A型肉毒毒素预防性治疗偏头痛有效性及安全性的随机对照试验的meta分析

目的评价A型肉毒毒素预防性治疗偏头痛的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed (CBM)、中国知网、万方等数据库中相关随机对照试验(RCT),采用Review manager 5. 3软件对数据进行meta分析。结果共纳入12项RCT,纳入4131例患者。meta分析结果显示,与安慰剂组比较,A型肉毒毒素组在平均每月偏头痛发作频率减少方面无明显差异(MD=-0. 1,95%CI:0. 41-0. 21,P=0. 53)。按偏头痛类型进行亚组分析后结果显示,A型肉毒毒素组在亚组慢性偏头痛组平均每月偏头痛发作频率减少方面优于安慰剂组(MD=-0. 43,95%CI:-0. 70～-0. 17,P=0. 001);而在亚组发作性偏头痛组,A型肉毒毒素组和安慰剂组在每月平均偏头痛发作频率减少方面无明显差异(MD=0. 08,95%CI:-0. 16～0. 33; P=0. 51)。与安慰剂组相比,A型肉毒毒素组平均每月偏头痛天数减少、平均每月急性头痛用药日数减少、生活质量量表评分改善情况等方面均优于安慰剂组(P 0. 05);总不良事件发生率均高于安慰剂组(OR=1. 38,95%CI:1. 20～1. 58; P 0. 00 001),但无严重不良反应发生。结论 A型肉毒毒素能有效地减少慢性偏头痛每月偏头痛发作频率、偏头痛天数和急性头痛用药的时间及改善生活质量,但对发作性偏头痛效果不明显,不良反应可耐受。     

Antidepressants for bipolar disorder——A meta-analysis of randomized,double-blind,controlled trials

OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.     

Meta-analysis of efficacy of topiramate in migraine prophylaxis

OBJECTIVE:To evaluate the treatment effects and safety of topiramate in migraine prophylaxis. DATA RETRIEVAL:We searched the Medline database,EMbase,Cochrane Library and China National Knowledge Infrastructure database for articles published between January 1995 and May 2011,using the key words"migraine","topiramate",and"prophylaxis". SELECTION CRITERIA:We selected randomized controlled trials of migraine patients,in which the experimental group was orally administered topiramate,and the control group was given placebo. Odds ratios(ORs)and mean differences(MDs)were calculated using a fixed effects model/random effects model.Quality evaluation and data extraction were performed independently by two researchers utilizing RevMan 5.0 software. MAIN OUTCOME MEASURES:Efficacy was recorded as the responder rate(response defined as at least a 50%reduction in average monthly migraine frequency)and change in mean monthly number of migraine days.Adverse events were recorded as the number of subjects exhibiting at least one adverse event. RESULTS:Eight randomized controlled trials were found to be appropriate,and had available data. The meta-analysis results revealed that topiramate(100 or 200 mg/d)was more effective than placebo in responder rate(OR=2.97,95%confidence interval(CI):2.17-4.08,P<0.01;OR=2.35, 95%CI:1.77-3.12,P<0.01).Topiramate(100 mg/d)was more effective than placebo in terms of the change in mean monthly migraine days(MD:-1.14,95%CI:-1.69 to-0.59,P<0.01).The total incidence rate of adverse events for topiramate was higher than in the placebo group(P<0.01),but most adverse events were mild to moderate. CONCLUSION:Overall,topiramate obtained good outcomes and safety in migraine prophylaxis.     

A meta-analysis of Chinese herbal medicines for vascular dementia

OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia. DATA RETRIEVAL: We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the"Chinese medicine OR Chinese herbal medicine" and "vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia". SELECTION CRITERIA: Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l’Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers’ Handbook 5.0. MAIN OUTCOME MEASURES: Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions. RESULTS: We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR)=1.27; 95% confidence interval (CI): 1.18-1.38, P<0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD)=2.83; 95%CI: 2.55-3.12, P<0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD=2.41, 95%CI: 1.48-3.34, P<0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR=0.20, 95%CI: 0.08-0.47, P<0.01). CONCLUSION: Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.     

Correlation between X-ray cross-complementing group 1 polymorphisms and the onset risk of glioma A meta-analysis

OBJECTIVE:To evaluate the association of X-ray cross-complementing group 1(XRCC1)Arg399Gln,Arg194Trp and Arg280His polymorphisms with the risk of glioma.DATA SOURCES:A systematic literature search of papers published from January 2000 to August2012 in PubMed,Embase,China National Knowledge Infrastructure database,and Wanfang database was performed.The key words used were"glioma","polymorphism",and"XRCC1 or X-ray repair cross-complementing group 1".References cited in the retrieved articles were screened manually to identify additional eligible studies.STUDY SELECTION:Studies were identified according to the following inclusion criteria:case-control design was based on unrelated individuals;and genotype frequency was available to estimate an odds ratio(OR)and 95%confidence interval(CI).Meta-analysis was performed for the selected studies after strict screening.Dominant and recessive genetic models were used and the relationship between homozygous mutant genotype frequencies and mutant gene frequency and glioma incidence was investigated.We chose the fixed or random effect model according to the heterogeneity to calculate OR and 95%CI,and sensitivity analyses were conducted.Publication bias was examined using the inverted funnel plot and the Egger’s test using Stata 12.0 software.MAIN OUTCOME MEASURES:Association of XRCC1 Arg399Gln,Arg194Trp,and Arg280His polymorphisms with the risk of glioma,and subgroup analyses were performed according to different ethnicities of the subjects.RESULTS:Twelve articles were included in the meta-analysis.Eleven of the articles were concerned with the Arg399Gln polymorphism and glioma onset risk.Significantly increased glioma risks were found only in the dominant model(Gln/Gln+Gln/Arg versus Arg/Arg:OR=1.26,95%CI=1.03-1.54,P=0.02).In the subgroup analysis by ethnicity,significantly increased risk was found in Asian subjects in the recessive(OR=1.46,95%CI=1.04-2.45,P=0.03)and dominant models(OR=1.40,95%CI=1.10-1.78,P=0.007),and homozygote contrast(OR=1.69,95%CI=1.17-2.45,P=0.005),but not in Caucasian subjects.For association of the Arg194Trp(eight studies)and Arg280His(four studies)polymorphisms with glioma risk,the meta-analysis did not reveal a significant effect in the allele contrast,the recessive genetic model,the dominant genetic model,or homozygote contrast.CONCLUSION:The XRCC1 Arg399Gln polymorphism may be a biomarker of glioma susceptibility,especially in Asian populations.The Arg194Trp and Arg280His polymorphisms were not associated with overall glioma risk.     

A central analgesic mechanism of acupuncture for migraine An ongoing functional MRI study

Shaoyang acupoints are the most frequently used in migraine treatment. However, the central anal- gesic mechanism remains poorly understood. Studies have demonstrated that single stimulus of the verum acupuncture in healthy subjects can induce significant connectivity or activity changes in pain- related central networks compared with sham acupuncture. However, these findings are not indicative of the central analgesic mechanism of acupuncture at Shaoyang acupoints. Thus, we recruited 100 migraine sufferers and randomly assigned them into five groups： Shaoyang uncommon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, non-acupoint control, and blank control groups. Subjects were subjected to evaluation of curative effects and functional MRI prior to and after 10 and 20 acupuncture treatments. All subjects were diagnosed by physicians and enrolled following clinical physical examination. Subjects were observed during 1-4 weeks after inclusion. At the fifth week, the first clinical evaluation and resting functional MRI were conducted. The Shaoyang uncom- mon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, and non-acupoint control grousp then were treated with acupuncture, five times per week, 20 times in total over 4 weeks. The second and third clinical evaluations and resting functional MRI screenings were conducted following 10 and 20 acupuncture treatments. The blank control group was observed during the 5 to 8 week pe- riod, followed by clinical evaluation and resting functional MRI. The aim of this study was to examine changes in brain functional activity and central networks in subjects with migraine undergoing acu- puncture at Shaoyang uncommon acupoints. This study provides a further explanation of the central analgesic mechanism by which acupuncture at Shaoyang acupoints treats migraine,     

Paroxetine engenders analgesic effects through inhibition of p38 phosphorylation in a rat migraine model

In this study,a model of migraine was established by electrical stimulation of the superior sagittal sinus in rats.These rats were then treated orally with paroxetine at doses of 2.5,5,or 10 mg/kg per day for 14 days.Following treatment,mechanical withdrawal thresholds were significantly higher,extracellular concentrations of 5-hydroxytryptamine in the periaqueductal grey matter and nucleus reticularis gigantocellularis were higher,and the expression of phosphorylated p38 in the trigeminal nucleus caudalis was lower.Our experimental findings suggest that paroxetine has analgesic effects in a rat migraine model,which are mediated by inhibition of p38 phosphorylation.     

Efficacy and safety of 1,000mg effervescent aspirin: individual patient data meta-analysis of three trials in migraine headache and migraine accompanying symptoms

Migraine is often associated with health consequences including impaired quality of life, and the cost of treating migraine headaches places a significant financial burden on patients who suffer from migraines. Nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans are commonly used for the treatment of acute migraine attacks. Aspirin is widely accepted as a treatment option for migraine pain relief and could provide an alternative not only for treatment of moderate migraine attacks, but also for severe migraine attacks. The efficacy and safety of 1,000 mg effervescent aspirin (eASA) was evaluated in comparison to 50 mg sumatriptan and placebo in an individual patient data meta-analysis of three randomized, placebo-controlled, single- dose migraine trials. Pain-relief at 2 h, pain-free at 2 h and sustained pain-free up to 24 h were calculated. For eASA, the response rates were 51.5 % (95 % CI: 46.6–56.5 %), 27.1 % (95 % CI: 22.6–31.4 %), and 23.5 % (95 % CI: 19.3–27.7 %). For sumatriptan, the response rates were 46.6 % (95% CI: 40.0–53.2 %), 29% (95 % CI: 23.0–34.9 %), and 22.2 % (95 % CI: 16.7–27.6 %). The corresponding rates for placebo were 33.9 % (95% CI: 29.1–38.6 %), 15.1 % (95 % CI: 11.5–18.7 %), and 14.6 % (95 % CI: 11.0–18.1 %). The treatment effect of eASA and sumatriptan were significantly different from placebo (p < 0.001), but differences between eASA and sumatriptan were not significant. The remission of accompanying symptoms and the subgroup analyses of patients with moderate or severe migraine pain at baseline revealed no significant differences between eASA and sumatriptan. Safety was evaluated based on the frequency of reported adverse events, and treatment with eASA was associated with lower incidence of adverse events than was with sumatriptan. This individual patient data meta-analysis provided evidence that eASA 1,000mg is as effective as sumatriptan 50mg for the treatment of acute migraine attacks and has a better side effect profile. This is also true for patients with moderate as well as severe headache at baseline. Patients therefore should be advised to use eASA first for migraine attacks and use a triptan in case of no response.     

重复经颅磁刺激预防慢性偏头痛疗效和安全性的系统评价

目的系统评价重复经颅磁刺激(rTMS)预防慢性偏头痛中的疗效和安全性。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、CBM、CNKI和WanFang Data数据库,搜集rTMS预防慢性偏头痛的随机对照试验(RCT),检索时限是从建库开始至2016年7月,采用RevMan 5.3进行Meta分析。结果纳入3项RCT研究,共有133例患者。Meta分析结果显示:高频rTMS预防治疗1个月后rTMS组偏头痛患者头痛发作频率改善情况(MD=7.55,95%CI:6.88~8.21,P0.00001),偏头痛指数(发作频率×头痛程度)改善情况(MD=23.31,95%CI:21.50~25.12,P0.00001)均优于对照组。低频rTMS刺激在预防慢性偏头痛方面疗效不显著。两项研究显示不良反应主要有易怒、肌震颤、嗜睡等,但这些症状在短时间内都可自行缓解。结论当前证据显示,高频rTMS能有效预防慢性偏头痛,不良反应少。     

Angiotensinogen gene polymorphism and ischemic stroke in East Asians A meta-analysis

OBJECTIVE: To investigate the association between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians. DATA RETRIEVAL: A computer-based online search was conducted in PubMed, Google scholar, China National Knowledge lnfrastructure database between January 1990 and April 2012 for relevant studies. The were angiotensinogen or AGT, polymorphism or genetic and ischemic stroke or cerebral infarction. SELECTION CRITERIA: Case-controlled studies addressing the correlation between angiotensinogen gene M235T polymorphism and ischemic stroke in East Asians were included. The distribution of genotypes in the included studies was tested for Hardy-Weinberg equilibrium. Quality evaluation of the included studies was conducted by two physicians. Statistical analyses were carried out using Stata 12.0 software for meta-analysis. Heterogeneity tests, sensitivity analysis and publication bias were also conducted. MAIN OUTCOME MEASURES: The association between angiotensinogen gene M235T polymorphism and ischemic stroke risk in East Asians was assessed. RESULTS: Six relevant studies involving 891 patients with ischemic stroke and 727 controls were included in this meta-analysis. Results showed that there was a significant association between angiotensinogen gene M235T polymorphism and the risk of ischemic stroke in East Asians (T vs. M: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.10-2.16; TT vs. MM: OR = 2.24, 95%CI = 1.37-3.66; TT vs. MT: OR = 1.76, 95%CI = 1.41-2.20; MM + MT vs. TT: OR = 0.57, 95%CI = 0.46-0.70). Sensitivity analysis confirmed that the study results were stable and reliable, with no publication bias. CONCLUSION: The angiotensinogen gene M235T polymorphism is associated with ischemic stroke in East Asians, and the TT genotype and T allele are risk factors for ischemic stroke.     

Repetitive transcranial magnetic stimulation for hallucination in schizophrenia spectrum disorders A meta-analysis

OBJECTIVE:This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders.DATA SOURCES:Online literature retrieval was conducted using PubMed,ISI Web of Science,EMBASE,Medline and Cochrane Central Register of Controlled Trials databases from January1985 to May 2012.Key words were"transcranial magnetic stimulation","TMS","repetitive transcranial magnetic stimulation",and"hallucination".STUDY SELECTION:Selected studies were randomized controlled trials assessing therapeutic efficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders.Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders.Control groups received sham stimulation.MAIN OUTCOME MEASURES:The primary outcome was total scores of Auditory Hallucinations Rating Scale,Auditory Hallucination Subscale of Psychotic Symptom Rating Scale,Positive and Negative Symptom Scale-Auditory Hallucination item,and Hallucination Change Scale.Secondary outcomes included response rate,global mental state,adverse effects and cognitive function.RESULTS:Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened,with controls receiving sham stimulation.All data were completely effective,involving 398 patients.Overall mean weighted effect size for repetitive transcranial magnetic stimulation versus sham stimulation was statistically significant(MD=–0.42,95%CI:–0.64 to–0.20,P=0.000 2).Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation(OR=2.94,95%CI:1.39 to 6.24,P=0.005).No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms.Compared with sham stimulation,active repetitive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching.CONCLUSION:Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hallucination in schizophrenia spectrum disorders.     

Stem cell transplantation for spinal cord injury:a meta-analysis of treatment effectiveness and safety

OBJECTIVE: The aim of this study was to evaluate the effectiveness and safety of stem cell transplantation for spinal cord injury(SCI).DATA SOURCES: PubM ed, EMBASE, Cochrane, China National Knowledge Infrastructure, China Science and Technology Journal, Wanfang, and Sino Med databases were systematically searched by computer to select clinical randomized controlled trials using stem cell transplantation to treat SCI, published between each database initiation and July 2016. DATA SELECTION: Randomized controlled trials comparing stem cell transplantation with rehabilitation treatment for patients with SCI. Inclusion criteria:(1) Patients with SCI diagnosed according to the American Spinal Injury Association(ASIA) International standards for neurological classification of SCI;(2) patients with SCI who received only stem cell transplantation therapy or stem cell transplantation combined with rehabilitation therapy;(3) one or more of the following outcomes reported: outcomes concerning neurological function including sensory function and locomotor function, activities of daily living, urination functions, and severity of SCI or adverse effects. Studies comprising patients with complications, without full-text, and preclinical animal models were excluded. Quality of the included studies was evaluated using the Cochrane risk of bias assessment tool and Rev Man V5.3 software, provided by the Cochrane Collaboration, was used to perform statistical analysis. OUTCOME MEASURES: ASIA motor score, ASIA light touch score, ASIA pinprick score, ASIA impairment scale grading improvement rate, activities of daily living score, residual urine volume, and adverse events.RESULTS: Ten studies comprising 377 patients were included in the analysis and the overall risk of bias was relatively low level. Four studies did not detail how random sequences were generated, two studies did not clearly state the blinding outcome assessment, two studies lacked blinding outcome assessment, one study lacked follow-up information, and four studies carried out selective reporting. Compared with rehabilitation therapy, stem cell transplantation significantly increased the lower limb light touch score(odds ratio(OR) = 3.43, 95% confidence interval(CI): 0.01 – 6.86, P = 0.05), lower limb pinprick score(OR = 3.93, 95%CI: 0.74 – 7.12, P = 0.02), ASI grading rate(relative risk(RR) = 2.95, 95%CI: 1.64 – 5.29, P = 0.0003), and notably reduced residual urine volume(OR = –8.10, 95%CI: –15.09 to –1.10, P = 0.02). However, stem cell transplantation did not significantly improve motor score(OR = 1.89, 95%CI: –0.25 to 4.03, P = 0.08) or activities of daily living score(OR = 1.12, 95%CI: –1.17 to 4.04, P = 0.45). Furthermore, stem cell transplantation caused a high rate of mild adverse effects(RR = 14.49, 95%CI: 5.34 – 34.08, P 0.00001); however, these were alleviated in a short time. CONCLUSION: Stem cell transplantation was determined to be an efficient and safe treatment for SCI and simultaneously improved sensory and bladder functions. Although associated minor and temporary adverse effects were observed with transplanted stem cells, spinal cord repair and axon remyelination were apparent. More randomized controlled trials with larger sample sizes and longer follow-up times are needed to further validate the effectiveness of stem cell transplantation in the treatment of SCI.     

Xingnao Kaiqiao needling method for acute ischemic stroke: a meta-analysis of safety and efficacy

OBJECTIVE: To evaluate the effectiveness and safety of the Xingnao Kaiqiao needling method for treating acute ischemic stroke.DATA SOURCES: We retrieved relevant randomized controlled trials involving Xingnao Kaiqiao acupuncture for treatment of acute ischemic stroke. The China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and Pub Med were searched from June 2006 to March 2016.DATA SELECTION: We analyzed randomized and semi-randomized clinical controlled trials that compared Xingnao Kaiqiao acupuncture with various control treatments, such as conventional drugs or other acupuncture therapies, for treatment of acute ischemic stroke. The quality of articles was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions(Version 5.1), and the study was carried out using Cochrane system assessment methods. Rev Man 5.2 was used for the meta-analysis of the included studies.OUTCOME MEASURES: The mortality rate, disability rate, activities of daily living(Barthel Index), and clinical efficacy were observed.RESULTS: Twelve studies met the inclusion criteria for this review. The meta-analysis showed that between Xingnao Kaiqiao acupuncture and the control treatment, Xingnao Kaiqiao acupuncture reduced the disability rate [risk ratio(RR) = 0.51, 95% confidence interval(CI) = 0.27–0.98, z = 2.03, P 0.05], elevated the activities of daily living(weighted mean difference = 12.23, 95% CI: 3.66–20.08, z = 2.80, P 0.005), and had greater clinical efficacy(RR = 1.61, 95% CI: 1.23–2.09, z = 3.53, P 0.0004). However, there was no significant difference in mortality rate(RR = 0.61, 95% CI: 0.15–2.45, z = 0.70, P 0.05). CONCLUSION: The Xingnao Kaiqiao needling method is effective and safe for acute ischemic stroke. However, there was selective bias in this study, and the likelihood of measurement bias is high. Thus, more high-quality randomized controlled trials are needed to provide reliable evidence of the efficacy and safety of Xingnao Kaiqiao acupuncture in the treatment of acute ischemic stroke.     

Calcitonin gene-related peptide antagonism for acute treatment of migraine: a meta-analysis

Purpose: Calcitonin gene-related peptide (CGRP) is an effector of acute migraine attack. And the CGRP antagonisms have shown some early promise in the treatment of migraine. Here, we performed a meta-analysis to evaluate the efficacy of CGRP antagonisms in treating acute migraine attack. Methods: Pubmed, Cochrane Library, Web of Science and OvidSP were systematically searched up to 9 April 2015 for randomized controlled trials (RCTs) which is dealing with the efficacy of CGRP antagonisms in treating acute migraine attack. The bias and quality of RCTs were assessed with Cochrane collaboration's tool for assessing risk of bias. Reviewer manager 5.2 was utilized for data analysis. Results: Totally 13 publications matched the inclusion criteria, including 10 independent RCTs and 6803 patients. Pooled analysis indicated that CGRP antagonisms had better outcomes in number of patients with pain free at 2h, 2-24h sustained pain free, phonophobia free at 2h, patients with photophobia free at 2h and nausea free at 2h post-dose, as compared with placebo. But CGRP antagonisms were no superior than 5-HT agonists in the indices above mentioned. Conclusions: CGRP antagonisms may be an effective and promising treatment for acute migraine attack.     

Neurostimulation for the treatment of chronic migraine and cluster headache

Small subsets of patients who fail to respond to pharmacological treatment may benefit from alternative treatment methods. In the last decade, neurostimulation is being explored as a potential treatment option for the patients with chronic, severely disabling refractory primary headaches. To alleviate pain, specific nerves and brain areas have been stimulated, and various methods have been explored: deep brain stimulation, occipital nerve stimulation, and sphenopalatine ganglion stimulation are among the more invasive ones, whereas transcranial magnetic stimulation and supraorbital nerve stimulation are noninvasive. Vagal nerve stimulation can be invasive or noninvasive, though this review included only data for noninvasive VNS. Most of these methods have been tested in small open‐label patient series; recently, more data from randomized, controlled, and blinded studies are available. Although neurostimulation treatments have demonstrated good efficacy in many studies, it still has not been established as a standard treatment in refractory patients. This review analyzes the available evidence regarding efficacy and safety of different neurostimulation modalities for the treatment of chronic migraine and cluster headache.     

Therapeutic effect of regulating autophagy in spinal cord injury: a network meta-analysis of direct and indirect comparisons

Objective:An increasing number of studies indicate that autophagy plays an important role in the pathogenesis of spinal cord injury,and that regulating autophagy can enhance recovery from spinal cord injury.However,the effect of regulating autophagy and whether autophagy is detrimental or beneficial after spinal cord injury remain unclear.Therefore,in this study we evaluated the effects of autophagy regulation on spinal cord injury in rats by direct and indirect comparison,in an effort to provide a basis for further research.Data source:Relevant literature published from inception to February 1,2018 were included by searching Wanfang,CNKI,Web of Science,MEDLINE(OvidSP),PubMed and Google Scholar in English and Chinese.The keywords included"autophagy","spinal cord injury",and"rat".Data selection:The literature included in vivo experimental studies on autophagy regulation in the treatment of spinal cord injury(including intervention pre-and post-spinal cord injury).Meta-analyses were conducted at different time points to compare the therapeutic effects of promoting or inhibiting autophagy,and subgroup analyses were also conducted.Outcome measure:Basso,Beattie,and Bresnahan scores.Results:Of the 622 studies,33 studies of median quality were included in the analyses.Basso,Beattie,and Bresnahan scores were higher at 1 day(MD=1.80,95%CI:0.81-2.79,P=0.0004),3 days(MD=0.92,95%CI:0.72-1.13,P<0.00001),1 week(MD=2.39,95%CI:1.85-2.92,P<0.00001),2 weeks(MD=3.26,95%CI:2.40-4.13,P<0.00001),3 weeks(MD=3.13,95%CI:2.51-3.75,P<0.00001)and 4 weeks(MD=3.18,95%CI:2.43-3.92,P<0.00001)after spinal cord injury with upregulation of autophagy compared with the control group(drug solvent control,such as saline group).Basso,Beattie,and Bresnahan scores were higher at 1 day(MD=6.48,95%CI:5.83-7.13,P<0.00001),2 weeks(MD=2.43,95%CI:0.79-4.07,P=0.004),3 weeks(MD=2.96,95%CI:0.09-5.84,P=0.04)and 4 weeks(MD=4.41,95%CI:1.08-7.75,P=0.01)after spinal cord injury with downregulation of autophagy compared with the control group.Indirect comparison of upregulation and downregulation of autophagy showed no differences in Basso,Beattie,and Bresnahan scores at 1 day(MD=-4.68,95%CI:-5.840 to-3.496,P=0.94644),3 days(MD=-0.28,95%CI:-2.231-1.671,P=0.99448),1 week(MD=1.83,95%CI:0.0076-3.584,P=0.94588),2 weeks(MD=0.81,95%CI:-0.850-2.470,P=0.93055),3 weeks(MD=0.17,95%Cl:-2.771-3.111,P=0.99546)or 4 weeks(MD=-1.23,95%Cl:-4.647-2.187,P=0.98264)compared with the control group.Conclusion:Regulation of autophagy improves neurological function,whether it is upregulated or downregulated.There was no difference between upregulation and downregulation of autophagy in the treatment of spinal cord injury.The variability in results among the studies may be associated with differences in research methods,the lack of clearly defined autophagy characteristics after spinal cord injury,and the limited autophagy monitoring techniques.Thus,methods should be standardized,and the dynamic regulation of autophagy should be examined in future studies.     

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.