卒中急性期常压氧治疗有效性和安全性的系统评价

目的 系统评价卒中急性期常压氧治疗的有效性和安全性。方法 计算机检索CNKI、万 方、维普、CBM、Medline、EMBASE、Cochrane Library 等中英文数据库，全面收集卒中急性期常压氧治疗 的随机对照试验（RCT），检索时限均为建库至2018 年5 月1 日。采用改良Jadad 量表，由两位研究者共同 评价所纳入研究的质量，并采用RevMan 5.3 软件进行Meta 分析。结果 共有4 项研究符合纳入标准， 纳入了8 905 例卒中患者（试验组5 808 例，对照组3 097 例）。荟萃分析表明，急性卒中的常压氧治疗与 良好功能预后（mRS 评分：0～2 分）无关（RR=0.98，95%CI=0.94～1.03，P=0.46）。安全性方面，急性卒中 的常压氧治疗与死亡风险无关（RR=1.03，95%CI=0.91～1.16，P=0.67）。结论 卒中急性期常压氧治疗未明 显改善卒中长期预后，包括缺血性和出血性卒中。然而，卒中急性期氧气治疗的潜在益处不能被排除。     

促红细胞生成素治疗急性颅脑损伤疗效的meta分析

目的 系统评价促红细胞生成素（EPO）治疗急性颅脑损伤的有效性和安全性。方法 计算机检索The Cochrane Library、Clinical Trials、Web of Science、PubMed、EMbase、中国生物医学文献数据库、中国知网数据库和万方数据库，检索年限均从建库至2018年5月。搜集EPO治疗急性颅脑损伤的临床随机对照试验，试验组采用EPO治疗，对照组采用安慰剂或空白对照。采用RevMan 5.3软件进行meta分析。结果 纳入7项临床随机对照研究，共计1 101例，试验组564例，对照组537例。meta分析显示:EPO显著降低病死率（RR=0.69；95% CI 0.51~0.94；P=0.02），不能改善神经功能（RR=1.28；95%CI 0.90~1.81；P=0.17），不增加深静脉血栓形成发生率（RR=1.00；95% CI=0.74~1.35；P=0.99）。结论 EPO治疗急性颅脑损伤可以降低死亡率，无明显严重的不良反应，但不能改善神经功能。     

机械预防对卒中患者静脉血栓栓塞预防效果的meta分析

目的 评价机械预防对卒中患者静脉血栓栓塞（venous thromboembolism,VTE）的预防效果。 方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、中国知网、万方数据知 识服务平台、中国生物医学文献数据库有关机械预防（间歇充气加压泵、弹力袜）联合常规预防对卒 中患者VTE预防的随机对照研究,检索时间为各数据库建库至2021年2月。根据Cochrane风险偏倚评 估工具对纳入文献进行质量评价。使用RevMan 5.3进行meta分析,并采用推荐、评估、发展和评价等 级（grades of recommendation,assessment,development,and evaluation,GRADE）系统对VTE、深静脉血栓 （deep venous thrombosis,DVT）、肺栓塞（pulmonary embolism,PE）的发生率和入组30 d死亡率的meta分 析结果进行证据分级。 结果 共纳入8篇随机对照研究,5999例患者。meta分析结果显示,机械预防联合常规预防可降低 卒中患者VTE的发生率（RR 0.73,95%CI 0.55～0.98,P =0.03）;间歇充气加压泵联合常规预防在DVT 的发生率上预防效果优于单纯常规预防（RR 0.53,95%CI 0.31～0.93,P =0.03）,弹力袜对DVT的预防 效果不明显;机械预防联合常规预防对卒中患者入组30 d死亡率和PE的发生率改善不明显。GRADE 评分显示,机械预防对VTE和间歇充气加压泵对DVT发生率的证据级别为低级,机械预防对PE发生 率、机械预防对入组30 d死亡率、弹力袜对DVT的证据级别为中等。 结论 机械预防联合常规预防能降低卒中患者VTE发生率,但不能降低患者的PE发生率和入组 30 d死亡率。     

PLAN评分预测中国缺血性卒中相关性肺炎

目的 探讨院前合并症、意识水平、年龄、神经功能缺损（preadmission c omorbidities,l evel o f consciousness,age,and focal neurologic deficit,PLAN）评分对中国缺血性卒中相关性肺炎发生风险的 预测能力。 方法 从中国国家卒中登记研究（China National Stroke Registry,CNSR）中筛选符合入组条件的缺血 性卒中患者,采集临床信息并应用PLAN评分法对其评分,分析PLAN评分对缺血性卒中相关性肺炎的 预测能力。应用受试者工作特征曲线（receiver operating characteristic curve,ROC）及曲线下面积（area under curve,AUC）评价PLAN评分的辨别能力,应用Hosmer-Lemeshow法评价其校准能力。 结果 共纳入8909例缺血性卒中患者,平均年龄（65.4±12.3）岁,女性3410例（38.3%）,合并肺炎 患者共1069例（12.0%）。随着PLAN评分增高,卒中相关性肺炎的发生风险也逐渐增高。PLAN评分预 测缺血性卒中相关性肺炎的ROC曲线下面积为0.78[95%可信区间（confidence interval,CI）0.77～0.80], Hosmer-Lemeshow检验显示预测卒中后肺炎的显著性水平为0.001（P =0.001）。在男性中,ROC曲线下面 积为0.79（95%CI 0.77～0.81）,在女性中,ROC曲线下面积为0.77（95%CI 0.75～0.80）;在70岁以下缺 血性卒中患者中,ROC曲线下面积为0.77（95%CI 0.75～0.80）,在70岁及以上患者中,ROC曲线下面积为 0.73（95%CI 0.71～0.75）。     

脑白质疏松与卒中复发相关性的meta分析

目的系统评价脑白质疏松在卒中复发风险预测中的价值。方法计算机检索Pub Med、Web of science、Embase及维普、中国生物医学文献数据库、中国知网等数据库截止2019年3月15日收录的关于脑白质疏松及卒中复发关系的文献。提取资料进行质量评价并进行meta分析,利用Begg’s漏斗图和Egger’s检验评估发表偏倚。结果最终纳入33篇文献,共34444例。meta分析显示,当结局指标为任何类型复发性卒中时,中重度组与轻度或无组比较(RR=1. 71,95%CI:1. 44～2. 04),I~2=55. 69%;有脑白质疏松组与无脑白质疏松组比较(RR=1. 79,95%CI:1. 43～2. 25),I~2=56. 26%;连续性分析组(RR=1. 81,95%CI:1. 47～2. 23),I~2=34. 63%。当结局指标为缺血性卒中时,中重度组与轻度或无脑白质疏松组比较(RR=1. 82,95%CI:1. 36～2. 42),I~2=48. 43%;有脑白质疏松组与无脑白质疏松组比较(RR=2. 13,95%CI:1. 37～3. 32),I~2=70. 64%;连续性分析组(RR=2. 01,95%CI:1. 13～3. 58),I~2=69. 78%。亚组分析结果显示脑白质疏松对于远期复发性卒中的预测价值更高。通过Begg’s漏斗图和Egger’s检验,仅当结局指标为任何类型复发性卒中时,中重度组与轻度或无脑白质疏松组比较有显著性发表偏倚,经剪补法校正后仍提示相关性。结论脑白质疏松对于复发性卒中具有预测价值。     

缺血性进展性脑卒中的危险因素：来自19篇队例研究和10篇病例对照研究的系统评价

目的 为认识和了解进展性缺血性脑卒中可干预的危险因素,以利于预防其发生和判断预后,我们对进展性脑卒中危险因素的相关文献进行系统评价,为进展性脑卒中的诊断和治疗提供理论依据。 方法 检索Medline(1966-2007)数据库,中国生物医学数据库(CBM-disc 1979 - 2007),中国期刊全文数据库(www.cnki.net 1979 - 2007),再从选中文献的参考文献目录里筛选相关文献,纳入符合设定标准的队列研究和病例对照研究进行系统评价。 结果 从检索到的781篇中英文文献中纳入符合标准的文献29篇,其中队列研究19篇,病例对照研究10篇,对文献中有关进展性缺血卒危险因素的原始数据进行Meta分析,与进展性卒中显著相关的因素有：①发热：（RR 2.26, 95% CI 1.20, 4.26;OR 2.85,95% CI 1.64,4.98);②糖尿病史：（RR 1.38, 95% CI 1.18, 1.61; OR 2.48, 95% CI 1.93, 3.19）;③冠心病史：（RR 1.22, 95% CI 1.08, 1.38）;④早期影像改变：（RR 1.55, 95% CI 1.34, 1.80;OR 2.29, 95% CI 1.47, 3.58）;⑤高血糖：（RR 2.62, 95% CI 1.86, 3.68;OR 3.49, 95% CI 1.92, 6.35）;相对危险因素：①头痛病史：（RR 7.95, 95% CI 4.53,13.95; OR 2.81, 95% CI 1.10, 7.18）;②高纤维蛋白原（RR 1.20, 95% CI 1.02, 1.41）;无相关性因素：血清铁蛋白（RR 0.93, 95% CI0.33, 2.64）。其他因素因缺乏符合要求的资料没能进行meta分析。 结论 通过系统评价,我们认为发热、糖尿病史、冠心病史、早期影像改变、高血糖是进展性缺血性脑卒中重要的危险因素,而头痛病史、高纤维蛋白原与其发生的相关性不强,血清铁蛋白无明显相关性。及时干预上述危险因素能有效的预防进展性卒中的发生。今后的此类研究应尽可能采用统一的、实用性强的诊断标准,并对进展性卒中的预后进行随访观察,从中探索出影响其发生发展的可靠病因。     

缺血性卒中或短暂性脑缺血发作的Ⅱ级预防指南

本文目的在于为预防卒中提供综合及时的循证医学建议,预防缺血性卒中患者或短暂性脑缺血发作患者发生缺血性卒中。循证医学建议包括控制危险因素、动脉粥样硬化的介入治疗、心源性脑栓塞的抗凝治疗、非心源性栓塞性卒中的抗血小板药物治疗,提出了一系列特定情况下防止卒中复发的建议,如动脉夹层、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中特别是妊娠妇女及绝经后激素替代治疗及脑出血后如何使用抗凝药物等。     

症状性颈动脉狭窄伴有同侧中动脉狭窄的介入治疗效果研究

目的   比较单纯颈动脉支架置入术治疗和联合颈动脉、大脑中动脉支架置入术治疗症状性颈动脉狭窄伴有中动脉狭窄的缺血性卒中或短暂性脑缺血发作（transient ischemic attack,TIA）患者短期终点事件发生率。 方法  回顾2010年1月～2013年12月采用血管内支架治疗症状性颈动脉狭窄伴有同侧大脑中动脉狭窄的缺血性卒中或TIA患者的临床资料。根据治疗情况将患者分为单纯颈动脉支架置入术治疗组和联合颈动脉、大脑中动脉支架置入术治疗组。比较两组术后90?d终点事件（包括同侧缺血性卒中复发、症状性脑出血及死亡风险）的发生率。 结果  共有21例患者纳入本研究,男性15例,女性6例,平均年龄（58.5±3.6）岁,其中16例患者进行了颈动脉支架治疗,5例患者进行了颈动脉联合中动脉支架治疗。颈动脉支架治疗组90?d终点事件发生3例（18.75%）,颈动脉联合中动脉支架治疗组发生1例终点事件（20%）,两组间差异无显著性（P=0.952）。两组发生的终点事件均为缺血性卒中复发,无症状性脑出血及死亡患者。 结论  对于伴有颈动脉及大脑中动脉狭窄的缺血性卒中或TIA患者,与单纯颈动脉支架治疗相比同时进行颈动脉及大脑中动脉支架治疗手术未减少术后90?d同侧缺血性卒中复发风险。     

河北省南和县农村卒中患者二级预防药物依从性及其相关因素分析

目的 分析河北省南和县农村卒中患者应用二级预防抗血小板药物、他汀类药物和降压药物的服 药依从性现状，并探讨其影响因素。 方法 本研究使用群组随机对照试验“南和县实用创新型脑卒中防治项目”的基线调查数据。该横 断面调查于2017年7月抽取位于5个镇的50个村，每村抽取符合纳入和排除标准的卒中患者开展问卷 调查及体格检查。问卷主要信息包括：社会人口学信息、患病史、社会支持、服药依从性等。患者服 药依从性根据Morisky Green Levine量表评测。采用多因素Logistic回归分析法分析患者抗血小板药物、 他汀类药物和降压药物服药依从性的影响因素。 结果 共纳入1299例卒中患者，平均年龄65.7±8.2岁，男性746例（57.4%）。服用抗血小板类、他汀 类、降压药物的患者分别占依照诊断史估测应服药人数的72.0%（852/1184）、28.4%（340/1197）和 91.1%（1030/1131）。服药患者中，药物依从率分别为63.0%（537/852）、63.5%（216/340）和62.6% （645/1030）。多因素分析显示，自我感知照护需求低的患者（OR 0.58，95%CI 0.45～0.75，P＜0.001）， 服用抗血小板药物依从性好；有卒中复发史患者（OR 2.09，95%CI 1.17～3.71，P =0.013）服用他汀类 药物依从性差，无吸烟史患者（OR 0.43，95%CI 0.19～0.97，P =0.043）服用他汀类药物依从性好。 年龄较大（OR 0.97，95%CI 0.95～0.99，P =0.004）、服2种以上药物（OR 0.54，95%CI 0.39～0.75， P ＜0.001）、自我感知照护需求低（OR 0.58，95%C I 0.40～0.84，P =0.004）及无吸烟史患者 （OR 0.63，95%CI 0.41～0.84，P =0.046）服用降压类药物依从性好。 结论 河北省南和县农村卒中患者二级预防合理用药率较低，服药患者依从性不佳，服药依从性 与患者年龄、吸烟史、卒中复发史、服药数量、自我感知照护需求等因素相关。     

动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究

【摘要】 目的 在动脉-动脉栓塞性缺血性卒中患者中,探讨晨峰高血压与颈动脉溃疡斑块的相关性。 方法 连续入组120例经中国缺血性卒中亚型（Chinese Ischemic Stroke Subclassification,CISS）分型诊断为动脉-动脉栓塞性缺血性卒中患者,利用24 h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型,研究晨峰血压与颈动脉溃疡斑块的相关性。 结果 120例缺血性卒中患者的平均年龄为（62.6±12.8）岁,女性占36.8%。晨峰高血压组（n=48）溃疡斑块的检出率与无晨峰高血压组（n=72）相比,差异无显著性（31.3％ vs 30.6％,P=0.84）。进一步将溃疡斑块按照检出部位（出现在卒中病灶同侧颈动脉或对侧颈动脉）进行分类发现,晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组（27.1% vs 19.4%,P=0.008）。多因素分析的结果显示,在调整了年龄、性别之后,晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比（odds ratio,OR）：1.42;95%可信区间（confidence interval,CI）：1.09～4.22）］;进一步校正其他危险因素之后,两者相关性仍存在（OR 1.23;95%CI 1.02～3.46）。 结论 在动脉-动脉栓塞性缺血性卒中患者中,晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性,提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。     

Closure versus Medical Therapy for Patent Foramen Ovale in Patients with Cryptogenic Stroke: An Updated Meta-Analysis of Randomized Controlled Trials

Background

Debate continues about whether percutaneous closure of patent foramen ovale (PFO) is a better strategy for the treatment of patients with cryptogenic stroke in comparison with medical therapy alone. We performed an updated meta-analysis of 6 randomized controlled trials (RCTs) to assess the effectiveness and safety of percutaneous closure of PFO as secondary prevention for patients with previous cryptogenic stroke compared to medical therapy.

术前激素治疗在局限性前列腺癌治疗中的地位：一项基于6个随机对照试验的荟萃分析

背景：研究已证实术前激素治疗减低了前列腺癌患者的临床分期和病理分期,减少了切缘阳性率,但是并没有提高患者的无病生存率。目前术前激素治疗前列腺癌的价值尚无定论。 目的：评价术前激素治疗在治疗局限性前列腺癌中的作用。 方法：计算机检索PubMed、EMBASE、Cochrane Library(2009年第4期)、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库中2009年10月前发表的文章,手工检索相关领域的杂志。纳入随机对照试验,经病理学及细胞学检查确诊为局限性前列腺癌的患者,性别和民族不限,没有严重的心肺疾病;排除晚期或是复发的前列腺癌患者。同时从纳入文献的参考文献中查找符合要求的随机对照试验。采用国际Cochrane协作组提供的Revman 5.0软件进行统计分析。主要评价无病生存率、切缘阳性率、淋巴结阳性率、精囊浸润率4个结局指标。 结果与结论：共纳入6篇随机对照试验合计1 027人,meta分析结果显示：与单纯的前列腺癌手术相比,术前激素治疗联合前列腺癌手术在无病生存率[RR=1.02,95%CI (0.89,1.17)],淋巴结阳性率[RR=0.86,95%CI (0.47,1.57)]、精囊浸润率[RR=1.09, 95%CI (0.74,1.59)]方面差异无显著性意义,而在手术切缘阳性率[RR=0.46,95%CI (0.32,0.66)]方面差异有显著性意义。提示术前激素治疗联合前列腺癌根治术能减低局限性前列腺癌患者的手术切缘阳性率,但是并不能提高患者的无病生存率、淋巴结阳性率、精囊浸润率。     

Postmenopausal hormone therapy and vascular risk

Although experimental data and results of observational studies suggest that hormone replacement therapy (HRT) was associated with a reduction in the risk of heart disease, the results for stroke have been far less clear. Several recent randomized secondary prevention studies have found that HRT is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. Moreover, an increased risk of stroke and first coronary event with hormone therapy has been found in low-risk healthy post menopausal women. In light of these findings, although the absolute risk of vascular event associated with HRT is low, most organizations recommend caution in using HRT. Hormone therapy should not be initiated to prevent vascular disease among postmenopausal women. There are numerous plausible explanations for the divergent findings from observational and randomized clinical trials of hormone therapy. Some discrepancies are certainly the result of methodological differences between the study designs. They also suggest other biological effects of hormone therapy than modification of classic vascular risk factors. Further studies should focus on identifying the mechanisms of risk and determining whether and how different regimens of hormone therapy influence vascular risk.     

Dabigatran, rivaroxaban and apixaban versus enoxaparin for thomboprophylaxis after total knee or hip arthroplasty: pool-analysis of phase III randomized clinical trials

Objectives

To compare the main efficacy and safety endpoints of the pivotal randomised clinical trials (RCTs) on venous thromboembolism (VTE) prevention after total hip (THR) or knee (TKR) replacement with the new oral anticoagulants (NAs) versus enoxaparin.

Methods

A pool-analysis of 10 RCTs that included 32.144 randomised patients was performed. Efficacy outcomes were total VTE and all-cause mortality, major VTE, and proximal DVT. Safety outcomes were major bleeding, and clinically relevant (major or non-major) bleeding.

Results

Overall, a significant effect favouring NAs was found for the primary efficacy outcome (RR 0.71; 95%CI 0.56-0.90), major VTE (RR 0.59; 95%CI 0.41-0.84), and proximal DVT (RR 0.51; 95%CI 0.35-0.76). Compared to enoxaparin 40 mg QD, rivaroxaban showed superiority (RR 0.50; 95%CI 0.34-0.73), followed by apixaban (RR 0.63; 95%CI 0.36-1.01) and dabigatran (RR 1.02; 95%CI 0.86-1.20). There was significant heterogeneity among trials and subgroups analysed for these efficacy outcomes. Major bleeding (RR 1.04; 95% CI 0.74-1.46) and clinically relevant bleeding (RR 1.03; 95%CI 0.88-1.21) was similar with NAs or enoxaparin. Rivaroxaban showed a trend toward more major bleeding episodes than enoxaparin (RR 1.88; 95%CI 0.92-3.82) and apixaban showed the lowest clinically relevant bleeding risk (RR 0.81; 95%CI 0.64-1.01).

Conclusions

Overall, NAs showed more efficacy and same safety when compared to the recommended dose of enoxaparin after THR and TKR. There are little differences in efficacy and bleeding risk among NAs and the type of prophylaxis that should be analysed further.     

全髋与半髋关节置换治疗老年股骨颈骨折的Meta分析

背景：目前全髋关节置换和半髋关节置换是治疗老年移位股骨颈骨折的有效方法,但两种方案的选择在临床治疗仍存争议。 目的：对全髋关节置换与半髋关节置换治疗老年股骨颈骨折的疗效进行系统评价。 方法：计算机检索Cochrane协作网数据库(2009年第1期)、MEDLINE(1966-01/2009-05)、EMbase(1984-01/2009-05)、中国生物医学文献数据库(CBM,1979-01/2009-05)、中文期刊全文数据库(1979-01/2009-05)。收集所有相关随机对照试验及半随机对照试验,并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan5.0.18。 结果与结论：共纳入7个随机对照临床试验,包括648例患者。Meta分析结果显示,全髋与半髋关节置换的病死率、感染率差异均无显著性意义;全髋关节置换术中出血量多、手术时间长(P < 0.001);远期随访全髋置换翻修率低于半髋置换(RR=0.28,95%CI=0.12~0.66,P=0.003);全髋置换后脱位发生率高于半髋置换(RR=3.45,95%CI=1.29~9.19,P=0.01);全髋置换后疼痛发生率低于少于半髋置换(RR=0.12,95%CI=0.05~0.30,P < 0.000 01);全髋置换活动功能优于半髋置换(RR=1.32,95%CI=1.04~1.68,P=0.02)。提示短期随访全髋置换与半髋置换后病死率、翻修率、关节功能、脱位率、疼痛及感染率无明显差异;中期随访全髋置换的脱位发生率高于半髋置换;远期随访全髋置换后活动功能优于半髋置换,且翻修率和疼痛发生率明显低于半髋置换。     

Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study

Combined oral contraceptives, oral hormone replacement therapy and thrombophilias are recognised risk factors for venous thromboembolism in women. The objective of this study was to assess the risk of thromboembolism among women with thrombophilia who are taking oral contraceptives or hormone replacement therapy, conducting a systematic review and metaanalysis. Of 201 studies identified, only nine met the inclusion criteria. Seven studies included pre-menopausal women on oral contraceptives and two studies included peri-menopausal women on hormone replacement therapy. For oral contraceptive use, significant associations of the risk of venous thromboembolism were found in women with factor V Leiden (OR 15.62; 95%CI 8.66 to 28.15); deficiencies of antithrombin (OR 12.60; 95%CI 1.37 to 115.79), protein C (OR 6.33; 95%CI 1.68 to 23.87), or protein S (OR 4.88; 95%CI 1.39 to 17.10), elevated levels of factor VIIIc (OR 8.80; 95%CI 4.13 to 18.75); and factor V Leiden and prothrombin G20210A (OR 7.85; 95%CI 1.65 to 37.41). For hormone replacement therapy, a significant association was found in women with factor V Leiden (OR 13.16; 95%CI 4.28 to 40.47). Although limited by the small number of studies, the findings of this study support the presence of interaction between thrombophilia and venous thromboembolism among women taking oral contraceptives. However, further studies are required to establish with greater confidence the associations of these, and other, thrombophilias with venous thromboembolism among hormone users.     

Efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women: a meta-analysis

ABSTRACT

The aim of our study was to investigate the therapeutic efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women. In this systematic review and meta-analysis, randomized clinical trials (RCTs) that published up to 22 June 2016 were retrieved from several online electronic databases, including Cochrane Library, PubMed, Ovid, Scopus, Medline, CINHAL, and EBSCO. Fifty-seven studies were included in the meta-analysis. The results showed that both pharmacological interventions (mean difference (MD) = –0.86, 95% confidence interval (CI) = –1.49 to –0.90, p = 0.0001) and non-pharmacological interventions (MD = –0.92, 95% CI = –1.35 to –0.49, p = 0.0001) had statistically significant effects on improving sexual interest/arousal. Among pharmacological interventions, hormone therapy with dehydroepiandrosterone, testosterone, tibolone and estrogen in combination with progesterone, estrogen in combination with testosterone as well as estrogen in combination with progesterone and testosterone were found to be effective. Non-hormonal medications including flibanserin and sildenafil as well as herbal medicines were also shown to be effective. However, due to high heterogeneity of the findings and scarcity of the studies in certain domains, there is uncertainty of their true effect. So, further well-designed RCTs with larger samples are required to ascertain the long-term effects of studies.     

Seasonal variation in the occurrence of ischemic stroke and subarachnoid hemorrhage in Siberia, Russia. A population-based study

Epidemiological studies on the relationship between stroke occurrence and the seasons in different countries produced inconsistent results and little is known about these associations in a general population. We report a population-based study of 214 patients with first-ever ischemic stroke (IS, data for 1992) and 64 patients with first-ever subarachnoid hemorrhage (SAH) registered in the 25–74 years old population of Oktiabrsky District of Novosibirsk, Russia in 1982–92. IS and SAH incidence in four seasons (winter, spring, summer, autumn) was evaluated by means of a chi-square test. Poisson regression analysis was used to compute the rate ratios (RRs) and corresponding confidence intervals (CIs) for the occurrence ofIS and SAH in winter, spring, and autumn compared with summer. Seasonal variations in the occurrence of IS were significant for the group of young men (25–64 years) and the group of older women (65–74 years) only. The age and sex adjusted RR of the occurrence of IS in winter was 49% greater than in summer (95%CI 1–119%). When men and women were analyzed separately and the rates were adjusted for age, a significantly higher risk of IS was found only in men (RR = 2.48; 95% CI 1.27–4.83) in spring compared with summer. No seasonality was observed for the occurrence of SAH in both men and women. Our findings indicate that there is a significantly greater incidence of ischemic stroke during winter in Siberia, Russia, whereas the incidence of SAH does not show a seasonal variation.     

No association between hypertension and risk for Alzheimer's disease: a meta-analysis of longitudinal studies

This study examined the association between hypertension and AD by using a quantitative meta-analysis of longitudinal studies. EMBASE and MEDLINE were searched for articles published up to February 2011. All studies that examined the association of hypertension or antihypertensive medication use with the onset of AD were included. Pooled relative risks (RR) were calculated using fixed and random effects models. Twelve studies met our inclusion criteria for this meta-analysis. All subjects were without dementia at baseline. Among them, 9 studies compared the incidence of AD between subjects with (7,270) and without (8,022) hypertension. The quantitative meta-analysis showed that there was no significant difference in incidence of AD (RR: 1.02, 95% confidence interval (CI): 0.91-1.14) between subjects with and without hypertension. Seven studies compared the incidence of AD between subjects with (8,703) and without (13,041) antihypertensive medication use. The quantitative meta-analysis showed that there was no significant difference in incidence of AD (RR: 0.90, 95% CI: 0.79-1.03) between subjects with and without antihypertensive medication use. The quantitative meta-analysis showed that neither hypertension nor antihypertensive medication use was associated with risk for incident AD.