针灸治疗功能性消化不良临床对照文献用穴规律评析

目的:分析和总结针灸治疗功能性消化不良临床随机对照研究和非随机同期对照研究中的用穴规律.方法:检索针灸治疗功能性消化不良的临床随机对照和非随机同期对照研究文献,筛选合格研究.对文献中使用的腧穴进行提取,用Access数据库进行统计分析.结果:纳入合格文献22篇,共使用腧穴24个.各腧穴分布属于十四经脉,且均为特定穴,涉及特定穴10种.结论:针灸治疗功能性消化不良临床研究中使用的腧穴,归经以足阳明胃经、足太阳膀胱经为主,腧穴分类以特定穴为主,针灸治疗本病的良好疗效与循经取穴及相关经络特定穴的使用有密切关系.     

麻黄细辛附子汤加减治疗缓慢性心律失常有效性和安全性的Meta分析

[目的]系统评价麻黄细辛附子汤加减治疗缓慢性心律失常的有效性与安全性。[方法]计算机与手工检索相结合的方法,全面检索2000年1月-2017年4月公开发表的关于麻黄细辛附子汤加减治疗缓慢性心律失常的临床随机对照试验,根据纳排标准筛选,并提取数据,通过Revman5.3软件进行分析。[结果]共纳入研究19篇,患者1 530例;在综合疗效方面,麻黄细辛附子汤加减组疗效优于对照组,RR=1.30,95%CI[1.23,1.38（]P<0.000 01）;治疗后基础心率比较,麻黄细辛附子汤加减组优于对照组,MD7.87,95%CI[6.47,9.26（]P<0.000 01）;治疗后最慢心率比较,麻黄细辛附子汤加减组优于对照组,MD6.45,95%CI[4.72,8.18（]P<0.000 01）;治疗后平均心率比较：麻黄细辛附子汤加减组优于对照组,MD7.20,95%CI[6.23,8.16（]P<0.000 01）;治疗后静息心率比较,麻黄细辛附子汤加减组优于对照组,MD8.03,95%CI[6.52,9.54（]P<0.000 01）;治疗后中医证候改善比较：麻黄细辛附子汤加减组优于对照组,RR=1.47,95%CI[0.94,2.30（]P<0.10）;不良反应方面,共6篇文献提到均未发生严重肝肾功能不良反应。[结论]麻黄细辛附子汤加减对缓慢性心律失常在临床疗效、改善心率方面有一定作用,且具有一定安全性。     

伊曲康唑对比氟康唑治疗单纯性外阴阴道念珠菌病疗效的Meta分析

目的:系统评价伊曲康唑对比氟康唑治疗单纯性外阴阴道念珠菌病(VVC)的临床疗效,以为临床提供循证参考。方法:计算机检索PubMed、EMBase、Medline、The Cochrane Library、中文科技期刊数据库、中国期刊全文数据库、万方数据库,收集伊曲康唑对比氟康唑治疗单纯性VVC的随机对照试验(RCT),提取资料后采用Rev Man 5.2统计软件进行Meta分析。结果:纳入7项RCT,合计1 006例患者。Meta分析结果显示,氟康唑组患者总治愈率[OR=0.50,95%CI(0.32,0.79),P=0.003]、第一阶段随访的真菌学治愈率高于伊曲康唑组[OR=0.61,95%CI(0.42,0.89),P=0.01],两组比较差异有统计学意义;两组患者临床治愈率、第二阶段随访的真菌学治愈率以及复发率比较差异无统计学意义。结论:氟康唑治疗单纯性VVC的疗效优于伊曲康唑,可以提高患者的总治愈率和第一阶段随访的真菌学治愈率。由于纳入研究数量较少、质量偏低,该结论尚需大样本、高质量的RCT进一步证实。     

Yogurt consumption,weight change and risk of overweight/obesity: The SUN cohort study

Background and aimsEpidemiological studies on the association between yogurt consumption and the risk of overweight/obesity are scarce. We prospectively examined the association of yogurt consumption with overweight/obesity and average annual weight gain.Methods and resultsProspective cohort study of 8516 men and women (mean age 37.1, SD: 10.8 y). Participants were followed-up every two years. Participants were classified in 5 categories of yogurt consumption at baseline: 0–2, >2–<5, 5–<7, 7 and ≥7 servings/week. Outcomes were: 1) average yearly weight change during follow-up; and 2) incidence of overweight/obesity. Linear regression models and Cox models were used to adjust for potential confounders. After a median follow-up of 6.6 years, 1860 incident cases of overweight/obesity were identified. A high (>7 servings/week) consumption of total and whole-fat yogurt was associated with lower incidence of overweight/obesity [multivariable adjusted hazard ratios = 0.80 (95% CI: 0.68–0.94); and 0.62 (0.47–0.82) respectively] in comparison with low consumption (0–2 servings/week). This inverse association was stronger among participants with higher fruit consumption.ConclusionIn this Mediterranean cohort, yogurt consumption was inversely associated with the incidence of overweight/obesity, especially among participants with higher fruit consumption.     

Accuracy of geographically targeted internet advertisements on google adwords for recruitment in a randomized trial

Background

Google AdWords are increasingly used to recruit people into research studies and clinical services. They offer the potential to recruit from targeted control areas in cluster randomized controlled trials (RCTs), but little is known about the feasibility of accurately targeting ads by location and comparing with control areas.

Objective

To examine the accuracy and contamination of control areas by a location-targeted online intervention using Google AdWords in a pilot cluster RCT.

Methods

Based on previous use of online cognitive behavioral therapy for depression and population size, we purposively selected 16 of the 121 British postcode areas and randomized them to three intervention and one (do-nothing) control arms. Two intervention arms included use of location-targeted AdWords, and we compared these with the do-nothing control arm. We did not raise the visibility of our research website to normal Web searches. Users who clicked on the ad were directed to our project website, which collected the computer Internet protocol (IP) address, date, and time. Visitors were asked for their postcode area and to complete the Patient Health Questionnaire (depression). They were then offered links to several online depression resources. Google Analytics largely uses IP methods to estimate location, but AdWords uses additional information. We compared locations assessed by (1) Analytics, and (2) as self-identified by users.

Results

Ads were shown 300,523 times with 4207 click-throughs. There were few site visits except through AdWord click-throughs. Both methods of location assessment agreed there was little contamination of control areas. According to Analytics, 69.75% (2617/3752) of participants were in intervention areas, only 0% (8/3752) in control areas, but 30.04% (1127/3752) in other areas. However, according to user-stated postcodes, only 20.7% (463/2237) were in intervention areas, 1% (22/2236) in control areas, but 78.31% (1751/2236) in other areas. Both location assessments suggested most leakage from the intervention arms was to nearby postcode areas. Analytics data differed from postcodes reported by participants. Analysis of a subset of 200/2236 records over 10 days comparing IP-estimated location with stated postcode suggested that Google AdWords targeted correctly in just half the cases. Analytics agreed with our assessment that, overall, one-third were wrongly targeted by AdWords. There appeared little evidence that people who bothered to give their postcode did not answer truthfully.

Conclusions

Although there is likely to be substantial leakage from the targeted areas, if intervention and control areas are a sufficient distance apart, it is feasible to conduct a cluster RCT using online ads to target British postcode areas without significant contamination.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01469689","term_id":"NCT01469689"}}NCT01469689; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01469689","term_id":"NCT01469689"}}NCT01469689 (Archived by WebCite at http://www.webcitation.org/681iro5OU)     

Treatment strategies for carotid stenosis in patients at increased risk for surgery

The purpose of carotid revascularization is stroke prevention. The merits of carotid revascularization as well as the type of revascularization are dependent on the “natural risk” and the “revascularization risk.” In general, the natural risk of stroke in any patient with carotid stenosis (CS) is dependent on the symptomatic status of the patient and CS severity. Contemporary choices for carotid revascularization include carotid endarterectomy (CEA) and carotid artery stenting (CAS). Anatomical (hostile neck situations, severe bilateral CS, CEA restenosis) and clinical (severe cardiopulmonary diseases, prior cranial nerve injury) factors may increase the risk of CEA. Likewise, anatomical (complex aortic arch and brachiocephalic arterial anatomy, presence of thrombus, and heavy calcification) and clinical (need for heart surgery within 30 days) factors may increase the risk of CAS. Other factors such as the presence of symptomatic CS (transient ischemic attack or stroke within 6 months), decreased cerebral reserve, chronic kidney disease, and age older than 75 years may increase the risk of CEA and CAS. In general, symptomatic patients with severe CS exceed revascularization risk. In contrast, asymptomatic patients who are high risk for CEA should be considered for CAS because the natural risk of stroke should undergo careful assessment of baseline cognitive function, aortic arch and carotid artery anatomy, and likelihood of survival for 3 years. Patients who have normal cognitive function, favorable anatomy, and high likelihood of survival more than 3 years should be considered for CAS, whereas patients with multiple unfavorable features may be treated with optimal medical therapy, without revascularization.     

Quetiapine XR: Current status for the treatment of major depressive disorder

Quetiapine fumarate extended release (XR) has been approved for treatment of schizophrenia and bipolar disorder. Quetiapine may have antidepressant effects through effects on 5-HT_2A receptor, 5-HT_1A receptor, dopamine receptor, glutamate receptor and norepinephrine transporter. Recently, 7 large-scale randomized, double-blind, placebo (2-studies with active comparator)-controlled clinical trials have demonstrated that quetiapine XR has clinically meaningful efficacy as monotherapy and adjunct therapy to antidepressants for the treatment of adult patients with major depressive disorder (MDD). In such clinical trials, quetiapine XR was generally well tolerated, although weight gain and changes in metabolic parameters, consistent with the known profile of quetiapine, were observed in some patients. As of December 2009, the United States Food and Drug Administration has approved quetiapine XR for the adjunct treatment of MDD. From the data of currently available clinical trials, this review provides an overview of the data and clinical implications for quetiapine XR in the treatment of MDD to enhance clinicians understanding of the use of quetiapine XR in the treatment of MDD.     

Screening for disease in the newborn: the evidence base for blood-spot screening

This paper reviews the evidence of benefit resulting from newborn screening in Australia as well as for some of those disorders not yet included in the Australian panels, and discusses briefly disorders under active consideration for inclusion in the screening panels.There is solid evidence of benefit from newborn screening for phenylketonuria, congenital hypothyroidism, cystic fibrosis, and overall for the disorders included in tandem mass spectrometry screening. There is also some evidence of benefit for several disorders not screened for in Australia, including congenital adrenal hyperplasia. Harms resulting from screening include anxiety related to false positive results; adverse effects of unwarranted treatment for mild variants; unwanted genetic information; and the costs (opportunity costs) of screening. For well-run programs these harms are relatively small.Screening could become more effective with the development of good systems for rational consideration of disorders to be included, with the extended use of second tier testing to reduce the false positive rate, and with research on the most effective way to deal with mild variants. The most important aspect of increasing effectiveness is the full integration of the screening program, diagnostic laboratories, and the clinical service. This is already in place in Australasia.     

The effect of intestinal flora intervention on bone development in children: A systematic review and meta-analysis

BackgroundThe intestinal flora is involved in the bone development of children through a variety of mechanisms, but it remains unclear whether intervention of the intestinal flora can enhance children's bone development.MethodsSix databases (PubMed, Web of Science, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health, and China National Knowledge Infrastructure) were searched for all English and Chinese studies published up to August 2021. Stata version 16.0 (StataCorp, College Station, TX, USA) was used. Bone mass density and biochemical markers related to bone metabolism were reported as the primary outcome, and the secondary outcomes were anthropometric parameters such as height, height Z score for age, and height velocity. Intergroup differences were determined by standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA total of 3245 participants from 20 RCTs and 370 participants from 8 crossover trials were included in the study. Significant differences were found in bone mineral density (SMD 0.47; 95% CI, 0.28 to 0.66; p < 0.001; I² = 0.00%) and total serum calcium (SMD 1.07; 95% CI, 0.39 to 1.74; p < 0.001; I² = 61.9%), as well as in height Z score for age (SMD = 0.11; 95% CI, 0.00 to 0.22; P = 0.044; I² = 0%). The overall quality of evidence ranged from moderate to very low.ConclusionsThis systematic review and meta-analysis suggested that intestinal flora intervention was an effective method of improving bone mineral density, serum calcium, and height in infants, children, and adolescents. Future studies with a larger sample size and longer intervention period are needed.The protocol of this systematic review was registered in PROSPERO and the registered number was CRD42021282606.