Complementary and Alternative Medicines (CAM) in the Management of Asthma: An Examination of the Evidence

Although individuals are using Complementary and Alternative Medical (CAM) therapies to help manage their asthma, there is no clear direction in the current guidelines for the use of CAM in asthma. This literature review undertakes to determine the current science regarding the use of CAM in asthma management. Electronic literature searched all EBM Reviews, Medline, OVID full text, and PubMed and National Complementary and Alternative Medication databases for Randomised Controlled Trials (RCT) published in English between 1997 and 2002 with keywords “asthma” and “complementary medicine” or “complementary therapy” or “alternative medicine” or “alternative therapy.” Abstracts (N = 197) were reviewed for inclusion in the review and duplicates discarded (N = 65). Abstracts of non-RCT studies, review articles, and surveys were also discarded (N = 66). Abstracts discussing environmental control measures and pharmaceutical alternatives to steroid therapy were discarded (N = 9). The 15 final studies were grouped within three categories: mind-body and relaxation, manual therapies, and diet and reviewed for statistical and clinical significance, suggesting some CAM therapies have shown minimally significant improvements in asthma quality of life (breathing exercises) or pulmonary function (relaxation) and immune function (relaxation and acupuncture) in select asthma populations. Although CAM therapy is being used in the management of asthma, these 15 studies show a tendency to little or no significant difference between placebo or sham therapy. This may be due, in part, to the enhanced placebo effect of sham therapies used as control and the small size of most studies. Although the changes in the immune function seen in two studies are provocative, these changes did not translate to changes in lung function. More research is needed to assist in determining the efficacy of CAM therapies in asthma management.     

环丙沙星治疗家兔实验感染鼠疫疗效观察

目的观察环丙沙星治疗实验感染动物鼠疫疗效。方法实验感染鼠疫24h后的新西兰白兔按每日每公斤体重0.04g,2次静脉注射环丙沙星。结果环丙沙星治疗组动物全部治愈,停药后9d处死,鼠疫细菌学培养阴性。结论环丙沙星可用于鼠疫的临床治疗。     

Efficacy of Buspirone in Alcohol Dependence: A Review

The five published controlled studies on the effects of buspirone in alcoholism treatment are reviewed. They have been conducted mostly in alcoholics with comorbid anxiety. Significant differences in favor of the medication were observed in several psychopathological measures (anxiety, depression, hostility, interpersonal sensitivity, and global psychopathology). In only two studies were alcohol craving and consumption found influenced. Metaanalysis showed positive effects of buspirone on treatment retention, as well as on anxiety. It can be concluded that the main effect of buspirone in the treatment of alcoholism is not on ethanol consumption pew se, but on associated psychopathological symptoms. A favorable safety profile and a lack of interaction with alcohol make buspirone a useful pharmacological adjunct in the treatment of alcoholism.     

重视原发性肝癌的多学科综合治疗

我国是原发性肝癌的高发地区,全世界每年新增和死亡的肝癌患者54％左右发生在中国.根据最新公布的2012年《中国肿瘤登记年报》,在我国所有恶性肿瘤中,原发性肝癌的发病率居第四位,而病死率仍高居第二位.肝癌防治任务艰巨,探索适合我国国情、合理规范的肝癌诊治策略具有重要的现实意义.原发性肝癌恶性程度高,起病隐匿,病情进展快,容易复发转移;而且我国肝癌多发生在肝炎、肝硬化基础之上,不仅造成机体的损伤,还降低肝脏的储备功能,严重影响肿瘤的治疗和预后.肝癌的治疗不仅需关注消除肿瘤本身,而且必须同时注重保护患者肝功能、减少肝功能损害.     

Nebulized antibiotic therapy: the evidence

The main indications for nebulized antibiotic use are as maintenance therapy for patients with chronic Pseudomonas aeruginosa infection and in treatment protocols aimed at eradicating early P. aeruginosa infection. Daily nebulized antibiotic therapy has been used extensively in Europe for the last 25 years and recently in North America following the introduction of tobramycin solution for inhalation (TSI). The antibiotic is delivered directly to the site of infection, maximizing its efficacy and reducing its potential for toxicity. The efficacy of nebulized antibiotic therapy has been confirmed by meta-analyses of early studies which usually involved only small numbers of patients, and recently by large scale randomized control trials. These studies have shown that regular aerosolized antibiotic treatment results in improved respiratory function, less hospital admissions and respiratory exacerbations, and a significant reduction in the load of P. aeruginosa respiratory tract infection. Concerns about increasing bacterial resistance do not yet seem to have had any clinical impact. Successful eradication of early P. aeruginosa infection has been reported with nebulized colistin (in combination with oral ciprofloxacin), tobramycin and TSI. No advantage has been shown in studies comparing nebulized and intravenous antibiotics versus intravenous antibiotics alone in the treatment of acute respiratory exacerbations. Inhalation of antibiotics may provoke bronchospasm and patients should be assessed before and after treatment prior to continuing long-term therapy at home.     

晚期肝癌中西医综合个体化治疗研究

目的探索中西医综合个体化治疗晚期肝癌的临床疗效.方法根据每位病人的具体情况,用介入治疗、抗癌中药等"攻邪",用中医药辨证施治汤剂、药膳等"扶正".结果完全缓解(CR)、部分缓解(PR)、稳定(SD)和恶化(DP)分别为7.50%、35.00%、40.00%和17.50%,生存时间为20.83±16.42个月,1、3、5年生存率分别为63.75%、31.82%和22.22%.结论中西医综合个体化治疗晚期肝癌可取得较好的临床效果,显著延长病人的生命.     

Update on fibromyalgia therapy

Primary fibromyalgia, a poorly-understood chronic pain syndrome, is characterized by widespread musculoskeletal pain, nonrestorative sleep, fatigue, psychological distress, and specific regions of localized tenderness, all in the absence of otherwise apparent organic disease. While the etiology of fibromyalgia is unclear, accumulating data suggest that disordered central pain processing likely plays a role in the pathogenesis of symptoms. Although various pharmacological treatments have been studied and espoused for treating fibromyalgia, no single drug or group of drugs has proved to be particularly useful in treating fibromyalgia patients as a whole, and only one drug to date has earned U.S. Food and Drug Administration approval for treating the syndrome in the United States. This review critically and systematically evaluates clinical investigations of medicinal and nonmedicinal treatments for fibromyalgia dating from 1970 to 2007.     

Effectiveness of naltrexone in a community treatment program

OBJECTIVE: In several large, well-designed, randomized, double-blind studies, the opiate antagonist naltrexone demonstrated efficacy in the treatment of alcohol dependence. Specifically, when combined with certain psychosocial therapies, naltrexone reduces the number of drinking days, heavy drinking, and time to relapse to alcohol use in alcohol-dependent individuals. Whether this efficacy can be generalized to individuals who have alcohol use disorders and present for treatment at front-line community treatment programs has not been well established. METHODS: A total of 145 patients who presented for treatment at a rural community substance abuse treatment center were randomized to receive naltrexone 50 mg daily plus usual program treatment (n = 54), placebo plus usual treatment (n = 43), or usual treatment alone (n = 48) for 12 week. A total of 133 participants had at least one follow-up visit. Primary outcome measures included percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days (four or more for women and six or more for men), and time to first heavy drinking day. Secondary measures included changes in serum biological markers (alkaline phosphatase, alanine transaminase, aspartate transaminase, and gamma-glutamyltransferase), craving, and psychosocial functioning. RESULTS: In the intention-to-treat analysis, there were no between-group differences for any of the primary drinking outcomes at 12 weeks. In post hoc exploratory analyses, the entire sample of participants was divided into two new groups: (1) people who drank during the 2 weeks before the start of medication (entry drinkers) and (2) people who did not drink during this interval (entry abstainers). Entry abstainers were at an advantage at study entry in that they were significantly more likely to have an inpatient hospitalization immediately before entry into outpatient treatment. Mixed-model analysis of variance revealed a main effect for entry group at the 12-week treatment endpoint on the primary outcome measures of percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days, and time to first heavy drinking day. Participants in any of the randomized groups who were entry abstainers had significantly better improvement on all of the primary outcome measures. The abstainer groups that were randomized to placebo and usual treatment had significantly better outcomes than the entry drinkers in those perspective groups. However, for the naltrexone-treated group, entry drinkers and entry abstainers had similar improvement in drinking-related outcomes. CONCLUSIONS: These data suggest that naltrexone may offer particular benefit to patients who continue to drink during the early stages of the trial as compared with those who have achieved abstinence before treatment entry.     

Evaluating the Effectiveness of Epoetin Alfa in Community Oncology Practices

Purpose: This retrospective case-series review studied the effectiveness of epoetin alfa in community oncology practices, which until now has not been well documented.

Methods: We reviewed the medical records of 118 cancer patients treated between 1999 and 2001 with cyclic chemotherapy plus epoetin alfa in 27 US community-based oncology practices. Two analysis sets were examined: one including all patients (n=118) and one including only those patients with no concurrent events impacting hemoglobin data interpretation (n=73). Efficacy of epoetin alfa was evaluated by hemoglobin response (a≥2 g/dl increase in hemoglobin from baseline) at weeks 12 and 16, the time to hemoglobin response, and change in hemoglobin concentrations from baseline at specific time points.

Results: After 12 weeks of treatment, 43% (95% confidence interval [CI], 33-54%) of patients had a hemoglobin response, and the proportion of responders further rose to 61% (95% CI, 49-72%) after 16 weeks. The median time to response was 92 days (lower 95% confidence limit, 74 days; upper bound not estimable). Hemoglobin increased from baseline at all time points evaluated during epoetin alfa treatment, with a mean increase of 1.1 g/dl (95% CI, 0.77-1.4 g/dl) by the last observation.

Conclusion: These results indicate that epoetin alfa is effective in community practice, but most patients take longer than 3 months to respond. Because slow responses may negatively impact on the quality of life in these patients, alternative treatment approaches providing faster and perhaps better responses may provide greater clinical benefit.     

抗病毒是慢性乙肝治疗的首要措施

慢性乙型肝炎是我国感染人数最多、危害最大的 传染病,其危害主要在于大约20一40%的病人经过多 年的肝脏炎症损伤后可发展为肝硬化和肝癌,使病人 的生活质量明显下降,寿命缩短。遗憾的是迄今为止, 仍然没有特效药物一可以彻底治愈慢性乙型肝炎。因此 目前对于慢     

Studies of the efficacy and safety of methotrexate at dosages over 8 mg/week using the IORRA cohort database

Abstract

The maximum dosage of methotrexate (MTX) for treatment of rheumatoid arthritis (RA) formally approved in Japan is 8 mg/week. We intended to examine the efficacy and safety of MTX at dosages over 8 mg/week in Japanese rheumatoid arthritis patients using the large Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort database. Among 9,122 patients registered in the IORRA database from the October 2000 survey to the October 2007 survey, 5,201 patients who had been treated with MTX were selected. We attempted to overcome the drawbacks innate to nonrandomized studies by using longitudinal analyses and multifactorial logistic regression analyses. Cross-sectional analysis of data obtained from the October 2007 survey indicated that dosages of MTX higher than 8 mg/week were used in 27.5% of patients treated with MTX. Longitudinal analyses based on data from three consecutive phases showed that final Disease Activity Score-28 (DAS28) values were significantly lower [n = 260, mean difference 0.563, 95% confidence interval (CI) 0.438–0.688, P < 2.2 × 10^?22, two-sided paired t test] than initial values when MTX was increased from 8 mg/week or lower to over 8 mg/week. In addition, longitudinal analyses based on data from two consecutive phases indicated decreases in DAS28 values of 0.26 ± 1.04 (n = 690, P = 6.78 × 10^?11, two-sided paired t test) when MTX dosages were increased from 8 mg/week or lower to over 8 mg/week, compared with decreases of 0.07 ± 0.89 (n = 2,125, P = 0.000307) when the dosage was maintained at 8 mg/week. The decreases in DAS28 values were significantly larger in the former than the latter (P = 2.27 × 10^?6, two-sided unpaired t test). Concerning safety of MTX at dosages over 8 mg/week, we performed logistic regression analysis in which the objective variable was the existence or nonexistence of self-reported side-effects and the explanatory variable was the MTX dosage in the former phase, with adjustments made for age, sex, body mass index (BMI), steroid administration, folic acid administration, concomitant pulmonary diseases, and renal dysfunction. The results indicated that MTX dosages over 8 mg/week did not have any association with either severe or severe + moderate side-effects. These data regarding both efficacy and safety of MTX at dosages over 8 mg/week in Japanese RA patients would provide the basis for use of the drug at dosages currently not formally approved by the Japanese government.     

Effectiveness and safety of combined antiplatelet and anticoagulant therapy: a critical review of the evidence from randomized controlled trials

Antiplatelet and anticoagulant drugs are effective for the prevention of arterial and venous thrombosis but patients continue to experience major cardiovascular events despite their use. Strategies to improve the effectiveness of antithrombotic therapies include selecting the optimal drug and dosing regimen, the use of combinations of antiplatelet and anticoagulant drugs and the development of new more effective drugs to replace existing therapies. Evidence from randomized controlled trials indicates that the combination of aspirin and an anticoagulant is more effective than aspirin alone for the prevention of recurrent cardiovascular events in patients with acute coronary syndrome and is more effective than anticoagulation alone for the prevention of thromboembolic events in patients with mechanical heart valves, but at a cost of increased bleeding. Randomized controlled trials provide no evidence for improved effectiveness of combination therapy compared with antiplatelet therapy alone for the prevention of recurrent cardiovascular events in patients with non-cardioembolic stroke or peripheral artery disease, or compared with anticoagulant therapy alone for the prevention of stroke in patients with atrial fibrillation. Despite lack of evaluation in randomized controlled trials, combination therapy is commonly used in patients with separate indications for antiplatelet therapy (e.g., acute coronary syndrome, recent coronary artery stent) and anticoagulant therapy (e.g., atrial fibrillation with at least one additional risk factor for stroke). Randomized trials are urgently required to evaluate the effectiveness and safety of combining antiplatelet and anticoagulant therapy in these settings.     

A double-blind, placebo-controlled study of olanzapine in the treatment of alcohol-dependence disorder

BACKGROUND: A 12-week, double-blind, randomized, parallel-group clinical trial, comparing olanzapine and placebo treatment together with cognitive-behavioral psychotherapy, was carried out to determine the efficacy, safety, and tolerability of olanzapine in the treatment of alcoholism. METHODS: A total of 60 alcohol-dependent patients were assigned to 12 weeks' treatment with either olanzapine or placebo. The primary variable relapse to heavy drinking rate was evaluated by means of intention-to-treat analyses. Alcohol consumption, craving, adverse events, and changes in the biochemical markers of heavy drinking and possible toxicity were also evaluated. RESULTS: We did not find significant differences in the survival analysis between placebo and olanzapine-treated patients (Kaplan-Meier log rank = 0.46, df = 1, p = 0.50). Eleven (37.9%) patients treated with olanzapine relapsed compared with 9 (29%) of those receiving placebo (chi = 0.53, df = 1, p = 0.5). Although some adverse events (weight gain, increased appetite, drowsiness, constipation, and dry mouth) were found more frequently in the olanzapine group, differences did not reach statistical significance in comparison with the placebo group. CONCLUSIONS: Olanzapine was well tolerated, as the rate of adverse events was low, and it was safe, because it did not interfere with the normalization of biochemical markers of heavy drinking or alter liver function markers. Alcohol-dependent patients showed good adherence and compliance with the treatment protocol, but we found no differences in relapse rate or other drinking variables when comparing olanzapine with placebo-treated patients.     

Beyond Efficacy and Effectiveness: Conducting Economic Analyses During Clinical Trials

Few studies have examined cost issues in the field of dysphagia. This study presents cost data collected during a clinical trial in speech–language pathology, demonstrating the types of cost analyses that can be conducted and highlighting obstacles and issues facing investigators who seek to conduct economic analyses in this arena. Seventy-nine patients were enrolled in the clinical trial to assess the impact of a swallowing intervention on swallowing and speech function. The patients were at least one year past treatment for head and neck cancer. No significant intervention differences were detected in these outcomes. A companion economic analysis was conducted in 37 of these patients using patient diaries and followup with identified health care providers. Analyses indicated that (1) the intervention did not significantly reduce health care expenditures; (2) indirect costs and costs of hospitalizations are both important factors to consider during a trial; and (3) health care costs of this population are high relative to the rest of the U.S. population. Attrition from the overall study population can pose a serious threat to the viability of an economic study. The article concludes with a discussion of how these issues can be addressed in future studies.This research was supported by NIH/NCI P01 CA40007 and NIDCD U01 DC03206.     

心脏再同步化治疗的认识和存在问题

心脏再同步化治疗(cardiac resynchronization therapy,CRT)是有效治疗心力衰竭的非药物措施。CRT主要适应证为NYHA分级Ⅱ～Ⅳ级、窦性心律和完全性左束支传导阻滞患者,也适用于部分非左束支传导患者。尽管CRT在多数患者中可明显改善患者预后,但在部分患者中效果不佳,表现为CRT无反应者。如何减少CRT无反应者比例是CRT临床应用中的重要问题。该文对CRT治疗心力衰竭机制、目前主要临床研究结果和CRT无反应的可能原因及解决方案作一综述。