Community Pharmacist-Based Collaborative Disease Management Program for Patients with Poorly Controlled Diabetes

Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementation of an employer initiated community pharmacist-based disease management program for diabetic patients with poorly controlled diabetes. Methods： Employees with poorly controlled diabetes （glycosylated hemoglobin （A1 C） level 〉 7.5%） were identified fi＇om a large diabetes disease management program, in a rural setting in Texas, US. A longitudinal retrospective study was conducted, analyzing clinical indicators in the diabetes patients following the community pharmacist-based disease management program. The program involved a comprehensive drug therapy assessment and individualized disease management education. Primary outcome measured in the present study was A1C levels, assessed at the baseline visit and at the end of the intervention. Results： A total of 64 patients with poorly controlled diabetes were identified. Significant improvement in mean clinical outcome scores was achieved for A1C levels （p = 0.0011）. At the end of the 1 year longitudinal intervention, targeted body mass index and A1C goals were attained by 35.9% （p 〈 0.001） and 15.6% patients, respectively. The 10 patients reaching goal levels post intervention were in the group that had baseline A1C of 7.5 to 9%. However, patients with 〉 9% A1C levels at baseline had a significant reduction （mean 2.1, p 〈 0.001） post intervention. Conclusion： The community pharmacist-based diabetes disease management program improved A1C levels of patients with poorly controlled diabetes.

Disease monitoring strategies in inflammatory bowel diseases: What do we mean by “tight control”?

In recent years,there has been a critical change in treatment paradigms in inflammatory bowel diseases(IBD)triggered by the arrival of new effective treatments aiming to prevent disease progression,bowel damage and disability.The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy.The treat-to-target strategies,defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation,move away from only symptomatic disease control and support targeting composite therapeutic endpoints(clinical and endoscopical remission)and timely assessment.Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers(fecal calprotectin and C-reactive protein)leads to improved outcomes.This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of“early intervention”,“treat-to-target”and“tight control”strategies.We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and(“tight”)disease monitoring strategies.

Back propagation artificial neural network for community Alzheimer's disease screening in China

AIzheimer＇s disease patients diagnosed with the Chinese Classification of Mental Disorders diagnostic criteria were selected from the community through on-site sampling. Levels of macro and trace elements were measured in blood samples using an atomic absorption method, and neurotransmitters were measured using a radioimmunoassay method. SPSS 13.0 was used to establish a database, and a back propagation artificial neural network for Alzheimer＇s disease prediction was simulated using Clementine 12.0 software. With scores of activities of daily living, creatinine, 5-hydroxytryptamine, age, dopamine and aluminum as input variables, the results revealed that the area under the curve in our back propagation artificial neural network was 0.929 （95% confidence interval： 0.868-0.968）, sensitivity was 90.00%, specificity was 95.00%, and accuracy was 92.50%. The findings indicated that the results of back propagation artificial neural network established based on the above six variables were satisfactory for screening and diagnosis of Alzheimer＇s disease in patients selected from the community.

Vedolizumab for inflammatory bowel disease:from randomized controlled trials to real-life evidence

The biologic antitumor necrosis factor alpha(anti-TNFα) agents have revolutionised the treatment of inflammatorybowel disease(IBD). However,some patients experience primary nonresponse,loss of response,or intolerance. Therefore,introducing a newer class of therapy with a mechanism of action that acts on different inflammatory pathways involved in IBD pathogenesis is appealing. Vedolizumab is a fully humanised monoclonal antibody that selectively targets α4β7 integrin. Based on the results of the pivotal clinical GEMINI trials,vedolizumab was approved for the treatment of adult patients with moderately to severely active ulcerative colitis(UC) and Crohn's disease(CD) refractory or intolerant to either conventional therapy or TNFα inhibitors. This review describes the efficacy,safety,and tolerability of vedolizumab reported in both randomized,controlled,clinical trials and from real-world experience in patients with UC and CD in order to identify its place in treatment algorithms for IBD.

Emotion recognition and inhibitory control in manifest and pre-manifest Huntington’s disease: evidence from a new Stroop task

Huntington’s disease(HD)is a genetic neurodegenerative disorder that affects not only the motor but also the cognitive domain.In particular,cognitive symptoms such as impaired executive skills and deficits in recognizing other individuals’mental state may emerge many years before the motor symptoms.This study was aimed at testing two cognitive hypotheses suggested by previous research with a new Stroop task created for the purpose:1)the impairment of emotion recognition in HD is moderated by the emotions’valence,and 2)inhibitory control is impaired in HD.Forty manifest and 20 pre-manifest HD patients and their age-and gender-matched controls completed both the traditional“Stroop Color and Word Test”(SCWT)and the newly created“Stroop Emotion Recognition under Word Interference Task”(SERWIT),which consist in 120 photographs of sad,calm,or happy faces with either congruent or incongruent word interference.On the SERWIT,impaired emotion recognition in manifest HD was moderated by emotion type,with deficits being larger in recognizing sadness and calmness than in recognizing happiness,but it was not moderated by stimulus congruency.On the SCWT,six different interference scores yielded as many different patterns of group effects.Overall our results corroborate the hypothesis that impaired emotion recognition in HD is moderated by the emotions’valence,but do not provide evidence for the hypothesis that inhibitory control is impaired in HD.Further research is needed to learn more about the psychological mechanisms underlying the moderating effect of emotional valence on impaired emotion recognition in HD,and to corroborate the hypothesis that the inhibitory processes involved in Stroop tasks are not impaired in HD.Looking beyond this study,the SERWIT promises to make important contributions to disentangling the cognitive and the psychomotor aspects of neurological disorders.The research was approved by the Ethics Committee of the“Istituto Leonarda Vaccari”,Rome on January 24,2018.

Concomitant Othello syndrome and impulse control disorders in a patient with Parkinson’s disease:A case report

BACKGROUND Othello syndrome(OS)is characterized by delusional beliefs concerning the infidelity of a spouse or sexual partner,which may lead to extreme behaviors.Impulse control disorders refer to behaviors involving repetitive,excessive,and compulsive activities driven by an intense desire.Both OS and impulse control disorders in Parkinson’s disease(PD)may be side effects of dopamine agonists.At present,there are only a few case reports and studies related to PD with concomitant OS and impulse control disorders.CASE SUMMARY We describe a 70-year-old male patient with PD,OS,and impulse control disorders,who presented with a six-month history of the delusional belief that his wife was having an affair with someone.He began to show an obvious increase in libido presenting as frequent masturbation.He had been diagnosed with PD ten years earlier and had no past psychiatric history.In his fourth year of PD,he engaged in binge eating,which lasted approximately one year.Both OS and hypersexuality were alleviated substantially after a reduction of his pramipexole dosage and a prescription of quetiapine.CONCLUSION Given its potential for severe consequences,OS should be identified early,especially in patients undergoing treatment with dopamine agonists.

Lack of Association between Impulse Control Disorders and REM Sleep Behavior Disorder in Patients with Parkinson’s Disease

Purpose: Rapid eye movement sleep behavior disorder (RBD) and impulse control disorders (ICDs) are common in subjects with Parkinson’s disease. The association between these two conditions has been contradictory. The aim of this study is to analyze the association between these two non-motor symptoms. Methods: Consecutive subjects with Parkinson’s disease attending the Movement Disorders Outpatient Clinic were included. The presence of ICDs was assessed using the Questionnaire for Impulse Control Disorders Rating Scale. RBD was diagnosed by an overnight, single night polysomnography. Results: Fifty-five consecutive subjects with Parkinson’s disease were included. The prevalence of ICDs and related behaviors was 23.6% (ICD in 14.5% and related behaviors in 9.1%). RBD was diagnosed in 47.2% of the patients. No differences were found in the frequency of ICDs and related behaviors when comparing subjects with and without RBD (23% versus 24.1%, p = 0.926, respectively). Conclusion: No association between the presence of RBD and the frequency of ICDs in subjects with Parkinson’s disease was found.

Evaluation of reporting quality of randomized controlled trials for cognitive interventions among Alzheimer’s Disease using the CONSORT

Background:The increasing number of Alzheimer’s Disease has become a global health issue.Whether randomized controlled trials are fully reported has an immediate effect on the translation as well as implementation of research conclusions.However,the overall reporting quality of randomized controlled trials for cognitive interventions among Alzheimer’s Disease is unclear.Methods:Randomized controlled trials of cognitive inter-ventions among Alzheimer’s Dementia were searched from Cnki,Embase,Pubmed,Web of Science,WanFang Data,Cochrane Library,and VIP from their inception to December9th 2019.Firstly,the average CONSORT(Consolidated Standards of Reporting Trials)compliance of randomized controlled trials for cognitive interventions among Alzheimer’s Disease was estab-lished.Secondly,the compliance of per CONSORT item was calculated.Furthermore,the possible factors that determine the reporting quality were explored using univariate analysis and binary logistic regression.Results:A total of 55 studies were included.Mean CONSORT compliance of randomized controlled trials was 57.16%and standard deviation was 0.11.Univariate analysis showed that journal impact factor(p<0.001),sample size(p=0.002)as well as number of authors(p<0.001)were statistically significant,but post-2010 publication(p=0.206)as well as reporting of funding(p=0.221)had no significance.However,none of the above factors had statistical significance in binary logistic regression.Conclusions:The overall reporting quality was low,which would not be conducive to the evidence transformation and implementation.Furthermore,the reporting quality was not probably affected by aforementioned factors.

Mediative Sugeno’s-TSK Fuzzy Logic Based Screening Analysis to Diagnosis of Heart Disease

Fuzzy logic is an approach which deals with the incomplete information to handle the imperfect knowledge. In the present research paper we have proposed a new approach that can handle the imperfect knowledge, in a broader way that we will consider the unfavourable case also as the intuitionistic fuzzy logic does. The mediative fuzzy logic is an extensive approach of intuitionistic fuzzy logic, which provides a solution, when there is a contradiction in the expert knowledge for favourable as well as unfavourable cases. The purpose of the present paper is to design a mediative fuzzy inference system based Sugeno-TSK model for the diagnosis of heart disease. Our proposed method is the extension of Sugeno-TSK fuzzy logic controller in the form of Sugeno-TSK mediative fuzzy logic controller.

The effect of conduction exercise and selfacupressure in treatment of Parkinson’s disease:Protocol for a pilot study

Objective:Parkinson’s disease(PD)is the second most common neurodegenerative disease in the world.In 2004,approximately 13,000 individuals in Hong Kong,China,had PD.PD greatly affects quality of life and conventional medication can produce severe side effects.The traditional Chinese medicine(TCM)practices of conduction exercise(CE)and selfacupressure(SA)may relieve PD symptoms.This paper presents a protocol for a randomized controlled trial to determine the effectiveness of CE and SA in treating PD.Methods:Patients with primary PD were recruited.Eligible patients were randomly assigned to either a treatment or control group.The assessor and data analysts were blind.The treatment phase duration was 8 weeks,with 8 weekly sessions of CE and SA practice.Baseline,midpoint,and final assessments were carried out during the treatment phase.The primary outcome is scores on the 39-item Parkinson’s Disease Questionnaire(PDQ-39),and the secondary outcome is scores on a custom-designed questionnaire based on TCM“Deficiency of Spleen Qi”scores and scores on a non-motor PD symptoms scale.Discussion:This trial is the first rigorous study of the effectiveness of CE and SA in relieving PD symptoms.The aim is to examine the effectiveness of CE and SA in treating a disease that is difficult to treat conventionally.The data obtained will form the foundation for future related studies.Trial registration:Chinese Clinical Trial Registry(ChiCTR-IPR-17011987,Date of registration:14 July,2017).

Capsule endoscopy and panendoscopy:A journey to the future of gastrointestinal endoscopy

In 2000,the small bowel capsule revolutionized the management of patients with small bowel disorders.Currently,the technological development achieved by the new models of double-headed endoscopic capsules,as miniaturized devices to evaluate the small bowel and colon[pan-intestinal capsule endoscopy(PCE)],makes this non-invasive procedure a disruptive concept for the management of patients with digestive disorders.This technology is expected to identify which patients will require conventional invasive endoscopic procedures(colonoscopy or balloon-assisted enteroscopy),based on the lesions detected by the capsule,i.e.,those with an indication for biopsies or endoscopic treatment.The use of PCE in patients with inflammatory bowel diseases,namely Crohn’s disease,as well as in patients with iron deficiency anaemia and/or overt gastrointestinal(GI)bleeding,after a non-diagnostic upper endoscopy(esophagogastroduodenoscopy),enables an effective,safe and comfortable way to identify patients with relevant lesions,who should undergo subsequent invasive endoscopic procedures.The recent development of magnetically controlled capsule endoscopy to evaluate the upper GI tract,is a further step towards the possibility of an entirely non-invasive assessment of all the segments of the digestive tract,from mouth-to-anus,meeting the expectations of the early developers of capsule endoscopy.

Socio-environmental factors associated with small mammal assemblage and Leptospira prevalence in Suburban Areas of Terengganu,Malaysia

Objective:To examine the socio-environmental factors associated with the assemblage of small mammals and the prevalence of Leptospira pathogen in poor suburban communities of Terengganu,Malaysia.Methods:We trapped small mammals from 119 trapping points scattered around three suburban communities of Terengganu using sausage-baited live traps.On the average,we set up five traps for three nights at each sampling point during the trapping period.Kidneys of captured animals were harvested and processed for Leptospira investigation.Additionally,environmental survey was conducted at each trapping point to obtain information about possible variables supporting small mammal assemblage.We used a generalized linear model to evaluate the effect of different socio-environmental variables on small mammals’assemblage.Results:A total of 89 small mammals,specifically,Rattus norvegicus(n=39),Rattus rattus(n=27),Rattus exulans(n=10),Suncus murinus(n=11),and Tupaia glis(n=2)were captured from 1385 trap nights.Fourteen individuals(15.7%)of the captured animals tested positive for Leptospira bacteria using PCR detection.Results of our generalized linear model showed only residences bordering vacant lots as the variable positively associated with small mammal occurrence in the three study sites.Conclusions:Small mammal community,especially the often neglected species,could harbour and potentially contribute towards pathogenic Leptospira maintenance in the study sites.To adequately control small mammals’population and subsequent human zoonoses transmission,it is critical to advocate and promote appropriate infrastructure and suburban services,together with good hygiene practices that can reduce the animals’access to food and harborage.

Enhancing Mild Cognitive Impairment Detection through Efficient Magnetic Resonance Image Analysis

Neuroimaging has emerged over the last few decades as a crucial tool in diagnosing Alzheimer’s disease(AD).Mild cognitive impairment(MCI)is a condition that falls between the spectrum of normal cognitive function and AD.However,previous studies have mainly used handcrafted features to classify MCI,AD,and normal control(NC)individuals.This paper focuses on using gray matter(GM)scans obtained through magnetic resonance imaging(MRI)for the diagnosis of individuals with MCI,AD,and NC.To improve classification performance,we developed two transfer learning strategies with data augmentation(i.e.,shear range,rotation,zoom range,channel shift).The first approach is a deep Siamese network(DSN),and the second approach involves using a cross-domain strategy with customized VGG-16.We performed experiments on the Alzheimer’s Disease Neuroimaging Initiative(ADNI)dataset to evaluate the performance of our proposed models.Our experimental results demonstrate superior performance in classifying the three binary classification tasks:NC vs.AD,NC vs.MCI,and MCI vs.AD.Specifically,we achieved a classification accuracy of 97.68%,94.25%,and 92.18%for the three cases,respectively.Our study proposes two transfer learning strategies with data augmentation to accurately diagnose MCI,AD,and normal control individuals using GM scans.Our findings provide promising results for future research and clinical applications in the early detection and diagnosis of AD.

S-腺苷蛋氨酸治疗酒精性肝病的系统评价

目的系统评价S-腺苷蛋氨酸治疗酒精性肝病的效果和安全性。方法采用Cochrane系统评价方法,检索Cochrane图书馆临床对照试验数据库、PubMed、EMbase、CBM、CNKI、中文科技期刊数据库VIP、万方数据库等电子资料库。由2名评价者共同评价纳入研究的质量,对同质研究进行Meta分析。结果共纳入10个研究,745例酒精性肝病患者。其中1篇文献采用随机数字法分组并实施盲法,其余9篇文献未描述具体随机方法,未实施盲法。所有文献均未描述分配隐藏方法。按测量指标和干预措施进行亚组分析:①在降低ALT方面:疗程为20天时,S-腺苷蛋氨酸+一般治疗组与还原型谷胱甘肽+一般治疗组差异无统计学意义[WMD = -18.00,95%CI(-38.36,-2.36)];疗程为4周时,S-腺苷蛋氨酸+多烯磷脂酰胆碱组与门冬氨酸钾镁+多烯磷脂酰胆碱组差异无统计学意义[WMD = -8.39,95%CI(-19.81,3.02)];疗程为2年时,S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = -7.30,95%CI(-15.49,0.89)],其余各研究组均优于对照组,差异有统计学意义;②在降低AST方面:疗程为4周时,S-腺苷蛋氨酸+多烯磷脂酰胆碱组与门冬氨酸钾镁+多烯磷脂酰胆碱组差异无统计学意义[WMD = -8.39,95%CI(-19.81,3.02)];疗程为2年时,S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = -7.40,95%CI(-17.96,3.16)],其余各研究组均优于对照组,差异有统计学意义;③在降低GGT方面:疗程为4周时,S-腺苷蛋氨酸+还原型谷胱甘肽组与门冬氨酸钾镁+维生素C组差异无统计学意义[WMD = -20.10,95%CI(-40.77,0.57)];疗程为2年时,S-腺苷蛋氨酸组与安慰剂组差异无统计学意义[WMD = -8.70,95%CI(-36.42,19.02)],其余各研究组均优于对照组,差异有统计学意义;④在降低TG方面:研究组均优于对照组,差异有统计学意义[WMD = -1.04,95%CI(-1.23,-0.85)];⑤在降低肝纤维化指标(PC Ⅲ、HA)方面:各研究组均优于对照组,差异有统计学意义[分别为WMD = -127.00,95%CI(-161.81,-92.19);WMD = -162.00,95%CI(-226.10,-97.90)];⑥在生存率方面:Child-Pugh A级、Child-Pugh B级(Child-Pugh分级)酒精性肝硬化患者生存率研究组优于对照组,差异有统计学意义[RR = 0.45,95%CI(0.20,1.00)]。结论现有研究显示,S-腺苷蛋氨酸对酒精性肝病患者的ALT、AST、GGT、肝纤维化和TG的改善可能有效,对Child-Pugh A级、Child-Pugh B级酒精性肝硬化患者生存率改善可能有效,且无严重不良反应。但本系统评价所纳入的文献多为较低质量的小样本研究,且用药时间不同,因此无法进行总体的效应合并分析,尚需更大量的文献支持。

基于B/S模式的茶树病虫害综合防治信息系统研发

为了快速、简便地鉴定茶树病虫害,为病虫害防治提供必需的信息,尽量减少病虫害造成的损失,利用网络和计算机技术设计开发基于B/S结构的茶树病虫害综合防治信息系统,系统采用ASP.NET编程技术,包括茶树病虫害浏览、查询、诊断等模块,能实现对茶树病虫害文字和图片信息的浏览、查询、诊断和后台管理等功能,满足当前茶树病虫害防治的数据需求。

S-921菌株发酵液对泡桐腐烂病菌作用的研究

室内实验结果表明,金色链霉菌S-921菌株对泡桐腐烂病菌具有很强的抗生作用,将两者于PDA平板培养基上共同培养8天,出现直径3cm的抑菌圈。经S-921菌株发酵液浸泡处理的泡桐腐烂病病原菌菌丝体,会出现大量液泡,原生质凝集,菌丝尖膨大等异常形态,并失去致病力。S-921菌株发酵液(原液)对泡桐腐烂病的治疗效果,以刮除病班后涂抹发酵液的效果最佳,治愈率达100％。

Chinese Medicine for Idiopathic Parkinson's Disease:A Meta Analysis of Randomized Controlled Trials

Objective：To evaluate the efficacy of Chinese medicine（CM）adjunct to conventional medications for idiopathic Parkinson’s disease（PD）.Methods：Electronic English and Chinese databases including Pub Med,Cochrane Library,Web of Science,Chinese Medical Current Contents,China National Knowledge Infrastructure,China Science and Technology Journal Database,Wanfang Med Database,and Traditional Chinese Medical Database System were used for key words searching in a highly sensitive search strategy.The extracted data was analyzed by the Review Manager 5.0.Results：Twelve trials involving 869 participants were included in the meta-analysis.Unified PD Rating Scale（UPDRS）Ⅰ,Ⅱ,Ⅲ,Ⅳscores and UPDRSⅠ–Ⅳtotal scores were used to be the primary outcomes,Parkinson Disease Question-39（PDQ-39）and Scores of Chinese Medical Symptoms were the secondary outcomes.CM adjunct therapy had greater improvement in UPDRSⅠ[2 trials;standardized mean difference（SMD）–0.40,95%confidence interval（CI）–0.71 to–0.09;Z=2.49（P=0.01）],Ⅱ[5 trials;SMD–0.47,95%CI–0.69 to–0.25;Z=4.20（P〈0.01）],Ⅲ[5 trials;SMD-0.35,95%CI–0.57 to–0.13;Z=3.16（P=0.002）],Ⅳscores[3 trials;SMD-0.32,95%CI–0.60 to–0.03;Z=2.17（P=0.03）],UPDRSⅠ–Ⅳtotal scores[7 trials;SMD-0.36,95%CI–0.53 to–0.20;Z=4.24（P〈0.05）].PDQ-39 and Chinese medical symptoms compared to the conventional medication only.Conclusion：CM adjunct therapy has potential therapeutic benefits by decreasing UPDRS scores and reducing adverse effect.

Scalp Acupuncture for Parkinson's Disease:A Systematic Review of Randomized Controlled Trials

Objective： To evaluate the effectiveness of scalp acupuncture （SA）, a modern acupuncture technique specialized to neurological disorders, in managing motor function and symptoms for Parkinson＇s disease （PD） patients. Methods： Two independent reviewers extracted data from all of the randomized clinical trials （RCTs） that assessed the efficacy of SA for PD compared with conventional therapies （CTs）. Sixteen electronic databases were searched. The risk of bias was appraised with the Cochrane Collaboration tool, and the reporting of the included studies was evaluated by the Consolidated Standards of Reporting Trials （CONSORT） 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture （STRICTA） guidelines. Results： In total, 4 RCTs met the inclusion criteria. As assessed by the Unified PD Rating Scale （UPDRS）, 2 RCTs showed that SA combined with CTs proved superior to CTs alone [60 cases; weighted mean difference, -3.94; 95% confidence interval （CI）, -6.05 to -1.64, P=0.01; 12=0%]. Based on the Webster scale, however, 3 RCTs showed no superior effect of SA when combined with CTs with high heterogeneity （154 cases; risk ratio, 1.29; 95% CI, 0.79 to 2.12, P=0.30; 12=84%）. The Cochrane risk of bias, adherence to the CONSORT and the STRICTA checklist showed that the quality of all the included RCTs was generally low. Conclusions： The result of our systematic review and meta-analysis suggested that the effectiveness of SA for PD is promising, however, the evidence is not convincing. A sham-controlled RCT design that adheres to the CONSORT and STRICTA guidelines to overcome methodological weakness and that includes a large sample size is strongly recommended to confirm the precise effect of SA on PD.

Chinese Medicine for Alzheimer's Disease:A Meta-Analysis of Randomized Controlled Trials

Objective： To evaluate the efficacy of oral Chinese medicine （CM） in comparison with donepezil, a cholinesterase inhibitor （ChEI）, for the treatment of Alzheimer＇s disease （AD）. Methods： Randomized controlled trials （RCTs） have been searched, and the effect of CM compared with donepezil in AD has been investigated. An electronic search of MEDLINE, Excerpta Medica Database （EMBASE）, Cochrane Library, Chinese Biological Medicine Database （CBMdisc）, and China National Knowledge Infrastructure （CNKI） to identify articles in English and Chinese from the inception of the database until October 18, 2015. A modified Jadad score （7-points） to judge the methodological quality of studies, comprehensive meta-analysis was performed with Cochrane Collaboration Revman 5.3. Dichotomous data were analyzed by relative risk （RR） with a 95% confidence interval （CI）, while continuous variables were analyzed by using mean differences （MD） with 95% CI for effect size. Results： Six studies involving 596 AD patients through Jadad assessment with low bias were included in the meta-analysis. No significant difference was observed in cognitive improvement and daily abilities of patients using the Mini Mental State Examination （MMSE） （MD： 0.69, 95% CI： -0.17 to 1.56） and Activities of Daily Living （ADL） scale （MD： 0.94, 95% CI： -1.54 to 3.43）. There were no significant differences in status of illness or MD for mUd-moderate AD patients at 24 weeks （MD： 0.62, 95% CI： -2.99 to 4.23） and 48 weeks （MD： -0.73, 95% CI： -5.02 to 3.56）. Severe AD patients were also assessed at 24 weeks （MD： 3.13, 95% CI： -6.92 to 13.18） and 48 weeks （MD： 4.23, 95% CI： -6.38 to 14.84）. Furthermore, compared with donepezil, Xin （Heart）-regulating CM and Shen （Kidney）-tonifying groups were observed （MD： -1.50, 95% CI： -3.08 to 0.08; MD： -1.92, 95% CI： -3.50 to -0.33; respectively）. CM had fewer side effects in AD patients. Conclusion： Compared with donepezil, oral CM showed no significant difference in effectiveness in AD patients, and more evidence is needed to verify the findings.

Pingchan granule for depressive symptoms in parkinson’s disease:A randomized,double-blind,placebo-controlled trial

Background:Depression in Parkinson’s disease(dPD)is closely related to quality of life.Current studies have suggested that Pingchan Granule(PCG)might be effective for treating dPD.Objective:This study determines the efficacy of PCG for depressive symptoms in Parkinson’s disease(PD).Design,setting,participants and interventions:This was a randomized,double-blind,placebo-controlled trial,conducted in Longhua Hospital,Shanghai,China.Patients diagnosed with idiopathic PD and clinically significant depressive symptoms(defined by a 24-item Hamilton Rating Scale for Depression[HAM-D]score≥8)were included in this study,randomly assigned to PCG or placebo group in a 1:1 ratio and followed for 24 weeks.Main outcome measures:The primary outcome was the change from baseline to week 24 in HAM-D score among the set of patients who completed the study following the treatment protocol(per-protocol set).Secondary outcomes included changes in scores on the Unified Parkinson’s Disease Rating Scale(UPDRS)part 2(UPDRS-Ⅱ),UPDRS part 3(UPDRS-Ⅲ),Parkinson’s Disease Sleep Scale(PDSS)and Hamilton Rating Scale for Anxiety(HAM-A),between baseline and week 24.Results:Eighty-six patients were enrolled,and 85 patients were included in the per-protocol set.HAM-D scores decreased by an adjusted mean of 11.77(standard error SE 0.25)in the PCG group and 3.86(SE0.25)in the placebo group(between-group difference=7.91,95%confidence interval[7.22,8.80],P<0.001),in the multivariable linear regression.Improvements in scores on the UPDRS-II,UPDRS-III,PDSS,and HAM-A scales were also observed.Conclusion:Treatment with PCG was well tolerated and improved depressive symptoms and motor and other non-motor symptoms in PD.Trial registration:Chinese Clinical Trial Register:ChiCTR-INR-17011949.