Ketamine for Bipolar Depression: A Systematic Review

BackgroundKetamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is less clear. This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression.MethodsWe conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since each database’s inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies.ResultsWe identified 6 studies, with 135 participants (53% female; 44.7 years; standard deviation, 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from 1 to 6; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well tolerated; however, 2 participants (1 receiving ketamine and 1 receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in 2 trials.ConclusionsThere is some preliminary evidence supporting use of intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine.     

Suicidal Ideation in Veterans Receiving Treatment for Opiate Dependence

Abstract

Persons with opiate use disorders, especially veterans. have a number of both chronic and acute indicators of risk for suicide, but are not typically screened for suicidal ideation on a routine basis, beyond initial evaluations. One hundred one veterans receiving treatment for opiate dependence at an urban VA medical center were screened for suicidal ideation. Over 24% reported some suicidal ideation. Current ideation was associated with severe chronic pain, ongoing problems with street drugs. firearm ownership, and with having recently enrolled in treatment. It was also associated with a variety of recent negative life events and mental health issues, especially depression, recurring troubling thoughts, hallucinations, loss of jobs, and conflicts with family members. Two veterans endorsing suicidal ideation required immediate hospitalization. The implications of these findings are discussed, and frequent screening for suicidal ideation among patients receiving treatment for opiate dependence is recommended.     

Omalizumab for the Treatment of Chronic Idiopathic Urticaria: Systematic Review of the Literature

Omalizumab is recombinant humanized monoclonal antibody to immunoglobulin E. Guidelines for the treatment of chronic idiopathic urticaria (also known as chronic spontaneous urticaria) recommend the use of omalizumab as third‐line therapy in addition to high doses of histamine receptor type 1 (H₁) antihistamines when they are unsuccessful as first‐ and second‐line therapy. We performed a systematic review of the literature to identify studies that evaluated the efficacy of omalizumab for the treatment of chronic idiopathic urticaria, in both controlled and real‐world settings, to assess its potential role as a preferred therapy. The PubMed, ScienceDirect, LILACS (Latin American and Caribbean Health Sciences Literature), and Google Scholar databases were searched between January 1, 2000, and November 21, 2016. The search was limited to articles published in peer‐reviewed journals in the English language, and 29 studies were included in this review. Omalizumab 300 mg administered every 4 weeks appears to be the most effective and safe dosage, with a rapid response time, for the treatment of chronic idiopathic urticaria, with few minor adverse effects, and appears to be safe in the offspring of pregnant patients who received the drug. However, as published studies of omalizumab are sparse, future studies are warranted. When findings are confirmed in larger studies, due to its efficacy, safety, and increased benefit/cost ratio, omalizumab could become the preferred method of treatment for chronic idiopathic urticaria in patients unresponsive to H₁ antihistamines.     

维生素D辅助治疗肺结核的系统评价

目的:系统评价维生素D辅助治疗结核的有效性和安全性。方法:计算机检索Cochrane图书馆、PubMed、EMbase、CBM、VIP、CNKI数据库,对纳入的随机对照试验(RCT)进行质量评价,并用RevMan 5.0软件进行Meta分析。结果:共纳入2个RCT。结果显示6周和8周痰涂片阴转率维生素D组较之安慰剂组差异无统计学意义(P>0.05);维生素D亦未缩短痰培养阴转时间(P=0.07);2个月不良反应发生率,2组比较差异无统计学意义(P=0.54)。结论:基于有限的证据,尚不能认为维生素D可以加快肺结核治疗的进程。对于维生素D在肺结核辅助治疗中的价值,仍需更多高质量的RCT研究以提供更充分可靠的证据,尤其是针对我国人群的RCT。     

A Systematic Review of Traditionally Used Herbs and Animal-Derived Products as Potential Analgesics

Pain is a distressing but fundamental manifestation that prepares the body for potentially detrimental stimuli while ensuring its protection. Plant and animal products have traditionally been used to relieve pain for centuries. However, no attempt has been made to compile a single report of plant and animal products possessing analgesic properties. This review enadeavours to recover data from published articles to establish a collective literature review on folk remedies from plant and animal sources used as analgesics and in the treatment of pain-related conditions, identifying gaps in existing knowledge and future works. Relevant information was systematically retrieved using the PRISMA method. In this review, in total, 209 plants were found to be either used raw or prepared by decoctions or maceration. Administration was either oral or topical, and they were predominantly used in Asian countries. In vivo studies of plants with analgesic properties, which were tested using different methods including acetic-induced writhing test, hotplate test, tail-flick test, and formalin-induced pain test, were compiled. Animal products with analgesic properties were obtained mainly from compounds present in venom; their bioactive compounds were also identified. In the literature search, certain gaps were noted, which could be reviewed in future studies. For instance, there was a disparity of information regarding the traditional uses of medicinal plants. In this review, an attempt was made to critically assess and describe the pharmacological properties and bioactive composition of indigenous plants, some animal species, and animal venom by scrutinizing databases and looking for published articles. Therefore, it can be concluded that the compounds obtained from these sources can serve as important ingredients in therapeutic agents to alleviate pain once their limitations are assessed and improved upon. In the literature search, certain gaps were noted, which could be reviewed in future studies.     

丁苯酞软胶囊治疗进展性卒中的系统评价

目的 系统评价丁苯酞软胶囊治疗进展性卒中的疗效和安全性。方法 检索Cochrane图书馆、万方、CNKI等数据库收集关于丁苯酞治疗进展性卒中的随机对照试验（randomized controlled trials,RCTs）,时间截至2018年12月,根据明确的纳入与排除标准筛选相关研究,采用RevMan 5.3软件进行统计分析。结果 共纳入26个RCTs（2 519例患者）,meta分析结果示,与对照组比较,丁苯酞治疗进展性卒中疗效更好（RR=1.23,95%CI 1.17~1.29,P<0.000 01）;丁苯酞治疗进展性卒中在神经功能缺损评分（The National Institutes of Health Stroke Scale,NIHSS）（MD=-3.01,95%CI -3.49~-2.52,P<0.000 01）、卒中评分量表（Chinese Stroke Scale,CSS）评分（MD=-3.39,95%CI -4.70~-2.08,P<0.000 01）及日常生活活动能力评分量表（Barthel Index,BI）评分（MD=9.84,95%CI 6.06~13.62,P<0.000 01）改善方面均优于对照组,差异有统计学意义。2组在不良反应方面差异无统计学意义（RR=1.27,95%CI 0.50~3.18,P=0.61）。结论 丁苯酞软胶囊能有效改善进展性卒中患者的神经功能,且不增加不良反应。     

Drug Abuse Treatment Process: A Review of the Literature

The literature on drug abuse treatment is reviewed in two sections. The first of these briefly describes the three major treatment modalities (outpatient methadone, residential, and outpatient drug-free). The objectives and approaches of each modality are outlined, and a number of issues surrounding each modality are sketched. The second section of the review covers general studies of drug abuse treatment. In particular, studies of retention, counselor characteristics, program policies and goals, the nature and extent of services received by clients, the context in which treatment is administered, methadone dosage levels, and other such variables are reviewed. Various typologies of treatment are presented and discussed. Conclusions and implications for future research are also discussed.     

Immunomodulatory Potential of Cannabidiol in Multiple Sclerosis: a Systematic Review

Multiple sclerosis (MS) is the most common chronic autoimmune disease of the central nervous system. Efficacy of treatments for MS is associated with risk of adverse effects, and effective and well-tolerated drugs remain a major unmet need. Cannabis (Cannabis sativa L., fam. Cannabaceae) and cannabinoids are popular among MS patients to treat spasticity and pain. Cannabinoids are endowed with remarkable immunomodulating properties, and in particular the non-psychotropic cannabinoid cannabidiol (CBD) is increasingly recognized as anti-inflammatory and immunosuppressive, nevertheless with excellent tolerability even at high doses. In this systematic review, we retrieved and critically evaluated available evidence regarding the immune and disease-modifying effects of CBD in experimental autoimmune encephalomyelitis (EAE) and in MS. Evidence in rodent models of EAE strongly supports CBD as effective, while clinical evidence is still limited and usually negative, due to paucity of studies and possibly to the use of suboptimal dosing regimens. Better characterization of targets acted upon by CBD in MS should be obtained in ex vivo/in vitro studies in human immune cells, and higher doses should be tested in well-designed clinical trials with clinically relevant efficacy endpoints.

Graphical Abstract

     

Anxiety and Suicidal Ideation Predict Successful Completion of Substance Abuse Treatment in a Criminal Justice Sample

The goal of this study was to identify predictors of successful substance abuse treatment in an out-patient clinic for individuals being monitored under community corrections supervision. Of the 615 participants, 117 (19%) successfully completed treatment. The results of a multivariate logistic regression analysis indicated that successful treatment was associated with several baseline characteristics including: older age, White race, having greater than a high school education, lower level of care, meeting criteria for an anxiety disorder, reporting suicidal ideation, and not having a history of opioid use. The value of self-report of problems and its influence on treatment in the culture of the criminal justice population is discussed in this article.     

米非司酮治疗子宫肌瘤不良反应中文文献的系统性综述

目的：综合和了解米非司酮治疗子宫肌瘤中文文献中不良反应研究结果。方法：全面检索有关中文文献;应用定性综述的方法分析和综合研究的主要结果。结果：搜集到24篇文献的全文,占可能达标文献的87％。9篇文献明示进行不良反应的观测,18篇文献较为详细地介绍了不良反应的结果,未见文献制定或标示了判定标准;发生频率最高的反应是潮热多汗（138／805）,最严重的反应似为ALT升高;3篇文献指出无因过敏或不良反应而停药的情况,5篇文献强调疗程结束后不良反应消失。结论：有关文献对不良反应的观测比较重视,但观测方式似不够严谨;米非司酮治疗子宫肌瘤时的不良反应不太严重,不影响治疗,且停药后消失,但对于ALT升高和米非司酮的中长期安全性需要更为严格的研究。     

尼莫地平治疗蛛网膜下腔出血的系统评价

目的：系统评价尼莫地平治疗蛛网膜下腔出血的疗效和安全性。方法：计算机检索Cochrane图书馆、Pubmed、EMbase、ISI、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP）、万方数字化期刊全文库以及中国生物医学文献服务系统,纳入尼莫地平与安慰剂治疗蛛网膜下腔出血的随机对照试验（RCT）、系统评价和Meta分析,对纳入的RCT进行方法学质量评价,采用RevMan5．0软件进行系统评价。结果：共纳入8项研究,合计2223例患者。Meta分析结果显示,2组死亡率比较差异无统计学意义[RR=0．67,95％CI（0．44,1．03）,P=0．07],尼莫地平组在预防脑缺血方面优于对照组,2组比较差异有统计学意义[RR=0．57,95％CI（0．42,0．78）,P=0．0004],2组不良反应发生率比较差异无统计学意义。结论：尼莫地平能够安全、有效地预防蛛网膜下腔出血患者脑缺血的发生,但在降低死亡率方面没有明显的优势。     

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

Cannabinoid hyperemesis syndrome (CHS) has become more prevalent with increasing cannabis use. CHS is often resistant to standard antiemetics. The objective of this study is to review the current evidence for pharmacologic treatment of CHS. Medline, PsycINFO, DARE, OpenGrey, Google Scholar, and the Cochrane Library were searched from inception to February 2017. Articles were selected and reviewed independently. Evidence was graded using Oxford Center for Evidence‐Based Medicine guidelines. The search resulted in 1262 articles with 63 of them eligible for inclusion (205 human subjects). There were 4 prospective level‐2, 3 retrospective level‐3 studies, 12 level‐4 case series, and 44 level‐5 case reports. Among level‐2 studies (64 subjects), tricyclic antidepressants (TCAs) and lorazepam were discussed as effective long‐ and short‐term treatments, respectively, in two studies. Ondansetron, promethazine, diphenhydramine, and opioids were also mentioned, but the authors did not comment on their efficacy. Among level‐3 studies (43 subjects), one reported effective treatment with antiepileptics zonisamide and levetiracetam, but not TCAs. Another reported favorable response to morphine, ondansetron, and lorazepam but did not specify the actual number of patients receiving specific treatment. Among the level‐4 case series (54 subjects), benzodiazepines, haloperidol, and capsaicin were reported as helpful. For level‐5 case reports (44 subjects), benzodiazepines, metoclopramide, haloperidol, ondansetron, morphine, and capsaicin were reported as effective. Effective treatments mentioned only once included fentanyl, diazepam, promethazine, methadone, nabilone, levomepromazine, piritramide, and pantoprazole. Hot showers and baths were cited in all level‐4 and ‐5 articles as universally effective. High‐quality evidence for pharmacologic treatment of CHS is limited. Benzodiazepines, followed by haloperidol and capsaicin, were most frequently reported as effective for acute treatment, and TCAs for long‐term treatment. As the prevalence of CHS increases, future prospective trials are greatly needed to evaluate and further define optimal pharmacologic treatment of patients with CHS.     

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost‐effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.     

冠脉宁联合常规治疗对冠心病的系统评价

目的系统评价冠脉宁联合常规治疗对冠心病的疗效。方法计算机检索Cochrane图书馆（2013年第2期）、EMBase、PubMed、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（vIP）（各数据库检索时间均从创建至2013年3月）关于冠脉宁联合常规治疗对冠心病的随机对照试验。2名数据员按纳入与排除标准独立筛选试验,并对纳入研究的方法学质量进行评价,提取资料,用RevMan 5．14软件对数据进行Meta分析。结果共纳入6篇RCT,包括725例患者。Meta分析结果显示,与对照组相比,冠脉宁组临床有效率优于常规治疗组[RR=5．87,95％CI（3．45,9．99）,P〈0．00001];冠脉宁组心电图改善率优于常规治疗组[RR=2,95％CI（1．33,3．02）,P〈0．00001],差异均有统计学意义。结论基于现有临床证据,冠脉宁联合常规治疗对冠心病有效,安全性好。但由于纳入研究数量较少,研究质量不统一,本结论尚需要更多大样本、高质量临床随机对照试验予以证实。     

晚期肝癌治疗药物的经济学文献研究

目的 探讨晚期肝癌治疗药物的成本-效果,为临床合理用药提供参考.方法 检索国内外关于治疗晚期肝癌的药物经济学文献,分析研究设计、模型建立及参数设置.结果 共纳入文献18篇,大多数研究根据Ⅲ期临床试验的数据建立Markov模型,比较治疗方案间的增量-成本比和患者支付意愿阈值;多数研究结果显示,索拉非尼不具有成本-效果,肝...     

哌罗匹隆对比利培酮治疗精神分裂症的系统评价

目的:系统评价哌罗匹隆对比利培酮治疗精神分裂症的疗效与安全性,为临床提供循证参考。方法:计算机检索万方数据库、中文科技期刊数据库、中国期刊全文数据库、中国生物医学文献数据库和PubMed,收集哌罗匹隆(试验组)对比利培酮(对照组)治疗精神分裂症的临床随机对照试验(RCT),提取资料并按照改良后的Jadad评分标准评价纳入研究质量后,采用Rev Man5.0统计软件对各效应指标进行Meta分析。结果:共纳入12项RCT,合计1 050例患者。Meta分析结果显示,两组患者痊愈率比较,差异无统计学意义[OR=0.99,95%CI(0.75,1.30),P=0.93];对照组患者锥体外系反应发生率[OR=0.63,95%CI(0.43,0.92),P=0.02]、泌乳素水平升高发生率[OR=0.23,95%CI(0.14,0.38),P<0.001]和体质量增加发生率[OR=0.23,95%CI(0.13,0.39),P<0.001]显著高于试验组,差异均有统计学意义。结论:哌罗匹隆与利培酮治疗精神分裂症疗效相当,但哌罗匹隆的安全性优于利培酮。     

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966–December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross‐referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative‐hypnotic that exerts its actions through agonism of GABA_A receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N‐methyl‐d ‐aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more‐resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine‐ and haloperidol‐sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first‐line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with propofol may be considered but requires further research to recommend its use either preferentially or as monotherapy.     

胰激肽释放酶治疗糖尿病视网膜病变的系统评价

目的：评价胰激肽释放酶治疗糖尿病视网膜病变的疗效与安全性。方法：检索MEDLINE（1977～2008）、EMBASE（1989～2008）、Cochrane临床试验数据库、CBMdisc（1978～2008）和CNKI（1979～2008）等文献数据库，收集胰激肽释放酶治疗糖尿病视网膜病变的临床研究，进行质量评价，并对符合纳入标准的临床研究进行Meta分析。结果：共纳入4项随机、对照研究，全部为中文，未检索到关于此题目的其他语种研究报告。4项研究的质量均较低，4项研究Juni评分为C级。所有研究均未对远期效果进行评价。有1项研究未提到随机分组，其他3项研究提到采用随机分组，但未描述具体的随机方法，未进行分配方案的隐藏。所有研究均未使用盲法，也未进行随访。由于缺乏高质量的临床研究，上述Meta分析未进行敏感性分析。结论：胰激肽释放酶可能对糖尿病视网膜病有一定的疗效。由于目前的临床研究质量较低，且未对远期疗效进行评价，胰激肽释放酶对于糖尿病视网膜病变的疗效还需要进行大规模及高质量的随机对照研究加以证实。