观察依达拉奉注射液治疗急性脑梗死的疗效

目的对依达拉奉治疗急性脑梗死的疗效和安全性进行评价。方法将67例急性脑梗死的患者随机分成治疗组(34例)和对照组(33例),两组患者在同时使用阿司匹林和维脑路通进行基础治疗的前提下,治疗组静脉注射依达拉奉进行治疗,对照组患者使用等量的安慰剂进行静脉注射,两组患者每次注射药剂为30mL,每日注射2次,7d为1个疗程,共治疗2个疗程。在患者治疗前后,对患者的日常生活能力和神经功能缺损情况进行评分判定。结果经过3个疗程的治疗后,治疗组患者的和对照组患者日常生活能力取得有效改善的有效率分别为62.1%和34.5%;治疗组患者和对照组患者神经功能缺损情况的发生率为3.4%和3.1%,两组患者的治疗效果有差异具有统计学意义,神经缺损情况差异无统计学意义。结论依达拉奉静脉滴注对于急性脑梗死患者的治疗效果较好。

Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.

A randomized,double-blind,placebo-controlled trial assessing the efficacy and safety of tegaserod in patients from China with chronic constipation

AIM： To evaluate the efficacy and safety of tegaserod, 6 mg twice daily （b.i.d.）, in men and women with chronic constipation （CC） from China. METHODS： This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatmentfree baseline period, patients were randomized to receive either tegaserod （6 mg b.i.d.） or placebo （b.i.d.） for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements （CSBMs） during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients＇ daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events （AEs）. RESULTS： A total of 607 patients were randomized to receive either tegaserod （n = 304） or placebo （n = 303）. Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo （1.39 vs 0.91, P = 0.0002）. A statistically significant difference in favor of tegaserod was also observed for a mean increase ≥ 1 CSBM/wk over wk 1-4 （47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018） and for the absolute number of≥ 3 CSBMs/wk over wk 1-4 （25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021）. Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod （3.6%） compared with placebo （1.7%）. CONCLUSION： Tecjaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.

Present and future of prophylactic antibiotics for severe acute pancreatitis

AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and metaanalyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR ) = 1.01, P = 0.98]. Funnel plot indi-cated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction:A systematic review and meta-analysis

AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated. RESULTS:Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI:0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI:0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI:0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI:0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI:0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13). CONCLUSION:SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.

Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis

AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profi le.

Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?

The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.

Laparoscopic distal pancreatectomy is as safe and feasible as open procedure:A meta-analysis

AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane Central Register of Controlled Trials,Web of Science and BIOSIS Previews.Articles should contain quantitative data of the comparison of LDP and ODP.Each article was reviewed by two authors.Indices of operative time,spleen-preserving rate,time to fluid intake,ratio of malignant tumors,postoperative hospital stay,incidence rate of pancreatic fistula and overall morbidity rate were analyzed.RESULTS:Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria.LDP was performed in 501(37.4%) patients,while ODP was performed in 840(62.6%) patients.There were significant differences in the operative time,time to fluid intake,postoperative hospital stay and spleen-preserving rate between LDP and ODP.There was no difference between the two groups in pancreatic fistula rate [random effects model,risk ratio(RR) 0.996(0.663,1.494),P = 0.983,I2 = 28.4%] and overall morbidity rate [random effects model,RR 0.81(0.596,1.101),P = 0.178,I2 = 55.6%].CONCLUSION:LDP has the advantages of shorter hospital stay and operative time,more rapid recovery and higher spleen-preserving rate as compared with ODP.

Management of liver cirrhosis between primary care and specialists

This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: "ascites", "liver fibrosis", "cirrhosis", "chronic hepatitis", "chronic liver disease", "decompensated cirrhosis", "hepatic encephalopathy", "hypertransaminasemia", "liver transplantation" and "portal hypertension". Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.

Three initial diets for management of mild acute pancreatitis:A meta-analysis

AIM:To compare non-liquid and clear-liquid diets,and to assess whether the latter is the optimal treatment for mild acute pancreatitis.METHODS:The Cochrane Library,PUBMED,EMBASE,EBM review databases,Science Citation Index Expanded,and several Chinese databases were searched up to March 2011.Randomized controlled trials(RCTs) that compared non-liquid with clear-liquid diets in patients with mild acute pancreatitis were included.A meta-analysis was performed using available evidence from RCTs.RESULTS:Three RCTs of adequate quality involving a total of 362 participants were included in the final analysis.Compared to liquid diet,non-liquid diet significantly decreased the length of hospitalization [mean difference(MD):1.18,95% CI:0.82-1.55;P﹤0.00001] and total length of hospitalization(MD:1.31,95% CI:0.45-2.17;P = 0.003).The subgroup analysis showed solid diet was more favorable than clear liquid diet in the length of hospitalization,with a pooled MD being-1.05(95% CI:-1.43 to-0.66;P﹤0.00001).However,compared with clear liquid diet,both soft and solid diets did not show any significant differences for recurrence of pain after re-feeding,either alone [relative risk(RR):0.95;95% CI:0.51-1.87;P = 0.88] and(RR:1.22;95% CI:0.69-2.16;P = 0.49),respectively,or analyzed together as non-liquid diet(RR:0.80;95% CI:0.47-1.36;P = 0.41).CONCLUSION:The non-liquid soft or solid diet did not increase pain recurrence after re-feeding,compared with the clear-liquid diet.The non-liquid diet reduced hospitalization.

A meta-analysis of tight versus conventional glycemia control in critically ill brain-injured adults

Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.

Andropause and the development of cardiovascular disease presentationmore than an epi-phenomenon

Andropause refers to a generalized decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and aging men. This decline in hormones has been associated with changes such as depression, loss of libido, sexual dysfunction, and changes in body composition. Aging has been associated with an abundance of concomitant diseases, in particular cardiovascular diseases, and although andropause is correlated to aging, a causal relationship between reduction of androgens and the development of chronic diseases such as atherosclerosis and heart failure has not been convincingly established yet. On the other hand, increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease. Whether hormone replacement therapy that is used for andropausal men to alleviate symptoms of ＂male menopause＂ can halt progression of cardiovascular disease, remains controversially discussed, primarily due to the lack of well-designed, randomized controlled trials. At least for symptom improvement, the use of androgen replacement therapy in andropausal men may be clinically indicated, and with the appropriate supervision and follow up may prove to be beneficial with regard to preservation of the integrity of cardiovascular health at higher ages.

A multi-center randomized controlled clinical trial of three-step acupuncture and cupping therapy for cervicogenic headache

Objective:To assess the clinical efficacy and safety of three-step acupuncture and cupping therapy for cervicogenic headache(CEH).Methods:A randomized,single-blind,multi-center,parallel controlled clinical trial was performed,including 63 patients with CEH who met the study criteria.They were randomly divided into treatment(n=32)and control groups(n=31).The treatment group was treated with three-step acupuncture and cupping therapy,and the control group was treated with sham acupuncture.The simplified McGill pain scores,comprising three parts:the pain rating index,visual analogue scale score,and present pain intensity,alongside head and neck stiffness and cervical vertebra range of motion,and a safety evaluation were recorded in the two groups before treatment,immediately after the first treatment,after 10 days of treatment,after 20 days of treatment,and 3 months after the end of treatment.Results:Compared with before treatment,the scores at each follow-up time point were significantly improved after treatment;moreover,the treatment group was significantly better than the control group.When the scores at the 3 months follow-up after the end of the treatment were compared with the scores after 20 days of treatment,there were no significant differences in the treatment group while significant differences from the scores of the control group,suggesting that the treatment group had better long-term benefits than the control group.Conclusion:Compared with the sham acupuncture group,the three-step acupuncture and cupping method has a beneficial effect in the treatment of CEH.It provides rapid benefits,has better short-and long-term efficacy than sham acupuncture,and is associated with a low recurrence rate.

Short- and Long-term Therapeutic Efficacies of Intravenous Transplantation of Bone Marrow Stem Cells on Cardiac Function in Rats with Acute Myocardial Infarction:A Meta-analysis of Randomized Controlled Trials

Objective To investigate the short- and long-term therapeutic efficacies of intravenous transplantation of bone marrow stem cells(MSCs) in rats with experimental myocardial infarction by metaanalysis.Methods Randomized controlled trials were systematically searched from Pub Med,Science Citation Index(SCI),Chinese journal full-text database(CJFD) up to December 2014.While the experimental groups(MSCs groups) were injected MSCs intravenously,the control groups were injected Delubecco's minimum essential medium(DMEM) or phosphate buffered saline(PBS).Subgroup analysis for each outcome measure was performed for the observing time point after the transplantation of MSCs.Weighted mean differences(WMD) and 95% confidence intervals(CI) were calculated for outcome parameters including ejection fraction(EF) and fractional shortening(FS),which were measured by echocardiogram after intravenous injection and analyzed by Rev Man 5.2 and STATA 12.0.Results Data from 9 studies(190 rats) were included in the meta-analysis.As compared to the control groups,the cardiac function of the experimental groups were not improved at day 7(EF:WMD=0.08,95%CI-1.32 to 1.16,P>0.01; FS:WMD=-0.12,95%CI-0.90 to 0.65,P>0.01) until at day 14 after MSCs' transplantation(EF:WMD=10.79,95%CI 9.16 to 12.42,P<0.01; FS:WMD=11.34,95%CI 10.44 to 12.23,P<0.01),and it lasted 4 weeks or more after transplantation of MSCs(EF:WMD=13.94,95%CI 12.24 to 15.64,P<0.01; FS:WMD=9.64,95%CI 7.98 to 11.31,P<0.01).Conclusion The therapeutic efficacies of MSCs in rats with myocardid infarction become increasing apparent as time advances since 2 weeks after injection.

Short- and long-term effect of complete versus culprit-only revascularization in patients undergoing primary PCI for multivessel disease： a meta-analysis

Objective The optimal strategy during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction and multivessel disease is still controversial. Therefore, the aim of our study is to evaluate the short- and long-term effect of complete revas- cularization （CR） versus infarct-related artery revascularization （IR） following primary PCI. Methods We identified randomized controlled studies （RCTs） by systematic search of PubMed, EMBASE, Web of Science, ClinicalTrials.gov Website, Cochrane Library and Google scholar Database. Primary outcome was major adverse cardiac events （MACE）. Result Nine RCTs （2198 patients） with mean follow-up of 21.1 months were retrieved. Overall, CR was associated with significantly lower risk of MACE compared with IR therapy when followed by long-term duration （≥ 12 months） （RR： 0.56; 95% Ch 0.47-0.68; I^2 = 58.5%）. Additionally, CR was associated with equivalent rates of all-cause mortality （RR： 0.76; 95% CI： 0.53-1.08; I^2= 0.0%） and myocardial infarction （RR： 0.81; 95% CI： 0.57-1.16; I^2= 26.4%） compared with control. Meanwhile, risk of stroke was similar between groups （RR： 0.73; 95% CI： 0.24-2.19; I^2= 0.0%）. However, rates of cardiac death and target vessel revascularization were significantly decreased in the CR group （RR： 0.41; 95% CI： 0.23-0.72; I^2 = 0.0% and RR： 0.46; 95% CI： 0.37-0.57; I^2= 47.4%）. Conclusion Complete revascularization appears to have long-term clinical benefit with regard to adverse cardiac events following primary PCI. However, more studies are needed to confirm these findings.

Based on the process management of traditional Chinese medicine comprehensive intervention method on outcomes in patients with mild/moderate chronic obstructive pulmonary disease:study protocol for a practical randomized controlled trial

Background:The prevalence,morbidity and mortality of chronic obstructive pulmonary disease(COPD)is very high,so it has become a public health problem.The early stage of COPD has been paid much attention before it develops severely.As well,traditional Chinese medicine has some advantages in relieving symptoms and reducing the incidence of COPD exacerbations.Methods:A practical randomized controlled trial will be designed to test the clinical effects of traditional Chinese medicine treatment according to syndrome differentiation.A total of 80 patients with mild/moderate COPD will participate in this study,40 in the treatment group and 40 in the control group.On the basis of the lifestyle intervention,traditional Chinese medicine formula granules for treatment group and the placebo simulation of traditional Chinese medicine granules for control group.The exacerbation and the improvement of pulmonary function will be used as the primary outcome measures.The improvement of clinical symptoms and signs,the quality of life and Dyspnea will be used as the secondary outcomes measures.Conclusion:We assume that the COPD patients will be benefit from therapy with Traditional Chinese medicine treatment.

Effect of pricking Shenmai(申脉 BL 62) and Zhaohai(照海 KI 6) on daytime arousal of patients with chronic insomnia:a randomized controlled trial

Objective To compare the different efficacy in treating patients with chronic insomnia by pricking,acupuncture and estazolam.Methods Sixty patients were divided into pricking group（group A）,acupuncture group（group B） and western medicine group（group C） according to the random number table,with 20 cases in each group.In group A,hook-type needles were applied on Shenmai（申脉 BL 62） and Zhaohai（照海 Kl 6） bilaterally by piercing the skin,a small amount of mucus was squeezed and subcutaneous fibers were broken;in group B,disposable acupuncture needles were applied by needling BL 62 and Kl 6 bilaterally at the depth of 0.5 cun;in group C,patients were asked to take 1 mg estazolam once a day at bedtime.The three groups were observed for 28 days,and Epworth scores and improvement of symptoms in daytime dysfunction were recorded.Results The total effective rate of improvement of symptoms in daytime dysfunction of group A（100%,20/20） was superior to that of group B（70%,14/20）,and the differences were statistically significant（P〈0.05）;the total effective rates of group A and group B were superior to that of group C（25%,5/20）,and the differences were statistically significant（P〈0.01,P〈0.05）.In terms of Epworth scores,the efficacy of group A was significantly superior to that of group B（13.35±2.85 vs 11.10±3.88,P〈0.05）,the efficacy of group A was superior to that of group C（13.35±2.85 vs 5.30±3.28,P〈0.01）,and the efficacy of group B was superior to that of group C（11.10±3.88 vs 5.30±3.28,P〈0.01）.Epworth scores significantly decreased in each group after treatment（P〈0.01）.Conclusion The therapy of pricking BL 62 and Kl 6 for patients of chronic insomnia was effective,daytime sleepiness was relieved and daytime dysfunctions were improved,and the therapy was superior to estazolam,and more advantageous than acupuncture.

Controlled study on therapeutic effect of vessel pricking therapy and western medication for treatment of henoch-schonlein purpura nephritis

Objective To compare the difference of therapeutic effects between vessel pricking therapy and Prednisone for treatment of henoch-schonlein purpura nephritis（HSPN）.Methods Seventy cases of acute purpura nephritis syndrome were randomly divided into an observation group （40 cases） and a control group （30 cases）.Patients in observation group were differentiated into sthenic and asthenic syndromes.Vessel pricking therapy was applied at Hégǔ（合谷 LI 4）,Qūchí（曲池 LI 11）,Xuèhǎi（血海 SP 10） etc.by three-edged needle for sthenic symptom;shallow needling was used at Píshū（脾俞 BL 20）,Shènshū（肾俞 BL 23）,Zúsānlǐ（足三里 ST 36） etc.by filiform needle for asthenic syndromes.The control group was treated with oral administration of Prednisone.The symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment of both groups were observed before and after treatment and therapeutic effects were compared.Results The total effective rate of 92.5%（37/40） in observation group was superior to that of 80.0%（24/30） in control group,and there was a significant difference between two groups （P0.05）;the symptom score of TCM,24 h urinary protein,red blood cell count of urinary sediment were all improved in both groups after treatment （all P0.05）,and moreover,the improvement in observation group was superior to that of control group （all P0.05）;after treatment,the symptom score of TCM of sthenic syndrome was lower than that of asthenic syndrome in observation group （P0.05）.Conclusion Vessel pricking therapy has a significant therapeutic effect for treatment of HSPN,superior to that of oral administration of Prednisone,and the therapeutic effect is better for treating sthenic syndrome than for asthenic syndrome.

Randomized controlled study on acupuncture treatment for chronic fatigue syndrome

Objective To observe the therapeutic effect of acupuncture treatment for chronic fatigue syndrome （CFS）. Methods Ninety cases of CFS were randomly divided into an observation group and a control group, 45 cases in each group. The observation group was treated with acupuncture at Renying （人迎 ST 9）, Fengfu（风府 GV 16）, Batihui （百会 GV 20）; the control group was treated with 250 mL 5% Glucose injeetio combined with 20 mL Shenmai injectio （参脉注射液）. Fatigue Scale （FS） was used to compare the scores between the two groups after treatment. Results The total scores in the observation group ,were 9.37±2.33 and 5.41±1.96 before and after treatment respectively, and in the control group, they were 9.08±2.27 and 7.34±2.03 respectively. FS brainwork integral, physical fatigue integral, and total integral all decreased after treatment in two groups （all P〈0.001）, and it decreased much more obviously in the observation group （P〈0.05, P〈0.01）. Conclusion Both of the acupuncture treatment and Shenmai injectio are able to decrease Fatigue Scale score, improve the fatigue symptoms of CFS patients, and the effect of acupuncture treatment is obviously superior to that of Shenmai injectio.

Preliminary clinical randomized controlled trial on knee osteoarthritis treated with moxibustion

Objective To observe the therapeutic effect of moxibustion on pain, stiffness and physical dysfunction caused by knee osteoarthritis （KOA）, and make an assessment on the effectiveness and safety of this therapy. Methods Fifty-nine cases of KOA were randomly divided into a moxibustion group （31 cases） and a sham-moxibustion group （28 cases）. The treatment of moxibustion was given at Nèixīyǎn （内膝眼 EX-LE 4）, Dúbí （犊鼻 ST 35） and Ashi points with real moxa cone in the moxibustion group and sham moxa cone in the sham-moxibustion group, 3 cones on each point per time, once every two days, 3 times per week for consecutively 6 weeks. The results were recorded in week 3 and 6 of the treatment, and the follow-up visit was performed 6 weeks after the end of treatment. The Western Ontario and Mcmaster Universities Osteoarthritis Index （WOMAC） and the shortest walking time of 46 m were adopted to evaluate the recovery situation of joint function. The UT-325 digital thermal detector was put to use to record the temperature change in the most obvious painful points of knee joint before and after the moxibustion. Results All the scores of WOMAC in the moxibustion group were apparently decreased in week 3 and 6 of the treatment as well as the follow-up visit, separately （P〈0.05, P〈0.01, P〈0.001）. The stiffness score of follow-up visit in the sham-moxibustion group, compared before the treatment, was lowered （P〈0.05）. The scores of pain, stiffness and physical function in the moxibustion group had a greater decrease than those in the sham-moxibustion group in week 6 of treatment and the follow-up visit （P〈0.01, P〈0.05）. The shortest walking time of 46 m in the moxibustion group after 6 weeks of the treatment was apparently reduced as compared with that before treatment （P〈0.01）, but there was no apparent improvement in the sham-moxibustion group （P〉0.05）, and the between-group difference was not significant statistically （P〉0.05）. The temperature of treatment point after the moxibustion was （49.81±3.10）？℃ in the moxibustion group and （40.98±1.67）？℃ in the sham-moxibustion group, which was both increased apparently as compared with that before the treatment （P〈0.001, P〈0.01）, and more obviously in the moxibustion group （P〈0.001）. Conclusion The moxibustion, which can obviously improve the clinical symptoms of the patients with KOA, such as pain, stiffness and physical dysfunction, is safe and effective.