Acupuncture treatment in gastrointestinal diseases： A systematic review

The purpose of this work was to assess the evidence for effectiveness of acupuncture （AC） treatment in gastrointestinal diseases. A systematic review of the Medline-cited literature for clinical trials was performed up to May 2006. Controlled trials assessing acupuncture point stimulation for patients with gastrointestinal diseases were considered for inclusion. The search identified 18 relevant trials meeting the inclusion criteria. Two irritable bowel syndrome （IBS） trials, 1 Crohn＇s disease and 1 colitis ulcerosa trial had a robust random controlled trial （RCT） design. In regard to other gastrointestinal disorders, study quality was poor. In all trials, quality of life （QoL） improved significantly independently from the kind of acupuncture, real or sham. Real AC was significantly superior to sham acupuncture with regard to disease activity scores in the Crohn and Colitis trials. Efficacy of acupuncture related to QoL in IBS may be explained by unspecific effects. This is the same for QoL in inflammatory bowel diseases （IBD）, whereas specific acupuncture effects may be found in clinical scores. Further trials for IBDs and in particular for all other gastrointestinal disorders would be necessary to evaluate the efficacy of acupuncture treatment. However, it must be discussed on what terms patients benefit when this harmless and obviously powerful therapy with regard to QoL is demystified by further placebo controlled trials.     

Metalloproteases and inhibitors in arthritic diseases

Controlling degradation of the extracellular matrix is crucial in arthritic diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA), as conventional treatments do not positively affect the structural properties of the articular tissues. Metalloproteases, a family of zinc-dependent enzymes, and more specifically the matrix metalloproteases (MMPs), play a premier role in joint articular tissue degeneration. Additional enzymes of the metalloprotease family, such as the membrane-type metalloproteases (MT-MMPs) and the adamalysins that include the ADAMs and the ADAMTS families, have also been found to be involved in these disease processes. At present, therapeutic intervention based on the inhibition of metalloproteases, and more particularly of the MMPs, is under intensive investigation, and several MMP inhibitors are in clinical development. Currently, MMP inhibitors are exemplified by several chemical classes: hydroxamic acids, carboxylic acids and thiols. One key issue in the clinical development of MMP inhibitors relates to whether broad-spectrum inhibitors active against a range of different enzymes or selective inhibitors targeted against a single enzyme or particular subset of the MMPs represents the optimal strategy. In this chapter, we address the different metalloprotease enzymes and sub-families and their implication in arthritic diseases. Furthermore, we assess physiological and chemical metalloprotease inhibitors, and for the latter, the current inhibitory classes of compounds being studied.     

A behavioral-chromosome relationship in the elderly: a critical review of a biobehavioral hypothesis.

The evidence for the hypothesis that an increased frequency of hypodiploid cells is related to mental status in older persons, as well as the underlying assumptions crucial to the hypothesis, are reviewed. Results of chromosome examinations reported by several independent laboratories favor an increasing proportion of hypodiploid cells in older age groups as well as sex differences in the level and distribution of missing chromosomes. However, the presence, extent, and development course of chromosome loss associated with major modifying variables and their interactions, e.g., age, morbidity, sex, environmental conditions, remain to be empirically documented. Furthermore, the meaning of chromosome loss, including its relationship to mental status, is not clear.     

Clinical review 138: Anabolic-androgenic steroid therapy in the treatment of chronic diseases.

The purpose of this study was to review the preclinical and clinical literature relevant to the efficacy and safety of anabolic androgen steroid therapy for palliative treatment of severe weight loss associated with chronic diseases. Data sources were published literature identified from the Medline database from January 1966 to December 2000, bibliographic references, and textbooks. Reports from preclinical and clinical trials were selected. Study designs and results were extracted from trial reports. Statistical evaluation or meta-analysis of combined results was not attempted. Androgenic anabolic steroids (AAS) are widely prescribed for the treatment of male hypogonadism; however, they may play a significant role in the treatment of other conditions as well, such as cachexia associated with human immunodeficiency virus, cancer, burns, renal and hepatic failure, and anemia associated with leukemia or kidney failure. A review of the anabolic effects of androgens and their efficacy in the treatment of these conditions is provided. In addition, the numerous and sometimes serious side effects that have been known to occur with androgen use are reviewed. Although the threat of various side effects is present, AAS therapy appears to have a favorable anabolic effect on patients with chronic diseases and muscle catabolism. We recommend that AAS can be used for the treatment of patients with acquired immunodeficiency syndrome wasting and in severely catabolic patients with severe burns. Preliminary data in renal failure-associated wasting are also positive. Advantages and disadvantages should be weighed carefully when comparing AAS therapy to other weight-gaining measures. Although a conservative approach to the use of AAS in patients with chronic diseases is still recommended, the utility of AAS therapy in the attenuation of severe weight loss associated with disease states such as cancer, postoperative recovery, and wasting due to pulmonary and hepatic disease should be more thoroughly investigated.     

Smoking-related interstitial lung diseases: a concise review.

Interstitial lung diseases (also known as diffuse infiltrative lung diseases) are a heterogeneous group of parenchymal lung disorders of known or unknown cause. These disorders are usually associated with dyspnoea, diffuse lung infiltrates, and impaired gas exchange. The majority of interstitial lung diseases are of unknown cause. Known causes of interstitial lung disease include inhalation of organic and inorganic dusts as well as gases or fumes, drugs, radiation, and infections. This review summarizes the clinical, radiological, and histopathological features of four interstitial lung disorders that have been linked to smoking. These disorders include desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, pulmonary Langerhans' cell histiocytosis, and idiopathic pulmonary fibrosis. Available evidence suggests most cases of desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, and pulmonary Langerhans' cell histiocytosis are caused by cigarette smoking in susceptible individuals. Smoking cessation should be a main component in the initial therapeutic approach to smokers with these interstitial lung diseases. In addition, smoking appears to be a risk factor for the development of idiopathic pulmonary fibrosis.     

寄生虫感染与“卫生假说”关系研究进展

近年来,许多发达国家感染性疾病发病率不断下降,但自身免疫性疾病和过敏性哮喘发病率呈逐年上升趋势。"卫生假说"的提出为基于寄生虫感染治疗自身免疫性疾病和过敏性哮喘提供了新思路。大量流行病学和动物实验数据均显示,寄生虫感染能有效抑制糖尿病、多发性硬化症、炎症性肠病、类风湿性关节炎、过敏性哮喘等疾病发生。寄生虫感染和"卫生假说"间存在复杂的潜在机制,其中调节性T(Treg)细胞和Th17细胞的各自作用和相互调节逐渐成为研究热点。本文阐述了寄生虫感染与"卫生假说"关系研究进展,并简要概述Treg细胞和Th17细胞在其中的作用。     

On case-fatality rate: review and hypothesis

The relationship between log cumulative number of patients (X) and that of deaths (Y) in an epidemic follows the equation logY = klogX - klogN(0), where k is a constant determining the slope and N(0) is the value of X when Y = 1. Diseases with k = 1 are Ebola hemorrhagic fever, avian influenza H5N1, cholera, and hand, foot, and mouth disease; those with k > 1 are the influenza H1N1 2009 pandemic in countries other than Mexico and the SARS epidemic in some countries; and those with k < 1 include the influenza H1N1 2009 pandemic in Mexico. Epidemics with k > 1 can be simulated by postulating two subpopulations (normal population [NP] and vulnerable population [VP]), where the epidemic proceeds at higher speed and at higher mortality in VP than in NP. Epidemics with k < 1 can be simulated by postulating coexisting high virulence virus (HVV) and low virulence virus (LVV), with the former being propagated at slower speed and with a higher mortality rate than the latter. An epidemic with k > 1 was simulated using parameters that are fractions of subpopulations NP or VP from the total population (f) and NP- or VP-specific patient multiplication (M) and mortality (D) rates. An epidemic with k < 1 was simulated using parameters that are fractions of HVV- or LVV-infected human populations (f), and HVV- or LVV-specific M and D.     

Hyperthyroidism and atrioventricular block. Pathogenic hypothesis. Apropos of a case and review of the literature

The authors report the case of a 26-year old male patient who had Graves' disease with a first degree atrioventricular block (AVB) and intermittent episodes of a second degree AVB of the Lucciani-Wenckebach type. These disorders of conduction had features characteristic of a nodal block and disappeared after treatment of the hyperthyroidism. The pathogenesis of atrioventricular conduction disorders in hyperthyroidism remains controverted. The authors put forward the following hypothesis: under the influence of thyroid hormones in excessive amounts, the autonomic nervous system would act by reciprocal excitation and exacerbate a patent or latent hypervagotonia which was pre-existent to the hyperthyroidism. This hypothesis needs to be tested by intracardiac electrophysiological studies with atrial stimulation.     

Evaluation of costs in rheumatic diseases: a literature review.

The aim of our review was to examine recently published cost-evaluations presenting originally developed data in rheumatic conditions. We identified 21 articles: 9 presenting original data on rheumatoid arthritis and/or osteoarthritis; 7 focusing on other musculoskeletal conditions such as back pain, scleroderma, Lyme disease, and fibromyalgia; and 5 assessing costs in total knee and hip arthroplasty. Most of the studies originated in the United States. In contrast to earlier reviews in this journal, fewer studies focused on only pharmacoeconomic aspects. In reviewing these studies, we found a lack of standardization in cost-assessment leading to a limited comparability of study results. As main tasks to improve the evidence achieved by performing cost-evaluations in clinical settings, we identified a standardization of main cost-components that should be covered by each clinical trial and the assessment of validity, reliability, and comparability of different data sources used to collect cost-data.     

Biomass fuels and respiratory diseases: a review of the evidence

Globally, about 50% of all households and 90% of rural households use solid fuels (coal and biomass) as the main domestic source of energy, thus exposing approximately 50% of the world population-close to 3 billion people-to the harmful effects of these combustion products. There is strong evidence that acute respiratory infections in children and chronic obstructive pulmonary disease in women are associated with indoor biomass smoke. Lung cancer in women has been clearly associated with household coal use. Other conditions such as chronic obstructive pulmonary disease in men and tuberculosis could be also associated but evidence is scarce. According to estimates of the World Health Organization, more than 1.6 million deaths and over 38.5 million disability-adjusted life-years can be attributable to indoor smoke from solid fuels affecting mainly children and women. Interventions to suppress or reduce indoor exposure include behavior changes, improvements of household ventilation, improvements of stoves, and, outstandingly, transitions to better and cleaner fuels. These changes face personal and local beliefs and economic and sociocultural conditions. In addition, selection of fuels should consider cost, sustainability, and protection of the environment. Consequently, complex solutions need to be locally adapted, and involve the commitment and active participation of governments, scientific societies, nongovernmental organizations, and the general community.     

Hygiene hypothesis in inflammatory bowel disease： A critical review of the literature

The hygiene hypothesis is thought to be a significant contributor to the growing incidence of inflammatory bowel disease （IBD） around the world, although the evidence for specific factors that underlie the hygiene hypothesis in IBD is unclear. We aimed to systematically review the literature to determine which hygiene-related factors are associated with the development of IBD. Publications identified from a broad based MEDLINE and Current Contents search between 1966 and 2007 on key terms relevant to the ＇hygiene hypothesis＇ and IBD including H pylori exposure, helminths, cold chain hypothesis, measles infection and vaccination, antibiotic use, breastfeeding, family size, sibship, urban upbringing, day care attendance and domestic hygiene were reviewed. The literature suggests that the hygiene hypothesis and its association with decreased microbial exposure in childhood probably plays an important role in the development of IBD, although the strength of the supporting data for each of the factors varies considerably. The most promising factors that may potentially be associated with development of IBD include H pylori exposure, helminths, breastfeeding and sibship. However, the vast majority of studies in this area are plagued by serious methodological shortcomings, particularly the reliance on retrospective recall of information making it difficult to truly ascertain the importance of a ＇hygiene hypothesis＇ in IBD. The ＇hygiene hypothesis＇ in IBD is an important area of research that may give clues to the aetiology of this disease. Directions for future research are recommended.     

Proarrhythmia as a pharmacogenomic entity: a critical review and formulation of a unifying hypothesis

Proarrhythmia represents an extreme example of the phenomenon that drug effects vary widely among individuals. Studies of mechanisms leading to proarrhythmia have had important implications for understanding arrhythmogenesis, rational use of antiarrhythmic therapies, selection of patients for specific therapies, and drug development. In addition, because proarrhythmia often seems to develop in the absence of clear risk predictors, a role for genetics in predisposing to this adverse drug reaction has been postulated. This review presents mechanisms whereby genetic factors may contribute to variable drug responses and describes our current understanding of how these mechanisms play a role in proarrhythmia. A unifying hypothesis is presented: physiologic processes (such as drug elimination or cardiac repolarization) include multiple redundancies, and congenital or acquired absence of such redundancies--due to disease, interacting drugs, or genetic makeup--may confer no baseline phenotype, but nevertheless enhance susceptibility to unusual drug responses.