Vaginal reconstruction after extended radical pelvic surgery for cancer: comparison of two techniques

An immediate partial or total vaginal reconstruction is frequently proposed in cases of exenterative or extended radical pelvic surgery for cancer treatment. One of the main complications after this reconstruction is the vagina obliteration caused by the healing process. This study compares the results of two different reconstructive techniques, particularly focusing on general complications and the risk of vaginal occlusion. A transversus rectus abdominis musculoperitoneal (TRAMP) composite flap has been performed in five cases, and an inverted inferior transverse rectus abdominis musculocutaneous flap (TRAM) has been used in another five cases. Recovery was uneventful in eight cases. One patient (case 5) developed an aortofemoral embolism requiring a bilateral transfemoral embolectomy and heparin administration. Another patient (case 9) experienced severe peritonitis because of the partial leak of the rectal anastomosis, and therefore a Mikulicz's colostomy was performed. Four patients who underwent the TRAMP flap developed a complete closure of the neovagina. In one patient with a TRAMP flap, a severe shortening (2 cm) of the neovagina occurred. Five patients out of five who underwent a reconstruction with a TRAM flap had a stable length of the neovagina (6 to 12 cm) and no shrinkage in diameter occurred, even though a vaginal stent was not used. The conventional inferior TRAM flap with a skin paddle seems to better maintain a stable length of the neovagina than the TRAMP composite flap with peritoneum.     

Comparing the efficacy of pain managements after total hip arthroplasty: A network meta-analysis

The aim of our current study is to compare efficiency of various interventions implemented for pain management after total hip arthroplasty (THA). PubMed and EMBASE were searched for randomized clinical trials (RCTs) reporting the pain scales for evaluate the efficacy of pain control after THA including at least one pair of direct control groups. Pain scale values and the associated 95% credible interval (CrI) were used to describe efficacy. Surface under the cumulative ranking curve (SUCRA) of each means of pain control was calculated to compare the relative ranking of different interventions. Thirty-five eligible literatures were involved in data analysis. The interventions for postoperative pain management we examined were psoas compartment block (PCB), posterior nerve block (PNB), fascia iliaca block (FIB), periarticular injection (PAI), femoral nerve block (FNB), lumbar plexus block (LPB), spinal anesthesia (SA), epidural analgesia (EPI), intrathecal morphine (IA), intravenous patient-controlled analgesia (IV-PCA), patient-controlled analgesia (PCA), onsteroidal anti-inflammatory drug (NSAID), local infiltration analgaesia (LIA), and reverse LIA (rLIA). In 0 to 6 hours analysis, patients under SA were found to have significantly lower pain score and SA was ranked the best. In 6 to 12 hours analysis, SA was found to be significantly more effective than other interventions and its SUCRA was the highest. No intervention showed a significant effect on reducing pain score for 12 to 24 hours and 24 to 48 hours after THA. SA is the best intervention to reduce THA postoperative pain in the first 24 hours. LPB is a better choice to reduce pain 12 to 48 hours after THA.     

Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap.

A number of techniques have been introduced to support the orbital floor after maxillectomy without orbital exenteration. These methods include skin graft or muscular sling, but they have resulted in severe complications, such as enophthalmos, global ptosis, diplopia, and facial deformity. Currently, advanced microvascular reconstruction using bone and soft tissue is performed by many surgeons. This usually results in the filling of the postmaxillectomy defect, but the lack of support for the orbital rim and floor by the bone flap may still cause the complications mentioned above. Vascularized calvarial bone flap was chosen in this study for reconstruction of the orbital floor and infraorbital rim to function as a buttress, to reconstruct recipient sites of poor vascular bed after radiation therapy, and to withstand further postoperative radiation. By providing a solid floor and rim, these complications can be prevented with satisfactory function and aesthetically acceptable results. From September of 1995 to July of 1998, we performed vascularized bone flap for the reconstruction of the orbital floor and infraorbital rim in four cases after total maxillectomy involving the orbital floor. With a follow-up period from 19 to 35 months (mean, 27 months), we obtained significant improvement of functional and aesthetically acceptable results without global ptosis, enophthalmos, diplopia, or severe facial contour deformity.     

Effects of prolactin on the morphology and function of rat Leydig cells: short-term versus long-term administration

Summary The bolus administration of prolactin (PRL) to adult rats did not cause any apparent change in the basal and luteinizing hormone (LH)-stimulated blood levels of testosterone (as estimated by radioimmune assay). Prolonged PRL infusion did not affect either basal testosterone plasma concentration or the morphology of Leydig cells (as evaluated by electron microscopy and stereology). Conversely, prolonged PRL treatment notably increased the gonadotrophic effects of chronic LH administration; this mainly consisted of a rise in the blood concentration of testosterone and a conspicuous hypertrophy of Leydig cells. The LH-induced increase in the volume of Leydig cells was the result of an increase in the volumes of all the organelles involved in steroid synthesis (i.e., smooth endoplasmic reticulum, peroxisomes and mitochondria). However, the trophic effects of PRL infusion exclusively concerned smooth endoplasmic reticulum and peroxisomes. In the light of these findings, the hypothesis is advanced that the mechanism underlying the gonadotrophic action of PRL involves an enhancement of the endogenous cholesterol synthesis, which could provide an abundance of precursors for testosterone synthesis, the post-cholesterol steps of which, in turn, would be exclusively controlled by LH.     

Radiation therapy after radical prostatectomy: why patience is a virtue! The case for salvage radiation therapy

Without reliable clinical or pathologic predictors of local recurrence, selection of patients for adjuvant radiotherapy based on any combination of clinical or pathological parameters is bound to lead to the unnecessary treatment of significant numbers of patients whose disease might not have ultimately recurred or who might have been destined to have recurrence with extrapelvic metastatic disease, for which pelvic radiation would be ineffective. Furthermore, new ultrasensitive prostate-specific antigen (PSA) assays can identify patients actually failing surgery with a detectable and rising PSA earlier than ever, when disease volume is low and still amenable to salvage radiation therapy, and can allow the calculation of the PSA doubling time, which is gaining widespread acceptance as a proven predictor of response to salvage radiation therapy in this setting. Therefore, the rationale for preemptive adjuvant radiation therapy after radical prostatectomy is weaker than ever.     

Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit,oncologic outcomes and incidence of gastrointestinal and urinary toxicities

AimThe purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP).BackgroundRP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT.Materials and methodsA total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated.ResultsThe rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses.ConclusionPostprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed.     

The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth

Vaginal childbirth is the leading cause of pelvic floor muscles injury, which contributes to pelvic floor dysfunction, being enhanced by fetal malposition. Therefore, the aim of the present study is to verify the influence of mediolateral episiotomies in the mechanics of the pelvic floor with the fetus in occiput posterior position when compared to the occiput anterior position. Numerical simulations of vaginal deliveries, with and without episiotomy, are performed based on the Finite Element Method. The biomechanical model includes the pelvic floor muscles, a surface to delimit the anterior region of the birth canal and a fetus. Fetal malposition induces greater extension of the muscle compared to the normal position, leading to increases of stretch. The faster enlargement may be responsible for a prolonged second stage of labor. Regarding the force required to achieve delivery, the difference between the analyzed cases are 35 N, which might justify the increased need of surgical interventions. Furthermore, episiotomy is essential in reducing the damage to values near the ones obtained with normal position, making the fetal position irrelevant. These biomechanical models have become extremely useful tools to provide some understanding of pelvic floor function during delivery helping in the development of preventative strategies.     

The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials

Background

Recent lipid guidelines recommend aggressive low-density lipoprotein (LDL) cholesterol lowering in patients with coronary artery disease. To clarify the evidence for this recommendation, we conducted a meta-analysis of randomized controlled trials that compared different intensities of statin therapy.

Methods

We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registery of Controlled Trials, Web of Science) for randomized controlled trials published up to July 19, 2007, that compared statin regimens of different intensities in adults with coronary artery disease and that reported cardiovascular events or mortality. Data were pooled using random-effects models to calculate odds ratios (OR).

Results

A total of 7 trials (29 395 patients) were included. Compared with less intensive statin regimens, more intensive regimens further reduced LDL levels (0.72 mmol/L reduction, 95% confidence interval [CI] 0.60–0.84 mmol/L), and reduced the risk of myocardial infarction (OR 0.83, 95% CI 0.77–0.91) and stroke (OR 0.82, 95% CI 0.71–0.95). Although there was no effect on mortality among patients with chronic coronary artery disease (OR 0.96, 95% CI 0.80–1.14), all-cause mortality was reduced among patients with acute coronary syndromes treated with more intensive statin regimens (OR 0.75, 95% CI 0.61–0.93). Compared with lower intensity regimens, more intensive regimens were associated with small absolute increases in rates of drug discontinuation (2.5%), elevated levels of aminotransferases (1%) and myopathy (0.5%), and there was no difference in noncardiovascular mortality. All 7 trials reported events by randomization arm rather than by LDL level achieved. About half of the patients treated with more intensive statin therapy did not achieve an LDL level of less than 2.0 mmol/L, and none of the trials tested combination therapies.

Interpretation

Our analysis supports the use of more intensive statin regimens in patients with established coronary artery disease. There is insufficient evidence to advocate treating to particular LDL targets, using combination lipid-lowering therapy to achieve these targets or for using more intensive regimens in patients without established coronary artery disease.Dyslipidemia is the most important modifiable risk factor for myocardial infarction worldwide,¹ and serum cholesterol levels are directly related to mortality from coronary artery disease in all populations studied.^2–4 Over the past decade, randomized controlled trials enrolling a wide variety of patients have confirmed that for every 1-mmol/L reduction in serum low-density lipoprotein (LDL) cholesterol achieved by statin therapy, the relative risks of cardiovascular events and mortality are reduced (by 21% and 12% respectively).⁵Statins exert their beneficial effects primarily by reducing the level of LDL cholesterol,⁶ and the reductions in the relative risk of cardiovascular events achieved by statin therapy appears to be similar regardless of baseline cholesterol levels.⁵ As a result, attention has increasingly focused on defining optimal target LDL levels, particularly in patients at highest risk (i.e., those with coronary artery disease). Based on the observational studies mentioned above,^2,3 the apparent lack of a lower threshold for statin benefit in the randomized controlled trials, and recent trials reporting greater benefits with more intensive statin regimens (compared with less intensive regimens), Canadian⁷ and American⁸ guidelines for secondary prevention now recommend target LDL levels below 2.0 mmol/L in patients with coronary artery disease. On the other hand, European guidelines specify a target LDL of 2.5 mmol/L in these patients.⁹ Questions have been raised about the safety and incremental benefits of more intensive statin regimens.^10–12We performed a systematic review and meta-analysis to critically examine the evidence for the safety, efficacy (LDL lowering) and clinical effectiveness from trials comparing more intensive statin therapy with less intensive statin therapy in patients with coronary artery disease.     

Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis

Objective: Overweight and obesity are often assumed to be risk factors for postprocedural mortality in patients with coronary artery disease (CAD). However, recent studies have described an “obesity paradox”—a neutral or beneficial association between obesity and mortality postcoronary revascularization. We reviewed the effect of overweight and obesity systematically on short‐ and long‐term all‐cause mortality post‐coronary artery bypass grafting (CABG) and post‐percutaneous coronary intervention (PCI). Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify cohort, case control, and randomized controlled studies evaluating the effect of obesity on in‐hospital/short‐term (within 30 days) and long‐term (up to 5 years) mortality. Full‐text, published articles reporting all‐cause mortality between individuals with and without elevated BMI were included. Two reviewers independently assessed studies for inclusion and performed data extraction. Results: Twenty‐two cohort publications were identified, reporting results in ten post‐PCI and twelve post‐CABG populations. Compared to individuals with non‐elevated BMI levels, obese patients undergoing PCI had lower short‐ (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.54–0.73) and long‐term mortality (OR 0.65; 95% CI 0.51–0.83). Post‐CABG, obese patients had lower short‐term (OR 0.63; 95% CI 0.56–0.71) and similar long‐term (OR 0.88; 95% CI 0.60–1.29) mortality risk compared to normal weight individuals. Results were similar in overweight patients for both procedures. Conclusions: Compared to non‐obese individuals, overweight and obese patients have similar or lower short‐ and long‐term mortality rates postcoronary revascularization. Further research is needed to confirm the validity of these findings and delineate potential underlying mechanisms.     

Disturbances in the rabbit cornea after short-term and long-term wear of hydrogel contact lenses

Summary The influence of soft contact lenses (SCL) with low (37%, L) and high (65%, H) water content on rabbit corneas was investigated. The lenses were worn continuously for 1, 2, 4, 7, 10, 14, 21 or 28 days. The changes in corneal transparency, hydration and enzyme activities were studied. A slight change in corneal transparency due to higher hydration caused by a decreased activity of Na⁺–K⁺-dependent adenosine triphosphatase (Na⁺–K⁺-ATPase) in the corneal endothelium is followed by a decrease in the activity of -glutamyl transferase (GGT). Slight morphological disturbances appear within 4 days in animals wearing SCL (L). SCL (H) produce similar changes one week later. Subsequently, the corneal epithelium becomes thinner and changes in the size of corneal endothelial cells are obvious. Disturbances of enzyme activities in cells of all corneal layers are present. In the epithelium highly increased activities of acid glycosidases, acid phosphatase, and dipeptidyl peptidase I and II, in keratocytes decreased activities of alkaline phosphatase and GGT, and in the endothelium decreased activity of Na⁺–K⁺-ATPase and GGT were found. These changes are more severe after SCL (L). In this case, inflammatory cells displaying high activities of lysosomal hydrolases appear in the anterior part of the stroma during the 3rd and 4th weeks and local degradation of glycosaminoglycans and proteins takes place. In contrast, after SCL (H) a remarkable thinning of the corneas was observed during extended wear, accompanied by decreased stainability of stromal glycosaminoglycans and highly decreased enzyme activities in keratocytes. The histochemical methods proved very useful in the assessment of tesions caused by a continuous wear of SCL.     

Interventions led by nurse continence advisers in the management of urinary incontinence: a randomized controlled trial

Background

The short-term efficacy of combined lifestyle and behavioural interventions led by nurses in the management of urinary incontinence has not been rigorously evaluated by randomized controlled trial. We conducted a 6-month randomized controlled trial to determine whether a model of service delivery that included lifestyle and behavioural interventions led by “nurse continence advisers” in collaboration with a physician with expertise in continence management could reduce urinary incontinence and pad use in an outpatient population. We also aimed to evaluate the impact of this approach on subjects'' knowledge about incontinence and their quality of life.

Methods

We used advertising in the mainstream media, newsletters to family physicians and community information sessions in 1991 to invite volunteers who were 26 years of age or older and suffered from incontinence to participate in a randomized controlled trial. Men and women who met the eligibility criteria were randomly allocated to receive either counselling from specialized nurses to manage incontinence using behavioural and lifestyle modification sessions every 4 weeks for 25 weeks or usual care. Symptoms of incontinence and the use of incontinence pads were the primary outcome measures.

Results

Using sealed envelopes, 421 patients were randomly allocated to the treatment or control groups. On average, patients in the treatment group experienced 2.1 “incontinent events” per 24 hours before treatment and 1.0 incontinent event per 24 hours at the end of the study. Control patients had an average of 2.4 incontinent events per 24 hours before the study and 2.2 incontinent events per 24 hours at the end of the study. The mean decrease in events in the treatment group was 1.2 and in the control group 0.2 (p = 0.001). Pad use declined from a mean of 2.2 per 24 hours before randomization in the treatment group to 1.2 per 24 hours at the end of the study, compared with 2.6 pads per 24 hours in the control group at the start of the study and 2.4 per 24 hours at the end. Pad use per 24 hours decreased on average by 0.9 pads in the treatment group and 0.1 in the control group (p = 0.021).

Interpretation

Behavioural and lifestyle counselling provided by specialized nurses with training in managing incontinence reduces incontinent events and incontinence pad use.Urinary incontinence primarily affects young-to-middle-aged women and elderly men and women. The prevalence of urinary incontinence in people aged 65 years and older living in the community ranges from 8% to 30%.^1,2,3,4,5,6 Urinary incontinence is underrecognized and those affected are often embarrassed and ashamed, thus, the problem frequently remains hidden.^1,2North American and Canadian practice guidelines for the effective management of adult urinary incontinence have advocated thorough initial assessment, then staged multidisciplinary approaches beginning with the least invasive and reversible (lifestyle and behavioural) interventions, before drug therapy (reversible) and surgery (invasive and irreversible).^1,2,3 The role of continence advisers in the management of urinary incontinence has evolved from its early beginnings in the United Kingdom^7,8,9,10,11 and is now increasingly recognized in North America.^12,13,14 There has been some evaluation of the short-term efficacy of multidisciplinary incontinence management by nurse practitioners or “nurse continence advisers” in community and outpatient settings.^{15,16,17,18,19,20} However, the short-term efficacy of combined lifestyle and behavioural interventions led by nurse continence advisers has not been rigorously evaluated using randomized controlled trials.Urinary incontinence has many causes, particularly in elderly people,²¹ and the potential for overall clinical improvement is greater when multiple interventions target several factors. Each intervention effects a small positive change, and these small changes cumulatively have a large positive outcome.²¹ Individual components of lifestyle and behavioural interventions are increasingly being shown to be effective. For example, behavioural training, including pelvic muscle exercises, has reduced urinary incontinence significantly,^22,23,24 in some cases up to 57%.²⁵ A combined approach consisting of both bladder training and pelvic muscle exercises, provided by trained registered nurses, has resulted in significantly fewer incontinent episodes than either approach alone.²⁶ Pelvic floor exercises have been shown to be equally effective in women with stress, urge and mixed urinary incontinence.²⁷ Adherence to pelvic floor muscle exercises has been shown to be sustained for up to 5 years in 70% of women who have intensive exercise training.²⁸ Decreasing caffeine intake has also been shown to reduce episodes of incontinence.²⁹ Reducing fluid intake in people with detrusor instability, but not those with genuine stress incontinence, reduces the number of “incontinent events.” Increasing fluid intake makes the urinary incontinence worse.³⁰Our 6-month randomized controlled trial was conducted to determine whether a model of service delivery that included lifestyle and behavioural interventions led by nurse continence advisers in collaboration with a physician with expertise in continence management could reduce urinary incontinence and pad use. Our secondary aim was to investigate the impact of incontinence management led by nurse continence advisers on subjects'' knowledge about incontinence and their quality of life.     

Split-skin grafting with lidocaine-prilocaine cream: A meta-analysis of efficacy and safety in geriatric versus nongeriatric patients

Although the efficacy and safety of the topical anesthetic EMLA cream (lidocaine-prilocaine) have been studied extensively in children and adults, no published studies have focused on geriatric patients (>/=65 years of age). The objective of this study was to compare the efficacy and safety of EMLA in geriatric versus nongeriatric adults. A pooled analysis was made from original data of six studies of EMLA cream for split-skin grafting. The studies selected had a sufficient number of geriatric and nongeriatric adults and a uniform, standardized pain stimulus (split-skin grafting), pain rating (visual analogue scale, verbal rating scale) and adverse event recording. A total of 182 geriatric patients (82 aged 65 to 74 years; 100 aged 75 to 96 years) and 221 nongeriatric EMLA-treated patients were evaluated. There was no difference in the efficacy of EMLA between geriatric and nongeriatric adults who underwent similar onset and duration of anesthesia. EMLA cream 1.5 g/10 cm2 applied for 2 to 5 hours had a similar anesthetic effect in both age groups. A dose of 3 g/10 cm2 gave no further benefit. In a geriatric population, EMLA cream provided effective cutaneous anesthesia for the cutting of split-skin grafts to the same extent as did infiltrated lidocaine. Adverse event frequency and severity were similar in geriatric and nongeriatric patients. Transient application site pallor, redness, and edema were the most frequent adverse events. Topical anesthesia with EMLA cream for split-skin grafting is as safe and effective in geriatric as in nongeriatric adults.     

Contemporary trends of pelvic lymph node dissection at radical cystectomy for urothelial carcinoma of urinary bladder and associated cancer specific mortality and complications: comparison between octogenarian versus younger patients

BackgroundWe analysed contemporary pelvic lymph node dissection (PLND) trend during radical cystectomy (RC) for urothelial carcinoma of urinary bladder (UCUB), as well as PLND association with cancer specific mortality (CSM) and complications after stratification according to octogenarian vs. younger age.Materials and methodsWithin the SEER and NIS databases, respectively 10,427 (T2 and T3 stages) and 19,203 (all T-stages) RC patients (2004–2015) for UCUB were identified. Univariable and multivariable analyses focused on PLND rates, CSM after inverse probability of treatment weighting (IPTW) adjustment, complication rates, length of stay (LOS) and total hospital charge (THC).ResultsWithin the SEER database, RC and PLND was performed in 9,406 patients (87.4%), 981 (10.4%) octogenarians and 8,227 younger patients (at, respectively, 83 and 89% PLND). PLND rates increased over time in both patients groups (p < 0.05). PLND was independently associated with lower CSM in both age groups (octogenarians: hazard ratio [HR] 0.51, p < 0.001; younger patients: HR 0.56, p < 0.001). Within the NIS database, PLND was marginally higher associated with overall complications in octogenarians than in younger patients (odd ratio [OR]: 1.32 vs. 1.23, both p < 0.001), with longer LOS (OR: 1.20 vs. 1.08, both p < 0.001), higher THC (relative increase: 6933 vs. 4484, both p < 0.001), but not with higher in-hospital mortality.ConclusionsPLND is associated with lower CSM, but its rate lags in octogenarian vs. younger patients. In both age groups, PLND leads to marginally higher complications, longer LOS and higher THC, but not to higher in-hospital mortality.     

The vesicle cluster as a major organizer of synaptic composition in the short-term and long-term

For decades, the synaptic vesicle cluster has been thought of as a storage space for synaptic vesicles, whose obvious function is to provide vesicles for the depolarization-induced release of neurotransmitters; however, reports over the last few years indicate that the synaptic vesicle cluster probably plays a much broader and more fundamental role in synaptic biology. Various experiments suggest that the cluster is able to regulate protein distribution and mobility in the synapse; moreover, it probably regulates cytoskeleton architecture, mediates the selective removal of synaptic components from the bouton, and controls the responses of the presynapse to plasticity. Here we discuss these features of the vesicle cluster and conclude that it serves as a key organizer of synaptic composition and dynamics.     

The efficacy and safety of Curcuma longa extract and curcumin supplements on osteoarthritis: a systematic review and meta-analysis

Objective: To assess the efficacy and safety of Curcuma longa extract and curcumin supplements on osteoarthritis (OA).Methods: The databases such as Pubmed and Cochrane Library were searched to collect the article about Curcuma longa extract and curcumin in the treatment of OA. Then, randomized controlled trials (RCTs) were selected and their data were extracted. Finally, the RevMan5.3 was utilized for risk of bias assessment and meta-analysis, the STATA15.0 were utilized for publication bias assessment, and GRADE tool were used for the evidence quality assessment of primary outcomes.Results: A total of 15 RCTs involving 1621 participants were included. (1) Compared with placebo, Curcuma longa extract and curcumin (C.) can decrease the visual analog scale (VAS) and The Western Ontario and McMaster Universities (WOMAC) score-pain, the WOMAC score-function and the WOMAC score-stiffness. In terms of adverse events, Curcuma longa extract and curcumin are comparable with those of placebo. (2) Compared with non-steroidal anti-inflammatory drugs (NSAIDs), Curcuma longa extract and curcumin have similar effects on joint pain, function and stiffness. The incidence of adverse events in Curcuma longa extract and curcumin was lower. (3) Compared with the NSAIDs group, C.+NSAIDs can also decrease the VAS and WOMAC score-pain, the WOMAC score-function and the WOMAC score-stiffness. In terms of adverse events, the addition of Curcuma longa extract and curcumin to NSAIDs did not increase adverse events.Conclusion: Curcuma longa extract and curcumin may be a safer and effective supplement for OA patients. It is recommended to use Curcuma longa extract and curcumin supplement for OA patients for more than 12 weeks.     

The use of actigraphy in the monitoring of methylphenidate versus placebo in ADHD: a meta-analysis

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. There is an increasing need to find objective measures and markers of the disorder in order to assess the efficacy of the therapy and to improve follow-up strategies. Actigraphy is an objective method for recording motor activity and sleep parameters using small, computerized, watch-like devices worn on the body, and it has been used in many clinical trials to assess methylphenidate efficacy and adverse effects in ADHD. Our article aim is to systematically review and perform a meta-analysis of the current evidence on the role of actigraphy in both the detection of changes in activity and in sleep patterns in randomized clinical trials that compared methylphenidate against placebo in the treatment of ADHD. A comprehensive literature search of PubMed/MEDLINE, Scopus, Embase, Cochrane Library, CINHAL and PsycINFO databases was carried out to find randomized clinical trials comparing methylphenidate versus placebo in children with ADHD, using actigraphic measures as an outcome. No start date limit was used and the search was updated until June 2013. The primary outcome measures were ‘total sleep time’ and daytime ‘activity mean’. As secondary outcomes, we analyzed ‘sleep onset latency’, ‘sleep efficiency’ and ‘wake after sleep onset’. Eight articles comprising 393 patients were included in the analysis. Children with ADHD using MPH compared to placebo have a significant difference of a large effect with a diminishing value in the activity mean. For the total sleep time, we found a significant and large effect in the decrease in sleep in MPH group. This study shows that MPH may effectively reduce mean activity in ADHD children, but it may negatively affect total sleep time.