A network meta-analysis on the improvement of cognition in patients with vascular dementia by different acupuncture therapies

IntroductionThe second most prevalent cause of dementia is vascular dementia (VaD). Furthermore, acupuncture is a relatively safe and effective traditional therapy for individuals with VaD. We performed a network meta-analysis to assess the effectiveness and safety of various acupuncture therapies for VaD based on existing research.MethodsWe searched six electronic databases to screen for randomized controlled trials (RCTs) comparing different acupuncture treatments in VaD patients. The Cochrne tool (Review Manager 5.3) was used to evaluate the risk of bias of the included RCTs. Based on the Grading of Recommendations Assessment, Development and Evaluation framework, we assessed the confidence in the evidence using the Confidence In the results from Network Meta-Analysis approach. We used the frequency approach to perform the network meta-analysis. Data were analyzed using R 4.1.1.ResultsIn total, we included 46 eligible studies. The results of the network analysis showed that the combined interventions of moxibustion (MB) with body acupuncture (BA) (MB + BA) and electroacupuncture (EA) with scalp acupuncture (SA) with BA (EA + SA + BA) were more effective in improving cognitive functions and activities of daily living compared with SA or BA alone. However, in the subgroup analysis, EA + SA + BA showed better efficacy in short- and mid-term acupuncture compared with other acupuncture therapies.ConclusionCombined acupuncture therapy may be a safe and effective intervention for individuals with VaD, and MB + BA and EA + SA + BA appear to be the most effective interventions. However, because the analysis of this study was based on low-to-moderate evidence, there remains no strong supporting evidence. Thus, high-quality, large-scale, and long-term studies should be conducted in the future to assess the effectiveness and safety of acupuncture in VaD.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022354573

Reasons given by general practitioners for non-treatment decisions in younger and older patients with newly diagnosed type 2 diabetes mellitus in the United Kingdom: a survey study

<p>Abstract</p> <p>Background</p> <p>Older patients with newly diagnosed type 2 diabetes mellitus are less likely to receive antihyperglycaemic therapy compared to their younger counterparts. The purpose of this study was to assess the reasons of general practitioners (GPs) for not treating younger and older patients with newly diagnosed type 2 diabetes mellitus with antihyperglycaemic agents.</p> <p>Methods</p> <p>In a survey conducted between November 2009 and January 2010, 358 GPs from the United Kingdom selected reasons for not initiating antihyperglycaemic therapy in younger (< 65 years) and older (≥65 years) patients with newly diagnosed type 2 diabetes mellitus and untreated with any antihyperglycaemic agent for at least six months following diagnosis. Thirty-six potential reasons were classified into four major categories: <it>Mild hyperglycaemia</it>, <it>Factors related to antihyperglycaemic agents</it>, <it>Comorbidities and polypharmacy</it>, and <it>Patient-related reasons</it>. Reasons for non-treatment were compared between younger (n = 1, 023) and older (n = 1, 005) patients.</p> <p>Results</p> <p>Non-treatment reasons related to <it>Mild hyperglycaemia </it>were selected more often by GPs for both younger (88%) and older (86%) patients than those in other categories. For older patients, <it>Factors related to antihyperglycaemic agents </it>(46% vs. 38%) and <it>Comorbidities and polypharmacy </it>(33% vs. 19%), both including safety-related issues, were selected significantly (p < 0.001) more often by GPs. No between-group difference was observed for the <it>Patient-related reasons </it>category. The GP-reported HbA_1cthreshold for initiating antihyperglycaemic therapy was significantly (p < 0.001) lower for younger patients (mean ± standard deviation: 7.3% ± 0.7) compared to older patients (7.5% ± 0.9).</p> <p>Conclusions</p> <p>GPs selected reasons related to <it>Mild hyperglycaemia </it>for non-treatment of their untreated patients with newly diagnosed type 2 diabetes mellitus, despite nearly one-third of these patients having their most recent HbA_1cvalue ≥7%. The findings further suggest that safety-related issues may influence the non-treatment of older patients with type 2 diabetes mellitus.</p

Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: A survey study

<p>Abstract</p> <p>Background</p> <p>Some oral antihyperglycemic agents may increase risk of hypoglycemia and thereby reduce patient quality of life. Our objective was to assess the impact of the severity and frequency of self-reported hypoglycemia on health-related quality of life (HRQoL) among patients with type 2 diabetes treated with oral antihyperglycemic agents.</p> <p>Findings</p> <p>A follow-up survey was conducted in participants with self-reported type 2 diabetes treated with oral antihyperglycemic agents from the US National Health and Wellness Survey 2007. Data were collected on the severity and frequency of hypoglycemic episodes in the 6 months prior to the survey, with severity defined as mild (no interruption of activities), moderate (some interruption of activities), severe (needed assistance of others), or very severe (needed medical attention). HRQoL was assessed using the EuroQol-5D Questionnaire (EQ-5D) US weighted summary score (utility) and Worry subscale of the Hypoglycemia Fear Survey (HFS). Of the participants who completed the survey (N = 1,984), mean age was 58 years, 57% were male, 72% reported an HbA_1c<7.0%, and 50% reported treatment with a sulfonylurea-containing regimen. Hypoglycemic episodes were reported by 63% of patients (46% mild, 37% moderate, 13% severe and 4% very severe). For patients reporting hypoglycemia, mean utility score was significantly lower (0.78 versus 0.86, p < 0.0001) and mean HFS score was significantly higher (17.5 versus 6.2, p < 0.0001) compared to patients not reporting hypoglycemia. Differences in mean scores between those with and without hypoglycemia increased with the level of severity (mild, moderate, severe, very severe) for utility (0.03, 0.09, 0.18, 0.23) and HFS (6.1, 13.9, 20.1, 25.6), respectively. After adjusting for age, gender, weight gain, HbA_1c, microvascular complications, and selected cardiovascular conditions, the utility decrement was 0.045 (by level of severity: 0.009, 0.055, 0.131, 0.208), and the HFS increase was 9.6 (by severity: 5.3, 12.4, 17.6, 23.2). HRQoL further decreased with greater frequency of hypoglycemic episodes.</p> <p>Conclusions</p> <p>Self-reported hypoglycemia is independently associated with lower HRQoL, and the magnitude of this reduction increases with both severity and frequency of episodes in patients with type 2 diabetes treated with oral antihyperglycemic agents.</p

Rates of asthma attacks in patients with previously inadequately controlled mild asthma treated in clinical practice with combination drug therapy: an exploratory post-hoc analysis

<p>Abstract</p> <p>Background</p> <p>Differences could exist in the likelihood of asthma attacks in patients treated with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and montelukast (MON) (ICS/LABA/MON) and patients treated with an inhaled corticosteroid (ICS) and montelukast (MON) (ICS/MON).</p> <p>Methods</p> <p>This was a post-hoc analysis of a pretest-posttest retrospective cohort study. Patients with mild persistent asthma and allergic rhinitis, who were taking an ICS either alone or in combination with a LABA, started concomitant MON treatment as part of their routine care. Rates of asthma- and allergic rhinitis-related medical resource use in the 12-months after the initial (index) MON prescription were compared in the ICS/MON and ICS/LABA/MON groups. An asthma attack was defined as an asthma-related hospitalization, ER visit, or use of an oral corticosteroid.</p> <p>Results</p> <p>Of the total of 344 patients, 181 (53%) received ICS/MON and 163 (47%) received ICS/LABA/MON in the post-index period for means of 10.5 and 11.4 months, respectively, (P < 0.05). Short-acting beta-agonists were used by 74.6% in the ICS/MON and 71.8% in the ICS/LABA/MON groups (P > 0.05). An asthma attack occurred in 4.4% of the ICS/MON group and 6.8% of the ICS/LABA/MON group (P > 0.05). The adjusted odds of an asthma attack in the post-index period in the ICS/LABA/MON group relative to the ICS/MON group was 1.24, 95% confidence interval 0.35–4.44.</p> <p>Conclusion</p> <p>In this observational study of combination drug treatment of mild persistent asthma and allergic rhinitis, no difference was observed between LABA/ICS/MON combination therapy and the ICS/MON combination without LABA use, for the rate of asthma attacks over one year.</p

Maternal anemia and adverse pregnancy outcomes

Background: Maternal anemia is a ubiquitous pregnancy complication, and has been associated with an array of adverse perinatal and reproductive outcomes. Despite scores studies, the association between anemia and perinatal outcomes remains poorly understood. The objectives of our study were to describe the epidemiology of maternal anemia, and to examine the associations of maternal anemia with perinatal mortality and preterm birth. Method: A prospective cohort study was conducted, using existing data from a population-based pregnancy-monitoring system in 13 counties in East China (1993-96). Women who delivered singleton infants at 20 to 44 weeks with at least one hemoglobin assessment during pregnancy were included (n=164,667). The prevalence of anemia (hemoglobin &lt;10 g/dL) during pregnancy and rates of stillbirth, neonatal death, and preterm birth were estimated. Multivariable log-Binomial regression models were used to evaluate risk factors associated with anemia. Associations between anemia and adverse outcomes were examined using multiple Cox proportional hazards regression models after adjusting for a variety of confounding factors. Results: The overall prevalence of anemia was 32.6%, with substantial variations across trimesters (11%, 20%, and 26% in the 1st, 2nd and 3rd trimesters, respectively). Older maternal age, lower education, farm occupation, delayed prenatal care, pregnancy-induced hypertension and preeclampsia were associated with increased risk for anemia, whereas peri-conceptional folic acid use was associated with reduced risk for 1st trimester anemia. Anemia in the first half of pregnancy was associated with increased risk of stillbirth (adjusted hazard ratio (HR) 1.7, 95% confidence internal (CI) 1.1, 2.7), but not neonatal deaths. Anemia in the 1st trimester was associated with increased risk for preterm premature rupture of membranes (PROM). Women with hemoglobin ≤5 g/dL were at highest risk (HR 3.3, 95% CI 1.4, 7.7) with progressively declining risk with increasing hemoglobin levels. In contrast, anemia in the 3rd trimester was associated with reduced risk for all preterm birth and spontaneous preterm labor, potentially due to hemo-dilution. Anemia was not associated with medically indicated preterm birth. Conclusion: Anemia in early pregnancy was associated with increased risk for stillbirth and preterm PROM. These findings underscore that early identification and treatment to alleviate anemia may help improve adverse pregnancy outcomes and related complications.Ph.D.Includes bibliographical references

Characteristics and Geological Significance of High-Frequency Cycles in Salinized Lake Basins: The Paleogene Kumugeliemu Group in the Xinhe Area, Northern Tarim Basin

Salinized lake basins have distinctive sedimentary response characteristics, similar to marine shallow-water carbonate platforms. High-frequency cycles can also be used to reveal more sedimentological information, such as relative lake-level fluctuations, lithofacies sequence combinations, and paleogeographic evolution. In this article, a comprehensive study on the stratigraphic shelf delineation and high-frequency cycles of the Paleozoic Kumugeliemu Group in Xinhe area, northern Tarim Basin, was performed using drilling cores, logging curves, and seismic analyses. As a result of the study, the following data were obtained: the three sets of marker beds in the Kumugeliemu Group in the study area could be divided into a bottom sandstone component (E1-2 km1), a lower gypsum mudstone component (E1-2 km2), a salt rock component (E1-2 km3), and an upper gypsum mudstone component (E1-2 km4) by petrology vertical overlay combination and isochronous tracking correlation, which constituted two third-order cycles (ESQ1, ESQ2). They were further divided into seven fourth-order cycles (Esq1–Esq7). Due to the droughty and saline lacustrine depositional system background, the internal rock fabric changed frequently and showed a periodic vertical overlay pattern. Stratified gypsum salt, gypsum mud (sand) rock, and gypsum rock were used as the cycle interface. A single cycle was mainly characterized by an upward shallower depositional sequence of rapid lake transgression followed by a slow lake regression, composed of massive sandstone–lamellar mudstone–lime dolomite–gypsum rock, massive sandstone–lamellar mudstone–gypsum rock (gypsum salt), massive sandstone–massive gypsum mud (sand) rock–gypsum rock, and other cycle structure types. The complete sedimentary cycle was superposed by a single cycle and compared by the inter-well thickness difference, indicating that the study area had a paleogeomorphology pattern of “West-Low–East-High”. The thickness of the cycles decreased gradually from bottom to top vertically, and five sedimentary stages were determined, i.e., freshwater, brackish, brackish water, salt lake, and semi-saltwater, reflecting the evolutionary process of increasing salinity, lake basin filling, and gradual salinization and shrinkage