The effects of health education and exercise style changes on the maturation of autologous arteriovenous fistula in hemodialysis patients: A randomized controlled trial.

BACKGROUND: Upper limb exercise has long been considered to be the main means to promote autogenous arteriovenous fistula (AVF) maturation, but in practice exercise intensity and compliance are both typically lacking. Several randomized controlled trials (RCTs) have demonstrated the good effects of functional resistance or pressure exercise in patients with AVF. However, many patients' have difficulty complying with upper limb exercise programs without systematic health education. Therefore, we argue that resistance and pressure exercise supported by health education is actually the most beneficial for AVF patients. METHODS: We randomly divided 114 patients into a control group and an experimental group of 57 patients each. In the control group, conventional care was used, and in the experimental group, online health education based on the IMB (Information-Motivation-Behavior skills) model and functional resistance and pressure upper limb exercises was implemented with the AVF side arm. The failure rate of AVF maturation, clinical maturation time, cephalic venous blood flow, vessel diameter, and vessel skin thickness were compared between the two groups. RESULTS: Fifty-five cases were included for each in the final study. The primary outcome of this study was the failure rate of AVF maturation. Secondary outcomes included clinical maturation time, cephalic vein flow, vessel diameter, and vessel thickness. The failure rate of AVF maturation in the experimental group was significantly lower than that in the control group, and the clinical maturation time in the experimental group was significantly shorter than that in the control group. For the remaining three indicators, there were between-group effects, time effects, and interaction effects in both groups. Comparison between groups showed that there was no statistical difference in the observed indicators of cephalic vein flow, vessel diameter, or vessel thickness between the two groups before the intervention but that there was a statistical difference at the end of the 4th, 8th, and 12th weeks of the intervention. A 2 × 2 comparison also showed that there was a statistical difference between the three indicators at each time point within the two groups. CONCLUSION: IMB model-based online health education combined with functional resistance and pressure exercises can improve AVF maturation status and accelerate AVF maturation within 12 weeks of surgery.

Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function.

Host-microbe interactions have been implicated in the pathogenesis of chronic fatigue syndrome (CFS), but whether the oral microbiome is altered in CFS patients is unknown. We explored alterations of the oral microbiome in Chinese Han CFS patients using 16S rRNA gene sequencing and alterations in the functional potential of the oral microbiome using PICRUSt. We found that Shannon and Simpson diversity indices were not different in CFS patients compared to healthy controls, but the overall oral microbiome composition was different (MANOVA, p < 0.01). CFS patients had a higher relative abundance of Fusobacteria compared with healthy controls. Further, the genera Leptotrichia, Prevotella, and Fusobacterium were enriched and Haemophilus, Veillonella, and Porphyromonas were depleted in CFS patients compared to healthy controls. Functional analysis from inferred metagenomes showed that bacterial genera altered in CFS patients were primarily associated with amino acid and energy metabolism. Our findings demonstrate that the oral microbiome in CFS patients is different from healthy controls, and these differences lead to shifts in functional pathways with implications for CFS pathogenesis. These findings increase our understanding of the relationship between the oral microbiota and CFS, which will advance our understanding of CFS pathogenesis and may contribute to future improvements in treatment and diagnosis.

Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis.

BACKGROUND: As the etiology of chronic fatigue syndrome (CFS) is unclear and the treatment is still a big issue. There exists a wide range of literature about acupuncture and moxibustion (AM) for CFS in traditional Chinese medicine (TCM). But there are certain doubts as well in the effectiveness of its treatment due to the lack of a comprehensive and evidence-based medical proof to dispel the misgivings. Current study evaluated systematically the effectiveness of acupuncture and moxibustion treatments on CFS, and clarified the difference among them and Chinese herbal medicine, western medicine and sham-acupuncture. METHODS: We comprehensively reviewed literature including PubMed, EMBASE, Cochrane library, CBM (Chinese Biomedical Literature Database) and CNKI (China National Knowledge Infrastructure) up to May 2016, for RCT clinical research on CFS treated by acupuncture and moxibustion. Traditional direct meta-analysis was adopted to analyze the difference between AM and other treatments. Analysis was performed based on the treatment in experiment and control groups. Network meta-analysis was adopted to make comprehensive comparisons between any two kinds of treatments. The primary outcome was total effective rate, while relative risks (RR) and 95% confidence intervals (CI) were used as the final pooled statistics. RESULTS: A total of 31 randomized controlled trials (RCTs) were enrolled in analyses. In traditional direct meta-analysis, we found that in comparison to Chinese herbal medicine, CbAM (combined acupuncture and moxibustion, which meant two or more types of acupuncture and moxibustion were adopted) had a higher total effective rate (RR (95% CI), 1.17 (1.09 ~ 1.25)). Compared with Chinese herbal medicine, western medicine and sham-acupuncture, SAM (single acupuncture or single moxibustion) had a higher total effective rate, with RR (95% CI) of 1.22 (1.14 ~ 1.30), 1.51 (1.31-1.74), 5.90 (3.64-9.56). In addition, compared with SAM, CbAM had a higher total effective rate (RR (95% CI), 1.23 (1.12 ~ 1.36)). In network meta-analyses, similar results were recorded. Subsequently, we ranked all treatments from high to low effective rate and the order was CbAM, SAM, Chinese herbal medicine, western medicine and sham-acupuncture. CONCLUSIONS: In the treatment of CFS, CbAM and SAM may have better effect than other treatments. However, the included trials have relatively poor quality, hence high quality studies are needed to confirm our finding.