The BEST-CLI trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease and is associated with a significant risk of limb loss. It is currently treated with limb revascularization by a variety of specialists. Although both open vascular bypass and endovascular therapy are offered to patients with infrainguinal peripheral arterial disease and CLI, significant disagreement exists as to which therapy works best in candidates for both types of intervention. Persistent clinical equipoise in combination with a paucity of comparative effectiveness data to guide treatment of CLI has led to a multidisciplinary effort to organize the Best Endovascular versus Best Surgical Therapy in patients with CLI (BEST-CLI) trial. The BEST-CLI trial is a pragmatic, multicenter, open label, randomized trial that compares best endovascular therapy with best open surgical treatment in patients eligible for both treatments. This trial is highly innovative in both its design and its collaborative nature. BEST-CLI aims to provide urgently needed clinical guidance for CLI management by using (1) a pragmatic design comparing the effectiveness of established techniques while allowing for the introduction of newer therapies as they become available; (2) a novel primary end point that includes limb amputation rates, repeat intervention, and mortality; (3) a multidisciplinary structure that fosters cooperation among interventional cardiologists, interventional radiologists, vascular surgeons, and vascular medicine specialists; and (4) novel techniques to evaluate the cost-effectiveness and quality-of-life outcomes of the 2 treatment strategies being tested.

The interventional relationship between frequent fish consumption and depression symptoms in aging adults: a randomized controlled trial

OBJECTIVE

The present investigation was intended to test the hypothesis that the elderly provided with the frequent consumption of fishes marinated in essential oil of Perilla frutescens (EOPF) or not would experience fewer depressive symptoms after 6 months.

METHODS

A total of 180 participants were recruited from Sina Hospital, Mashhad, Iran, who were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision and Beck Depression Inventory. Participants (n = 180) were randomly assigned in a 1:1:1 ratio to Groups A, B, and C. The last two were provided with an instruction to consume Caspian white fish marinated in the presence or absence of EOPF (434 g each week or four meals per week). Group A served as the control with the common diet. The outcome measures were performed using the Beck Depression Inventory and the General Health Questionnaire.

RESULTS

There were no statistically significant differences in depressive symptom scores between groups with frequent fish consumption as compared with the control (p > 0.05). Yet adjustment for covariates showed that there was a significant reduction in depression among them (p < 0.05). Moreover, consumption of fish and EOPF was associated with more considerable improvements than Groups A and B (p < 0.05).

CONCLUSIONS

It could be concluded that high intakes of unsaturated fatty acids can afford to diminish likelihood of late-life depression. Copyright © 2017 John Wiley & Sons, Ltd.

The effect of acupressure at the Sanyinjiao point (SP6) on primary dysmenorrhea in students resident in dormitories of Tabriz

BACKGROUND

There are two types of primary dysmenorrhea (spasmodic and congestive) which differ from each other in terms of the occurrence time in menstrual cycle, pain quality and other symptoms. The present study aimed to determine the effect of acupressure at the Sanyinjiao point (SP-6) on severity of menstrual symptoms (primary outcome) and the duration of resting time as well as the number of ibuprofen consumption (secondary outcome) in the two types of primary dysmenorrhea.

METHODS

This was a clustered randomized controlled trial on 72 eligible students residing in dormitories of public universities of Tabriz, Iran. Determining the type of primary dysmenorrhea using a Menstrual symptoms questionnaire (MSQ), 36 participants which suffered from each type of dysmenorrhea were enrolled from the four dormitories. The dormitories were randomly divided into intervention and control groups. No intervention was carried out at the first cycle. During the two next cycles, Sanyinjiao point of the subjects in the intervention group was pressed for twenty minutes at the time of pain. The subjects in both groups were allowed to consume ibuprofen, if needed. During these three cycles, the participants recorded and reported menstrual symptoms severity, duration of resting time and the number of the used ibuprofen.

RESULTS

The severity of menstrual symptoms and duration of resting time in the 2(nd) and 3(rd) cycles were significantly reduced more than control groups for both spasmodic and congestive types of primary dysmenorrhea. In addition, the aver-age numbers of ibuprofen pills taken by both intervention groups was significantly less than the control groups. There was no significant difference between the two intervention groups in terms of any of the outcomes.

CONCLUSIONS

Acupressure is effective on lowering the symptoms of dysmenorrhea and duration of resting time almost equally in both spasmodic and congestive types. Therefore, using this method either alone or along with other methods is recommended to treat dysmenorrhea.