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Muñoz Laguna J, Kurmann A, Hofstetter L, Nyantakyi E, Clack L, Bang H, Foster NE, Braun J, Puhan MA, Farshad M, Hincapié CA. Feasibility of blinding spinal manual therapy interventions among participants and outcome assessors: protocol for a blinding feasibility trial. Pilot Feasibility Stud 2024; 10:70. [PMID: 38698433 PMCID: PMC11064349 DOI: 10.1186/s40814-024-01492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Blinding is a methodologically important aspect in randomised controlled trials yet frequently overlooked in trials of spinal manual therapy interventions for back pain. To help inform the blinding methods of a future, double-placebo-controlled trial comparing spinal manual therapy and nerve root injection for lumbosacral radicular pain, we set four objectives: (1) to assess the feasibility of blinding participants, randomly allocated to an active or placebo-control spinal manual therapy intervention protocol, (2) to assess the feasibility of blinding outcome assessors within the trial, (3) to explore the influence of spinal manual therapy experience and low back pain on blinding, and (4) to explore factors contributing to perceptions about intervention assignment among participants and outcome assessors. METHODS AND ANALYSIS Two-parallel-group, single-centre, placebo-controlled, methodological blinding feasibility randomised trial. We will recruit between 60 and 100 adults with or without back pain and with or without experience of spinal manual therapy from Zurich, Switzerland. Participants will be randomised to either an active spinal manual therapy or a placebo-control spinal manual therapy protocol-both interventions delivered over two study visits, up to two weeks apart. The primary outcome is participant blinding using the Bang blinding index within each intervention arm immediately after each of the two study visits. Secondary outcomes are participant blinding using the James blinding index, outcome assessor blinding (Bang and James blinding indices), self-reported factors influencing perceived intervention assignment among participants and outcome assessors, and participant-reported credibility and expectancy of study interventions. Other outcomes-included to blind the study objective from participants-are lumbar spine range of motion, self-rated general health, satisfaction with care, pain intensity, and function. Intervention provider outcomes include intervention component fidelity and quality of intervention delivery. ETHICS AND DISSEMINATION The independent ethics commission of Canton Zurich granted ethical approval for this study (KEK 2023-00381). Written informed consent will be obtained from all participants. Findings will be disseminated in scientific conferences and a peer-reviewed publication and inform the blinding methods of a future double-placebo controlled trial comparing spinal manual therapy and nerve root injection for lumbosacral radicular pain-the SALuBRITY trial. TRIAL REGISTRATION NCT05778396.
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Affiliation(s)
- Javier Muñoz Laguna
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Astrid Kurmann
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Emanuela Nyantakyi
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, United States
| | - Nadine E Foster
- Surgical Treatment and Rehabilitation Service (STARS), STARS Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- School of Medicine, Keele University, Keele, United Kingdom
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Muñoz Laguna J, Nyantakyi E, Bhattacharyya U, Blum K, Delucchi M, Klingebiel FKL, Labarile M, Roggo A, Weber M, Radtke T, Puhan MA, Hincapié CA. Is blinding in studies of manual soft tissue mobilisation of the back possible? A feasibility randomised controlled trial with Swiss graduate students. Chiropr Man Therap 2024; 32:3. [PMID: 38287417 PMCID: PMC10826218 DOI: 10.1186/s12998-023-00524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY DESIGN Single-centre, two-parallel group, methodological randomised controlled trial to assess blinding feasibility. BACKGROUND Trials of manual therapy interventions of the back face methodological challenges regarding blinding feasibility and success. We assessed the feasibility of blinding an active manual soft tissue mobilisation and control intervention of the back. We also assessed whether blinding is feasible among outcome assessors and explored factors influencing perceptions about intervention assignment. METHODS On 7-8 November 2022, 24 participants were randomly allocated (1:1 ratio) to active or control manual interventions of the back. The active group (n = 11) received soft tissue mobilisation of the lumbar spine. The control group (n = 13) received light touch over the thoracic region with deep breathing exercises. The primary outcome was blinding of participants immediately after a one-time intervention session, as measured by the Bang blinding index (Bang BI). Bang BI ranges from -1 (complete opposite perceptions of intervention received) to 1 (complete correct perceptions), with 0 indicating 'random guessing'-balanced 'active' and 'control' perceptions within an intervention arm. Secondary outcomes included blinding of outcome assessors and factors influencing perceptions about intervention assignment among both participants and outcome assessors, explored via thematic analysis. RESULTS 24 participants were analysed following an intention-to-treat approach. 55% of participants in the active manual soft tissue mobilisation group correctly perceived their group assignment beyond chance immediately after intervention (Bang BI: 0.55 [95% confidence interval (CI), 0.25 to 0.84]), and 8% did so in the control group (0.08 [95% CI, -0.37 to 0.53]). Bang BIs in outcome assessors were 0.09 (-0.12 to 0.30) and -0.10 (-0.29 to 0.08) for active and control participants, respectively. Participants and outcome assessors reported varying factors related to their perceptions about intervention assignment. CONCLUSIONS Blinding of participants allocated to an active soft tissue mobilisation of the back was not feasible in this methodological trial, whereas blinding of participants allocated to the control intervention and outcome assessors was adequate. Findings are limited due to imprecision and suboptimal generalisability to clinical settings. Careful thinking and consideration of blinding in manual therapy trials is warranted and needed. TRIAL REGISTRATION ClinicalTrials.gov: NCT05822947 (retrospectively registered).
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Affiliation(s)
- Javier Muñoz Laguna
- EBPI-UZWH Musculoskeletal Epidemiology Research Group, University of Zurich, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Emanuela Nyantakyi
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Urmila Bhattacharyya
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Kathrin Blum
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Matteo Delucchi
- Centre of Computational Health, Institute of Computational Life Sciences, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
- Department of Mathematics, University of Zurich, Zurich, Switzerland
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
- Harald Tscherne Laboratory for Orthopaedic and Trauma Research, University of Zurich, Zurich, Switzerland
| | - Marco Labarile
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Roggo
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Manuel Weber
- School of Health Professions, Academic-Practice-Partnership between Bern University of Applied Sciences and University Hospital of Bern, Bern University of Applied Sciences, Bern, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UZWH Musculoskeletal Epidemiology Research Group, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Hemilä H, Chalker E. Vitamin C reduces the severity of common colds: a meta-analysis. BMC Public Health 2023; 23:2468. [PMID: 38082300 PMCID: PMC10712193 DOI: 10.1186/s12889-023-17229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Randomized trials have shown that vitamin C shortens the duration of common colds. Some trials reported greater effects on severe cold symptoms compared with mild symptoms. This review systematically compares the effects of vitamin C on severe and mild common cold symptoms. METHODS We included all placebo-controlled trials of orally administered vitamin C in doses of at least 1 g/day for the common cold for people in good health at baseline. The analysis was restricted to trials which reported both the total duration of the common cold, and the severity of the common cold measured using severity scales, the duration of more severe stages of the cold, or proxies for severe colds such as days indoors. Findings were pooled using the inverse variance, fixed effect options of the metacont function of the R package meta to calculate the ratio of means estimate. RESULTS Fifteen comparisons from 10 trials which reported both mild and severe symptoms were identified. All trials were randomized and double-blind. Compared to placebo, vitamin C significantly decreased the severity of the common cold by 15% (95% CI 9-21%). The direct comparison of the effect of vitamin C on mild and severe symptoms was limited to five comparisons which found that vitamin C had a significant benefit on the duration of severe symptoms. In this subset, there was a significant difference in the size of the effect of vitamin C on the overall duration of colds versus the duration of severe colds (P = 0.002), and vitamin C had no significant effect on the duration of mild symptoms. CONCLUSIONS The common cold is the leading cause of acute morbidity and a major cause of absenteeism from work and school. However, absenteeism is dependent on the severity of symptoms. The finding that vitamin C may have a greater effect on more severe measures of the common cold is therefore important. Further research on the therapeutic effects of vitamin C on the common cold should measure outcomes of differing levels of severity.
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Affiliation(s)
- Harri Hemilä
- Department of Public Health, University of Helsinki, POB 20, Helsinki, FI, FI-00014, Finland.
| | - Elizabeth Chalker
- Biological Data Science Institute, Australian National University, Canberra, ACT, 2601, Australia
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Reijman MD, Schweizer A, Peterson ALH, Bruckert E, Stratz C, Defesche JC, Hegele RA, Wiegman A. Rationale and design of two trials assessing the efficacy, safety, and tolerability of inclisiran in adolescents with homozygous and heterozygous familial hypercholesterolaemia. Eur J Prev Cardiol 2022; 29:1361-1368. [PMID: 35175352 DOI: 10.1093/eurjpc/zwac025] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inclisiran is a small interfering RNA molecule that reduces low-density lipoprotein cholesterol (LDL-C) by inhibition of proprotein convertase subtilisin/kexin type 9. This subcutaneous, twice-yearly administered agent has been shown to effectively and safely lower LDL-C in adult patients with established atherosclerotic cardiovascular disease, adults at high risk for atherosclerotic cardiovascular disease, as well as in adults with heterozygous familial hypercholesterolaemia. With the current, limited treatment options available to reach treatment goals in children with severe heterozygous familial hypercholesterolaemia, homozygous familial hypercholesterolaemia, or statin intolerance, inclisiran could be a valuable new therapeutic option. OBJECTIVES The objective of these ongoing studies is to investigate the efficacy, safety, and tolerability of inclisiran in adolescents diagnosed with homozygous familial hypercholesterolaemia (ORION-13) or heterozygous familial hypercholesterolaemia (ORION-16). STUDY DESIGN ORION-13 and ORION-16 are both two-part (1-year double-blind inclisiran vs. placebo/1 year open-label inclisiran) multicentre trials including adolescents aged 12 to <18 years diagnosed with familial hypercholesterolaemia. ORION-13 will include ∼12 participants diagnosed with homozygous familial hypercholesterolaemia and ORION-16 will include ∼150 participants diagnosed with heterozygous familial hypercholesteroleamia. The primary endpoint is the percentage change in LDL-C from baseline to Day 330. Secondary efficacy and safety endpoints include changes in other lipid parameters and treatment-emergent adverse events as well as laboratory parameters and vital signs. Exploratory endpoints include individual responsiveness of the participants and change in LDL-C according to the type of underlying causal mutation. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov/. Unique identifier: NCT04659863 (ORION-13) and NCT04652726 (ORION-16).
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Affiliation(s)
- M Doortje Reijman
- Department of Paediatrics, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anja Schweizer
- Global Drug Development, Cardiovascular, Renal and Metabolism, Novartis Pharma AG, Basel, Switzerland
| | - Amy L H Peterson
- Division of Paediatric Cardiology, Department of Paediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Disease, Pitié-Salpêtrière University Hospital, Paris, France
| | - Christian Stratz
- Global Drug Development, Cardiovascular, Renal and Metabolism, Novartis Pharma AG, Basel, Switzerland
| | - Joep C Defesche
- Department of Clinical Genetics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Albert Wiegman
- Department of Paediatrics, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Žaja O, Fiolić M, Ćuk MC, Tiljak MK. "The role of L. reuteri DSM17938 in nutritional recovery and treatment of constipation in children and adolescents with anorexia nervosa - a randomized, double blind, placebo controlled study". Clin Nutr ESPEN 2021; 46:47-53. [PMID: 34857236 DOI: 10.1016/j.clnesp.2021.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) carries the risk of potentially irreversible medical complications, especially in children and adolescents. Constipation is frequent and difficult to manage. Due to the symptoms it causes, constipation can further compromise nutritional rehabilitation. OBJECTIVE To investigate the role of probiotics (Lactobacillus reuteri DSM 17938) in children and adolescent with AN. DESIGN, SETTING AND PARTICIPANTS Randomized, double blind, placebo controlled study in 31 female pediatric AN patients with constipation, referred to nutritional therapy in Pediatric Gastroenterology Department, Sestre milosrdnice University Hospital Centre in Zagreb. METHODS At hospitalization, patients were randomly assigned into two groups; one taking L. reuteri, and other placebo for 3 months, along with the conventional nutritional rehabilitation. Patients were followed 3 months after stopping the treatment. The primary outcome was relief of constipation, assessed after 3 months, while secondary outcomes were normalization of body weight, stool frequency and consistency, relief of dyspepsia, weight gain and recovery of malnutrition regarding bone density and vitamin D3 levels. RESULTS The study showed statistically significant difference between the two groups considering the stool frequency (6.4 vs. 4.2 stools/week; p < 0.05) and normalization of body weight (93 vs. 63%; p = 0.04) after 6 months, but no significant effect on the rate of relief of constipation (87 vs. 64%; p = 0.22) at 3 months. In the L. reuteri group, the normalization of BMD was achieved in 8/15, whereas in the placebo group, in 3/16 patients. However, there was no statistically significant difference compared to the placebo group regarding the BMD recovery as well as the normalization of D3 levels (p = 0.056). CONCLUSIONS Probiotics may serve as simple and safe adjuvant therapy of constipation in childhood AN and contribute to faster nutritional recovery. Although a statistically significant difference between the two group in relief of constipation could not be shown after 3 months, a benefit from probiotics could be in increasing stool frequency and nutritional recovery in childhood AN after six months. Registered under ClinicalTrials.gov Identifier no. NCT02004288.
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Affiliation(s)
- Orjena Žaja
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; University of Zagreb, School of Dental Medicine, Croatia
| | | | - Matea Crnković Ćuk
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
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Cho YK, Choi MG, Park H, Kim JW, Lee DH, Ko KH, Kim SG, Jung HY, Hong SJ, Lee YC, Lee SH. Efficacy of S-pantoprazole 10 mg in the Symptom Control of Non-erosive Reflux Disease: A Phase III Placebo-controlled Trial. J Neurogastroenterol Motil 2021; 27:223-230. [PMID: 33795542 PMCID: PMC8026380 DOI: 10.5056/jnm19053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background/Aims S-isomer (S) pantoprazole is more bioavailable and less dependent on cytochrome 2C19 than is racemic pantoprazole. We aim to evaluate the efficacy and safety of 10 mg S-pantoprazole for treatment of non-erosive reflux disease (NERD). Methods In this phase 3, double-blind, randomized placebo controlled, multicenter study, 174 NERD patients were randomized to one of both treatment groups 10 mg S-pantoprazole, or placebo once daily for 4 weeks. Symptoms and safety were assessed. The efficacy endpoints were complete relief of symptoms, > 50% improvement of all reflux symptoms and recurrence. Results Eighty-eight patients were assigned to the S-pantoprazole group (25 males, mean 43.7 years old) and 86 to the placebo group (32 males, mean 43.0 years old), and 163 patients were subjected to full Analysis Set. A higher proportion of patients in the S-pantoprazole group had complete symptom relief (42.0 % [34/81] vs 17.1% [14/82], P < 0.001) and > 50% symptom responses (66.0% vs 50.0%, P = 0.010 for heartburn; 64.2% vs 28.0%, P = 0.010 for acid regurgitation; and 51.9% vs 30.5%, P = 0.03 for epigastric discomfort) compared to the placebo group. The factors associated with poor responsiveness to PPI were older age, female, greater body mass index, and severe baseline symptoms. Conclusions Low dose of S-pantoprazole (10 mg) for 4 weeks was more efficacious than placebo in providing reflux symptom relief in patients with NERD, especially acid regurgitation. More doses or longer periods of treatment with S-pantoprazole would be needed to completely eliminate symptoms.
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Affiliation(s)
- Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University of College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea
| | - Kwang Hyun Ko
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Gyeonggi-do, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Si Hyung Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Hyun SJ, Yoon SH, Kim JH, Oh JK, Lee CH, Shin JJ, Kang J, Ha Y. A Prospective, Multi-Center, Double-Blind, Randomized Study to Evaluate the Efficacy and Safety of the Synthetic Bone Graft Material DBM Gel with rhBMP-2 versus DBM Gel Used during the TLIF Procedure in Patients with Lumbar Disc Disease. J Korean Neurosurg Soc 2021; 64:562-574. [PMID: 33906347 PMCID: PMC8273782 DOI: 10.3340/jkns.2020.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objective This study is to evaluate the efficacy and safety of demineralized bone matrix (DBM) gel versus DBM gel with recombinant human bone morphogenetic protein-2 (rhBMP-2) used in transforaminal lumbar interbody fusion (TLIF).
Methods This study was designed as a prospective, multi-center, double-blind method, randomized study. All randomized subjects underwent TLIF with DBM gel with rhBMP-2 group (40 patients) as an experimental group or DBM gel group (36 patients) as a control group. Post-operative observations were performed at 12, 24, and 48 weeks. The spinal fusion rate on computed tomography scans and X-rays films, Visual analog scale pain scores, Oswestry disability index and SF-36 quality of life (QOL) scores were used for the efficacy evaluation. The incidence rate of adverse device effects (ADEs) and serious adverse device effects (SADEs) were used for safety evaluation.
Results The spinal fusion rate at 12 weeks for the DBM gel with rhBMP-2 group was higher with 73.68% compared to 58.82% for the DBM gel group. The 24 and 48 weeks were 72.22% and 82.86% for the DBM gel with rhBMP-2 group and 78.79% and 78.13%, respectively, for the DBM gel group. However, there were no significant differences between two groups in the spinal fusion rate at 12, 24, and 48 weeks post-treatment (p=0.1817, p=0.5272, p=0.6247). There was no significant difference between the two groups in the incidence rate of ADEs (p=0.3836). For ADEs in the experimental group, ‘Pyrexia’ (5.00%) was the most common ADE, followed by ‘Hypesthesia’, ‘Paresthesia’, ‘Transient peripheral paralysis’, ‘Spondylitis’ and ‘Insomnia’ (2.50%, respectively). ADEs reported in control group included ‘Pyrexia’, ‘Chest discomfort’, ‘Pain’, ‘Osteoarthritis’, ‘Nephropathy toxic’, ‘Neurogenic bladder’, ‘Liver function analyses’ and ‘Urticaria’ (2.86%, respectively). There was no significant difference between the two groups in the incidence rate of SADEs (p=0.6594). For SADE in the experimental group, ‘‘Pyrexia’ and ‘Spondylitis’ were 2.50%. SADE reported in the control group included 'Chest discomfort’, ‘Osteoarthritis’ and ‘Neurogenic bladder’. All SADEs described above were resolved after medical treatment.
Conclusion This study demonstrated that the spinal fusion rates of DBM gel group and DBM gel with rhBMP-2 group were not significantly different. But, this study provides knowledge regarding the earlier postoperative effect of rhBMP-2 containing DBM gel and also supports the idea that the longer term follow-up results are essential to confirm the safety and effectiveness.
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Affiliation(s)
- Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Yongin, Korea
| | - Jiin Kang
- Department of Neurosurgery, Yongin Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Schwitzguebel AJ, Bogoev M, Nikolov V, Ichane F, Lädermann A. Tennis elbow, study protocol for a randomized clinical trial: needling with and without platelet-rich plasma after failure of up-to-date rehabilitation. J Orthop Surg Res 2020; 15:462. [PMID: 33028383 PMCID: PMC7542691 DOI: 10.1186/s13018-020-01998-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. Methods This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0–10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6, and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons. Discussion The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. Trial registration ClinicalTrials.gov NCT03987256. Registered on 20 August 2019.
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Affiliation(s)
- A J Schwitzguebel
- Sports Medicine Division, La Providence Hospital, Fbg de l'Hopital 81, 2000, Neuchâtel, Switzerland.
| | - M Bogoev
- Giant Studio, Rue des Noyers 2, 2000, Neuchâtel, Switzerland
| | - V Nikolov
- Giant Studio, Rue des Noyers 2, 2000, Neuchâtel, Switzerland
| | - F Ichane
- Service Médecine interne, Groupe Hospitalier Est Reunion, 30 rte Nationale 3 - ZAC Madeleine, 186 97470, Saint Benoît, BP, France
| | - A Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211, 14, Geneva, Switzerland
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9
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Yang Y, Lu Y, Zhou D, Pei F, Li Q, Chen S, Wang Q, Wang Y, Jin Z, Liu Y. "Effectiveness of Jinying capsule on pelvic inflammatory disease in patients with symptom pattern of damp and heat accumulation: a double-blinded, multicenter, randomized, placebo-controlled clinical trial". J TRADIT CHIN MED 2020; 40:432-439. [PMID: 32506857 DOI: 10.19852/j.cnki.jtcm.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effectiveness and safety of Jinying capsule on pelvic inflammatory disease (PID) in patients with symptoms identified as the pattern of damp and heat accumulation in terms of Traditional Chinese Medicine (TCM). METHODS We conducted a double-blinded, multicenter, randomized, placebo-controlled clinical trial which included 155 patients diagnosed with PID and identified as symptom pattern of damp and heat accumulation. They were randomly divided into experimental group (n = 78) and control group (n = 77) according to a random number table. The treatment lasted for a period of 28 d. The experimental group was given Jinying capsules and oral levofloxacin plus oral metronidazole for first 7 d. They continued with Jinying capsules and levofloxacin placebo and metronidazole placebo for another 7 d. For the remaining 14 d, they continued with Jinying capsules only. Whereas, the control group was treated with oral levofloxacin and metronidazole and Jinying capsule placebo for the first 14 d in the same way as the experimental group and then continued with Jinying capsule placebo only for the remaining 14 d. The clinical efficacy was assessed using McCormack scale, TCM symptom pattern scores, physicochemical indexes including white blood cell and erythrocyte sedimentation rate, C-reaction protein, smear of vaginal discharge, and pelvic ultrasound. RESULTS Comparing McCormack scale between both groups after treatment, the difference in curative effect between both groups was significant (P = 0.0269). The cure rate of the experimental group and control group is 76.32% and 59.46% respectively at week 4. Comparing TCM symptom pattern scores between both groups before and after treatment, the differences in total effective rate were both significant (P < 0.05). The curative effect rate of experimental group is 2.63% and 13.70% of the control group at week 1 (P = 0.0131), and 73.33% of the experimental group and 56.94% of the control group at week 4 (P = 0.0369). No significant differences were found between the two groups on the Physicochemical indexes (all P > 0.05). No adverse events or reactions occurred in the experimental groups. CONCLUSION Jinying capsule can reduce the dosage of antibiotics needed for PID treatment, and improve the symptoms in PID patients.
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Affiliation(s)
- Yan Yang
- Department of Gynecology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yao Lu
- Department of Clinical Pharmacological Base, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Deping Zhou
- Department of Emergency Gynecology, Chongqing health center for women and children, Chongqing 401147, China
| | - Fenglan Pei
- Department of Obstetrics and Gynecology, Chinese medicine hospital of Handan, Hebei 056000, China
| | - Qin Li
- Department of Gynecology and Reproductive Medicine, The secondary hospital affiliated to Shanxi university of Chinese Medicine, Shanxi 712000, China
| | - Shuqiong Chen
- Department of Gynecology, Hunan Health Center for Women and Children, Changsha 410008, China
| | - Qiufeng Wang
- Department of Obstetrics and Gynecology, Chinese medicine hospital of Luohe, Luohe 462000, China
| | - Yanting Wang
- Department of Obstetrics, People's Hospital of Xinzhou, Xinzhou 034000, China
| | - Zhe Jin
- Department of Gynecology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
| | - Yanxia Liu
- Department of Gynecology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China
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10
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Mori S, Tomita T, Fujimura K, Asano H, Ogawa T, Yamasaki T, Kondo T, Kono T, Tozawa K, Oshima T, Fukui H, Kimura T, Watari J, Miwa H. A Randomized Double-blind Placebo-controlled Trial on the Effect of Magnesium Oxide in Patients With Chronic Constipation. J Neurogastroenterol Motil 2019; 25:563-575. [PMID: 31587548 PMCID: PMC6786451 DOI: 10.5056/jnm18194] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/15/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Magnesium oxide (MgO) has been frequently used as a treatment for chronic constipation (CC) since the 1980s in Japan. The aim of this study is to evaluate its therapeutic effects of MgO in Japanese CC patients. Methods We conducted a randomized, double-blind placebo-controlled study. Thirty-four female patients with mild to moderate constipation were randomly assigned to either placebo (n = 17) or MgO group (n = 17) 0.5 g × 3/day for 28 days. Primary endpoint was overall improvement over the 4-week study period. Secondary endpoints were changes from baseline in spontaneous bowel movement (SBM), response rates of complete spontaneous bowel movement (CSBM), stool form, colonic transit time (CTT), abdominal symptom, and quality of life. Results One patient failed to complete the medication regimen and was omitted from analysis: data from 16 placebo and 17 MgO patients were analyzed. The primary endpoint was met by 25.0% of placebo vs 70.6% of MgO group (P = 0.015). MgO significantly improved SBM changes compared to placebo (P = 0.002). However, MgO did not significantly improved response rates of CSBM compared to placebo (P = 0.76). In addition, MgO significantly improved Bristol stool form scale changes (P < 0.001) and significantly improved CTT compared to the placebo group (P < 0.001). MgO significantly improved the Japanese version of the patient assessment of constipation quality of life (P = 0.003). Conclusion Our placebo-controlled study demonstrated that MgO was effective treatment for improving defecation status and shortened CTT in Japanese CC patients with mild to moderate symptoms.
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Affiliation(s)
- Sumire Mori
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuki Fujimura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Haruki Asano
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomohiro Ogawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahisa Yamasaki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoaki Kono
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Baretić M, Kušec V, Uroić V, Pavlić-Renar I, Altabas V. GLUCAGON-LIKE PEPTIDE-1 AFFECTS TASTE PERCEPTION DIFFERENTLY IN WOMEN: A RANDOMIZED, PLACEBO-CONTROLLED CROSSOVER STUDY. Acta Clin Croat 2019; 58:240-248. [PMID: 31819319 PMCID: PMC6884376 DOI: 10.20471/acc.2019.58.02.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract is an important connector between food intake and body weight, it senses basic tastes in a similar manner as the tongue. The aim of the study was to find out how gut hormone glucagon-like peptide-1 (GLP-1) influences taste preference. Fourteen healthy participants (six male and eight female) were included in this double-blind, placebo-controlled crossover study. After overnight fast and salty fluid (oral sodium load), participants were randomized to receive placebo (500 mL of 0.9% saline) or GLP-1 infusion (1.5 pmol/kg/min) over a 3-hour period. At the end of infusion, participants chose food preferences from illustrations of food types representing 5 tastes. After 7 days, the protocol was repeated, this time those that had received placebo first got GLP-1 infusion, and those having received GLP-1 first got placebo. Change of taste preference after GLP-1 infusion but not after placebo was reported as response, and non-response was reported in case of taste persistence. A statistically significant difference in response type was found between genders, with women being more likely to change their taste preference after GLP-1 than men. The change of taste upon GLP-1 infusion observed in women might be ascribed to estrogen weight-lowering effects accomplished by receptor-mediated delivery.
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Affiliation(s)
| | - Vesna Kušec
- 1Division of Endocrinology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Institute of Laboratory Diagnosis, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nutrition and Dietetics, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Valentina Uroić
- 1Division of Endocrinology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Institute of Laboratory Diagnosis, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nutrition and Dietetics, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Pavlić-Renar
- 1Division of Endocrinology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Institute of Laboratory Diagnosis, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nutrition and Dietetics, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Velimir Altabas
- 1Division of Endocrinology, Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Institute of Laboratory Diagnosis, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nutrition and Dietetics, Zagreb University Hospital Centre, Zagreb, Croatia; 4Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5School of Medicine, University of Zagreb, Zagreb, Croatia
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12
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Hansen JP, Pareek M, Hvolby A, Schmedes A, Toft T, Dahl E, Nielsen CT. Vitamin D3 supplementation and treatment outcomes in patients with depression (D3-vit-dep). BMC Res Notes 2019; 12:203. [PMID: 30944021 PMCID: PMC6446320 DOI: 10.1186/s13104-019-4218-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/19/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To examine whether vitamin D supplementation in patients with depression would result in a reduction in Hamilton D-17 depression score (primary outcome) at 3 and 6 months compared to controls and to explore the correlations between serum vitamin D and symptoms of depression, wellbeing, systolic blood pressure, and waist circumference. In this outpatient multicentre study conducted between 2010 and 2013, patients, 18-65 years old, diagnosed with mild to severe depression were randomly assigned to receive D supplementation 70 micrograms daily or placebo on top of standard treatment. Participants, care givers and those assessing the outcomes were blinded to group assignment. RESULTS At baseline, 23 patients had a normal 25(OH)D level, 22 had insufficiency (< 25 nmol/L), and 17 had deficiency (25-50 nmol/L). No significant reduction in depression was seen after vitamin D supplementation compared to placebo at Hamilton (18.4-18.0; p = 0.73 at 12 weeks). Vitamin D supplementation did not provide a reduction in symptom score among patients with depression. Trial registration The trial was registered in the National Board of Health (EudraCT: 2011-002585-20) and in ClinicalTrials.Gov (NCT01390662).
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Affiliation(s)
- Jens Peter Hansen
- Mental Health Services in Esbjerg, Region of Southern Denmark, Gl. Vardevej 101, DK-6715, Esbjerg N, Denmark. .,The Department of Regional Health Research, University of Southern Denmark, Winsloewparken 19, DK-5000, Odense C, Denmark.
| | - Manan Pareek
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, DK-4300, Holbaek, Denmark
| | - Allan Hvolby
- Mental Health Services in Esbjerg, Region of Southern Denmark, Gl. Vardevej 101, DK-6715, Esbjerg N, Denmark.,The Department of Regional Health Research, University of Southern Denmark, Winsloewparken 19, DK-5000, Odense C, Denmark
| | - Anne Schmedes
- Clinical Chemical Laboratory, Lillebaelt Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark
| | - Tomas Toft
- Mental health Services in Odense, Region of Southern Denmark, J.B. Winsloewsvej, DK-5000, Odense C, Denmark
| | - Erik Dahl
- Mental Health Services in Svendborg, Region of Southern Denmark, Baagoeesvej Alle 25, DK-5700, Svendborg, Denmark
| | - Connie Thurøe Nielsen
- Mental Health Services in Esbjerg, Region of Southern Denmark, Gl. Vardevej 101, DK-6715, Esbjerg N, Denmark.,Mental Health Services in Vejle, Region of Southern Denmark, Nordbanen 5, DK-7100, Vejle, Denmark
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13
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Sotoodehnia M, Farmahini-Farahani M, Safaie A, Rasooli F, Baratloo A. Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial. Korean J Pain 2019; 32:97-104. [PMID: 31091508 PMCID: PMC6549592 DOI: 10.3344/kjp.2019.32.2.97] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.
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Affiliation(s)
- Mehran Sotoodehnia
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Farmahini-Farahani
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Safaie
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rasooli
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Baratloo
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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14
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Joshi ND, Deshpande KS, Roehmer CW, Vyas D. A slight glance at peer review. World J Surg Proced 2018; 8:1-5. [DOI: 10.5412/wjsp.v8.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023] Open
Abstract
In order to ensure that the highest quality of literature is published, most journals utilize a peer review process for manuscripts submitted. Although the primary purpose for this process is to filter out ”bad science”, the process is not perfect. While there is a general consensus among researchers and clinicians that something must be done to improve upon the method for properly vetting manuscripts, there are conflicting opinions on how to best implement new policies. In this paper, we discuss the most well-supported suggestions to improve the process, with the hopes of increasing rigor and reproducibility, ensuring double-blinding, developing set guidelines, offering early training to reviewers, and giving reviewers better feedback and recognition for their work.
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Affiliation(s)
- Neil D Joshi
- Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI 48824, United States
| | - Kaivalya S Deshpande
- Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI 48824, United States
| | - Christian W Roehmer
- Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI 48824, United States
| | - Dinesh Vyas
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, United States
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15
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Bogers JPAM, Schulte PFJ, Broekman TG, Moleman P, de Haan L. Dose reduction of high-dose first-generation antipsychotics or switch to ziprasidone in long-stay patients with schizophrenia: A 1-year double-blind randomized clinical trial. Eur Neuropsychopharmacol 2018; 28:1024-1034. [PMID: 30025751 DOI: 10.1016/j.euroneuro.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022]
Abstract
Long-stay patients with severe schizophrenia are frequently treated with high doses of first-generation antipsychotics (FGA). Dose reduction or switching to ziprasidone may reduce the severity of negative symptoms and side effects. We investigated in a randomized double-blind trial whether a dose-reduction strategy to achieve an adequate dose of a FGA (5 mg/day haloperidol equivalents, n = 24) or switching to ziprasidone (160 mg/day, n = 24) in treatment resistant patients would decrease negative symptoms after 1 year of treatment. We found that negative symptoms did not change significantly in either condition. Positive symptoms, excited symptoms, and emotional distress worsened over time with ziprasidone, resulting in a significant difference between conditions in favour of FGA dose reduction. Relapse and treatment failure, defined as a prolonged or repeated relapse, occurred more often with ziprasidone than with FGA (45.8% versus 20.8%, and 25.0% versus 16.7%, respectively). Treatment with ziprasidone was superior for extrapyramidal symptoms. Our study establishes that lowering high FGA doses to an equivalent of 5 mg/day haloperidol or switching to ziprasidone is feasible in the vast majority of patients but does not improve negative or other symptoms. Neither FGA dose reduction nor switching to ziprasidone is an adequate alternative to clozapine for long-stay patients with severe treatment resistant schizophrenia.
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Affiliation(s)
- Jan P A M Bogers
- High Care Clinics, Mental Health Services Rivierduinen, Valklaan 3, Oegstgeest, 2342EB Leiden, The Netherlands.
| | - Peter F J Schulte
- Mental Health Services North-Holland North, Alkmaar, The Netherlands
| | | | - Peter Moleman
- Moleman Research and formerly Radboud University, Nijmegen, The Netherlands
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16
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Takakura N, Takayama M, Nasu M, Nishiwaki M, Kawase A, Yajima H. Patient blinding with blunt tip placebo acupuncture needles: comparison between 1 mm and 2 mm skin press. J Integr Med 2018; 16:164-171. [PMID: 29753429 DOI: 10.1016/j.joim.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/05/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate the influence of the depth of skin press in blunt tip placebo acupuncture needles on patient blinding and its relationship to needle diameter. METHODS Forty healthy volunteers were enrolled as subjects for patient blinding. Four acupuncturists applied the following needles randomly at three points in each forearm: 0.18 mm and 0.25 mm diameter penetrating needles inserted to a depth of 5 mm, and 0.18 mm and 0.25 mm diameter skin-touch needles depressing the skin at the acupoint to a depth of 1 mm and 2 mm from the skin surface. The subjects reported their guesses at the nature of needles they received, and rated needle pain and de qi. A blinding index was calculated to define the success of blinding for subjects. RESULTS The blinding status of subjects for 1 mm press needles of 0.18 mm diameter was "random guess", but "unblinded" for 1 mm press needles of 0.25 mm diameter. For 2 mm press needles of both diameters, the blinding status was "opposite guess" and the blinding status for penetrating needles of both diameters was "unblinded." The percentages of "felt pain" with 2 mm press needles of both diameters were similar to that with penetrating needles, but those were not similar for 1 mm press needles. The frequency of de qi occurrence with 2 mm press needles of 0.18 mm diameter was similar to that of penetrating needles of both diameters. CONCLUSION Placebo needles of 2 mm press made more subjects guess that the needles penetrated the skin than 1 mm press needles. The use of small diameter needles increased patient blinding.
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Affiliation(s)
- Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan.
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
| | - Morihiro Nasu
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Masako Nishiwaki
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan
| | - Akiko Kawase
- Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; Department of Physiology, Showa University School of Medicine, Tokyo 142-8555, Japan; Japan School of Acupuncture, Moxibustion and Physiotherapy, Tokyo 150-0031, Japan
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17
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Hajmohammadi Z, Heydari M, Nimrouzi M, Faridi P, Zibaeenezhad MJ, Omrani GR, Shams M. Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: a double-blind placebo-controlled randomized clinical trial. J Integr Med 2018; 16:45-50. [PMID: 29397092 DOI: 10.1016/j.joim.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/20/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lipid-lowering effect of Rhus coriaria L. (Rhus) has been investigated in multiple animal studies with promising results. Nonetheless, its clinical efficacy has not been adequately examined. OBJECTIVE The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyperlipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks. MAIN OUTCOME MEASURES The serum lipid levels, apolipoprotein-A1 (Apo-A1) and apolipoprotein-B (Apo-B) were measured. RESULTS Mean serum high-density lipoprotein cholesterol (HDL-C) and Apo-A1 levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention (P = 0.001). The analysis of covariance test including age, gender, body mass index (BMI), and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipoprotein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients (BMI ≥ 30 kg/m2). CONCLUSION The study showed significant increases in HDL-C and Apo-A1 levels in response to Rhus supplementation in patients with hyperlipidemia. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02295293.
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Toniolo RA, Silva M, Fernandes FDBF, Amaral JADMS, Dias RDS, Lafer B. A randomized, double-blind, placebo-controlled, proof-of-concept trial of creatine monohydrate as adjunctive treatment for bipolar depression. J Neural Transm (Vienna) 2017; 125:247-257. [PMID: 29177955 PMCID: PMC5775367 DOI: 10.1007/s00702-017-1817-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/19/2017] [Indexed: 11/14/2022]
Abstract
Depressive episodes are a major cause of morbidity and dysfunction in individuals suffering from bipolar disorder. Currently available treatments for this condition have limited efficacy and new therapeutic options are needed. Extensive research in the pathophysiology of bipolar disorder points to the existence of mitochondrial and bioenergetic dysfunction. We hypothesized that creatine monohydrate, a nutraceutical that works as a mitochondrial modulator, would be effective as an adjunctive therapy for bipolar depression. We conducted a double-blind trial in which 35 patients with bipolar disorder type I or II in a depressive episode by DSM-IV criteria and in use of regular medication for the treatment of this phase of the disease were randomly allocated into two adjunctive treatment groups for 6 weeks: creatine monohydrate 6 g daily (N = 17) or placebo (N = 18). Primary efficacy was assessed by the change in the Montgomery–Åsberg Depression Rating Scale (MADRS). We did not find a statistically significant difference in the comparison between groups for the change in score on the MADRS after 6 weeks in an intention-to-treat (ITT) analysis (p = 0.560; Cohen’s d = 0.231). However, we found significant superiority of creatine add-on vs. placebo when we considered the remission criterion of a MADRS score ≤ 12 at week 6 analyzing the outcome of the 35 randomized patients on ITT (52.9% remission in the creatine group vs. 11.1% remission in the placebo group) and of the 23 completers (66.7% remission in the creatine group vs. 18.2% remission in the placebo group) (p = 0.012; OR = 9.0 and p = 0.036; OR = 9.0, respectively). Two patients who received creatine switched to hypomania/mania early in the trial. No clinically relevant physical side-effects were reported or observed. This proof-of-concept study, aiming to restore brain bioenergetics using an adjunctive mitochondrial modulator, is not conclusive on the efficacy of creatine add-on for bipolar depression, but suggests that this compound may have a role in the adjunctive treatment of this phase of the illness. Further investigation through randomized controlled trials with larger samples should be conducted to verify the efficacy of creatine supplementation for bipolar depression and also for subsyndromal depressive symptoms.
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Affiliation(s)
- Ricardo Alexandre Toniolo
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil.
| | - Michelle Silva
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil
| | - Francy de Brito Ferreira Fernandes
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil
| | - José Antonio de Mello Siqueira Amaral
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil
| | - Rodrigo da Silva Dias
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-010, Brazil
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Manouilenko I, Humble MB, Georgieva J, Bejerot S. Brainstem Auditory Evoked Potentials for diagnosing Autism Spectrum Disorder, ADHD and Schizophrenia Spectrum Disorders in adults. A blinded study. Psychiatry Res 2017; 257:21-26. [PMID: 28710948 DOI: 10.1016/j.psychres.2017.06.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to examine the clinical utility of complex auditory brainstem response (c-ABR) and investigate if c-ABR is helpful in the diagnostic procedure. Thirty-one adult psychiatric patients, thoroughly diagnosed with autism spectrum disorder (ASD) (n=16), ADHD (n=8), or schizophrenia spectrum disorder (SSD) (n=7) and 15 healthy controls (HC), were blindly assessed with SensoDetect BERA. This c-ABR correctly identified psychiatric diagnoses in 4 patients (13%) and provided partially correct diagnoses in 11 more patients. Of the 15 HC, 6 were misclassified as psychiatric patients. The Cohen´s kappa coefficient (κ) was substantial for HC (κ=0.67), fair for SSD (κ=0.37), slight for ADHD (κ=0.09) and without agreement in ASD (κ=-0.03). In conclusion, we found the c-ABR method unhelpful and unreliable as a tool in clinical diagnostics.
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Affiliation(s)
- Irina Manouilenko
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Järva psychiatric out-patient clinic, Praktikertjänst AB, Stockholm, Sweden
| | - Mats B Humble
- School of Medical Sciences, Örebro University, Örebro, SE-70182 Örebro, Sweden; University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Jeanette Georgieva
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Bejerot
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, SE-70182 Örebro, Sweden; University Health Care Research Centre, Örebro University, Örebro, Sweden.
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Moreira DM, Andriole GL, Nickel JC, Roehrborn CG, Castro-Santamaria R, Freedland SJ. Dutasteride is associated with reduced risk of transrectal prostate biopsy-associated urinary tract infection and related hospitalizations. World J Urol 2017; 35:1525-30. [PMID: 28396999 DOI: 10.1007/s00345-017-2036-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate whether the use of dutasteride is associated with a lower risk of transrectal prostate biopsy-associated urinary tract infection (TPBA-UTI) among men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study. METHODS Retrospective analysis of 6045 men undergoing 2-year repeat prostate biopsy in REDUCE. Participants were randomized to receive dutasteride 0.5 mg or placebo daily. TPBA-UTI was defined as the presence of urinary symptoms and the prescription of antibiotics by the treating physician within 30 days after biopsy. Severe TPBA-UTI was defined as TPBA-UTI requiring hospitalization. Comparison of TPBA-UTI between treatment arms was done using Chi-square test and logistic regression adjusting for participant characteristics. RESULTS Of the subjects included in the study, 3067 (50.7%) were randomized to the placebo arm and 2978 (49.3%) to the dutasteride arm. A total 51 (0.8%) men had TPBA-UTI, including 38 (1.2%) in the placebo arm and 13 (0.4%) in the dutasteride arm (univariable relative risk [RR] = 0.35, P = 0.001; multivariable odds ratio [OR] = 0.34, P = 0.003). The number needed to treat (NNT) to prevent one TPBA-UTI was 125 subjects. Of these, 14 (28%) had severe TPBA-UTI, including 12 (0.4%) in the placebo arm and only 2 (0.07%) in the dutasteride arm (univariable RR = 0.17, P = 0.021; multivariable OR = 0.17, P = 0.031). The NNT to prevent one severe TPBA-UTI was 309 subjects. CONCLUSION Among men undergoing a 2-year repeat prostate biopsy, the use of dutasteride for 2 years was associated with a reduced the risk of overall and severe TBPA-UTI. CLINICALTRIALS. GOV IDENTIFIER NCT00056407.
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Suzuki Y, Iida M, Ito H, Saida I, Hibi T. Efficacy and safety of two pH-dependent-release mesalamine doses in moderately active ulcerative colitis: a multicenter, randomized, double-blind, parallel-group study. Intest Res 2016; 14:50-9. [PMID: 26884735 PMCID: PMC4754523 DOI: 10.5217/ir.2016.14.1.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS The therapeutic effect of mesalamine is considered to be dose-dependent; however, no consensus has been reached regarding the optimal doses for individual patients. This study aimed to provide new insight for dose optimization using two doses of pH-dependent release mesalamine for induction of remission of moderately active ulcerative colitis (UC). METHODS In a multicenter, double-blind, randomized study, 110 patients with moderately active UC were assigned to two groups after treatment with a constant dose of mesalamine. Fifty-five patients were treated with a pH-dependent release formulation of 3.6 or 4.8 g/day for 8 weeks. The primary endpoint was a decrease in the UC disease activity index (UCDAI) adjusted by covariates. RESULTS In the full analysis set (n=110), the mean decrease in UCDAI was 3.1 in the 3.6 g/day group and 3.4 in the 4.8 g/day group (P>0.05). In a subgroup analysis, the effectiveness of the 4.8 g/day dose was greater in particular populations, such as those who had been previously treated with a lower dose of mesalamine and those with more severe disease. The safety was comparable between the two groups. CONCLUSIONS The results suggest that treatment with pH-dependent release mesalamine at either 3.6 or 4.8 g/day was effective and safe for the induction of remission in patients with moderately active UC. However, the patients receiving mesalamine at 2.4 g/day but in whom the therapeutic effect is not sufficient and having more severe symptoms (UCDAI 9-10), benefit from higher doses of mesalamine compared to others.
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Affiliation(s)
- Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Mitsuo Iida
- Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | | | - Isamu Saida
- Zeria Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Toshifumi Hibi
- Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
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Khetarpal R, Chatrath V, Kaur J, Bala A, Singh H. Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries. Anesth Essays Res 2016; 10:425-431. [PMID: 27746527 PMCID: PMC5062227 DOI: 10.4103/0259-1162.176411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics. Aim: This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia. Settings and Design: Randomized double-blind study. Materials and Methods: One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose. Statistical Analysis: Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test. Results: A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II. Conclusion: RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.
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Affiliation(s)
- Ranjana Khetarpal
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Veena Chatrath
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Jagjit Kaur
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Anju Bala
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
| | - Harjeet Singh
- Department of Anaesthesia and Critical Care, Government Medical College, Amritsar, Punjab, India
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MacIntyre NJ, Negm A, Loyola-Sánchez A, Bhandari M. Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials. World J Meta-Anal 2014; 2:78-90. [DOI: 10.13105/wjma.v2.i3.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/01/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis (OA).
METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases (MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared to sham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.
RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials (281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference (SMD) (95%CI) = -0.39 (-0.70, -0.08); P = 0.01] but not physical function [self-reported in 3 trials (130 participants/OA knees): SMD (95%CI) = -0.21 (-0.55, 0.14), P = 0.24; walking performance in 4 trials (130 participants/OA knees): SMD (95%CI) = -0.11 (-0.59, 0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error (χ2 = 8.37, P = 0.04, I² = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency (I2 = 28%) but the treatment effect remained insignificant.
CONCLUSION: Meta-analyzed double-blind placebo-controlled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.
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Järvinen TL, Sihvonen R, Bhandari M, Sprague S, Malmivaara A, Paavola M, Schünemann HJ, Guyatt GH. Blinded interpretation of study results can feasibly and effectively diminish interpretation bias. J Clin Epidemiol 2014; 67:769-72. [PMID: 24560088 DOI: 10.1016/j.jclinepi.2013.11.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Controversial and misleading interpretation of data from randomized trials is common. How to avoid misleading interpretation has received little attention. Herein, we describe two applications of an approach that involves blinded interpretation of the results by study investigators. STUDY DESIGN AND SETTINGS The approach involves developing two interpretations of the results on the basis of a blinded review of the primary outcome data (experimental treatment A compared with control treatment B). One interpretation assumes that A is the experimental intervention and another assumes that A is the control. After agreeing that there will be no further changes, the investigators record their decisions and sign the resulting document. The randomization code is then broken, the correct interpretation chosen, and the manuscript finalized. Review of the document by an external authority before finalization can provide another safeguard against interpretation bias. RESULTS We found the blinded preparation of a summary of data interpretation described in this article practical, efficient, and useful. CONCLUSIONS Blinded data interpretation may decrease the frequency of misleading data interpretation. Widespread adoption of blinded data interpretation would be greatly facilitated were it added to the minimum set of recommendations outlining proper conduct of randomized controlled trials (eg, the Consolidated Standards of Reporting Trials statement).
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Lee JE, Han DH, Won TB, Rhee CS. A Randomized, Double-blinded, Open Label Study of the Efficacy and Safety of Cefcapene Pivoxil and Amoxicillin·Clavulanate in Acute Presumed Bacterial Rhinosinusitis. Clin Exp Otorhinolaryngol 2011; 4:83-7. [PMID: 21716955 DOI: 10.3342/ceo.2011.4.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/27/2011] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Currently established first line therapy of acute (presumed bacterial) rhinosinusitis (ARS) consists of 10 to 14 days of oral amoxicillin or cephalosporins. This study compared the clinical efficacy and tolerance of cefcapene pivoxil (CP) and amoxicillin-clavulanate (AMC) in patients with ARS. METHODS A randomized, open labeled, double-blinded trial of ARS patients over 15 years of age was performed. Patients diagnosed with ARS received paranasal sinus X-rays and nasal endoscopies and 2 weeks of either CP (150 mg, 3 times/ day) or AMC (625 mg, amoxicillin 500 mg, 3 times/day). All patients revisited the clinic on days 7, 14, and 28 for evaluation of changes in symptoms, endoscopy, and monitoring of any adverse reactions. Demographics, clinical characteristics and drug efficacy were also compared between the two groups. RESULTS Among the 60 initially enrolled patients (CP 30, AMC 30), 5 patients in the CP group and 6 in the AMC group were excluded due to poor compliance. There were no significant differences in demographic data including age, sex, initial signs and symptoms, endoscopic and X-ray findings between the two groups. Rates of improvement after 2 weeks were 96% and 95.8% in the CP and AMC group, respectively. Sinus symptoms were changed significantly after 2 and 4 weeks, however, there was no difference between groups (P=0.41). The most common adverse reaction was gastrointestinal complication, diarrhea occurred in 1 patient in the CP group and 6 in the AMC group (P=0.04). CONCLUSION CP and AMC were both effective in treating ARS. The difference of treatment outcome was not found between the two groups, however, gastrointestinal complications were less prevalent in the CP group.
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