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Psychoneuroendocrinology Feb 2022Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of major depressive disorder (MDD) in adulthood. Less work has... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of major depressive disorder (MDD) in adulthood. Less work has focused on the role of the HPA axis in depression in adolescence and young adulthood globally. The aim of this study was to conduct a systematic review and meta-analysis of worldwide research investigating the relationship between cortisol, a measure of HPA axis activity, and MDD in adolescence and young adulthood.
METHOD
We searched MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, and Global Health for studies which examined the relationship between cortisol and MDD in global youth (10-24 years old).
RESULTS
Twenty-six studies were included in the systematic review and 14 were eligible for the meta-analysis, but only one study included young adults in their sample. Results from the meta-analysis demonstrated that elevated morning, but not evening, cortisol levels was prospectively associated with later MDD development in adolescence and young adulthood. However, morning cortisol levels did not significantly differ between healthy controls and individuals with MDD in cross-sectional studies. Afternoon cortisol and cortisol stress response also did not differ between adolescents with MDD and healthy controls. Qualitative synthesis of the three studies examining nocturnal cortisol showed higher nocturnal cortisol was both longitudinally and cross-sectionally associated with MDD in adolescence.
CONCLUSION
Our findings suggest elevated morning cortisol precedes depression in adolescence. Despite this, we did not find any differences in other cortisol measures in association with MDD in cross-sectional studies. Taken together, these findings suggest that elevated morning and nocturnal cortisol are risk factors for depression in adolescence rather than a biomarker of existing MDD. This supports a role for the hyperactivity of the HPA axis in the development of MDD in adolescence. Most of the studies were from high-income-countries (HICs) and thus further work would need to be conducted in low- and middle-income countries (LMICs) to understand if our findings are generalisable also to these populations.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Depression; Depressive Disorder, Major; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Young Adult
PubMed: 34920399
DOI: 10.1016/j.psyneuen.2021.105625 -
Pharmaceuticals (Basel, Switzerland) Mar 2021Levothyroxine (l-thyroxine, l-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between l-T4 and... (Review)
Review
Levothyroxine (l-thyroxine, l-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between l-T4 and food can alter the safety and efficacy of the treatment, they still seem to be generally underestimated by patients, physicians and pharmacists. This review aimed to investigate the effects of meals, beverages, and dietary supplements consumption on l-T4 pharmacokinetics and pharmacodynamics, to identify the most evident interactions, and to perform the recommendations for safe co-administering of l-T4 and food. A total of 121 studies were identified following a systematic literature search adhering to PRISMA guidelines. After full-text evaluation, 63 studies were included. The results proved that l-T4 ingestion in the morning and at bedtime are equally effective, and also that the co-administration of l-T4 with food depends on the drug formulation. We found limited evidence for l-T4 interactions with coffee, soy products, fiber, calcium or iron supplements, and enteral nutrition but interestingly they all resulted in decreased l-T4 absorption. The altered l-T4 efficacy when ingested with milk, juices, papaya, aluminium-containing preparations, and chromium supplements, as well as observed enhancement effect of vitamin C on l-T4 absorption, shall be further investigated in larger, well-designed studies. Novel formulations are likely to solve the problem of coffee, calcium and iron induced malabsorption of l-T4. Maintaining a proper time interval between l-T4 and food intake, especially for coffee and calcium, or iron supplements, provides another effective method of eliminating such interactions.
PubMed: 33801406
DOI: 10.3390/ph14030206 -
International Journal of Environmental... Aug 2021The aim of the study was to systematically evaluate the biceps femoris long head activation across cross-sectional hamstring strength exercise studies. (Review)
Review
BACKGROUND
The aim of the study was to systematically evaluate the biceps femoris long head activation across cross-sectional hamstring strength exercise studies.
METHODS
A systematic review design was followed. The search strategy conducted in PubMed, Cochrane Library, and Web of Sciences databases found a total of 3643 studies. Once inclusion and exclusion criteria were applied, 29 studies were finally included in this systematic review. A total of 507 participants and 114 different exercises were analyzed. Exercises were evaluated individually and grouped into several categories: Nordics, isokinetic exercises, lunges, squats, deadlifts, good mornings, hip thrusts, bridges, leg curls, swings, hip and back extensions, and others.
RESULTS
Results showed the isokinetic and Nordic exercises as the categories with highest biceps femoris activation (>60% of Maximal Voluntary Isometric Contraction). Nordic hamstring exercise ankle dorsiflexion was the exercise that achieved the highest biceps femoris long head activation (128.1% of its Maximal Voluntary Isometric Contraction).
CONCLUSIONS
The results from this systematic review suggest that isokinetic and Nordic exercises seem to be the best option to activate biceps femoris long head. Future studies evaluating the implementation of these exercises in prevention programs are needed.
Topics: Cross-Sectional Studies; Electromyography; Exercise; Hamstring Muscles; Humans; Isometric Contraction
PubMed: 34444481
DOI: 10.3390/ijerph18168733 -
Sports Medicine (Auckland, N.Z.) Nov 2022Sleep loss may influence subsequent physical performance. Quantifying the impact of sleep loss on physical performance is critical for individuals involved in athletic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sleep loss may influence subsequent physical performance. Quantifying the impact of sleep loss on physical performance is critical for individuals involved in athletic pursuits.
DESIGN
Systematic review and meta-analysis.
SEARCH AND INCLUSION
Studies were identified via the Web of Science, Scopus, and PsycINFO online databases. Investigations measuring exercise performance under 'control' (i.e., normal sleep, > 6 h in any 24 h period) and 'intervention' (i.e., sleep loss, ≤ 6 h sleep in any 24 h period) conditions were included. Performance tasks were classified into different exercise categories (anaerobic power, speed/power endurance, high-intensity interval exercise (HIIE), strength, endurance, strength-endurance, and skill). Multi-level random-effects meta-analyses and meta-regression analyses were conducted, including subgroup analyses to explore the influence of sleep-loss protocol (e.g., deprivation, restriction, early [delayed sleep onset] and late restriction [earlier than normal waking]), time of day the exercise task was performed (AM vs. PM) and body limb strength (upper vs. lower body).
RESULTS
Overall, 227 outcome measures (anaerobic power: n = 58; speed/power endurance: n = 32; HIIE: n = 27; strength: n = 66; endurance: n = 22; strength-endurance: n = 9; skill: n = 13) derived from 69 publications were included. Results indicated a negative impact of sleep loss on the percentage change (%) in exercise performance (n = 959 [89%] male; mean % = - 7.56%, 95% CI - 11.9 to - 3.13, p = 0.001, I = 98.1%). Effects were significant for all exercise categories. Subgroup analyses indicated that the pattern of sleep loss (i.e., deprivation, early and late restriction) preceding exercise is an important factor, with consistent negative effects only observed with deprivation and late-restriction protocols. A significant positive relationship was observed between time awake prior to the exercise task and % in performance for both deprivation and late-restriction protocols (~ 0.4% decrease for every hour awake prior to exercise). The negative effects of sleep loss on different exercise tasks performed in the PM were consistent, while tasks performed in the AM were largely unaffected.
CONCLUSIONS
Sleep loss appears to have a negative impact on exercise performance. If sleep loss is anticipated and unavoidable, individuals should avoid situations that lead to experiencing deprivation or late restriction, and prioritise morning exercise in an effort to maintain performance.
Topics: Humans; Male; Female; Physical Endurance; Exercise; Physical Functional Performance; Sleep
PubMed: 35708888
DOI: 10.1007/s40279-022-01706-y -
Advances in Nutrition (Bethesda, Md.) Dec 2022The timing and nutritional composition of food intake are important zeitgebers for the biological clocks in humans. Thus, eating at an inappropriate time (e.g., during... (Review)
Review
The timing and nutritional composition of food intake are important zeitgebers for the biological clocks in humans. Thus, eating at an inappropriate time (e.g., during the night) may have a desynchronizing effect on the biological clocks and, in the long term, may result in adverse health outcomes (e.g., weight gain, obesity, and poor metabolic function). Being a very late or early chronotype not only determines preferred sleep and wake times but may also influence subsequent mealtimes, which may affect the circadian timing system. In recent years, an increased number of studies have examined the relation between chronotype and health outcomes, with a main focus on absolute food intake and metabolic markers and, to a lesser extent, on dietary intake distribution and eating behavior. Therefore, this review aimed to systematically determine whether chronotype indirectly affects eating behaviors, dietary intake (timing, choice, nutrients), and biomarkers leading to body composition outcomes in healthy adults. A systematic literature search on electronic databases (PubMed, CINAHL, MEDLINE, SCOPUS, Cochrane library) was performed (International Prospective Register of Systematic Reviews number: CRD42020219754). Only studies that included healthy adults (aged >18 y), classified according to chronotype and body composition profiles, using outcomes of dietary intake, eating behavior, and/or biomarkers, were considered. Of 4404 articles, 24 met the inclusion criteria. The results revealed that late [evening type (ET)] compared with early [morning type (MT)] chronotypes were more likely to be overweight/obese with poorer metabolic health. Both MT and ET had similar energy and macronutrient intakes, consuming food during their preferred sleep-wake timing: later for ET than MT. Most of the energy and macronutrient intakes were distributed toward nighttime for ET and exacerbated by unhealthy eating behaviors and unfavorable dietary intakes. These findings from our systematic review give further insight why higher rates of overweight/obesity and unhealthier metabolic biomarkers are more likely to occur in ET.
Topics: Adult; Humans; Overweight; Chronotype; Energy Intake; Circadian Rhythm; Feeding Behavior; Eating; Obesity; Sleep; Body Composition
PubMed: 36041181
DOI: 10.1093/advances/nmac093 -
The Cochrane Database of Systematic... Jun 2021Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling urethral catheterisation at some point during their care. However, the use of urinary catheters is associated with an increased risk of developing urinary tract infection. Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. It is estimated that around 20% of hospital-acquired bacteraemias arise from the urinary tract and are associated with mortality of around 10%. This is an update of a Cochrane Review first published in 2005 and last published in 2007.
OBJECTIVES
To assess the effects of strategies for removing short-term (14 days or less) indwelling catheters in adults.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 17 March 2020), and reference lists of relevant articles.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effectiveness of practices undertaken for the removal of short-term indwelling urethral catheters in adults for any reason in any setting.
DATA COLLECTION AND ANALYSIS
Two review authors performed abstract and full-text screening of all relevant articles. At least two review authors independently performed risk of bias assessment, data abstraction and GRADE assessment.
MAIN RESULTS
We included 99 trials involving 12,241 participants. We judged the majority of trials to be at low or unclear risk of selection and detection bias, with a high risk of performance bias. We also deemed most trials to be at low risk of attrition and reporting bias. None of the trials reported on quality of life. The majority of participants across the trials had undergone some form of surgical procedure. Thirteen trials involving 1506 participants compared the removal of short-term indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants; low-certainty evidence). We are uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low-certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants; low-certainty evidence). Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants; low-certainty evidence), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants; moderate-certainty evidence) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants; low-certainty evidence). Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants; low-certainty evidence). We are uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants; very low-certainty evidence) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants; very low-certainty evidence). Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. We are uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants; very low-certainty evidence) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants; very low-certainty evidence). None of the included trials investigating prophylactic alpha blockers reported the number of participants with dysuria.
AUTHORS' CONCLUSIONS
There is some evidence to suggest the removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. It appears that catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. The other evidence relating to the risk of symptomatic CAUTI and dysuria is too uncertain to allow us to draw any conclusions. Due to the low certainty of the majority of the evidence presented here, the results of further research are likely to change our findings and to have a further impact on clinical practice. This systematic review has highlighted the need for a standardised set of core outcomes, which should be measured and reported by all future trials comparing strategies for the removal of short-term urinary catheters. Future trials should also study the effects of short-term indwelling urethral catheter removal on non-surgical patients.
Topics: Adult; Bias; Catheter-Related Infections; Catheters, Indwelling; Device Removal; Female; Humans; Length of Stay; Male; Randomized Controlled Trials as Topic; Time Factors; Urethra; Urinary Catheterization; Urinary Tract Infections; Urination
PubMed: 34184246
DOI: 10.1002/14651858.CD004011.pub4 -
PloS One 2020This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Humans; Middle Aged; Observational Studies as Topic; Polysomnography; Quality of Life; Rhinitis, Allergic; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring; Young Adult
PubMed: 32053609
DOI: 10.1371/journal.pone.0228533 -
Cureus Jan 2022The objective of this study was to compare the outcomes of extracorporeal shockwave therapy (ESWT) versus ultrasound therapy (UST) in plantar fasciitis. A systematic... (Review)
Review
The objective of this study was to compare the outcomes of extracorporeal shockwave therapy (ESWT) versus ultrasound therapy (UST) in plantar fasciitis. A systematic review and meta-analysis were performed. An electronic search identifying studies comparing ESWT and UST for plantar fasciitis was conducted. Primary outcomes were morning and activity pain, functional impairment, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. Secondary outcomes included the fascial thickness, primary efficacy success rate, activity limitations, pain intensity, and satisfaction. Seven studies enrolling 369 patients were identified. No significant difference was found between ESWT and UST for functional impairment (mean difference [MD] = -2.90, P = 0.22), AOFAS scale score (MD = 35, P = 0.20), and pain in the first steps in the morning (MD = -4.72, P = 0.39). However, there was a significant improvement in pain during activity for the ESWT group (MD = -1.36, P = 0.005). For secondary outcomes, ESWT had improved results in terms of primary efficacy success rate, activity limitations, and patient satisfaction. The reduction of plantar fascia thickness showed no significant difference. Pain intensity after treatment had varied results amongst included studies. In conclusion, ESWT is superior to UST for plantar fasciitis as it improves pain activity and intensity, primary efficacy success rate, and activity limitations.
PubMed: 35145778
DOI: 10.7759/cureus.20871 -
The Cochrane Database of Systematic... Nov 2020Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnoea (OSA) is a syndrome characterised by episodes of apnoea (complete cessation of breathing) or hypopnoea (insufficient breathing) during sleep. Classical symptoms of the disease - such as snoring, unsatisfactory rest and daytime sleepiness - are experienced mainly by men; women report more unspecific symptoms such as low energy or fatigue, tiredness, initial insomnia and morning headaches. OSA is associated with an increased risk of occupational injuries, metabolic diseases, cardiovascular diseases, mortality, and being involved in traffic accidents. Continuous positive airway pressure (CPAP) - delivered by a machine which uses a hose and mask or nosepiece to deliver constant and steady air pressure- is considered the first treatment option for most people with OSA. However, adherence to treatment is often suboptimal. Myofunctional therapy could be an alternative for many patients. Myofunctional therapy consists of combinations of oropharyngeal exercises - i.e. mouth and throat exercises. These combinations typically include both isotonic and isometric exercises involving several muscles and areas of the mouth, pharynx and upper respiratory tract, to work on functions such as speaking, breathing, blowing, sucking, chewing and swallowing.
OBJECTIVES
To evaluate the benefits and harms of myofunctional therapy (oropharyngeal exercises) for the treatment of obstructive sleep apnoea.
SEARCH METHODS
We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search 1 May 2020). We found other trials at web-based clinical trials registers.
SELECTION CRITERIA
We included RCTs that recruited adults and children with a diagnosis of OSA.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We assessed our confidence in the evidence by using GRADE recommendations. Primary outcomes were daytime sleepiness, morbidity and mortality.
MAIN RESULTS
We found nine studies eligible for inclusion in this review and nine ongoing studies. The nine included RCTs analysed a total of 347 participants, 69 of them women and 13 children. The adults' mean ages ranged from 46 to 51, daytime sleepiness scores from eight to 14, and severity of the condition from mild to severe OSA. The studies' duration ranged from two to four months. None of the studies assessed accidents, cardiovascular diseases or mortality outcomes. We sought data about adverse events, but none of the included studies reported these. In adults, compared to sham therapy, myofunctional therapy: probably reduces daytime sleepiness (Epworth Sleepiness Scale (ESS), MD (mean difference) -4.52 points, 95% Confidence Interval (CI) -6.67 to -2.36; two studies, 82 participants; moderate-certainty evidence); may increase sleep quality (MD -3.90 points, 95% CI -6.31 to -1.49; one study, 31 participants; low-certainty evidence); may result in a large reduction in Apnoea-Hypopnoea Index (AHI, MD -13.20 points, 95% CI -18.48 to -7.93; two studies, 82 participants; low-certainty evidence); may have little to no effect in reduction of snoring frequency but the evidence is very uncertain (Standardised Mean Difference (SMD) -0.53 points, 95% CI -1.03 to -0.03; two studies, 67 participants; very low-certainty evidence); and probably reduces subjective snoring intensity slightly (MD -1.9 points, 95% CI -3.69 to -0.11 one study, 51 participants; moderate-certainty evidence). Compared to waiting list, myofunctional therapy may: reduce daytime sleepiness (ESS, change from baseline MD -3.00 points, 95% CI -5.47 to -0.53; one study, 25 participants; low-certainty evidence); result in little to no difference in sleep quality (MD -0.70 points, 95% CI -2.01 to 0.61; one study, 25 participants; low-certainty evidence); and reduce AHI (MD -6.20 points, 95% CI -11.94 to -0.46; one study, 25 participants; low-certainty evidence). Compared to CPAP, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.30 points, 95% CI -1.65 to 2.25; one study, 54 participants; low-certainty evidence); and may increase AHI (MD 9.60 points, 95% CI 2.46 to 16.74; one study, 54 participants; low-certainty evidence). Compared to CPAP plus myofunctional therapy, myofunctional therapy alone may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.56 to 2.96; one study, 49 participants; low-certainty evidence) and may increase AHI (MD 10.50 points, 95% CI 3.43 to 17.57; one study, 49 participants; low-certainty evidence). Compared to respiratory exercises plus nasal dilator strip, myofunctional therapy may result in little to no difference in daytime sleepiness (MD 0.20 points, 95% CI -2.46 to 2.86; one study, 58 participants; low-certainty evidence); probably increases sleep quality slightly (-1.94 points, 95% CI -3.17 to -0.72; two studies, 97 participants; moderate-certainty evidence); and may result in little to no difference in AHI (MD -3.80 points, 95% CI -9.05 to 1.45; one study, 58 participants; low-certainty evidence). Compared to standard medical treatment, myofunctional therapy may reduce daytime sleepiness (MD -6.40 points, 95% CI -9.82 to -2.98; one study, 26 participants; low-certainty evidence) and may increase sleep quality (MD -3.10 points, 95% CI -5.12 to -1.08; one study, 26 participants; low-certainty evidence). In children, compared to nasal washing alone, myofunctional therapy and nasal washing may result in little to no difference in AHI (MD 3.00, 95% CI -0.26 to 6.26; one study, 13 participants; low-certainty evidence).
AUTHORS' CONCLUSIONS
Compared to sham therapy, myofunctional therapy probably reduces daytime sleepiness and may increase sleep quality in the short term. The certainty of the evidence for all comparisons ranges from moderate to very low, mainly due to lack of blinding of the assessors of subjective outcomes, incomplete outcome data and imprecision. More studies are needed. In future studies, outcome assessors should be blinded. New trials should recruit more participants, including more women and children, and have longer treatment and follow-up periods.
Topics: Apnea; Child; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Exercise; Female; Humans; Isotonic Contraction; Male; Middle Aged; Myofunctional Therapy; Oropharynx; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Snoring; Therapeutic Irrigation; Waiting Lists
PubMed: 33141943
DOI: 10.1002/14651858.CD013449.pub2 -
Frontiers in Immunology 2022The refractory, repetitive, and disabling characteristic of rheumatoid arthritis (RA) has seriously influenced the patients' quality of life, and makes it a major public... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The refractory, repetitive, and disabling characteristic of rheumatoid arthritis (RA) has seriously influenced the patients' quality of life, and makes it a major public health problem. As a classic complementary and alternative therapy, acupuncture is usually applied for RA combined with disease-modifying anti-rheumatic drugs (DMARDs). However, there are various types of acupuncture, and the curative effects are different in different acupuncture therapies. In this study, we evaluated the clinical efficacy of different acupuncture therapies combined with DMARDs in the treatment of RA.
METHODS
The randomized controlled trials (RCTs) of acupuncture combined with DMARDs in the treatment of RA were searched in both English and Chinese database of PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, VIP database, Wanfang, and SinoMED, up to October 2021. Literature screening, data extraction, and evaluation of the risk of bias were carried out independently by two researchers, and the data were analyzed by Stata14.2 and GeMTC 0.14.3 software.
RESULTS
A total of 32 RCTs were included, including 2,115 RA patients. The results of network meta-analysis were as follows: in terms of improving DAS28 score, Electro-acupuncture + DMARDs has the best efficacy. In terms of improving VAS score, Fire Needle + DMARDs showed the best efficacy. In terms of improving morning stiffness time, acupuncture-related therapies combined with DMARDs were not better than DMARDs alone in improving morning stiffness time in RA patients. In terms of reducing CRP and ESR, Fire Needle + DMARDs showed the best efficacy. In terms of reducing RF, Moxibustion + DMARDs has the best efficacy.
CONCLUSIONS
The comprehensive comparison of the outcome indicators in 8 different treatments indicates that electro-acupuncture combined with DMARDs is the best combined therapy in improving DAS28 score, while in terms of improving pain and serological markers, fire needle combined with DMARDs and moxibustion combined with DMARDs were the best combined therapies. However, it is impossible to find out which is better between fire needle and moxibustion due to the limited studies. Clinically, appropriate treatment should be selected according to the actual situation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/#recordDetails, CRD42021278233.
Topics: Acupuncture Therapy; Antirheumatic Agents; Arthritis, Rheumatoid; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic
PubMed: 35320944
DOI: 10.3389/fimmu.2022.829409