Comparative efficacy and acceptability of non-pharmacological interventions in fibromyalgia: Protocol for a network meta-analysis

INTRODUCTION

Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients.

METHODS AND ANALYSIS

We will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called "Control". The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta-analysis (CINeMA) framework.

ETHICS AND DISSEMINATION

This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal.

REGISTRATION

OSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).

Evaluation of a serum-free transport medium supplemented with cyanobacterial extract, for the optimal survival of Helicobacter pylori from biopsy samples and strains

The purpose of this work was to evaluate the use of an alternative transport medium supplemented with a cyanobacterial extract (CE), free of animal derivatives, to preserve the viability of Helicobacter pylori strains during long-term transportation and allow its recovery from biopsy samples. The transport media evaluated were Mueller-Hinton broth 0.3% agar (MH) and 0.3% of CE (MH-CE). MH broth 5% fetal calf serum (FCS) was used as the reference medium (MH-FCS). Biopsy samples from 134 patients, H. pylori NCTC 11638 and six clinical isolates were studied. A higher recovery (p ≤ 0.001) at 4°C was obtained in MH-CE than in MH-FCS after 96 h of storage. Only MH-CE allowed recovery after 120 h. The H. pylori recovery at room temperature after 96 h was higher (p ≤ 0.005) in MH-CE than in MH-FCS. Similar survival rates were observed in biopsy samples conserved in MH-CE and MH-FCS at 4°C. The recovery after 48 h at room temperature in MH-CE was higher (p ≤ 0.05) than MH-FCS and was the only medium allowing recovery after 72 h. The MH-CE medium is a simple, inexpensive and animal derivatives-free transport medium that can be used to preserve H. pylori viability and its recovery from biopsy samples.

Effect of mineral nutrients on cell growth and self-flocculation of Tolypothrix tenuis for the production of a biofertilizer

The influence of mineral nutrients on the growth and self-flocculation of Tolypothrix tenuis was studied. The identification of possible limiting nutrients in the culture medium was performed by the biomass elemental composition approach. A factorial experimental design was used in order to estimate the contribution of macronutrients and micronutrients, as well as their interactions. Iron was identified to be limiting in the culture medium. The micronutrients influenced mainly cellular growth without effects on self-flocculation. Conversely, the self-flocculation capacity of the biomass increased at higher concentrations of macronutrients. The optimization of mineral nutrition of T. tenuis allowed a 73% increase in the final biomass level and 3.5 times higher flocculation rates.

Enhancement of growth and toxin production of Clostridium argentinense by co-culture with Pseudomonas mendocina

The growth and toxin production of Clostridium argentinense in co-culture with Pseudomonas mendocina was examined in a micro-fermenter without aeration characterizing the association in terms of several growth parameters. The biomass obtained in co-cultures was 4.4 times higher than that in C. argentinense monocultures with total consumption of the carbon source. The pH and Eh attained in co-cultures at later stages of cultivation were suitable for toxin production by C. argentinense. In comparison with C. argentinense monocultures the production of toxin was 17.5 times higher with a specific toxicity of 0.56 LD50 per g of co-culture biomass.

[Biodegradation of a lipid-rich effluent by native bacteria]

From samples of effluent derived from a biological treatment plant of a mayonnaise and margarine producing factory, several bacteria strains presenting high lipolytic activities were isolated. The strain having the highest activity was used for treating a typical final effluent and the results obtained were compared with those achieved with Yarrowia lipolytica and Saccharomycopsis lipolytica strains. The isolated strain showed the highest specific capacity for reducing chemical oxygen demand (COD).

Vertical thin-layer photoreactor for controlled cultivation of cyanobacteria

Nostoc sp. was cultivated in an air-lift reactor with continuous recirculation of the head gas phase that aerated and agitated the cyanobacterial suspension at regulated flow rates. The supply of inorganic carbon for growth was coupled with pH control, in the range of 7.7 to 8.1, by intermittent sparging of CO2-head gas mixtures. The formation of irregular bubbles with swirling motion at the photostage of the reactor promoted efficient CO2 transference in dense populations of Nostoc sp. (1.1 g/l) when bubbling at flow rates of 10 l/min. Biomass productivity was almost six-fold higher in the photoreactor (16.4 mg/l.h) than in a conventional system (2.8 mg/l.h). The exponential growth phase of cultures in the photoreactor amounted to 60% of the total growth period.