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1.
Successful Treatment of Hypersplenism in Wilson's Disease by Partial Splenic Embolization.
Li, LY, Chen, HZ, Bao, YC, Yu, QS, Yang, WM
Journal of investigative surgery : the official journal of the Academy of Surgical Research. 2018;(2):75-81
Abstract
AIM: Hypersplenism can occur in patients with Wilson's disease (WD). Surgical splenectomy is a conventional treatment for this condition; however, emotional and neurological deterioration may follow splenectomy. In recent years, partial splenic embolization (PSE) has been increasingly performed as a nonsurgical alternative treatment for hypersplenism. The aim of this study was to evaluate the effectiveness and safety of PSE compared with splenectomy in the treatment of hypersplenism in WD patients. METHODS Fifty WD patients with hypersplenism were randomly divided into two groups (group A and group B), each including 25 patients. Patients in groups A and B were treated with PSE and splenectomy, respectively. Data were collected on the clinical efficacy of each procedure, adverse reactions, hematologic and blood chemistry test results, and abdominal computed tomography (CT) scan findings (group A only). RESULTS Marked improvements in the platelet and leukocyte counts after PSE and splenectomy were observed in all patients. PSE was associated with improved liver function without severe complications, and no significant changes in emotional and neurological symptoms were observed. In contrast, seven WD patients suffered neurological deterioration after splenectomy. CONCLUSIONS Hypersplenism in WD patients was successfully treated by PSE, which appears to be a safe and effective alternative treatment for WD-induced hypersplenism.
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2.
Efficacy of a mixture of probiotic agents as complementary therapy for chronic functional constipation in childhood.
Russo, M, Giugliano, FP, Quitadamo, P, Mancusi, V, Miele, E, Staiano, A
Italian journal of pediatrics. 2017;(1):24
Abstract
BACKGROUND About 30% of constipated children continue to struggle with constipation beyond puberty. Growing interest has recently raised on the use of probiotics as complementary therapy for FC, in order to prevent the possible PEG-related intestinal dysbiosis. Our study aimed at evaluating the effect on childhood FC of a probiotic mixture (PM), including Bifidobacteria breve M-16 V®, infantis M-63®, and longum BB536®. METHODS Fifty-five consecutive children suffering from FC were randomly assigned into two groups: group A received a daily oral combination of PEG plus PM and group B received oral PEG only. Physical and clinical data were collected from each patient at week-1, week-2, week-4, and week-8. RESULTS After 1 month, children who experienced improvement in the PEG and in the PEG + PM group were 88 and 81.8%, respectively (p = 0.24). After 1 month from the end of the study treatment, a positive trend towards a higher rate of clinical remission was observed within children treated with PM compared to those who took only PEG (percentage of children off therapy: 64 vs 52, respectively; p = 0.28). CONCLUSIONS PEG and PEG + PM are equally effective and safe in the treatment of children with chronic constipation. Nevertheless, further studies are needed to show if adding Bifidobacteria strains to conventional therapy may lead to a better long-term outcome.
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Whole-Body Vibration Exercise Therapy Improves Cardiac Autonomic Function and Blood Pressure in Obese Pre- and Stage 1 Hypertensive Postmenopausal Women.
Wong, A, Alvarez-Alvarado, S, Kinsey, AW, Figueroa, A
Journal of alternative and complementary medicine (New York, N.Y.). 2016;(12):970-976
Abstract
OBJECTIVE Whole-body vibration (WBV) is an unconventional exercise therapy that appears to provide the same benefits of resistance training in postmenopausal women while being more safe and gentle on the joints. This study evaluated the effect of an 8-week WBV exercise regimen on heart rate variability (HRV) and blood pressure (BP) in obese postmenopausal women. DESIGN Randomized controlled study with two parallel groups. PARTICIPANTS Twenty-five (age 50-65 years) obese (body-mass index >30 and <40 kg/m2) postmenopausal women. INTERVENTION Participants were randomly assigned to a WBV training group or nonexercising control group. Participants in the WBV group completed the supervised training 3 times a week. WBV training consisted of four static and four dynamic leg exercises (normal, high, and wide-stance squats and calf-raises) with vertical vibration (25-40 Hz and low-high amplitude) progressed throughout the 8 weeks. OUTCOME MEASURES Brachial systolic BP (SBP) and diastolic BP (DBP) and HRV: sympathovagal balance (natural logarithm of low frequency [LnLF]/natural logarithm of high frequency [LnHF]; normalized low frequency [nLF]/normalized high frequency [nHF]), parasympathetic tone (LnHF, nHF, natural logarithm of root mean square of successive differences [LnRMSSD]), sympathetic tone (LnLF, nLF), natural logarithm of total power, and heart rate (HR). RESULTS There were significant group × time interactions (p < 0.05) for brachial SBP, DBP, LnLF/LnHF, and nLF/nHF that significantly decreased (p < 0.01) after WBV, compared with no changes after control. There was a significant (p < 0.05) increase in nHF and decrease in nLF in the WBV group compared with baseline, yet the changes were not different than those in the control group. No significant changes were observed in LnTP, LnLF, LnHF, LnRMSSD, or HR after 8 weeks in either group. CONCLUSIONS WBV training for 8 weeks is an adequate unconventional exercise intervention for improving sympathovagal balance and BP in previously sedentary obese postmenopausal women.
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Management of gastroesophageal reflux disease: lifestyle modification and alternative approaches.
Eherer, A
Digestive diseases (Basel, Switzerland). 2014;(1-2):149-51
Abstract
The first step in the management of gastroesophageal reflux disease (GERD) is lifestyle modification, with dietary recommendations such as increasing fiber intake and lowering dietary fat. While there is some physiological evidence that various foods as well as alcohol and tobacco affect the pressure of the lower esophageal sphincter (LES), targeted interventions have not shown any benefit in clinical trials. The general recommendation is for the patient to avoid foods and beverages that in his or her experience trigger GERD symptoms. The only measures that have been shown with some degree of scientific evidence to be beneficial are weight loss on the part of obese patients and elevation of the head of the bed. We, in contrast, developed a training program that induces a change from thoracic to abdominal breathing. We hypothesized that this change in breathing actively trains the diaphragm, and so potentially strengthens the LES. In a randomized trial using breathing exercises as the intervention, we found an improvement in gastroesophageal reflux symptoms, assessed by quality of life, pH-metry and proton pump inhibitor use. Most patients would prefer to take proton pump inhibitors than to do exercises, but at least for a subgroup of highly motivated patients who would prefer an alternative to medication, structured physical exercises could offer new help with their GERD.
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A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes.
Yamada, Y, Uchida, J, Izumi, H, Tsukamoto, Y, Inoue, G, Watanabe, Y, Irie, J, Yamada, S
Internal medicine (Tokyo, Japan). 2014;(1):13-9
Abstract
OBJECTIVE Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance, many patients are unable to comply with such dietary therapy for long periods. The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association. However, randomised trials of dietary interventions in Japanese patients with type 2 diabetes are scarce. Therefore, the aim of this study was to examine the effects of a non-calorie-restricted, low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet. METHODS The enrolled patients were randomly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet. The patients received consultations every two months from a registered dietician for six months. We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles. RESULTS The HbA1c levels decreased significantly from baseline to six months in the low-carbohydrate diet group (baseline 7.6±0.4%, six months 7.0±0.7%, p=0.03) but not in the calorie-restricted group (baseline 7.7±0.6%, six months 7.5±1.0%, n.s.), (between-group comparison, p=0.03). The patients in the former group also experienced improvements in their triglyceride levels, without experiencing any major adverse effects or a decline in the quality of life. CONCLUSION Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet.
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Mistletoe as complementary treatment in patients with advanced non-small-cell lung cancer treated with carboplatin-based combinations: a randomised phase II study.
Bar-Sela, G, Wollner, M, Hammer, L, Agbarya, A, Dudnik, E, Haim, N
European journal of cancer (Oxford, England : 1990). 2013;(5):1058-64
Abstract
INTRODUCTION Mistletoe preparations, such as iscador, are common complementary medications. This randomised phase II study of iscador combined with carboplatin-containing regimens was conducted in chemotherapy-naïve advanced non-small-cell lung cancer (NSCLC) patients to assess its influence on chemotherapy-related side-effects and QoL. METHODS Patients with advanced NSCLC were randomised to receive chemotherapy alone or chemotherapy plus iscador thrice weekly until tumour progression. Chemotherapy consisted of 21-day cycles of carboplatin combined with gemcitabine or pemetrexed. RESULTS Seventy-two patients (control: 39; iscador: 33) were enrolled in the study. Most (65%) were in stage IV, and 62% had squamous histology. Median overall survival in both groups was 11 months. Median TTP was 4.8 months for the controls and 6 months in the iscador arm (p=NS). Differences in grade 3-4 haematological toxicity were not significant but more control patients had chemotherapy dose reductions (44% versus 13%, p=0.005), grade 3-4 non-haematological toxicities (41% versus 16%, p=0.043) and hospitalisations (54% versus 24%, p=0.016). CONCLUSION No effect of iscador could be found on quality of life or total adverse events. Nevertheless, chemotherapy dose reductions, severe non-haematological side-effects and hospitalisations were less frequent in patients treated with iscador, warranting further investigation of iscador as a modifier of chemotherapy-related toxicity.
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Double-blind placebo-controlled randomized clinical trial on the efficacy of Aerosal in the treatment of sub-obstructive adenotonsillar hypertrophy and related diseases.
Gelardi, M, Iannuzzi, L, Greco Miani, A, Cazzaniga, S, Naldi, L, De Luca, C, Quaranta, N
International journal of pediatric otorhinolaryngology. 2013;(11):1818-24
Abstract
BACKGROUND Adenotonsillar hypertrophy (ATH) is a frequent cause of upper airways obstructive syndromes associated to middle ear and paranasal sinuses disorders, swallowing and voice disorders, sleep quality disorders, and occasionally facial dysmorphisms. ATH treatment is essentially based on a number of medical-surgical aids including nasal irrigation with topical antibiotics and corticosteroids and/or treatment with systemic corticosteroids, immunoregulators, thermal treatments, adenotonsillectomy, etc. OBJECTIVES The aim of the present study is to assess the efficacy of Aerosal halotherapy in the treatment of sub-obstructive adenotonsillar disease and correlated conditions compared to placebo treatment. METHODS A total of 45 patients with sub-obstructive adenotonsillar hypertrophy were randomized to receive either Aerosal halotherapy or placebo for 10 treatment sessions. The main outcome was a reduction greater than or equal to 25% from the baseline of the degree of adenoid and/or tonsillar hypertrophy. RESULTS In the intention-to-treat analysis, a reduction of the degree of adenoid and/or tonsillar hypertrophy ≥25% from baseline after 10 therapy sessions was found in 44.4% of the patients in the halotherapy arm and in 22.2% of the patients in the placebo arm (P=0.204). Among the secondary outcomes, the reduction of hearing loss after 10 treatment sessions in the halotherapy arm was higher than the placebo arm (P=0.018) as well as the time-dependent analysis showed significantly improved peak pressure in the Aerosal group (P=0.038). No side effects were reported during the trial. In addition, the therapy was well accepted by the young patients who considered it as a time for play rather than a therapy. CONCLUSIONS Aerosal halotherapy can be considered a viable adjunct, albeit not a replacement, to conventional medical treatment of sub-obstructive adenotonsillar syndrome and related conditions. Further research is however needed to improve ATH treatment.
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L-carnitine supplementation for the management of fatigue in patients with cancer: an eastern cooperative oncology group phase III, randomized, double-blind, placebo-controlled trial.
Cruciani, RA, Zhang, JJ, Manola, J, Cella, D, Ansari, B, Fisch, MJ
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2012;(31):3864-9
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Abstract
PURPOSE L-carnitine, a popular complementary and alternative medicine product, is used by patients with cancer for the treatment of fatigue, the most commonly reported symptom in this patient population. The purpose of this study was to determine the efficacy of L-carnitine supplementation as a treatment for fatigue in patients with cancer. PATIENTS AND METHODS In this double-blind, placebo-controlled trial, patients with invasive malignancies and fatigue were randomly assigned to either 2 g/d of L-carnitine oral supplementation or matching placebo. The primary end point was the change in average daily fatigue from baseline to week 4 using the Brief Fatigue Inventory (BFI). RESULTS Three hundred seventy-six patients were randomly assigned to treatment with L-carnitine supplementation or placebo. L-carnitine supplementation resulted in significant carnitine plasma level increase by week 4. The primary outcome, fatigue, measured using the BFI, improved in both arms compared with baseline (L-carnitine: -0.96, 95% CI, -1.32 to -0.60; placebo: -1.11, 95% CI -1.44 to -0.78). There were no statistically significant differences between arms (P = .57). Secondary outcomes, including fatigue measured by the Functional Assessment of Chronic Illness Therapy-Fatigue instrument, depression, and pain, did not show significant difference between arms. A separate analysis of patients who were carnitine-deficient at baseline did not show statistically significant improvement in fatigue or other outcomes after L-carnitine supplementation. CONCLUSION Four weeks of 2 g of L-carnitine supplementation did not improve fatigue in patients with invasive malignancies and good performance status.
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Treating chronic fatigue syndrome - a study into the scientific evidence for pharmacological treatments.
Kreijkamp-Kaspers, S, Brenu, EW, Marshall, S, Staines, D, Van Driel, ML
Australian family physician. 2011;(11):907-12
Abstract
BACKGROUND Chronic fatigue syndrome, or myalgic encephalomyelitis (CFS), is a severe disabling condition. Patients with CFS usually trial many different medicines, both conventional and complementary. An overview of the pharmacological treatments used by CFS patients and the available evidence underpinning the use of these treatments would be of great value to both patients and their healthcare providers. METHODS Ninety-four CFS patients recruited into an Australian study investigating immunological biomarkers filled out a questionnaire assessing the medicines they were taking. Evidence from randomised clinical trials was sought in biomedical databases. RESULTS The 94 CFS patients used 474 different medicines and supplements. The most commonly used medicines were antidepressants, analgesics, sedatives, and B vitamins. We identified 20 randomised controlled trials studying these medicines in CFS patients. DISCUSSION While conventional and complementary medicines are widely used by CFS patients, the evidence for effectiveness in CFS is very limited.
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Therapeutic effects of magnetic and copper bracelets in osteoarthritis: a randomised placebo-controlled crossover trial.
Richmond, SJ, Brown, SR, Campion, PD, Porter, AJ, Moffett, JA, Jackson, DA, Featherstone, VA, Taylor, AJ
Complementary therapies in medicine. 2009;(5-6):249-56
Abstract
OBJECTIVES To test the effectiveness of a typical magnetic wrist strap for reducing pain and stiffness, and for improving physical functioning amongst patients with osteoarthritis. DESIGN A randomised double-blind placebo-controlled crossover trial. Each participant wore four devices over a 16-week period. SETTING Forty five patients with osteoarthritis were recruited from general practices in rural and urban areas of Yorkshire. INTERVENTIONS Experimental device: a commercially available magnetic wrist strap. Control devices: a weak magnetic wrist strap, a demagnetised wrist strap, and a copper bracelet. MAIN OUTCOME MEASURES The WOMAC Osteoarthritis Index, the McGill Pain Questionnaire-Pain Rating Index (PRI), a pain visual analogue scale (VAS), and medication use. RESULTS No difference was observed between devices in terms of their effects on pain as measured by the primary outcome measure (WOMAC A), the PRI and the VAS. Similar results were obtained for stiffness (WOMAC B), physical function (WOMAC C), and medication use. Further analyses of the PRI subscales revealed a statistically significant difference between devices (P=0.025), which favoured the experimental device. Participants reported lower sensory pain after wearing the standard magnetic wrist strap, than when wearing control devices. However, no adjustment was made for multiple testing. CONCLUSIONS Our results indicate that magnetic and copper bracelets are generally ineffective for managing pain, stiffness and physical function in osteoarthritis. Reported therapeutic benefits are most likely attributable to non-specific placebo effects. However such devices have no major adverse effects and may provide hope.