ointment in patients with lumbar disc herniation(LDH).Methods:This study presents a prospective randomized,double-blind,placebo-controlled,multicenter clinical trial protocol.A total of 194 cases will be employed,with a 1:1 allocation ratio for each group.Patients will receive either Baimai ointment or placebo over a 14-day treatment period,which will be followed by a 1-week follow-up period.Visual analogue scale scores will be used for the level of pain,the Japanese Orthopedic Association score will be measured primarily to determine the functional status,the Likert scale will be graded for the level of numbness,and rescue therapy use and compliance with health education will be recorded.Laboratory tests and adverse event records will also be applied for safety assessments.Discussion:In summary,this trial will assess the clinical efficacy and safety of Baimai ointment for LDH for the first time.The use of a placebo has the advantage of precluding anticipatory biases resulting from inadequate blinding.Outcome assessors,data managers,statisticians,and all related study staff will be blinded to avoid any bias caused by subjective factors in the study subjects and investigators.Valuable information for clinical LDH treatment and future research on Baimai ointment will be generated from the findings.展开更多
BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.So...BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes,while some studies have reported negative results.AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODS This randomized,double-blind,and placebo-controlled trial was conducted in a single center in Jiangsu,China.This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent.A computer-generated randomization sequence(in a 1:1 ratio)was used to randomly assign patients to receive either rosuvastatin(40 mg/d)or placebo.Participants,care providers,and investigators were all masked to group assignments.The primary endpoint was the incidence of delirium,which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days.Analyses were performed on intention-to-treat and safety populations.RESULTS Between January 1,2017 and January 1,2020,3512 patients were assessed.A total of 821 patients were randomly assigned to receive either placebo(n=411)or rosuvastatin(n=410).The incidence of postoperative delirium was significantly lower in the rosuvastatin group[23(5.6%)of 410 patients]than in the placebo group{42(13.5%)of 411 patients[odds ratios(OR)=0.522,95%confidence interval(CI):0.308-0.885;P<0.05]}.No significant difference in 30-d all-cause mortality(6.1%vs 8.7%,OR=0.67,95%CI:0.39-1.2,P=0.147)was observed between the two groups.Rosuvastatin decreased the hospitalization time(13.8±2.5 vs 14.2±2.8,P=0.03)and hospitalization expenses(9.3±2.5 vs 9.8±2.9,P=0.007).No significant differences in abnormal liver enzymes(9.0%vs 7.1%,OR=1.307,95%CI:0.787-2.169,P=0.30)or rhabdomyolysis(0.73%vs 0.24%,OR=3.020,95%CI:0.31-29.2,P=0.37)were observed between the two groups.CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia.However,the evidence does not reveal that rosuvastatin improves clinical outcomes.The therapy is safe.Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.展开更多
Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exer...Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exercise to routine activities,usual care,non-physical activity,or health education to measure the Pittsburgh Sleep Quality Index.Data source Studies retrieved from Medline,Embase,CINAHL,Scopus,ClinicalTrial.gov and ThaiJo from the database’s inception to October 2022.Data extraction and synthesis Two reviewers independently identified studies,collected data and assessed bias.In the absence of heterogeneity,a fixed effect model was used for pairwise meta-analysis.Alternatively,a random effect model was used.A two-stage network meta-analysis used the surface under the cumulative ranking curve(SUCRA)to compare exercise efficacy.Main outcome Global Pittsburgh Sleep Quality Index(GPSQI)and subdomain score.Results This review comprised 2170 people from 25 trials.Direct meta-analysis revealed significant improvement in GPSQI with combined exercise(unstandardised mean difference(USMD)−2.35,95%CI−3.13 to-1.57,p<0.001,I^(2)=69.13%).GPSQI decreased considerably with aerobic activity(USMD−4.36,95%CI−7.86 to-0.86,p=0.01,I^(2)=97.83%).For the network meta-analysis,strengthening,aerobic and combination exercise significantly lowered GPSQI(USMD−5.75,-3.76 and−2.54,respectively).Strength training improved GPSQI scores most effectively(SUCRA 94.6%).Conclusion Exercise that strengthens muscles,rather than aerobic or combination exercises,is the most effective way to enhance sleep quality.展开更多
BACKGROUND Bismuth quadruple therapy(BQT)induces troublesome gastrointestinal side effects that reduce adherence and efficacy.AIM To evaluate multistrain probiotics efficacy for alleviating gastrointestinal sym-ptoms ...BACKGROUND Bismuth quadruple therapy(BQT)induces troublesome gastrointestinal side effects that reduce adherence and efficacy.AIM To evaluate multistrain probiotics efficacy for alleviating gastrointestinal sym-ptoms during BQT for Helicobacter pylori(H.pylori)eradication.METHODS One hundred seventy-four adults(18-60 years)with confirmed H.pylori infections between July 2022 and December 2023 were randomised to receive BQT plus a multispecies probiotic(n=89)or a maltodextrin placebo(n=85)for 4 weeks.Gastrointestinal Symptom Rating Scale(GSRS)and Bristol Stool Classification Scale scores were collected at baseline,2,4 and 8 weeks;eradication was assessed 8 weeks post-treatment.Intention-to-treat analysis used multiple imputation and SPSS 26.0.RESULTS After 8 weeks,GSRS scores(all dimensions and total)decreased significantly compared with those at baseline.ITT analysis showed significantly greater reductions for the intervention vs the placebo in reflux by week 2,total/diarrhea scores by week 4,and total/dyspepsia scores by week 8.Probiotics provided no protective effect against gastrointestinal symptoms at week 2 but showed significant protection at weeks 4 and 8.Both groups reported decreased diarrhea/constipation-type stools and increased normal-type stools post-intervention.H.pylori eradication rates were slightly higher for the intervention group(88.8%)than for the placebo group(84.7%),but the difference was not significant(P=0.430).CONCLUSION Multistrain probiotics significantly relieved BQT-associated gastrointestinal symptoms without affecting era-dication success.展开更多
Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network con...Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network connectivity and predictors of iTBS treatment outcomes in adolescents and young adults with depression.Aim This study aimed to identify default mode network(DMN)-based connectivity patterns associated with varying iTBS treatment outcomes in depression.Methods Data from a randomised controlled trial of iTBS in depression(n=82)were analysed using a data-driven approach to classify homogeneous subgroups based on the DMN.Connectivity subgroups were compared on depressive symptoms and cognitive function at pretreatment and post-treatment.Furthermore,the predictive significance of baseline inflammatory cytokines on post-treatment outcomes was evaluated.Results Two distinct subgroups were identified.Subgroup 1 exhibited high heterogeneity and greater centrality in the posterior cingulate cortex and retrosplenial cortex,while subgroup 2 showed more homogeneous connectivity patterns and greater centrality in the temporoparietal junction and posterior inferior parietal lobule.No main effect for subgroup,treatment or subgroup×treatment interaction was revealed in the improvement of depressive symptoms.A significant subgroup×treatment interaction related to symbol coding improvement was detected(F=5.22,p=0.026).Within subgroup 1,the active group showed significantly greater improvement in symbol coding compared with the sham group(t=2.30,p=0.028),while baseline levels of interleukin-6 and C-reactive protein emerged as significant indicators for predicting improvements in symbolic coding(R2=0.35,RMSE(root-mean-square error)=5.72,p=0.013).Subgroup 2 showed no significant findings in terms of cognitive improvement or inflammatory cytokines predictions.展开更多
The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of I...The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidencebased, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.展开更多
The use of fibrates in the treatment of dyslipidaemia has changed significantly over recent years.Their role appeared clear at the start of this century.The Helsinki Heart Study and Veterans Affairs High-Density Chole...The use of fibrates in the treatment of dyslipidaemia has changed significantly over recent years.Their role appeared clear at the start of this century.The Helsinki Heart Study and Veterans Affairs High-Density Cholesterol Intervention Trial suggested significant benefit,especially in patients with atherogenic dyslipidaemia.However,this clarity disintegrated following the negative outcomes reported by the Bezafibrate Infarction Prevention,Fenofibrate Intervention and Event Lowering in Diabetes and Action to Control Cardiovascular Risk in Diabetes randomised controlled trials.In this review we discuss these and other relevant trials and consider patient subgroups such as those with the metabolic syndrome and those needing treatment to prevent the microvascular complications associated with diabetes in whom fibrates may be useful.We also discuss observations from our group that may provide some explanation for the varying outcomes reported in large trials.The actions of fibrates in patients who are also on statins are interesting and appear to differ from those in patients not on statins.Understanding this is key as statins are the primary lipid lowering agents and likely to occupy that position for the foreseeable future.We also present other features of fibrate treatment we have observed in our clinical practice;changes in creatinine,liver function tests and the paradoxical high density lipoprotein reduction.Our purpose is to provide enough data for the reader to make objective decisions in their own clinical practice regarding fibrate use.展开更多
Objective: To assess effects of EGb 761? on cognition and quality of life in subjects with very mild cognitive impair-ment. Methods: We randomized 300 subjects aged 45 to 65 with cognitive complaints and low functioni...Objective: To assess effects of EGb 761? on cognition and quality of life in subjects with very mild cognitive impair-ment. Methods: We randomized 300 subjects aged 45 to 65 with cognitive complaints and low functioning (more than one standard deviation below appropriate norm) in at least one cognitive test to double-blind treatment with once daily 240 mg EGb 761? or placebo for 12 weeks. Results: The exploratory intention-to-treat analysis showed significant im-provement (p < 0.025, one-sided) beyond practice effects for EGb 761? in a measure of attention (Vienna Test System - Work Performance Series) and trends in favour of EGb 761? in measures of memory (Wechsler Memory Scale III - Faces I, Appointments Test – delayed recall), and perceived physical health (SF36 - factor score Physical Health). Cognitive effects were more pronounced and more consistent (p < 0.025 in 4 of 5 tests) in subjects with lower memory function at baseline. Specifically, practice effects in the more demanding tests were attenuated or absent in these sub-jects. Conclusion: Ginkgo biloba extract EGb 761? improved cognitive functioning and aspects of quality of life in sub-jects with very mild cognitive impairment.展开更多
AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systema...AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systematic Reviews of Interventions. Fifteen English and three Chinese databases were searched from their respective inceptions until July 2014. Key words used in the search consisted of acupuncture, needles, obesity, overweight, randomised trial and their synonyms. The risk of bias of included studies was assessed. The differences in effect size between acupuncture and control （including sham, no treatment, western medicine and dietary therapy/exercise） groups were compared using Cochrane Collaboration’s RevMan5.3 software.RESULTS： Two thousand six hundred and twenty-one records were identifed; after full-text articles assessed for eligibility, 9 of them met inclusion criteria. Majority of included studies had unclear or high risk of bias across all domains. All included studies had high or unclear risk of bias in randomisation, blinding and outcome data. Meta-analysis showed that acupuncture was more effective for reducing body weight and body mass index than no treatment group. Manual acupuncture was also superior to dietary therapy alone for decreasingbody weight. With dietary therapy as co-intervention, combined acupuncture group achieved lower body mass index than combined sham acupuncture group or dietary therapy alone group at the end of treatment period. No severe adverse events from acupuncture group were reported from all included studies.CONCLUSION： Due to the poor quality of included studies the effectiveness of acupuncture cannot be concluded. Better-designed, large-scale, randomised, sham-controlled clinical trials with long-term follow-up are needed.展开更多
基金Supported by The Medical University of Warsaw,Poland
文摘AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.
文摘AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.
基金supported by the University of Macao(SRG2014-00019-FHSMYRG2015-00230 FHS+4 种基金MYRG2016-00005-FHS)the Affiliated Brain Hospital of Guangzhou Medical University(2016YFC0906302816713342014Y2-001052015BAI13B02)
文摘Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.
文摘Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.
基金supported financially by the Dr.Hauschka Stiftung Stuttgart(Germany)the SOFTWARE AG–Stiftung(Germany)the Christophorus Stiftung in der GLS Treuhand(Germany)
文摘Background： Rhythmical massage therapy（RMT） is a massage technique used in anthroposophic medicine.Objective： The authors aimed to investigate the physiological action of RMT on the cardiovascular system by analysing heart rate variability（HRV）.Design, setting, participants and intervention： This study was a randomised, controlled and single-blinded trial, involving 44 healthy women（mean age：（26.20 ± 4.71） years）. The subjects were randomised to one of three arms： RMT with aromatic oil（RA）, RMT without aromatic oil（RM） or standardised sham massage（SM）. In the study the subjects were exposed to a standardised stress situation followed by one of the study techniques and Holter electrocardiograms（ECGs） were recorded for 24 h.Main outcome measures： HRV parameters were calculated from linear（time and frequency domain） and nonlinear dynamics（symbolic dynamics, Poincare plot analysis） of the 24-h Holter ECG records.Results： Short-and long-term effects of massage on autonomic regulation differed significantly among the three groups. Immediately after an RMT session, stimulation of HRV was found in the groups RA and RM. The use of an aromatic oil produced greater short-term measurable changes in HRV compared with rhythmic massage alone, but after 24 h the effect was no longer distinguishable from the RM group.The lowest stimulation of HRV parameters was measured in the SM group.Conclusion： RMT causes specific and marked stimulation of the autonomic nervous system. Use of a medicinal aromatic oil had only a temporary effect on HRV, indicating that the RM causes the most relevant long-term effect. The effect is relatively specific, as the physiological effects seen in the group of subjects who received only SM were considerably less pronounced.
文摘OBJECTIVE:To detect the impact of moderate-intensity aerobic exercise combined with acupuncture on the attention function of mentally-retarded adolescents from the three dimensions of attention concentration,attention transfer and attention span.METHODS:A total of 48 adolescents with mild to moderate mental disabilities were recruited.The participants were randomly divided into four groups:control group(C),Traditional Chinese Medicine acupuncture group(M),moderate-intensity aerobic exercise group(E)and exercise and acupuncture combined intervention group(J).Before and after the experimental intervention,the participant’s height,weight and attention ability were measured.RESULTS:The improved range of attention total duration of the J group after the intervention was significantly higher than that of the E and M groups(P<0.05),whereas that of the latter groups was significantly higher compared to that of the C group(P<0.05).The J group showed significantly higher(P<0.05)attention span values after the intervention compared to the E,M and C groups.The C group did not show a significant difference in attention transfer at 12 weeks compared to before intervention(P>0.05),whereas the E,M and J groups increased significantly(P<0.05)after intervention than the C group.CONCLUSIONS:Moderate-intensity aerobic exercise combined with acupuncture can more effectively improve the attention concentration and attention span of mentally-retarded adolescents than aerobic exercise or acupuncture alone.
文摘Background: Ginkgo biloba extract EGb 761<sup>®</sup> is widely used to treat various types of vertigo. Aims: An exploratory trial was conducted to evaluate the efficacy of EGb 761<sup>®</sup> in addition to vestibular exercises in central vestibular vertigo caused by vertebro-basilar ischaemia. Subjects and Methods: In this randomised, placebo-controlled, double-blind trial, 40 patients were enrolled in the vertigo clinic of a neurological university hospital and treated with daily doses of 240 mg EGb 761<sup>®</sup> or placebo for a period of 180 days. All patients regularly performed vestibular exercises in addition. Efficacy was assessed using: a visual analogue scale for the patients to rate the overall intensity of vertigo;a numeric scale for physician-rated change;a vertigo score based on intensity, duration, and frequency of vertigo;and electronystagmography. Results: Until day 180, the mean patient-rated intensity of vertigo decreased by 46% during EGb 761<sup>®</sup> treatment and by 19% with placebo (p <sup>®</sup> group compared to the placebo group. Nystagmus or other eye movement disorders were present only in small subgroups of patients without sufficient statistical power to detect differences between treatment groups. Conclusions: EGb 761<sup>®</sup> alleviated vertigo caused by ischaemic lesions in the brainstem or cerebellum in patients undergoing vestibular exercises.
基金This study was supported by Singapore Health Services Pte Ltd.Prof Ecosse L.Lamoureux received the funding under the SingHealth Research Strategic Hires Scheme,STH-1202-SERI.The grant body had no roles in design,conduct or data analysis of the study.
文摘Background:Using a pilot randomised controlled trial(RCT),to assess the short-term effectiveness of a structured diabetic retinopathy(DR)-specific,intensive,and personalised care planning(DR-IPCP)intervention on diabetes control outcomes in Singaporeans with poorly controlled type 2 diabetes.Methods:Eighteen individuals with mild-moderate DR and poor glycemic control[HbA1c≥64 mmol/mol(≥8.0%)over two consecutive 6-month readings]were randomized to DR-IPCP(n=9)or usual care(UC,n=9).The intervention included a physician consultation,an initial personalised eye consultation with a experienced diabetes nurse educator,and three behaviour change follow-up calls.HbA1c(primary outcome),lipids and blood pressure were assessed at baseline and three months post-intervention.Participant feedback regarding the DR-IPCP program was collected at three months via a semi-structured telephone interview.Results:While no significant between-group differences were observed,DR-IPCP participants experienced significant within-group reductions in HbA1c,total cholesterol,and low density lipoprotein at follow-up compared to baseline[7 mmol/mol(−0.8%),−0.64 mmol/L,and−0.66 mmol/L,respectively].No significant within-group changes in these parameters were observed in the UC group.Following the DR-IPCP intervention,participants reported a clearer understanding of the link between diabetes management;the development and progression of DR.Conclusions:DR-IPCP provides an effective short-term improvement in diabetes control parameters in DR patients with poor diabetes control.An adequately powered and longitudinal RCT is warranted to assess the clinical,patient-centred and economic potential of this programme in this population.
文摘The aim of this study was to compare the scores of maternal self-efficacy for child diarrhoea prevention, between intervention and control groups, according to sanitary, social and demographic characteristics. A randomised clinical trial was carried out on 163 mothers of children under 5 years old. Data collection was conducted during two months, at two different moments (M0 and M1);at the moment M0 only the intervention group watched the educational video to promote self-efficacy for child diarrhoea prevention;at M1 (two months later) the scale was applied to both groups. In the intervention group, greater mean self-efficacy scores were obtained compared with the control group. The following variables showed statistically significant associations (p < 0.05) with maternal self-efficacy: age 35 or over;high school education;working outside the home;residence with 4 to 5 people;house not of brick or mortar;public refuse collection;piped water supply;consumption of mineral water;and public sewerage network. After use of the video “Diarrhoea: you can prevent it”, the maternal self-efficacy increased, proving that this strategy is able to assist the nursing staff in educational practices.
基金supported by the Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(ZYYCXTD-C-202006)Gansu Cheezheng Tibetan Medicine(BUCM-2021-JS-FW-087,Beijing,China).
文摘Objective:To evaluate the efficacy and safety of Baimai ointment in patients with lumbar disc herniation(LDH).Methods:This study presents a prospective randomized,double-blind,placebo-controlled,multicenter clinical trial protocol.A total of 194 cases will be employed,with a 1:1 allocation ratio for each group.Patients will receive either Baimai ointment or placebo over a 14-day treatment period,which will be followed by a 1-week follow-up period.Visual analogue scale scores will be used for the level of pain,the Japanese Orthopedic Association score will be measured primarily to determine the functional status,the Likert scale will be graded for the level of numbness,and rescue therapy use and compliance with health education will be recorded.Laboratory tests and adverse event records will also be applied for safety assessments.Discussion:In summary,this trial will assess the clinical efficacy and safety of Baimai ointment for LDH for the first time.The use of a placebo has the advantage of precluding anticipatory biases resulting from inadequate blinding.Outcome assessors,data managers,statisticians,and all related study staff will be blinded to avoid any bias caused by subjective factors in the study subjects and investigators.Valuable information for clinical LDH treatment and future research on Baimai ointment will be generated from the findings.
文摘BACKGROUND Experimental evidence has indicated the benefits of statins for the treatment of postoperative delirium.Previously,clinical trials did not reach definite conclusions on the effects of statins on delirium.Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes,while some studies have reported negative results.AIM To evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODS This randomized,double-blind,and placebo-controlled trial was conducted in a single center in Jiangsu,China.This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent.A computer-generated randomization sequence(in a 1:1 ratio)was used to randomly assign patients to receive either rosuvastatin(40 mg/d)or placebo.Participants,care providers,and investigators were all masked to group assignments.The primary endpoint was the incidence of delirium,which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days.Analyses were performed on intention-to-treat and safety populations.RESULTS Between January 1,2017 and January 1,2020,3512 patients were assessed.A total of 821 patients were randomly assigned to receive either placebo(n=411)or rosuvastatin(n=410).The incidence of postoperative delirium was significantly lower in the rosuvastatin group[23(5.6%)of 410 patients]than in the placebo group{42(13.5%)of 411 patients[odds ratios(OR)=0.522,95%confidence interval(CI):0.308-0.885;P<0.05]}.No significant difference in 30-d all-cause mortality(6.1%vs 8.7%,OR=0.67,95%CI:0.39-1.2,P=0.147)was observed between the two groups.Rosuvastatin decreased the hospitalization time(13.8±2.5 vs 14.2±2.8,P=0.03)and hospitalization expenses(9.3±2.5 vs 9.8±2.9,P=0.007).No significant differences in abnormal liver enzymes(9.0%vs 7.1%,OR=1.307,95%CI:0.787-2.169,P=0.30)or rhabdomyolysis(0.73%vs 0.24%,OR=3.020,95%CI:0.31-29.2,P=0.37)were observed between the two groups.CONCLUSION The current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia.However,the evidence does not reveal that rosuvastatin improves clinical outcomes.The therapy is safe.Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.
文摘Objective To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.Study selection Eligible randomised controlled trials that compare physical exercise to routine activities,usual care,non-physical activity,or health education to measure the Pittsburgh Sleep Quality Index.Data source Studies retrieved from Medline,Embase,CINAHL,Scopus,ClinicalTrial.gov and ThaiJo from the database’s inception to October 2022.Data extraction and synthesis Two reviewers independently identified studies,collected data and assessed bias.In the absence of heterogeneity,a fixed effect model was used for pairwise meta-analysis.Alternatively,a random effect model was used.A two-stage network meta-analysis used the surface under the cumulative ranking curve(SUCRA)to compare exercise efficacy.Main outcome Global Pittsburgh Sleep Quality Index(GPSQI)and subdomain score.Results This review comprised 2170 people from 25 trials.Direct meta-analysis revealed significant improvement in GPSQI with combined exercise(unstandardised mean difference(USMD)−2.35,95%CI−3.13 to-1.57,p<0.001,I^(2)=69.13%).GPSQI decreased considerably with aerobic activity(USMD−4.36,95%CI−7.86 to-0.86,p=0.01,I^(2)=97.83%).For the network meta-analysis,strengthening,aerobic and combination exercise significantly lowered GPSQI(USMD−5.75,-3.76 and−2.54,respectively).Strength training improved GPSQI scores most effectively(SUCRA 94.6%).Conclusion Exercise that strengthens muscles,rather than aerobic or combination exercises,is the most effective way to enhance sleep quality.
文摘BACKGROUND Bismuth quadruple therapy(BQT)induces troublesome gastrointestinal side effects that reduce adherence and efficacy.AIM To evaluate multistrain probiotics efficacy for alleviating gastrointestinal sym-ptoms during BQT for Helicobacter pylori(H.pylori)eradication.METHODS One hundred seventy-four adults(18-60 years)with confirmed H.pylori infections between July 2022 and December 2023 were randomised to receive BQT plus a multispecies probiotic(n=89)or a maltodextrin placebo(n=85)for 4 weeks.Gastrointestinal Symptom Rating Scale(GSRS)and Bristol Stool Classification Scale scores were collected at baseline,2,4 and 8 weeks;eradication was assessed 8 weeks post-treatment.Intention-to-treat analysis used multiple imputation and SPSS 26.0.RESULTS After 8 weeks,GSRS scores(all dimensions and total)decreased significantly compared with those at baseline.ITT analysis showed significantly greater reductions for the intervention vs the placebo in reflux by week 2,total/diarrhea scores by week 4,and total/dyspepsia scores by week 8.Probiotics provided no protective effect against gastrointestinal symptoms at week 2 but showed significant protection at weeks 4 and 8.Both groups reported decreased diarrhea/constipation-type stools and increased normal-type stools post-intervention.H.pylori eradication rates were slightly higher for the intervention group(88.8%)than for the placebo group(84.7%),but the difference was not significant(P=0.430).CONCLUSION Multistrain probiotics significantly relieved BQT-associated gastrointestinal symptoms without affecting era-dication success.
基金supported by the Guangzhou Municipal Key Discipline in Medicine(2021-2023)the Guangzhou High-level Clinical Key Specialty,the Guangzhou Research-oriented Hospital,the Innovative Clinical Technique of Guangzhou(2024-2026)+6 种基金the Guangdong Basic and Applied Basic Research Foundation(grant number 2022A1515011567,2020A1515110565)the Guangzhou Science,Technology Planning Project(grant number 202201010714,202103000032)the National Natural Science Foundation of China(grant number 82471546)the Guangdong College Students Innovation and Entrepreneurship Training Project(grant number S202310570038)the Guangzhou Health Science and Technology Project(grant number 20231A010038)the Guangzhou Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine Technology Project(grant number:20232A010013)the Science and Technology Plan Project of Guangzhou(2023A03J0842).
文摘Background The heterogeneity of depression limits the treatment outcomes of intermittent theta burst stimulation(iTBS)and hinders the identification of predictive factors.This study investigated functional network connectivity and predictors of iTBS treatment outcomes in adolescents and young adults with depression.Aim This study aimed to identify default mode network(DMN)-based connectivity patterns associated with varying iTBS treatment outcomes in depression.Methods Data from a randomised controlled trial of iTBS in depression(n=82)were analysed using a data-driven approach to classify homogeneous subgroups based on the DMN.Connectivity subgroups were compared on depressive symptoms and cognitive function at pretreatment and post-treatment.Furthermore,the predictive significance of baseline inflammatory cytokines on post-treatment outcomes was evaluated.Results Two distinct subgroups were identified.Subgroup 1 exhibited high heterogeneity and greater centrality in the posterior cingulate cortex and retrosplenial cortex,while subgroup 2 showed more homogeneous connectivity patterns and greater centrality in the temporoparietal junction and posterior inferior parietal lobule.No main effect for subgroup,treatment or subgroup×treatment interaction was revealed in the improvement of depressive symptoms.A significant subgroup×treatment interaction related to symbol coding improvement was detected(F=5.22,p=0.026).Within subgroup 1,the active group showed significantly greater improvement in symbol coding compared with the sham group(t=2.30,p=0.028),while baseline levels of interleukin-6 and C-reactive protein emerged as significant indicators for predicting improvements in symbolic coding(R2=0.35,RMSE(root-mean-square error)=5.72,p=0.013).Subgroup 2 showed no significant findings in terms of cognitive improvement or inflammatory cytokines predictions.
文摘The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidencebased, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.
文摘The use of fibrates in the treatment of dyslipidaemia has changed significantly over recent years.Their role appeared clear at the start of this century.The Helsinki Heart Study and Veterans Affairs High-Density Cholesterol Intervention Trial suggested significant benefit,especially in patients with atherogenic dyslipidaemia.However,this clarity disintegrated following the negative outcomes reported by the Bezafibrate Infarction Prevention,Fenofibrate Intervention and Event Lowering in Diabetes and Action to Control Cardiovascular Risk in Diabetes randomised controlled trials.In this review we discuss these and other relevant trials and consider patient subgroups such as those with the metabolic syndrome and those needing treatment to prevent the microvascular complications associated with diabetes in whom fibrates may be useful.We also discuss observations from our group that may provide some explanation for the varying outcomes reported in large trials.The actions of fibrates in patients who are also on statins are interesting and appear to differ from those in patients not on statins.Understanding this is key as statins are the primary lipid lowering agents and likely to occupy that position for the foreseeable future.We also present other features of fibrate treatment we have observed in our clinical practice;changes in creatinine,liver function tests and the paradoxical high density lipoprotein reduction.Our purpose is to provide enough data for the reader to make objective decisions in their own clinical practice regarding fibrate use.
文摘Objective: To assess effects of EGb 761? on cognition and quality of life in subjects with very mild cognitive impair-ment. Methods: We randomized 300 subjects aged 45 to 65 with cognitive complaints and low functioning (more than one standard deviation below appropriate norm) in at least one cognitive test to double-blind treatment with once daily 240 mg EGb 761? or placebo for 12 weeks. Results: The exploratory intention-to-treat analysis showed significant im-provement (p < 0.025, one-sided) beyond practice effects for EGb 761? in a measure of attention (Vienna Test System - Work Performance Series) and trends in favour of EGb 761? in measures of memory (Wechsler Memory Scale III - Faces I, Appointments Test – delayed recall), and perceived physical health (SF36 - factor score Physical Health). Cognitive effects were more pronounced and more consistent (p < 0.025 in 4 of 5 tests) in subjects with lower memory function at baseline. Specifically, practice effects in the more demanding tests were attenuated or absent in these sub-jects. Conclusion: Ginkgo biloba extract EGb 761? improved cognitive functioning and aspects of quality of life in sub-jects with very mild cognitive impairment.
文摘AIM： To evaluate the effectiveness and safety ofacupuncture for the treatment of obesity by reviewing currently available randomised controlled trials.METHODS： This review followed the Cochrane Hand-book for Systematic Reviews of Interventions. Fifteen English and three Chinese databases were searched from their respective inceptions until July 2014. Key words used in the search consisted of acupuncture, needles, obesity, overweight, randomised trial and their synonyms. The risk of bias of included studies was assessed. The differences in effect size between acupuncture and control （including sham, no treatment, western medicine and dietary therapy/exercise） groups were compared using Cochrane Collaboration’s RevMan5.3 software.RESULTS： Two thousand six hundred and twenty-one records were identifed; after full-text articles assessed for eligibility, 9 of them met inclusion criteria. Majority of included studies had unclear or high risk of bias across all domains. All included studies had high or unclear risk of bias in randomisation, blinding and outcome data. Meta-analysis showed that acupuncture was more effective for reducing body weight and body mass index than no treatment group. Manual acupuncture was also superior to dietary therapy alone for decreasingbody weight. With dietary therapy as co-intervention, combined acupuncture group achieved lower body mass index than combined sham acupuncture group or dietary therapy alone group at the end of treatment period. No severe adverse events from acupuncture group were reported from all included studies.CONCLUSION： Due to the poor quality of included studies the effectiveness of acupuncture cannot be concluded. Better-designed, large-scale, randomised, sham-controlled clinical trials with long-term follow-up are needed.
