Caracterización y seguimiento de una población de uruguayos usuarios de derivados de cannabis medicinal artesanal / Characterization and follow up of a population of Uruguayan cannabis derivatives users in artisanal medicine / Caracterização e monitoramento de uma população de usuários uruguaios de derivados artesanais de cannabis medicinal

Introducción: el conocimiento del cannabis medicinal data de hace más de 10.000 años y tiene sus orígenes en el continente asiático y en la medicina oriental. En el último tiempo ha surgido especial interés en su uso terapéutico, y Uruguay desde 2013 cuenta con una ley que regula la tenencia y uso de la planta de cannabis. Objetivo: caracterizar el uso de los derivados de cannabis medicinal (DCM) en una población de usuarios uruguayos. Metodología: se realizó un estudio observacional, prospectivo, en una población de usuarios de DCM, a través de encuestas telefónicas. Los datos obtenidos se analizaron utilizando Excel®, mediante estadística descriptiva. Resultados: se incluyeron 32 usuarios entre 29 y 78 años, la mayoría de sexo femenino. La forma farmacéutica más utilizada fue el aceite y la principal indicación fue para el tratamiento del dolor. Se observó una disminución en la intensidad del dolor postratamiento. El principal efecto adverso observado fue la sequedad de boca. Conclusiones: es el primer estudio nacional en caracterizar el uso de DCM artesanal. Se incluyeron 32 usuarios de DCM artesanal. La principal indicación de DCM fue para el tratamiento del dolor, siendo la artrosis su principal causa. Todos los usos fueron para indicaciones no aprobadas si se compara con sus equivalentes industrializados. Predominó el uso en mujeres adultas. Se destacó una gran expectativa frente al inicio del uso. Los eventos adversos observados estuvieron dentro de los esperados y de entidad leve.

Summary: Introduction: knowledge on medical cannabis is over 10,000 years old and stems from Asian and Eastern medicine. In recent years, special interest on its therapeutic use has arisen, and in 2013 Uruguay passed a law to regulate possession and use of cannabis plants. Objective: to characterize the use of medicinal cannabis derivatives in a population of Uruguayan users. Method: observational, prospective study in a population of medicinal cannabis derivatives users through telephone surveys. Data obtained were analysed with Excel®, by using descriptive statistics. Results: thirty two users were included in the study, between 29 and 78 years old, most of which were female. The most widely used pharmaceutical form was oil and the main indication was to treat pain. A decline in pain intensity after treatment was observed. The main adverse effect observed was dry mouth. Conclusions: this is the first national study to characterize the use of artisanal medicinal cannabis derivatives. Thirty two users of artisanal medicinal cannabis derivatives were included in the study. The main indication for artisanal medicinal cannabis derivatives was the treatment of pain, arthrosis being the main cause. All users followed non-approved indications if compared to industrialized equivalents. The use was more extended among women. Great expectation upon initiation of use was noticed. Adverse events observed were mild and the expected.

Introdução: o conhecimento da cannabis medicinal remonta a mais de 10.000 anos e tem suas origens no continente asiático e na medicina oriental. Nos últimos tempos, surgiu um interesse especial em seu uso terapêutico e, desde 2013, o Uruguai possui uma lei que regula a posse e o uso da planta de cannabis. Objetivo: caracterizar o uso de derivados de cannabis medicinal (DCM) em uma população de usuários uruguaios. Metodologia: Foi realizado um estudo observacional, prospectivo, em uma população de usuários de DCM, por meio de inquéritos telefônicos. Os dados obtidos foram analisados ​​no programa Excel®, por meio de estatística descritiva. Resultados: foram incluídos 32 usuários entre 29 e 78 anos, a maioria do sexo feminino. A forma farmacêutica mais utilizada foi o óleo e a principal indicação foi para o tratamento da dor. Observou-se diminuição da intensidade da dor pós-tratamento. O principal efeito adverso observado foi boca seca. Conclusões: este é o primeiro estudo nacional a caracterizar o uso de DCM artesanal. Foram incluídos 32 usuários artesanais de DCM. A principal indicação da CMD foi para o tratamento da dor, sendo a osteoartrite sua principal causa. Todos os usos foram para indicações não aprovadas quando comparados aos seus equivalentes industrializados. Predominou o uso em mulheres adultas. Houve uma grande expectativa desde o início do uso. Os eventos adversos observados estavam dentro do esperado e de entidade leve.

Componente curricular projeto de vida: perspectivas de professoras da rede estadual de São Paulo / Curricular component life purpose: perspectives of teachers of the São Paulo state network / Componente curricular proyecto de vida: perspectivas de profesores de la red estadual de São Paulo

O objetivo deste estudo foi conhecer a experiência de alguns professores ao lecionar projeto de vida durante a implementação do componente curricular Projeto de Vida no estado de São Paulo. Realizou-se uma pesquisa qualitativa, de caráter exploratório. Participaram do estudo sete professoras que lecionavam o componente curricular Projeto de Vida em duas escolas públicas, de uma cidade do interior do estado de São Paulo, escolhidas por conveniência. Foram utilizados o Questionário de Dados Sociodemográficos e o Protocolo de Entrevista Semiestruturada para Projeto de Vida de Professores, elaborados para este estudo. As professoras foram entrevistadas individualmente, on-line, e as entrevistas foram gravadas em áudio e vídeo. Os dados foram analisados por meio de análise temática. Os resultados indicaram possibilidades e desafios em relação à implementação do componente curricular Projeto de Vida. Constatou- se que a maioria das docentes afirmou que escolheu esse componente curricular devido à necessidade de atingir a carga horária exigida na rede estadual. As professoras criticaram a proposta, os conteúdos e os materiais desse componente curricular. As críticas apresentadas pelas professoras estão em consonância com aquelas presentes na literatura em relação à reforma do Ensino Médio e ao Inova Educação. Esses resultados sugerem a necessidade de formação tanto nos cursos de licenciatura quanto em ações de formação continuada, para que os professores se sintam mais seguros e preparados para lecionar o componente curricular Projeto de Vida na Educação Básica. Propõe-se uma perspectiva de formação pautada na reflexão e na troca entre os pares para a construção de um projeto coletivo da escola para o componente Projeto de Vida.(AU)

This study aimed to know the experience of some teachers when teaching life purpose during the implementation of the curricular component "Life Purpose" (Projeto de Vida) in the state of São Paulo. A qualitative, exploratory research was carried out. Seven teachers who taught the curricular component "Life Purpose" (Projeto de Vida) in two public schools in a city in the inland state of São Paulo, chosen for convenience, participated in the study. The Sociodemographic Data Questionnaire and the Semi-structured Interview Protocol for Teachers' Life Purposes, developed for this study, were used. The teachers were interviewed individually, online, and the interviews were recorded in audio and video. Data were analyzed using thematic analysis. The results indicated possibilities and challenges regarding the implementation of the Life Purpose curricular component. It was found that most teachers chose this curricular component due to the need to reach the required workload in the state network. The teachers criticized the proposal, the contents and the materials of this curricular component. Teacher's critics are in line with the criticisms present in the literature regarding the reform of High School and Inova Educação. Therefore, training is essential, both in undergraduate courses and in continuing education actions, so that teachers can teach the curricular component Life Purpose in Basic Education. A training perspective based on reflection and exchange between peers is proposed for the construction of a collective school project for the Life Purpose component.(AU)

El objetivo de este estudio fue conocer la experiencia de algunos profesores al enseñar proyecto de vida durante la implementación del componente curricular Proyecto de Vida en el estado de São Paulo. Se realizó una investigación cualitativa, exploratoria. Participaron en el estudio siete profesores que impartían el componente curricular Proyecto de Vida en dos escuelas públicas en un municipio del estado de São Paulo, elegidos por conveniencia. Los instrumentos utilizados fueron el cuestionario de datos sociodemográficos y el protocolo de entrevista semiestructurada para proyectos de vida de profesores, desarrollados para este estudio. Las entrevistas a los profesores fueron en línea, de manera individual, y fueron grabadas en audio y video. Los datos se sometieron a un análisis temático. Los resultados indicaron posibilidades y desafíos en relación a la implementación del componente curricular Proyecto de Vida. La mayoría de los profesores declararon elegir este componente curricular por la necesidad de alcanzar la carga horaria requerida en la red estatal. Los profesionales criticaron la propuesta, los contenidos y los materiales de este componente curricular. Las críticas presentadas están en línea con las críticas presentes en la literatura respecto a la reforma de la educación básica e Inova Educação. Por lo tanto, la formación es fundamental, tanto en los cursos de grado como en las acciones de educación permanente, para que los profesores puedan impartir el componente curricular Proyecto de Vida en la educación básica. Se propone una formación basada en la reflexión y el intercambio entre pares para la construcción de un proyecto escolar colectivo en el componente Proyecto de Vida.(AU)

Statistics and Colonial Medicine: A Doubt and Controversy on Tuberculosis Statistics in Colonial Korea / 의사학

This paper focuses on the criticism of tuberculosis statistics published by the Japanese Government-general in colonial Korea and a research on the reality of tuberculosis prevalence by medical doctors from the Department of Hygiene and Preventive Medicine at Keijo Imperial University (DHPMK). Recent studies have shown that colonial statistics shape the image of colonial subjects and justify the control to them. Following this perspective, this paper explores the process of producing the statistical knowledge of tuberculosis by medical scientists from DHPMK. Their goal was to find out the resistance to tuberculosis as biological characteristics of Korean race/ethnicity. In order to do so, they demonstrated the existence of errors in tuberculosis statistics by the Korean colonial government and devised a statistical method to correct them based on the conviction that the Western modern medicine was superior than Korean traditional medicine as well as the racist bias against Korean. By analyzing how the statistical concepts reflected these prejudices, this paper argues that the statistical knowledge of tuberculosis created images that Japanese people was healthier and stronger than the Korean people and justified the colonial government's control over Korean.

Association between Serum Selenium Level and the Presence of Diabetes Mellitus: A Meta-Analysis of Observational Studies

BACKGROUND: Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM. METHODS: We searched the PubMed database for studies on the association between Se and DM from inception to June 2018. RESULTS: Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found (I2 =82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I2 =77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I2 =0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I2 =0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I2 =91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias. CONCLUSION: This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.

Mesenchymal stem cells in acute myeloid leukemia: a focus on mechanisms involved and therapeutic concepts

Drug resistance in cancer, especially in leukemia, creates a dilemma in treatment planning. Consequently, studies related to the mechanisms underlying drug resistance, the molecular pathways involved in this phenomenon, and alternate therapies have attracted the attention of researchers. Among a variety of therapeutic modalities, mesenchymal stem cells (MSCs) are of special interest due to their potential clinical use. Therapies involving MSCs are showing increasing promise in cancer treatment and anticancer drug screening applications; however, results have been inconclusive, possibly due to the heterogeneity of MSC populations. Most recently, the effect of MSCs on different types of cancer, such as hematologic malignancies, their mechanisms, sources of MSCs, and its advantages and disadvantages have been discussed. There are many proposed mechanisms describing the effects of MSCs in hematologic malignancies; however, the most commonly-accepted mechanism is that MSCs induce tumor cell cycle arrest. This review explains the anti-tumorigenic effects of MSCs through the suppression of tumor cell proliferation in hematological malignancies, especially in acute myeloid leukemia.

Effects of Aromatherapy on Sleep Quality: A Systematic Review and Meta-Analysis

PURPOSE: The purpose of this study was to investigate the effects of aromatherapy on sleep quality.METHODS: This is a systematic review of randomized controlled trial studies (PROSPERO registration number CRD42017064519). In this study, the PICO were adults and the elderly, aromatherapy intervention, a comparative intervention with the control and placebo oil groups, and sleep. The selected articles were in English, Korean, and Chinese.RESULTS: The results of the meta-analysis showed that the effect sizes of the experimental group were 1.03 (n=763, SMD=1.03, 95% CI 0.66 to 1.39) (Z=5.47, p<.001). In the aromatherapy intervention group, the effect size of sleep was statistically significant (Q(B)=9.39, df=2, p=.009), with a difference of 0.77 for inhalation, 1.12 for oral intake and 2.05 for massage. A post-analysis showed that the effect of massage on sleep was significantly greater than the inhalation method. The regression coefficient of the intervention period, B=0.01 (Z=1.43, p=.154), also showed that the longer the intervention period, the larger the effect size; however, it was not statistically significant.CONCLUSION: A total of 23 literature analyses showed that aromatherapy is effective in improving quality of sleep, and the massage method is more effective in improving quality of sleep than the inhalation method. A meta-ANOVA showed that the aromatherapy intervention affected the high heterogeneity of the effect size. Thus, future research with stricter control in methods and experimental procedures is necessary.

Current Management of Cancer-associated Venous Thromboembolism: Focus on Direct Oral Anticoagulants

Cancer-associated venous thromboembolism (CAT) is a common complication associated with high morbidity and mortality. In accordance with major clinical trials comparing low-molecular-weight heparin (LMWH) with a vitamin K antagonist (VKA), LMWH is currently the standard treatment for CAT, owing to its efficacy for thrombosis recurrence and improved safety profile compared to VKA. Over the past few years, direct oral anticoagulants (DOACs) have emerged as potential alternative therapies to LMWH due to their convenient route of administration and predictable pharmacokinetics, but evidence for their use in CAT is inconclusive, as only a small fraction of the study populations in these trials had CAT. Recently, two large head-to-head trials comparing DOACs to LMWH in CAT patients reported comparable efficacies of DOACs with increased bleeding risk. Occasionally, CAT treatment can be challenging due to the heterogeneity of underlying malignancies and comorbidities. Renal insufficiency and gastrointestinal defects are the main obstacles in anticoagulant selection. Careful choice of treatment candidates and proper anticoagulant strategies are critical for the treatment of CAT; hence, more studies are required to address these challenges.

Twenty-one-year follow-up of variable onset MELAS syndrome with heteroplasmic nt3243A>G mtDNA mutation: A case report

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a maternally inherited mitochondrial disorder of which m.3243A>G is the most commonly associated mutation, resulting in an inability to meet the energy requirements of various organs. MELAS poses a diagnostic challenge owing to its multiple organ involvement and great clinical variability due to its heteroplasmic nature. We report three cases from a family who were initially misdiagnosed with myasthenia gravis or undiagnosed. Although there is no optimal consensus treatment approach for patients with MELAS because of the disease's heterogeneity, our 21-year-long therapy regimen of l-arginine, l-carnitine, and coenzyme Q10 supplementation combined with dietary management appeared to provide noticeable protection from the symptoms and complications. Prompt early diagnosis is important, as optimal multidisciplinary management and early intervention may improve outcomes.

Analysis of secularization in Brazil / Análise da secularização no Brasil / Análisis de la secularización en Brasil

This paper analyzes whether Brazil is experiencing a religious secularization process using data from Brazil Religion Survey conducted in 2007. Models of discrete choice are estimated to understand which individual attributes affect disaffiliation, disbelief and lack of religious practice, therefore confirming or disproving secularism hypotheses. Estimations confirm some hypotheses of the theory, for example, that having liberal opinions concerning moral and social issues is positively associated with secularism, and that lower income levels result in lower chances of disaffiliation. In addition, the profile of non-religious people, non-believers and those who do not practice religion is similar. Therefore, it is possible to affirm that there is secularization in Brazil.

Este trabalho analisa se o Brasil está passando por um processo de secularização, utilizando dados da Pesquisa sobre Religião no Brasil, conduzida em 2007. Modelos de escolha discreta foram estimados para entender quais atributos dos indivíduos afetam a desfiliação, descrença e ausência de prática religiosa, para confirmar ou refutar as hipóteses do secularismo. A estimação confirmou algumas hipóteses da teoria. Por exemplo, ter uma opinião liberal acerca de assuntos morais e sociais está positivamente associado com secularismo, enquanto níveis mais baixos de renda incorrem em menores chances de desfiliação. Além disso, o perfil dos desfiliados, descrentes e não praticantes é semelhante. Portanto, é possível afirmar que existe secularização no Brasil.

Este trabajo analiza si Brasil está pasando por un proceso de secularización, para lo cual utiliza datos de la Investigación sobre Religión en Brasil, desarrollada en 2007. Modelos de elección discreta fueron estimados para entender qué atributos de los individuos afectan la desafiliación, la incredulidad y la ausencia de prácticas religiosas, para confirmar o refutar las hipótesis del secularismo. La estimación confirmó algunas hipótesis de la teoría. Por ejemplo, tener una opinión liberal acerca de asuntos morales y sociales está positivamente asociado con el secularismo, mientras que ingresos más bajos implican menores posibilidades de desafiliación. Además, el perfil de los desafiliados, no creyentes y no practicantes es similar. Por lo tanto, es posible afirmar que existe secularización en Brasil.

Entre Demografia e Antropologia: povos indígenas no Brasil / Between Demography and Anthropology indigenous peoples in Brazil

Oitavo livro da coleção Saúde dos Povos Indígenas, Entre Demografia e Antropologia: povos indígenas no Brasil apresenta profundas avaliações sobre as dinâmicas populacionais indígenas. A coletânea levanta contribuições que indicam que os escassos dados demográficos de décadas atrás se tornaram mais abundantes, passando a fomentar políticas públicas. Em suas abordagens, a obra passa por pesquisas e conhecimentos multidisciplinares, que vão de questões de migração, mobilidade e dinâmica territorial até a contextualização de dados censitários e a forma como a população indígena é retratada nos censos demográficos do Brasil. A antropóloga Marta Azevedo ressalta a importância de "buscar uma maior participação da população indígena na produção de dados e análises demográficas". Segundo ela, tão estratégico quanto continuar a fomentar a realização de uma demografia indígena é formar demógrafos indígenas no país. O anseio expressado pela autora e organizadora aparece no último capítulo do livro, que é dividido em três partes: Perspectivas a partir do Campo, Dados Censitários em Contexto e Trajetórias, Categorias, Implicações.

Effect of Aromatherapy on the Treatment of Psychological Symptoms in Postmenopausal and Elderly Women: A Systematic Review and Meta-analysis

OBJECTIVES: To critically assess the effect of aromatherapy on the psychological symptoms as noted in the postmenopausal and elderly women. METHODS: Three following databases were systematically searched: MEDLINE, Scopus and Cochrane Library (Cochrane Central Register of Controlled Trials) from inception to January 2018. The search keywords included ‘menopause’ AND (aromatherapy), without language restrictions. RESULTS: In this study, 4 trials were included which fit into our systematic review. The findings demonstrated that the aromatherapy massage have significantly improved psychological symptoms in menopausal and elderly women as compared to the control group (standardized mean difference [SMD] = −1.24; 95% confidence interval, −0.188 to −0.606; P < 0.001 random effect model; 3 trials, moderate to high heterogeneity, I2 = 0.76; P = 0.028). According to 1 of the trials, the aromatherapy oil massage was no more effective than the untreated group regarding their experience of symptoms such as nervousness. CONCLUSIONS: The aromatherapy may be beneficial in attenuating the psychological symptoms that these women may experience, such as anxiety and depression, but it is not considered as an effective treatment to manage nervousness symptom among menopausal women. This finding should be observed in light of study limitations.

Effect of Herbal Medicine on Vaginal Epithelial Cells: A Systematic Review and Meta-analysis

OBJECTIVES: The present meta-analysis aimed to assess the effect of the herbal medicine on the vaginal epithelial cells (VECs) among the menopausal subjects. METHODS: The literature related to VECs exposed to various herbal medicines in menopausal women were searched on three databases, MEDLINE (1966–August 2017), Scopus (1990–August 2017) and Cochrane Library (Cochrane Central Register of Controlled Trials; 2014). RESULTS: Totally, the meta-analysis was conducted on 11 randomised controlled trials. Based on the findings, the standardized mean difference (SMD) of maturation value (MV) was observed to be elevated by 0.48% (95% interval confidence [CI], 0.108–0.871; P = 0.012), as well as the heterogeneity was high (I2 = 84%; P < 0.001). The MV revealed a significant increase in soy group (SMD, 0.358; 95% CI, 0.073–0.871; P = 0.014) compared to the control group. CONCLUSIONS: The herbal medicines exhibited a statistically significant effect on the VECs. A significant effect on the VECs was also found in the subgroup analysis of the patients, who received soy. However, further and extensive studies are required to achieve reliable outcomes.

Aromatherapy for Sexual Problems in Menopausal Women: A Systematic Review and Meta-analysis

OBJECTIVES: The aim of the present systematic review and meta-analysis is the exploration of the potential evidence of the effectiveness of aromatherapy products on the sexual function of menopausal women. METHODS: From inception to December 2017, the search process was performed using the MEDLINE and Scopus databases and the Cochrane Library regarding the trials on the effectiveness of herbal-medicine aromatherapy on the sexual function of menopausal women. RESULTS: Three of the trials comprise suitable data for inclusion in the meta-analysis. According to the meta-analysis, it is possible to improve the standardized mean difference (SMD) of the sexual desire up to 0.56 in the aromatherapy group compared with the control group (SMD = 0.56; P < 0.001; heterogeneity; I² = 42%; P = 0.141). According to one of the trials, the serum-estrogen level of two different doses did not change in the neroli oil inhalation group compared with the almond-oil group. CONCLUSIONS: Both aromatherapy with neroli oil or lavender (monopreparation) and combined-oil aromatherapy with lavender, fennel, geranium, and rose significantly improved human sexual function; however, a significant change of the serum-estrogen level was not detected. The findings of the present review should be presented cautiously because of the corresponding limitations such as the lack of a standardized tool, the lack of intention-to-treat reporting, the low study amount, and the short-term follow-up.

Meta-analysis of randomized controlled trials on the efficacy of daikenchuto on improving intestinal dysfunction after abdominal surgery

PURPOSE: Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery. METHODS: PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I2 = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I2 = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results. CONCLUSION: These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.

Chinese Herbal Medicine to Treat Allergic Rhinitis: Evidence From a Meta-Analysis

PURPOSE: Chinese herbal medicine (CHM) has been widely used in China to treat allergic rhinitis (AR). However, several studies have produced conflicting data with regard to the efficacy of the medicine. Our aim was to perform a meta-analysis of randomized clinical trials (RCTs) to evaluate the relative efficacy of CHM. METHODS: We systematically searched the PubMed, Medline, and Springer electronic databases up to March 2017 for RCTs comparing the efficacy of CHM versus placebo for the treatment of patients with AR. Total nasal symptoms and quality of life were assessed through pooling mean difference (MD) with its 95% confidence interval (CI). Moreover, sensitivity and subgroup analyses according to control design and quality of life assessment were performed to evaluate the source of heterogeneity. RESULTS: Eleven RCTs were enrolled in the meta-analysis. Assessment of overall heterogeneity indicated significant heterogeneity among the individual studies (I 2=100%, P<0.00001), and thus ransomed effects model was used to pool data. CHM was found to significantly enhance quality of life compared with placebo (MD=-0.88, (95% CI: -1.55, -0.21); P=0.01). The symptom of itchy nose, sneezing or total nasal symptoms scores were not significantly improved after CHM treatment, although the improvement in itchy nose just failed to reach significance (MD=0.09, (95% CI: 0.00, 0.18); P=0.06). CONCLUSIONS: This study suggests that CHM appears to improve the quality of life of AR patients. However, these findings, as well as the findings for the effect of CHM on sneezing, total nasal symptoms, and the symptom of itchy nose, need to be substantiated in larger cohorts of AR patients by further well-designed studies.

Effects of Omega-3 Supplementation on Adipocytokines in Prediabetes and Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: The objective of this systematic review and meta-analysis was to determine the effects of omega-3 supplementation on adipocytokine levels in adult prediabetic and diabetic individuals. METHODS: We searched PubMed, Medline, EMBASE, Scopus, Web of Science, Google Scholar, Cochrane Trial Register, World Health Organization Clinical Trial Registry Platform, and Clinicaltrial.gov Registry from inception to August 1, 2017 for randomized controlled trials. Pooled effects of interventions were assessed as mean difference using random effects model. We conducted a sensitivity, publication bias and subgroup analysis. RESULTS: Fourteen studies individuals (n = 685) were included in the meta-analysis. Omega-3 supplementation increased levels of adiponectin (0.48 µg/mL; 95% confidence interval [CI], 0.27 to 0.68; P < 0.00001, n = 10 trials), but effects disappeared after sensitivity analysis. Tumor necrosis factor α (TNF-α) levels were reduced (−1.71; 95% CI, −3.38 to −0.14; P = 0.03, n = 8 trials). Treatment duration shorter than 12 weeks was associated with greater reduction than longer treatment duration. Levels of other adipocytokines were not significantly affected. Publication bias could generally not be excluded. CONCLUSION: Eicosapentaenoic acid and docosahexaenoic acid supplementation may increase adiponectin and reduce TNF-α levels in this population group. However, due to overall study heterogeneity and potential publication bias, a cautious interpretation is needed.

Effects of Ego-resilience Interventions among Children and Adolescents in Korea: A Meta-analysis / 정신간호학회지

PURPOSE: This study was a meta-analysis planned to exam effects of ego-resilience interventions among children and adolescents in Korea. METHODS: Search for relevant articles included several electronic databases and hand-search from article references. Thirteen studies met inclusion criteria from 1,638 studies. Comprehensive Meta-Analysis (version 3) and Review Manager (version 5) were used to analyze effect sizes, investigate possible causes of heterogeneity and check publication bias with a funnel plot and its trim-and-fill analysis. RESULTS: Overall effect size of ego-resilience interventions were medium (Hedges'g=0.66) and medium heterogeneity (I²=54%). Subgroup analysis was performed to estimate causes of heterogeneity. The effect size for normal populations (g=0.70) was larger than for risk populations (g=0.64). Interventions for primary school students (g=0.74) were more effective than interventions for adolescents (g=0.51). Interventions in the community (g=0.72) shown larger effect size than intervention at school (g=0.51). Art therapy (g=0.79) had a better effect than cognitive behavior therapy (g=0.62). Interventions with over 1,000 minutes (g=1.10) and intervention with over 11 sessions (g=1.40) were effective. This study found no significant publication bias. CONCLUSION: Based on current findings, there is obvious evidence that ego-resilience interventions have significant effects in improving ego-resilience among children and adolescents in Korea.

Vitamin D and Risk of Respiratory Tract Infections in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials

PURPOSE: Recent observational studies have found that vitamin D deficiency is associated with respiratory tract infections. However, randomized controlled trials (RCTs) regarding the efficacy of vitamin D in childhood respiratory tract infection (RTI) have yield inconsistent results. We performed a systematic review and meta-analysis to evaluate the association between vitamin D supplementation and the risk of RTI. METHODS: A comprehensive search was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trial. Randomized controlled trials of vitamin D supplementation for prevention of RTI in children were included for the analysis. Cochrane Collaboration's tool for assessing the risk of bias was used to assess the quality of the studies. Pooled risk ratios with 95% confidence intervals (CIs) were meta-analyzed using Review Manager 5.3. RESULTS: A total of seven RCTs were included in the meta-analysis. According to a random-effects model, the risk ratio for vitamin D supplementation was 0.82 (95% CI: 0.69-0.98) and I2=62% for heterogeneity. On subgroup analysis, heterogeneity decreased in the subgroup with follow-up less than 1 year, participants ≥5 years of age, patients subgroup, and subgroup with dosing daily. Funnel plot showed that there might be publication bias in the field. CONCLUSIONS: The present meta-analysis supports a beneficial effect of vitamin D supplementation for the prevention of RTI in children. However, the result should be interpreted with caution due to limitations including a small number of available RCTs, heterogeneity among the studies, and potential publication bias.

Sitosterolemia: a review and update of pathophysiology, clinical spectrum, diagnosis, and management

Sitosterolemia is an autosomal recessive disorder characterized by increased plant sterol levels, xanthomas, and accelerated atherosclerosis. Although it was originally reported in patients with normolipemic xanthomas, severe hypercholesterolemia have been reported in patients with sitosterolemia, especially in children. Sitosterolemia is caused by increased intestinal absorption and decreased biliary excretion of sterols resulting from biallelic mutations in either ABCG5 or ABCG8, which encode the sterol efflux transporter ABCG5 and ABCG8. Patients with sitosterolemia show extreme phenotypic heterogeneity, ranging from almost asymptomatic individuals to those with severe hypercholesterolemia leading to accelerated atherosclerosis and premature cardiac death. Hematologic manifestations include hemolytic anemia with stomatocytosis, macrothrombocytopenia, splenomegaly, and abnormal bleeding. The mainstay of therapy includes dietary restriction of both cholesterol and plant sterols and the sterol absorption inhibitor, ezetimibe. Foods rich in plant sterols include vegetable oils, wheat germs, nuts, seeds, avocado, shortening, margarine and chocolate. Hypercholesterolemia in patients with sitosterolemia is dramatically responsive to low cholesterol diet and bile acid sequestrants. Plant sterol assay should be performed in patients with normocholesterolemic xanthomas, hypercholesterolemia with unexpectedly good response to dietary modifications or to cholesterol absorption inhibitors, or hypercholesterolemia with poor response to statins, or those with unexplained hemolytic anemia and macrothrombocytopenia. Because prognosis can be improved by proper management, it is important to find these patients out and diagnose correctly. This review article aimed to summarize recent publications on sitosterolemia, and to suggest clinical indications for plant sterol assay.

Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis

PURPOSE: This study was a systematic review and meta-analysis designed to investigate the effects of stimulation-oriented interventions for behavioral problems among people with dementia. METHODS: Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a literature search was conducted using seven electronic databases, gray literature, and other sources. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) for randomized controlled trials (RCTs). Data were analyzed using R with the 'meta' package and the Comprehensive Meta-Analysis (CMA 2.0) program. RESULTS: Sixteen studies were included for meta-analysis to investigate the effect of stimulation-oriented interventions. The quality of individual studies was rated as '++' for eight studies and '+' for the rest. The effect sizes were analyzed according to three subgroups of interventions (light, music, and others); Hedges' g=0.04 (95% CI: -0.38~0.46), -0.23 (95% CI: -0.56~0.10), -0.34 (95% CI: -0.34~0.00), respectively. To explore the possible causes of heterogeneity (I²=62.8%), meta-regression was conducted with covariates of sample size, number of sessions, and length of session (time). No moderating effects were found for sample size or number of sessions, but session time showed a significant effect (Z=1.96, 95% CI: 0.00~0.01). Finally, a funnel plot along with Egger's regression test was performed to check for publication bias, but no significant bias was detected. CONCLUSION: Based on these findings, stimulation-oriented interventions seem to have a small effect for behavioral problems among people with dementia. Further research is needed to identify optimum time of the interventions for behavioral problems among dementia pateints.