Inhibitory effect of sulindac against chemically induced primary colonic tumours by N methyl N nitrosourea in mice

AIM To investigate the chemopreventive effect of sulindac, one of the nonstroidal anti inflammatory drugs (NSAIDs), on the growth of N methyl N nitrosourea (MNU) induced mouse colonic tumors.

Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications

AIM:To evaluate an evidence-based educational program for improving strategies for prevention of non-steroidal anti-inflammatory drug(NSAID)-associated gastrointestinal(GI)complications. METHODS:Four hundred and fifty-six specialists replied to a questionnaire that covered issues related to NSAID-induced adverse effects.They also collected data from their last five consecutive patients before and after they had attended an evidence-based seminar on GI prevention strategies. RESULTS:Four hundred and forty-one of 456 specialists(96.7%)participated in the survey,and 382(83.7%)in the education-based study that recorded data from 3728 patients.The specialists overestimated the risk of GI complications with NSAIDs,underestimated the GI safety profile of coxibs,but were aware of the risk factors and of the current prevention strategies.Proton pump inhibitors were co-prescribed with NSAIDs in>80% of patients with and without risk factors.The educational program had little impact on prescribing habits.CONCLUSION:Specialists are informed of advances in NSAID-associated adverse effects and have high rates of GI-prevention therapy.Our educational program did not alter these rates.

Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

AIM： TO establish the prevalence of He/icobacterpy/on （H. pylori） infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs （NSAIDs）.METHODS： A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease （CLO） test, his- tological examination, and bacterial culture. TgG anti- CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.RESULTS： Eighty patients, 61 males （76.3%）, mean age 61.2 ~ 15.9 years, were consecutively enrolled. Forty-seven （58.8%） patients occasionally consumed NSAIDs, while 33 （41.3%） were on chronic treatment with low-dose aspirin （LD ASA）. Forty-four （55.0%） patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The high- est accuracy （92.5%） was obtained with the culture of biopsy specimens.CONCLUSION： Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

Therapeutic massage for knee osteoarthritis:a systematic review and meta-analysis of randomized controlled trials

Objective:To evaluate the effectiveness of therapeutic massage(tuina)for treating knee osteoarthritis(KOA).Methods:Six English and Chinese databases,including Chinese National Knowledge Infrastructure(CNKI),Wanfang Academic Journal Full-text Database(Wanfang),Chongqing VIP Database(CQV1P),China Biology Medicine Disc(CBM),Cochrane Library and PubMed databases,were independently searched to identify appropriate randomized controlled trials(RCTs)studying therapeutic massage for KOA compared to oral non-steroidal anti-inflammatory drugs(NSAlDs)alone.The main outcome measures were total effectiveness and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score.Results:A total of 8 RCTs were included and they were of average quality.The results showed that therapeutic massage was more effective than NSAlDs comparing total effectiveness[risk ratio(RR)=1.14,95%confidence interval(CI)(1.07,1.21),P<0.0001];compared with NSAlDs,therapeutic massage produced more significant improvements in pain[mean difference(MD)=-2.06,95%CI(-2.75,-1.36),P<0.00001],stiffness intensity[MD=-0.90,95%CI(-1.05,-0.75),P<0.00001]and joint function[MD=-12.48/95%CI(-13.91,-11.05),P<0.00001].Con elusion:Therapeutic massage was more effective than oral NSAlDs in treati ng KOA.In relieving pain and stiffness and improving the function of knee joint,therapeutic massage was superior to NSAIDs.