A virtual, pilot randomized trial of a brief intervention to prevent suicide in an integrated healthcare setting.

OBJECTIVE: Patients who die by suicide are often seen in primary care settings in the weeks leading to their death. There has been little study of brief interventions to prevent suicide in these settings. METHOD: We conducted a virtual, pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients who presented to a primary care mental health walk-in clinic for a new mental health intake appointment and were at risk for suicide. Our primary aim was to assess feasibility. We measured our ability to recruit 20 patients. We measured the proportion of enrolled patients who completed all study assessments. We assessed adherence among patients assigned to VA BIC. RESULTS: Twenty patients were enrolled and 95% (N = 19) completed all study assessments. Among the 10 patients assigned to VA BIC, 90% (N = 9) of patients completed all required intervention visits, and 100% (N = 10) completed ≥70% of the required interventions visits. CONCLUSION: It is feasible to conduct a virtual trial of VA BIC in an integrated care setting. Future research should clarify the role of VA BIC as a suicide prevention strategy in integrated care settings using an adequately powered design. CLINICAL TRIAL REGISTRATION: NCT04054947.

Controlled observation of clinical efficacy on knee osteoarthritis treated with auricular electroacupuncture and the isolated moxibustion with Lingxian herbal paste / 中国针灸

<p><b>OBJECTIVE</b>To observe the difference in the therapeutic effects on knee osteoarthritis (KOA) among auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste (combined therapy), electroacupuncture (EA) and TDP irradiation.</p><p><b>METHODS</b>Eighty-nine cases were randomized into three groups. In the combined therapy group (30 cases), the auricular electroacupuncture therapy was adopted together with the isolated moxibustion with Lingxian herbal paste. The auricular points were xi (AH4), pizhixia (AT4), shenmen (TF4), etc. The Lingxian herbal paste was applied at Yanglingquan (GB 34), Dubi (ST 35), Zusanli (ST 36), Neixiyan (EX-LE 4), Heding (EX-LE 2) and Ashi points. In EA group (29 cases), EA was applied at the acupoints that were same as those in the isolated moxibustion with Lingxian herbal paste. In TDP group (30 cases), TDP irradiation was given at the affected knee. The treatment was given once every day, 10 treatments made one session and there was 1 week at the interval among sessions. Totally, 3 sessions of treatment were required. KOA clinical symptom and physical sign score and the single item pain symptom score of Lequesne index were observed before treatment and 1 week after treatment in the patients of each group separately. The efficacies were compared among the three groups.</p><p><b>RESULTS</b>One week after treatment, the total score of symptoms and physical signs of the patients in each group was reduced significantly as compared with that before treatment (all P < 0.05). The improvements in the symptoms and physical signs in the combined therapy group were better than those in the other two groups (1.50 +/- 1.57 vs 2.52 +/- 1.82, 2.63 +/- 1.97, both P < 0.05). The improvement in pain in the combined therapy group was also better than that in the other two groups (2.37 +/- 0.81 vs 2.83 +/- 0.92, P < 0.05; 2.37 +/- 0.81 vs 3.03 +/- 0.77, P < 0.01). The curative rate in the combined therapy group was 40.0% (12/30), which was higher than 17.2% (5/29) in EA group and 20.0% (6/30) in TDP group separately (both P < 0.01). The overall efficacy in the combined therapy group was superior to the other two groups (P < 0.05).</p><p><b>CONCLUSION</b>The auricular electroacupuncture therapy plus isolated moxibustion with Lingxian herbal paste is advantageous at the total score of the symptoms and physical signs and the overall efficacy in the patients of KOA as compared with EA at the local acupoints and local TDP irradiation.</p>

Association between folate levels and CpG Island hypermethylation in normal colorectal mucosa.

Gene-specific promoter methylation of several genes occurs in aging normal tissues and may predispose to tumorigenesis. In the present study, we investigate the association of blood folate levels and dietary and lifestyle factors with CpG island (CGI) methylation in normal colorectal mucosa. Subjects were enrolled in a multicenter chemoprevention trial of aspirin or folic acid for the prevention of large bowel adenomas. We collected 1,000 biopsy specimens from 389 patients, 501 samples from the right colon and 499 from the rectum at the follow-up colonoscopy. We measured DNA methylation of estrogen receptor alpha (ERα) and secreted frizzled related protein-1 (SFRP1), using bisulfite pyrosequencing. We used generalized estimating equations regression analysis to examine the association between methylation and selected variables. For both ERα and SFRP1, percentage methylation was significantly higher in the rectum than in the right colon (P = 0.001). For each 10 years of age, we observed a 1.7% increase in methylation level for ERα and a 2.9% increase for SFRP1 (P < 0.0001). African Americans had a significantly lower level of ERα and SFRP1 methylation than Caucasians and Hispanics. Higher RBC folate levels were associated with higher levels of both ERα (P = 0.03) and SFRP1 methylation (P = 0.01). Our results suggest that CGI methylation in normal colorectal mucosa is related to advancing age, race, rectal location, and RBC folate levels. These data have important implications regarding the safety of supplementary folate administration in healthy adults, given the hypothesis that methylation in normal mucosa may predispose to colorectal neoplasia.

Effect of calcium supplementation on fracture risk: a double-blind randomized controlled trial.

BACKGROUND: The effect of supplementation with calcium alone on risk fractures in a healthy population is not clear. OBJECTIVE: The objective was to determine whether 4 y of calcium supplementation would reduce the fracture risk during treatment and subsequent follow-up in a randomized placebo-controlled trial. DESIGN: The participants were aged <80 y at study entry (mean age: 61 y), were generally healthy, and had a recent diagnosis of colorectal adenoma. A total of 930 participants (72% men; mean age: 61 y) were randomly assigned to receive 4 y of treatment with 3 g CaCO(3) (1200 mg elemental Ca) daily or placebo and were followed for a mean of 10.8 y. The primary outcomes of this analysis were all fractures and minimal trauma fractures (caused by a fall from standing height or lower while sitting, standing, or walking). RESULTS: There were 46 fractures (15 from minimal trauma) in 464 participants in the calcium group and 54 (29 from minimal trauma) in 466 participants in the placebo group. The overall risk of fracture differed significantly between groups during the treatment phase [hazard ratio (HR): 0.28; 95% CI: 0.09, 0.85], but not during the subsequent posttreatment follow-up (HR: 1.10; 95% CI: 0.71, 1.69). Minimal trauma fractures were also less frequent in the calcium group during treatment (HR: 0; 95% CI: 0, 0.50). CONCLUSION: Calcium supplementation reduced the risk of all fractures and of minimal trauma fractures among healthy individuals. The benefit appeared to dissipate after treatment was stopped. This trial was registered at clinicaltrials.gov as NCT00153816.

[Clinical observation on treatment of male infertility with positive antisperm antibody by self-formulated Xiaokang Zhongzi Recipe].

OBJECTIVE: To observe the therapeutic effect of self-formulated Xiaokang Zhongzi Recipe (XZR) in treating male infertility with positive antisperm antibody (AsAb). METHODS: One hundred and ten male infertility patients with positive AsAb were randomly assigned, according to randomized digital table, to the trial group treated with XZR, and the control group, treated with prednisone, 55 in each group. Clinical therapeutic effect and adverse reactions of the drugs were observed after 3 months of treatment. RESULTS: In the trial group after treatment, 38 patients (69.1%) were cured, 14 (25.4%) improved and 3 treated in vain (5.5%, including 2 dropped out). While in the control group, the corresponding numbers were 12 (21.8%), 11 (20.0%) and 32 (58.2%, including 4 dropped out, 20 remained AsAb positive and 8 with AsAb reverted to positive after negative conversion). The negative conversion rate and average negative conversion time in the trial group and the control group were respectively 94.5%, (45 +/- 14) days and 41.8%, (62 +/- 21) days. Significant difference between the two groups was shown in therapeutic effectiveness and average negative conversion time (P < 0.01). Adverse reactions occurred in 3 cases (5.5%) in the trial group and 8 (14.5%) in the control group. CONCLUSION: XZR is better than prednisone in treating male infertility with positive AsAb, and with fewer and milder adverse reactions.

Clinical observation on treatment of male infertility with positive antisperm antibody by self-formulated Xiaokang Zhongzi Recipe / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of self-formulated Xiaokang Zhongzi Recipe (XZR) in treating male infertility with positive antisperm antibody (AsAb).</p><p><b>METHODS</b>One hundred and ten male infertility patients with positive AsAb were randomly assigned, according to randomized digital table, to the trial group treated with XZR, and the control group, treated with prednisone, 55 in each group. Clinical therapeutic effect and adverse reactions of the drugs were observed after 3 months of treatment.</p><p><b>RESULTS</b>In the trial group after treatment, 38 patients (69.1%) were cured, 14 (25.4%) improved and 3 treated in vain (5.5%, including 2 dropped out). While in the control group, the corresponding numbers were 12 (21.8%), 11 (20.0%) and 32 (58.2%, including 4 dropped out, 20 remained AsAb positive and 8 with AsAb reverted to positive after negative conversion). The negative conversion rate and average negative conversion time in the trial group and the control group were respectively 94.5%, (45 +/- 14) days and 41.8%, (62 +/- 21) days. Significant difference between the two groups was shown in therapeutic effectiveness and average negative conversion time (P < 0.01). Adverse reactions occurred in 3 cases (5.5%) in the trial group and 8 (14.5%) in the control group.</p><p><b>CONCLUSION</b>XZR is better than prednisone in treating male infertility with positive AsAb, and with fewer and milder adverse reactions.</p>